Developmental milestones are specific skills or behaviours that occur in typical kids in a predictable sequence as they grow and develop. They are generally considered to be a benchmark for assessing if a child is developing at a typical rate, and can aid in identifying areas where additional support might be needed. These milestones cover most areas of development including physical (gross and fine motor), cognitive (sensory and language), social and emotional skills, and adaptive and self-help ability (self care and daily living skills).
The key word in this story is ‘typical’. The standard developmental milestones are based on what typical development looks like, and does not account for any neurodiversity or physical disability. Researchers and experts have outlined these milestones through extensive studies involving literature reviews, observational studies (in schools, homes and childcare facilities), longitudinal studies (over months and years), cross sectional studies (comparing the same skill at different ages in different kids) and lots of data collection, analysis and statistics.
Despite all this effort, the use of developmental milestones as an assessment measure is limited. These limitations include:
Variation in development - All children develop at a different rate. The milestones provide a general framework, but individual differences mean that not all children reach these milestones at the same age.
Cultural differences - Developmental norms can vary across cultures, and what is considered typical in one culture may not be the same in another.
Socioeconomic factors - Children from different socioeconomic situations may have varying access to resources, education, intervention, food and stimulation.
Health conditions - Chronic illnesses and disabilities are examples of conditions that can affect the rate of development and cause developmental differences.
Overemphasis on age - The milestones are focused on age related expectations. Due to the non-linear nature of development, milestones may be reached earlier or later, which does not necessarily indicate a problem.
Lack of Individualisation - Milestones might not account for individual differences in temperament, learning styles, and personal experiences.
Measurement challenges - Assessing milestones can often be objective, as they rely on observations that can vary based on the experience and perspective of the observer.
Environmental influences - Changes in environment (a new home, changes in family dynamics and caregiving arrangements) can have an influence on development.
Parental / caregiver influences - The quality of interactions, responsiveness and stimulation from caregivers play a significant role in development.
Context of development - Milestones typically evaluate skills in isolation, but children develop within the context of their daily interactions and experiences. The interaction of different skills and experiences can impact how and when milestones are achieved.
It is important to consider the individual variability of children, especially recognising and respecting the differences for neurodivergent kids. Our kids show a wide range of abilities and developmental patterns, having strengths and compensatory skills that help them achieve milestones in their own, non-traditional ways. It is important to support their developmental path by acknowledging their individual needs and strengths.
As a neuro-affirming practice, we use a strength based approach when considering what goals to target. By focusing on the child’s strengths, preferences, and needs, and by providing appropriate support and accommodations; this approach helps children set and achieve meaningful goals in a supportive and empowering way. We aim to prioritise goals that support everyday functioning and skills that help us further down the track. An example of this is working on hand strength, so that when the child is ready they are able to hold their pencil! Or, working on core strength so that they are able to hold themselves up in a chair at school.
So, you might be wondering how we decide what skills will be worked on.
In short, we don’t - the family and child do! We use:
⭐ Case interviews
These involve outlining the child’s strengths, challenges and needs through a detailed and interactive discussion. This helps our therapists gather a comprehensive overview and enables them to develop an idea of what the child’s goals could be.
⭐ The FGST (The Family Goal Setting Tool)
The FGST assists in the identification, communication and prioritisation of a family's goals. It encompasses child focused goals, the need for information, support and the opportunity for active participation in the community. This is our favourite tool at the moment!!
⭐ The COPM (Canadian Occupational Performance Measure)
This is a client centred assessment tool used to evaluate individuals self-perceived performance in daily activities and their satisfaction with that performance. This helps identify and prioritise areas that are most important to the child and aids with individualised goal setting.
We also use the following frameworks to help with our goal setting process:
⭐ The ICF (International Classification of Functioning, Disability and Health)
This is a comprehensive approach to understanding and assessing health and disability, coming from a biopsychosocial* approach. This framework is designed to give a holistic view of an individual's functioning and disability, considering not only the medical aspect but also the personal and social dimensions. *Being a biopsychosocial model means that it incorporates the biological, psychological and social factors which impact a person and influence their abilities.
⭐ The CPIE (Child-Partner-Interaction-Environment)
This is a Speech Pathology framework we use to understand and improve the communication between children and their caregivers. It focuses on assessing and enhancing the quality of these interactions to support child development, learning and well-being.
⭐ The PEO (Person-Environment-Occupation)
This is a model used to understand and improve how individuals interact with their environment and engage in meaningful occupations. It focuses on the dynamic interaction between person, environment and their occupations and how these factors influence overall performance and well-being.
Tips for therapists
If you are a paediatric therapist wanting to develop meaningful goals for your clients without relying on developmental milestones, we recommend you:
Supplement standardised assessments with clinical observations and discussions with the child and family.
Familiarise yourself with assessment frameworks that focus on function and participation.
Complete goal setting in collaboration with the family.
Consider referring to additional services if this will support the most meaningful change and participation.
Tips for parents:
If you are a parent or carer and you are worried about the way your child is developing, we suggest you:
Remind yourself that all children develop differently, it’s okay when skills are seen early or later.
Keep a track of when your child is using new skills or the compensatory strategies that they use to do them
Trust your gut! If something is concerning you reach out to a professional for support.
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