The New CDC Guidelines and Why the Speech-Language Pathology Community is Concerned
Recently the CDC and American Academy of Pediatrics (AAP) updated various Speech and Language milestones in their "Learn the Signs, Act Early" program, which is a checklist from ages 2 months to 5 years to help parents and pediatricians identify children with developmental delays and autism. The CDC and AAP’s reasons for the updated "Learn the Signs, Act Early" program were the following:
-addition of checklists for ages 15 months and 30 months
-addition of social and emotional milestones
-eliminating vague terms such as “may” or “begins”
-removing duplicated milestones
-addition of open-ended questions for pediatricians to ask families (e.g., “Are there any
skills your child does/does not do that concern you?”)
-revising tips for promoting early development
At first glance, these updates may seem like a great idea. However, there are some BIG issues with these updates that with a more in-depth look make them concerning not only to a speech-language pathologist, but to many parents and caregivers who are seeking advice and counsel on when to seek further evaluation about their concerns in the areas of speech or language.
The CDC failed to include in these updates professional research, knowledge and input from Speech-Language Pathologists, individuals whose educational background and careers are based on speech and language development! This would be like a Speech Therapist meeting and deciding that the new concern for a fever is 103 degrees. Speech therapists are professionals but are by no means professionals in the medical field of deciding illnesses and diseases and the standards that should be set.
The CDC also changed the criteria for milestones from what 50% of children can do (the average) to what 75% of children can do. This ultimately means that some skills were pushed farther along and kids are no longer expected to reach the skills until several months later. Why does this matter? Because pediatricians now may erroneously follow a “wait and see” approach for various communication skills that should ultimately be further assessed by a Speech-Language Pathologist. This change will primarily impact the children whose skills may be mildly to moderately delayed and previously identified as needing further assessment to now being deemed as a “wait and see” case. Parents know that a few months in the life of a child and the skills they can do can make a huge difference and waiting a few months can make a huge impact as a child may fall further behind.
Additionally, some children who are identified as having a mild delay can receive therapy for a shorter periods of time and close the gap that is present while at a young age. Thus, potentially requiring no additional therapy in the future. Catching delays and providing intervention early in a child's life sets them up for success and provides foundational skills for all academic and social/ emotional learning to come. It’s like building a house, you don’t put the roof on before pouring the foundation! Children need a strong foundation of skills based in language, speech, and social skills to be successful students and eventually adults!
The CDC has said the new milestones and revised milestones have nothing to do with children’s skills being affected by use of masks. (Please know, we believe in the science behind the use of masks and are not debating that in this article.) Research has shown that children born in January 2019 and later have been negatively impacted by use of masks in terms of delayed developmental skills (Deoni, et al, 2021). Our clinic has seen a rise in the number of children 2.5 years of age and younger being referred for speech/language concerns since the beginning of the current pandemic. These kids have had and are continuing to have less interactions with peers, and when they are interacting, the language used by the adult and peer may be distorted/not understood fully because of the use of masks. Additionally, as families have been spending more time at home, many parents and caregivers are having to multitask taking care of their children while also completing their jobs remotely. These times have definitely not been ideal for fostering speech and language development! Even if the CDC’s new milestones were not based on the pandemic, it would behoove the CDC to acknowledge that children’s development has been negatively affected by environmental changes of the pandemic instead of hiding behind new developmental milestones. The CDC has basically lowered the bar for our children in a way that could hurt those who need therapy.
Ultimately, will the changes the CDC has made affect children receiving therapy?
Possibly. For kids whose skills may have been flagged by a pediatrician as “a little behind” previously may now be told they fall within the CDC’s guidelines and not referred to Speech-Language Pathologists.
Will the guidelines Speech Therapists use to determine whether a child qualifies for therapy be impacted? No. The standardized tests we use and the checklists our licensing organization uses to determine if a speech or language disorder has so far not been changed by the CDC’s updates. In addition to formal and standardized assessments, The Speech Spot uses clinical judgment, informal assessments, and research-based decisions on whether children need speech/language therapy.
Our advice to all parents is to ALWAYS follow your gut and seek out additional advice from a skilled professional in the area you have concern. Even if you believe your child’s speech and language skills are developing typically, it can’t hurt to reach out to a trusted Speech-Language Pathologist to just make sure. We at The Speech Spot are always open to discussing any of your speech, language, feeding, and social concerns and giving you our honest professional opinion on the best steps to take. When you call or email you will speak directly to a Speech Pathologist who can discuss your concerns with you. The Speech Spot views itself as a resource for the community and is happy to share our knowledge about child development with any concerned parent, caregiver, teacher, or leader looking for more answers to speech and language development questions.
Below is a table comparing the milestones most speech-language pathologist will use to determine if treatment is necessary for a child in the area of speech and/or language and the CDC's recommended guidelines for when a child should be referred to a speech-language pathologist for evaluation. As stated before, the discrepancies in the norms may deter some pediatricians from making a referral to a speech pathologist for an evaluation. Thus, creating larger gaps in development as the parents and caregivers "wait to see" what develops.
Milestones based on Speech-Language Licensing Agency (ASHA)
Updated CDC Milestone
7 months-12 months
Calls a parent “mama” or “dada” or another special name
around 12 months
Says 1-2 words besides “Mama” or “Dada”
around 12 months
Says 3 or more words besides “Mama” or “Dada”
at least 10 words by 18 months
Says at least 2 words together (2-word phrase)
Uses more gestures than just waving or pointing (such as blowing, nodding)
7 months-1 year (pointing, waving, reaching ‘up’, shaking head ‘no’)
Says about 50 words
Says 2 or more words together with one action word (such as “Mama go”)
Names items in a book when you point and ask, “What is this?”
2.5 years old
Says pronouns like “I, me, we”
2.5 years old
Talk with you in a conversation using at least 2 back-and-forth exchanges
3 years old
Asks “who,” “what,” “where,” or “why” questions (such as “Where is Mommy?”)
1-2 years (simple questions, yes/no), 2-3 years more complex (where is the ___, who is this?)
3 years old
Says first name when asked
2-3 years old
3 years old
Talks well enough for others to understand most of the time
2-3 years (75% intelligible)
3 years old
-ASHA. (N.d.) Development Norms for Speech and Language. Retrieved on 23 February 2022 from https://www.asha.org/slp/schools/prof-consult/norms/
-Centers for Disease Control and Prevention. (2022) Help Your Child Grow and Thrive. Retrieved on 23 February 2022 from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-15mo.html
-Deoni, et.al. (2021). Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health. the RESONANCE Consortium