CDC speech therapy guidelines have changed, but early intervention is still the goal

When the CDC updated the developmental milestones for its “Learn the Signs. Act Early” initiative for the first time since 2004, a controversy erupted, confusing pediatricians, speech therapists and parents.

The initiative details when children from birth to 5 years should reach milestones on how they play, learn, speak, act and move. The updated developmental tracker, published in 2022, pushed some speech milestones previously set at 24 months back to 30 months.

In this article, we’ll talk about how developmental milestones are meant to be used, what the updates mean for parents and caregivers, and what you should do if you’re worried your child might have a speech delay.

Developmental milestones and early intervention

The CDC launched “Learn the Signs. Act Early” in 2004 because they recognized that people didn’t always have the information they needed to catch developmental delays – such as speech disorders or speech delays – at the earliest stages. The earlier you can identify a developmental problem and start treating it, the better the outcomes for patients.

“We always want to intervene as early as possible, whether it’s strategies to help with communication, or help with a delay or disorder,” says Alison Barclift, a speech-language pathologist at Sentara Therapy Center - Pediatrics Newtown. “The sooner we’re in there the better.”

In addition to assisting parents, the developmental milestones checklist in “Learn the Signs. Act Early” is primarily used by pediatricians to identify children who might have a developmental issue so they can be referred to a specialist for a more thorough screening.

“Pediatricians are generalists for ages 0-18; they know a little bit about a whole lot of things,” Barclift says. “This checklist helps guide them, to give them a basis for saying ‘you know what, let me refer them.’”

New guidelines stir up controversy

The CDC’s developmental milestones are one of the primary tools that providers and parents use to determine if a child might need help. So the changes in speech milestones from 24 months to 30 months perplexed parents and providers.

According to the CDC, the new guidelines shift the expectation to the age when most children reach a specific milestone rather than when the average child has reached a specific milestone. For instance, the previous guidelines said children should be able to say 50 words at 24 months. That was based on research that showed that about 50 percent of children could do that by age 2. The new guidelines have moved this milestone to 30 months. Experts have determined that’s when 75 percent, or the majority, of children can say 50 words.

While this shift does seem to have the potential to delay the start of treatment for children with speech disabilities, the CDC’s checklist is not the only tool that pediatricians use to make referrals. For example, the communication milestones checklist created by the American Speech-Language-Hearing Association (ASHA) places children speaking at least 50 words in the 19-24 month range.

“I have not noticed a change in the referrals that we’re seeing, and I don’t think that I’m that surprised by that,” says Barclift.

Normal is a spectrum

Ultimately, the CDC’s checklist and similar tools are just the starting point. Once a child has been referred to a speech therapist, more in-depth testing is done to determine the exact nature of the delay, disability or needed support.

This data is then used to decide whether the child qualifies for services through state early intervention programs and/or in the outpatient setting. A simple checklist can only really serve as a starting point because ‘normal’ is a spectrum – all children develop differently.

“There’s a large range of normal,” says Barclift. “A 4-year-old who can speak in complete sentences and a 4-year-old who’s putting only three words together to make only simple sentences are both within that normal range.”

According to Barclift, the testing that professional speech therapists conduct is meant to get a more thorough picture of where the patient is having problems.

“For early intervention evaluations, we spend up to two hours with the child and most of the time in the home,” says Barclift. “That helps because the pediatrician's office is not always where your child is going to act the way they normally act. In the clinic setting, therapists may have less time to complete evaluations and take detailed histories from parents and caregivers to make sure they are capturing the whole child and any concerns.”

Parents know their children best

Parents know their children better than anyone and are well positioned to spot developmental issues before anyone else does. But that’s only if they know what to look for. Fortunately, the CDC has resources targeted specifically to parents that can help you screen your child while going about your daily lives.

“The CDC has children's books and parent resource guides that parents can get for free that help the checklist become more natural and understandable,” says Barclift. “These resources help parents bring this conversation into their daily lives, instead of making it this scary thing that only happens when they go to the pediatrician.”

If you think your child might have a speech delay or other developmental disability, speak to your child’s pediatrician as soon as possible. The earlier a problem is identified, the better, but even if a problem isn’t spotted until later, therapy can still help.

“There’s also no such thing as too late either,” says Barclift. “Any time a parent is concerned we want them to come in.”

Reach out to your pediatrician today to get your child screened for developmental delays.