Part I: A Closer Look

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What are some key developmental milestones for ages 6 months to 4 years?
Basic Developmental Milestones: 6 Months
  • Respond to own name
  • Respond to other people’s emotions and often seem happy
  • Copy sounds
  • Like to play with others, especially parents

All children develop at their own pace, and many reach particular milestones slightly late or early.

Basic Developmental Milestones: 12 Months
  • Use simple gestures, like shaking head “no” or waving “bye-bye”
  • Say “mama” and “dada” and exclamations like “uh-oh!”
  • Play games such as “peek-a-boo” and “pat-a-cake”
  • Respond to simple spoken requests

All children develop at their own pace, and many reach particular milestones slightly late or early.

Basic Developmental Milestones: 18 Months
  • Play simple pretend, such as feeding a doll
  • Point to show others something interesting
  • Likes to hand things to others as play
  • Say several single words

All children develop at their own pace, and many reach particular milestones slightly late or early.

Basic Developmental Milestones: 24 Months
  • Say sentences with two to four words
  • Follow simple instructions
  • Get excited when with other children
  • Point to things or pictures when they are named

All children develop at their own pace, and many reach particular milestones slightly late or early.

Basic Developmental Milestones: 36 Months
  • Show affection for friends without prompting
  • Carry on a conversation using two to three sentences
  • Copy adults and friends
  • Play make-believe with dolls, animals, and people

All children develop at their own pace, and many reach particular milestones slightly late or early.

Basic Developmental Milestones: 48 Months
  • Tell stories
  • Would rather play with other children than by themselves
  • Cooperates with other children

All children develop at their own pace, and many reach particular milestones slightly late or early.

Social Skills

It is evident that Elizabeth is concerned about Mark’s “shy” manner. What are typical social skills that most children obtain during the first 24 months?
Social Skills: 6 Months
  • Knows familiar faces and begins to know if someone is a stranger
  • Likes to play with others, especially parents
  • Responds to other people’s emotions and often seems happy
  • Likes to look at self in mirror

Social Skills: 12 Months
  • Is shy or nervous with strangers
  • Cries when mom or dad leaves
  • Has favorite things and people
  • Shows fear in some situations
  • Hands you a book when he wants to hear a story
  • Repeats sounds or actions to get attention
  • Puts out arm or leg to help with dressing
  • Plays games such as “peek-a-boo” and “pat-a-cake”

Watch the videos to compare

Responds to Namevideo icon

Does Not Respond to Name video icon

Social Skills: 18 Months
  • Likes to hand things to others as play
  • May have temper tantrums
  • May be afraid of strangers
  • Shows affection to familiar people
  • Plays simple pretend, such as feeding a doll
  • May cling to caregivers in new situations
  • Points to show others something interesting (joint attention)
  • Explores alone but with parent close by

Joint Attention video icon

Social Skills: 24 Months
  • Copies others, especially adults and older children
  • Gets excited when with other children
  • Shows more and more independence
  • Shows defiant behavior (doing what he has been told not to)
  • Plays mainly beside other children, but is beginning to include other children, such as in chase games

Imitation video icon

What are some of the key differences between a child with a shy temperament and autism spectrum disorder?
What are some of the key differences between a child with a shy temperament and autism spectrum disorder?
SHY TEMPERAMENT AUTISM SPECTRUM DISORDER
Quiet and withdrawn in new settings Lack of spontaneous seeking to share enjoyment, interests, or achievements with others
Slow to develop friends and play with others Failure to develop peer relationships appropriate to developmental level; even with closest peers, prefers to play alone
Tends to look away from others or look down Marked impairments in use of eye-to-eye gaze even with familiar people and family members
Takes a long time to become comfortable in new group settings Lack of emotional or social reciprocity, does not understand the back and forth of communication

Shyness video icon

24 Month Developmental Milestones

As you begin to ask Elizabeth about her son, what other 24-month developmental milestones do you want to consider?
24 Month Developmental Milestones: Language
A toddler lying on a stuffed animal.
  • Points to things or pictures when they are named
  • Knows names of familiar people and body parts
  • Says sentences with two to four words
  • Follows simple instructions
  • Repeats words overheard in conversation
  • Points to things in a book

Watch the videos to compare…

Pointing video icon

Inability to Locate Body Parts video icon

24 Month Developmental Milestones: Movement/Physical
A toddler boy playing with a ball
  • Stands on tiptoe
  • Kicks a ball
  • Begins to run
  • Walks up and down stairs holding on
  • Climbs onto and down from furniture without help
  • Throws ball overhand
  • Makes or copies straight lines and circles

24 Month Developmental Milestones: Cognitive
A toddler playing with blocks
  • Finds things even when hidden under two or three covers
  • Begins to sort shapes and colors
  • Completes sentences and rhymes in familiar books
  • Plays simple make-believe games
  • Builds towers of four or more blocks
  • Might use one hand more than the other
  • Follows two-step instructions such as “Pick up your shoes and put them in the closet”
  • Names items in a picture book such as a cat, bird, or dog

Temper Tantrums

How could you address Elizabeth’s concern about Mark’s temper tantrums? When are tantrums a cause for concern?
Temper Tantrums
An upset little girl.

Children vary in temperament and in their responses to frustrating experiences. Temper tantrums are a typical phase of development for most children and are often exacerbated when children are tired, hungry, and disappointed. Tantrums are likely related to children’s struggle to express themselves and their need to assert control over their environment.

Fortunately, most children’s tantrums begin to subside in intensity and frequency by 3 years of age, when their language skills enable them to express their needs and wants, and their capacity for self-regulation has grown.

Parent Response

Temper tantrums can be very upsetting for parents; therefore, it is always important to take parents’ concerns about temper tantrums seriously. Talk to parents about strategies for decreasing the likelihood of temper tantrums and how to help their children stay safe when tantrums do occur.

In extreme cases, parents may need help developing coping strategies while the behavior challenges are addressed.

Tantrums may be a cause for concern when:
  • A child has more than 10 to 20 discrete tantrum episodes on separate days at home during a 30-day period
  • A child has more than five tantrums a day on multiple days while at school or outside of home/school during a 30-day period
  • Tantrums regularly last longer than 25 minutes on average
  • Child is unable to calm himself or herself (i.e., frequently requires assistance from a caregiver) and shows very limited capacity for self-regulation regardless of tantrum intensity, frequency, or context
  • During tantrum, the child consistently shows aggression (e.g., hitting, kicking, biting, spitting, throwing) directed at caregiver or an object
  • Child attempts to hurt himself or herself (e.g., head-banging, scratching, or hitting himself or herself) during tantrums
  • Tantrums are accompanied by other atypical behaviors, such as self-stimulating behaviors that may not be injurious, atypical social responses, or aspects of mood that seem unusual to the situation
  • Tantrums seem exaggerated (i.e., child has strong reaction to seemingly minor events or changes in routine) or without clear pattern or trigger (e.g., when the child is hungry or tired)

Watch the videos to compare…

Temper Tantrum: ASD video icon

Temper Tantrum: Typical video icon