Developmental Milestones

Miscellaneous Milestones

Pervasive Developmental Disorders



24 mo

Concept of today

Autism - See above

Language skills

30 mo

Concept of tomorrow




Attends to bell

36 mo

Concept of yesterday

Retts - Girls, NI develop 1" 6-18 mo

2 mo

Cooing/searches with eyes for sound

7 yr

Concept of Left & Right

Regression of milestones, Motor- Walking/moving

4 mo

Turns head to voice/bell; Laughs (3mo)



Loss of ability to speak, Reason, Use of hands

6 mo


CEREBRAL PALSY - Static encephalopathy

Repetition of meaningless gestures of hands (hand

8 mo

Mama/Dada nonspecific

FT>premature b/c more FT babies born

wringing or washing)

9 mo

Understands the word No

15-20% Risk if <1500 grams



12 mo

Mama/Dada specific; Follows 1 step

Spastic (70%) - UMN, clasp-knife, increased DTR

Asperger’s - Lack social skills, delayed/awkward


commands w/gesture, 3-5 word

- Diplegia legs>>arms 30% (NH - germinal matrix)

Decr interests, Poor coordination/concentration,

14 mo

Follows one step command w/o gesture

Hemiplegia - Unilateral 30%

Average/above average cognitive fxn,

16 mo

Can point to several body parts

- Quadriplegia legs>arms, but arms 5%

Adequate language (vocabulary, grammar)

2 yr

50 word vocab; 2 word sentence; Uses

Dyskinetic (19%) - involuntary movements

Can't understand subtleties of conversation


pronouns indiscrim, Points to several picts

Mixed (10%)

Ataxic (1%)



2.5 yr

Gives first and last names; Uses plurals

Birth Injury 8-12%

Childhood Disintegrative Disorder


250 word vocab; 3 word sentences;

MR 30-77% (hemi/diplegia / increased cognition)

Nl development 1- 2 yrs -> Regression in Fxn


Speech intelligible to strangers 75%,

Mental score difficult secondary to motor bias

(including bowel/bladder fns)


knows age & sex, 3/4 of colors,

Language/learning disorder 40%

PDD-NOS - Don't fit other criteria

4 yr

Counts four pennies, tell a story

Presents - motor delay, Primitive reflexes



5 yr

Knows 4 colors, counts 10 pennies,

- Poor head control, generalized hypotonia




- Hypertonia (esp. w/ bathing/diapering)

1) Documented Exposure

Fine motor/adaptive skills

- Early preferential hand use (nl ),

2) Pre/postnatal Growth deficiency

1 mo

Tracks horizontally to midline

- Feeding problems. absent wt bearing

3) Neurological dysfxn (Speech/language delay,

2 mo

Tracks past midline/track vertically

R/ Progressive Disorders

Development retardation, ADHD, Clumsiness,

3 mo

Unfisted 50%, tracks 180, visual threat,

Think about - MRI, cytogenetics/metabolic studies

Subtle motor/speech problems


discovers midline

Services - Social, PT/OT, Audio/Speech, nutrition

4) Dysmorphic Features (Hypertelorism, Short

4 mo

Reaches for objects, brings to mouth



Palpebral fissures, Flat philtrum, Midface

5 mo

"Rakes" at object


Hypoplasia, Thin upper lip)

6 mo

Transfers object hand to hand

Mild - IQ 52-67, 3-51° grade level

Chronic Alcoholic 30-50% of FAS, C HD 35%

7 mo

Three finger pincer grasp

Can fxn independently as adults

lncr risk w/ amt of ETOH, flinging

9 mo

Neat pincer grasp, Bangs cubes at midline

Moderate - IQ 36-51, "Trainable"



12 mo

Turns pages 2-3 at a time

Severe - IQ 20-35, Need supervised setting



13 mo

Cup to mouth and drinks

Profound - Untestable

H & P - examine home life, teacher questionnaires

14 mo

Tower of 2 cubes, Scribble spontaneously



where & when pt has most trouble

15 mo

Tower of 3 cubes, Inserts pellet in bottle

Chromosomal - Downs 20%, Fragile X 1-6%

R/O out pysch issues, Hearing/vision problems

18 mo

Tower of four cubes

Endocrine/Metabolic 3-5%

Seizure disorder, Developmentally delayed?

2 yr

Copies horizont/vertical line, 6 cube tower

Multiple congenital anomaly syndromes

Signs & Symptoms ( prevalence 3-6%)

3 yr

Copies circle, Imitates a cross

Pre/Perinatal stresses, IUGR, IU Infxn, Toxins



4 yr

Copies "+" (3.5 yr)

Postnatal Injuries - Infxn, Near-drowning

Attention Deficit

5 yr

Copies square; person w/ 3 parts (4.5 yr)

CNS malformations - Neural tube defects

Difficulty sustaining attention/lack attention to details

6 yr

Copies triangle; person w/ 6 parts



Easily distracted, Poor organizer



Environmental factors- Abuse/neglect, malnourishment

Doesn't follow through on instructions,




Doesn't seem to listen. Often forgetful




Avoid things that require sustained mental effort

Gross Motor skills

1/1250 Males, 112500 Females, Trinucleotide repeat

Often loses things necessary for tasks (homework)


Reflex head turn. moves head side to side

Most common cause of MR except Downs



1 mo

Lifts head when prone

ADHD, Shyness, Social Avoidance, Poor eye contact



2 mo

Lifts shoulder when prone

Severe tantrums in response to limits/frustration

Fidgets/Can not sit still/Gets out of chair.

3 mo

Lifts upon elbows. Head steady - upright

Preservation of speech/actions

Talks excessively, Doesn't listen when spoken too

4 mo

Lifts up on hands, Rolls front to back, No

Hand flapping w/ excitement, Hand biting w/ anger

Trouble awaiting turn, Interrupts/intrudes on others


head lag pulled to sitting from supine

Oversens. to touch, Noises, Textures of food/clothing

Trouble playing/engaging in leisure activities quietly

5 mo

Rolls back to front

- May benefit from ADHD, Pysch meds

Rx - Behavior modification, Ritalin, Dexadrin

6 mo

Sits alone 30 sec or more



Side Eff- HA, Deer appetite, Motor tics, Abd pain

7-8 mo

Crawls/sits well

- Broad forehead/elongated face

Can have conduct/antisocial problems in adolescence

8-9 mo

Pulls to stand

- Large

ears, Strabismus, High arched palate



10-11 mo Cruises



General principles

12 mo


- hyperextensible joints, Hand calluses, Flat feet



15 mo

Walks backwards

- Pectus Excavatum, MVP (50-80%), Seizures

Skin - Mongolian spots, Hemangiomas, Erythema

18 mo

Runs, Kicks ball, Climbs on furniture

- Enlarged testicles, Hypotonia, Soft fleshy skin

toxicum, Salmon patch, Pustular Melanosis

2 yr

Walks up/down stairs one @ time)

Females - 50% Carriers borderline IQ

(brown macules, pustules, vesicles in AfroAmer)

3 yr

Walks up alternating, Rides tricycle,

50% w/ nl IQ will have learning/school problems

Head - Fontanelle, Cephalohematoma. Caput


Stand on one foot momentarily, Dresses



Eyes - RR (r/o cataracts) EOM, Subconj. hemo

3.5 yr

Hops on 1 foot



Ears - Placement, Patent canal, Tags, Pits

4 yr

Walks downstairs alternating/hops on I ft

Impairment of reciprocal social interaction

Nose - R/o choanal atresia. ?flaring


Throws ball overhand


Failure to seek comfort when distressed

Mouth - Palate. Uvula, Epstein pearls

5 yr

Skips, Running broad jump


Lack of awareness of feelings of others

Neck - Webbing? Low hair line?, Fistulas

Personal/Social Skills


Impaired imitation

Chest - Sternocleidomastoid hematomas, Clavicle


Regards face


Impaired social play

fx, Breast buds, ?Retractions, Chest expansion

6 wk

Spent. social smile


Impaired ability to make peer friendships

Heart - Murmurs, Pulses, Capillary refill

6 mo

Discriminates social smile

Impairment of language/communication development

Abdomen - R/o masses (kidneys?), Umbilical cord

7 mo

Stranger anxiety. Peekaboo/enjoys minor


Absent communication

Genitalia - Testis, meatus, Secretions, Vaginal tags

10 mo

Waves bye-bye, patty cake


Abnormal nonverbal communication

Skeleton - Hip click, Symmetry, Sacral dimple

12 mo

Drinks from cup, Helps w/dressing


Absent imagination

Neuro - Moro, Grasp, Suck, Tone, Symmetry

15-I8 mo

Uses spoon, Spilling a little, Hugs parents


Abnormal speech production



2 yr

Washes & dries hands, Listens to stories


Abnormal speech content



2.5 yr

Pretend games


Inability to initiate or sustain conversation



3 yr

Uses spoon well; buttons, Takes turns





4 yr

Washes & dries face; Cooperative play

Decr range of activities/interests,



5 yr

Dresses w/o assist, Domestic role play


Stereotyped body movements



Cognitive Skills


Preoccupation with objects



Newborn-2yr Sensorimotor


Distress with environmental play



2-6 yr



Insistence on following routines



6-11 yr

Concrete operational


Restricted range of interested



>11 yr

Formal operations

Onset is in 1st yr 25%, 2nd 50%, after 2nd 25%





Marked decrease pretend play





Associated Ss - Hypersensitivity to touch, certain





food textures, sounds