An Expert Weighs in on CDC’s Updated Milestone Guidelines
The CDC has released new milestone checklists that have caused an uproar amongst early intervention professionals (those who work with children under 3 years old). Milestones are there to help parents, caregivers, healthcare professionals, and teachers recognize that a child’s development may be different than expected and helps determine when it’s appropriate to refer to a specialist for further evaluation. A specialist then decides whether support is truly needed after a full evaluation is completed. While the CDC stated the intention of these updates was to decrease the time that parents “wait and see” (wait to get support), the changes will likely have the opposite effect, causing more children who need referrals to be missed.
For the speech and language milestones, the CDC added new checklists for 15 month olds and 30 month olds, simplified the information on the checklists so as not to overwhelm caregivers, and attempted to change the milestones on the lists to reflect what 75% of kids are able to do (the 25th percentile) versus what 50% of kids are able to do (the 50th percentile). This last part does not mean that the expectation has been lowered or that kids are saying less words than they used to, it just means that they narrowed the net of children who might be referred so that only those who really need support are getting identified. As a speech-language pathologist, I’m typically most concerned about children in the 10th percentile and below, so using the 25th percentile to make referrals is okay by me; however, the glaring issue is that the new numbers for expected word count don’t actually reflect what the research says is the 25th percentile. Most concerning are the numbers listed for 18 month olds and 30 month olds. According to the MacArthur-Bates Communicative Developmental Inventories (MB-CDIs), standardized information commonly used by researchers in childhood development, the numbers they listed for these ages are actually below the 5th percentile, not at the 25th percentile. For example, the CDC checklist states that 75% (or the 25th percentile) of 18 month olds should be able to say “one or two words besides mama and dada”; however, the MB-CDIs states that the 25th percentile is actually 37 words. The CDC checklist states that 75% of 30 month olds are saying “about 50 words”, however, the MB-CDIs says 412 words. These are huge discrepancies. This is problematic because many children who need referrals are going to be overlooked.
So what’s a parent to do if they can’t rely on this checklist? Don’t rely on a single source of information. Check multiple sources, like pathways.org and mayoclinic.org, talk to your pediatrician, and consult with a speech-language pathologist if concerned. You have access to a free or nearly free evaluation through your state’s early intervention program as well.
Another concern I hear from parents is that the CDC is covering up delays caused by the pandemic. While I don’t have answers as to why the authors of the changes didn’t use evidence-based information to come up with these numbers, we do know that the changes are not related to masking. These changes have been in the works since before the pandemic and the resources sourced for the changes are from before the pandemic as well. I’m hoping with all the push-back they received, the CDC will issue a revision soon.
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Sources:
The Informed SLP Staff. (2022, February 22). No SLPs Were in The Room Where it Happened [Blog post].
