This week I’m talking about the CDC milestones for surveillance that have just changed.
In March of 2022, this paper was published in pediatrics and today I am pulling out a
short clip from podcast 173 with Dr. Cheryl Tierney Aves who is a developmental pediatrician
and we talk all about the CDC milestones and the difference between surveillance and screening
to pick up signs of any kind of developmental delays and disorders including autism.
Welcome back to another video.
I am Dr. Mary Barbera and I am a autism mom, Board Certified Behavior Analyst, and best
selling author.
Each week I bring you a video to help you turn things around whether you are living
with, working with a toddler with signs of autism or an older child with moderate to
severe autism, many of my videos might be able to help you.
So if you haven’t subscribed to my Youtube channel, you can do that now.
So today we are presenting a snippet from podcast 173 with Dr. Cheryl Tierney-Aves where
we discuss the CDC milestones, what changes were made, why they were made, how this might
affect you in your parent or professional role, so let’s get to it.
Surveillance is different than screening is different than diagnosis.
Yeah.
You want to touch on that?
Yeah.
Yeah, for sure.
I think that that's something that's important for people to know about this.
So as we're updating, like why did, you know, why is this important?
Well, in the past, Um, I know that some of the criticisms of the surveillance that was
happening, why did we even update this?
Well, we know that we were missing a lot of children, that a lot of kids were being missed.
And the goal of this, of the author and of the medical community at large was that there
was too much, um, uh, wait and see.
There was a lot of, and I'm sure you hear this a lot, my pediatrician said, let's just
watch this and see.
Why was that happening?
That was happening because the old guidelines were at what we call the 50th percentile.
Right?
So 50% of kids should have the skill, for 50% of kids, it was still normal not to have
that, that milestone, to not meet that milestone.
So if you would refer every child who was not meeting that milestone, you would worry
a lot of parents, where it was still normal.
And pediatrician, some pediatricians were very proactive.
You're not meeting that milestone: refer, refer, refer.
Some pediatricians, very aggressive.
Some pediatricians, much more laid back.
They, they really didn't want to worry a lot of parents, maybe they'd say, listen, let's
just see if it, by the next visit, your child's not meeting that milestone, I'll refer you
then.
Right?
And a lot of kids who had real problems with their development would not, would be waiting
and seeing when they should have been referred.
By this re-analysis by this, these new guidelines now this allowed us that, what they chose
to do is move the recommendations to what we call the 75th percentile.
What that means is that if you miss this milestone, this survey, this surveillance at this milestone,
what that's telling us is that 75% of children should be doing this.
And the recommendation now with these new guidelines is that you should refer.
It is not a, maybe it is a, you should refer.
And that takes some of the ambiguity away now.
And the pediatricians now have much clearer recommendations for what to do, and there'll
be a whole lot less wait and see, and the, the wording is much clearer.
Um, so that's one of the things this paper really stresses is moving the recommendation
to 75th percentile and taking away that wishy washy language of may or might so that it's
much clearer what to do.
Yeah.
And, and, um, also in the same vein, I think the wording got stronger.
So it went from the old checklist where, you know, a child may begin to transfer objects
from hand to hand to the child will, or the child should be transferring objects from
one hand to another, that language.
It's it's clearer.
It's more direct and because 75% of children do, then if you don't, you need to, to go
the step farther.
But so this whole thing we're talking about is surveillance.
It's being aware of the milestones, which I'm a huge fan of.
Even for a child diagnosed with autism I'm a big fan of knowing what milestones come
first.
You know, you can't work on eating with utensils.
Well, you can.
I would prefer you work on the 18 month skills the, the eating with a spoon, the, um, drinking
from a straw, drinking from an open cup, eating finger foods.
If you can't do that, you really shouldn't be working on the higher level skills, like
using a fork and a knife.
And so I'm constantly in my book, in my work and all my video blogs talking about starting
with where there's the deficit.
Where's the biggest deficit.
Um, before you go adding higher level skills.
Yeah, we call that the foundational skills.
So, um, and I was saying the same thing.
So, um, maybe just to also say, cause I, I think I didn't answer, but you brought it
up again, is the difference between surveillance, right?
What surveillance is and, and that in the past, um, we surveillance, um, is where we.
check these skills at every single well-child visit.
So, um, where, you know, where we survey or we check whether your child is meeting these
or ha has these skills, um, by asking questions at every well child visit.
In the past, your pediatrician didn't do that, or may not have done that at every well-child
visit in particular, there were certain well-child visits that were left out of surveillance.
Right.
And surveillance the, these, this paper, um, focuses on surveillance being one aspect of
a comprehensive developmental assessment by your pediatrician.
History and asking you parental concerns is one.
Surveillance is another on your exam.
So there is a lot that goes into determining whether your child should be referred for
an evaluation.
And that is important to note because I know that in the, uh, social media comments and
the online comments that have been made, there's been some criticism of the surveillance milestones
that have been identified as the things that we are paying attention to.
But it's only one piece of a comprehensive, um, assessment of your child's overall wellbeing
development and a concern.
So if you, as a parent, go to your pediatrician and say, um, I know maybe, that they're meeting
these milestones, or they're not meeting these milestones, but I'm still concerned.
That's still an indication for an, to be referred.
So I want to make sure, I stress, what Mary, what you're saying.
Right.
Because, um, I've been asked these questions.
You know, what about the child who may have accelerated development in some areas they
may, um, they may have below expectations in social skills, but accelerated letter identification
or number identification.
Um, so they may seem advanced in some areas and behind in others.
What do you do in that situation?
Well, that may be a concern that you have and should be referred.
Um, so there is an unevenness to some children's development that might raise a concern.
So we don't want to discount parental concern.
I hope you enjoyed that short clip from the podcast.
If you want to watch or listen to the whole thing go to marybarbera.com/173.
And if you’d like to attend a free online workshop where you can learn about 3 things
you can do right now to help your child with autism or signs of autism, you can go to marybarbera.com/workshop
and I’ll see you right here next week.