Child Development for Behavior Analysts
Presented by Kristen Byra
A firm understanding of typical child development will aid practitioners in creating developmentally appropriate treatment plan goals and objectives. Clinicians also need to work with families to disseminate critical child developmental milestones. Information about child development—specifically early warning signs—needs to be supplied to parents so that they can be prepared for visits with their child’s health care provider to request referrals if necessary. While efforts for early detection are admirable, there is still restricted access to services, including a confirmed diagnosis and treatment, especially in rural communities and for certain demographic groups. Delayed diagnoses and access to treatment both have clinical implications that will be discussed. Finally, treatment planning needs to be evidence-based and should be linked to established curriculum and literature.
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“informative”
— Alyse S.“It was super helpful getting a refresher on developmental milestones! Dr. Byra had great insight on goal planning while keeping age and typical development in mind.”
— Jocelyn C.“This was super helpful and easy to listen too!!! Loved the presenter”
— Marisa B.“I like the presentation, though links and QR codes were not available through the playback.”
— Kari W.
About this CEU
A firm understanding of typical child development will aid practitioners in creating developmentally appropriate treatment plan goals and objectives. Clinicians also need to work with families to disseminate critical child developmental milestones. Information about child development—specifically early warning signs—needs to be supplied to parents so that they can be prepared for visits with their child’s health care provider to request referrals if necessary. While efforts for early detection are admirable, there is still restricted access to services, including a confirmed diagnosis and treatment, especially in rural communities and for certain demographic groups. Delayed diagnoses and access to treatment both have clinical implications that will be discussed. Finally, treatment planning needs to be evidence-based and should be linked to established curriculum and literature.
From the talk
What was covered
Kristen Byra on using typical child development to write better goals, set fair mastery criteria, and close late-diagnosis gaps.
- Check every new goal against a milestone chart before it goes into the plan.
- Stop filling blank boxes on an assessment grid and pick skills that pay off across settings.
- Hand worried parents the CDC Milestone Tracker or the M-CHAT, and say plainly that a screen is not a diagnosis.
- Ask the family what they need this month before you write a toileting or self-care goal.
- Set tantrum goals against typical rates for that age, not against zero.
- Never write 100 percent compliance into a plan, because blind compliance is a safety risk.
Why Typical Child Development Belongs in Every Treatment Plan
Most goal writing starts with an assessment grid. Kristen Byra asks a harder question first. Can a child this age do the skill you just picked? Typical growth is the yardstick. Drop it, and goals drift too high or too low.
She opened with the points she wanted people to keep. One test score is one data point. It is rarely enough to plan a year of care. Look at the learner from several angles. Talk to the people who live with them.
Her second point is that developmental sequencing (teaching skills in the usual order) matters a lot. It is still not the only thing that decides a goal. Age alone does not make a skill worth teaching. She also warned about mastery criteria (the rule for calling a skill learned) for challenging behavior. That is where plans get unrealistic fast.
She pointed to several free milestone resources. The Ages and Stages Questionnaire covers the early years. ASHA posts communication milestones plus feeding and swallowing charts. The self-care checklists from the VB-MAPP (a common early skills assessment) can be downloaded on their own. The CDC adds photos and short videos. Byra merged the CDC and Ages and Stages charts into one page through age five. It covers motor, communication, play, social, and adaptive skills. Most trackers stop near five, and only a few stretch to eight.
So one single assessment, just like one data point, is usually not sufficient really for goal planning.
From the talk — Kristen Byra
Early Warning Signs and Free Screening Tools to Hand Parents
When Byra started grad school, the autism rate sat near 1 in 125. Today it is 1 in 36. Part of that jump comes from better spotting of early signs. That is real progress, and it puts more weight on what we tell parents.
The CDC lists early signs worth a call to the pediatrician. A baby may not turn to their name by 12 months. They may not point or show interest by 14 months. Pretend play and eye contact may be thin. Speech may be late, or may come out as echolalia (repeating words heard from others). Answers may not match the question. Small routine changes may set off big upset. Interests may be narrow and intense. Sound, taste, smell, sight, or touch may draw unusual reactions.
Two free tools do a lot of work here. The CDC Milestone Tracker is built for parents. It holds short video clips that show what each item means. A parent watches a clip and then answers with more accuracy. They can walk into the next wellness check with data instead of a worry. Autism Speaks hosts the M-CHAT (a short autism screening checklist) for kids 16 to 30 months old. It comes in many languages, so a family who prefers another language can still use it.
Send these to a parent who is worried about a younger sibling, a niece, or a nephew. Then be clear about what the tools are not. A flag on a screen is not a label. It is a reason to call a health care provider.
Just a note, screening does not supplant diagnostics, right?
From the talk — Kristen Byra
Why Kids Still Get Diagnosed Late, and Who Waits Longest
A solid diagnosis can be made by age two. Most kids still wait until four or later. That gap costs families years of early help. Earlier help tends to lead to better outcomes, so the wait is not a small thing.
A 2011 study found that parent education, race, and maternal immigrant status all shifted the age of diagnosis. Socioeconomic status predicted that age more strongly than how severe the signs were. A 2014 study found that Latino children got a diagnosis about two and a half years later than white non-Latino children. They also tended to show more severe signs by then. The barriers were poverty, limited English, and low awareness. The process itself felt confusing, far away, and hard on the child.
Older case data, drawn from 1993 to 1999, showed the same split. Caucasian children were diagnosed near six and a half years. African American children waited until about 7.9 years. A 2022 study is more hopeful. Asian, white, Black, and Hispanic children all landed between 4.4 and 4.9 years. The spread closed. Four years is still late.
A 2023 article flagged a different gap. Girls are still caught later than boys. Place matters too. In rural areas there is a lag of 13 months or more between the first worry and a diagnosis. Byra lived in a remote mining town where families drove hours for testing. One study looked at running the ADOS (a common autism diagnostic test) by video. It found no real drop in accuracy against in-person testing. Note that starting at age three, public schools also owe these kids special education services.
So we're seeing some racial disparities here in our diagnostic process.
From the talk — Kristen Byra
What Typical Looks Like From 9 Months to 5 Years
At nine months a baby often gets shy with strangers and clings to familiar adults. They know what no means. They babble long strings of sounds. They copy sounds and gestures, and they point with one finger. They watch a toy fall and hunt for a hidden one. They put every object straight in the mouth. Motor skills move fast here. They sit without help, pull to stand, and start to crawl. They pass a toy hand to hand and pinch a cheerio between thumb and finger.
By 12 months the list grows. They hand you a book to ask for a story. They play peekaboo and patty cake. They wave bye bye and shake their head no. They say mama and dada and try whole words. They drink from a cup and brush their hair, with plenty of mess. They follow a simple direction like pick up the toy. They cruise the furniture and may take a few steps alone. At 18 months they use single words, point to ask, and walk well. They eat with a spoon, help with undressing, and scribble. Simple pretend play starts, and they know a phone goes to the ear.
Two-year-olds get excited around other kids, though they mostly play beside them. Defiance shows up right on schedule. They build towers, follow two-step directions, and name things in books. They run, kick a ball, and climb on and off furniture. Speech moves from single words to short strings. By three, kids have friends and get the idea of mine and yours. They follow two or three step directions and use prepositions. Strangers can understand them most of the time. They hold a short talk of two or three sentences. They copy a circle, turn pages one at a time, and pedal a trike.
Four-year-olds would rather play with other kids than alone. They sing a song from memory, give a first and last name, and use basic grammar. They count, sort same from different, use scissors, and draw a person with a few body parts. Five-year-olds want friends and want to be liked. They speak clearly, tell a story in full sentences, and use future tense. They count past ten, print some letters, hop, do somersaults, and handle a fork and spoon. Toileting should be on their own by then.
That's why we don't give little kids Legos.
From the talk — Kristen Byra
Turning Assessment Results Into Goals That Hold Up
Pick a tool that matches the whole span of skills, not the one already on the shelf. A book chapter she cited puts it plainly. To keep a curriculum age appropriate and balanced, test skills in every area of human functioning. Cover skills from infancy up through the child's chronological age (the age on the birth certificate). The ABLLS (a broad skills checklist) lists no target age range and covers a wide span. The VB-MAPP runs from zero to four. The Vineland (a broad life-skills assessment) runs from zero to 90 and gives an age equivalency score (the age that score matches).
Her warning: a 12-year-old scored on a zero-to-four tool leads somewhere bad. She has seen plans that teach a 12-year-old nursery rhymes, because the box on the grid was blank. Many teams run the Vineland only because a funder asks for it. The report then goes in a drawer until the next update. If you are going to sit with a parent for that interview, use what it tells you. Start with the age equivalency scores.
She listed twelve things to weigh before a goal goes in a plan. Six of them cover the basics: barriers to learning, current skill level, and pace of learning. Add to that how useful the skill is, social validity (does this matter to families), and the child's age. The other six cover fit. They are prerequisite skills (skills a learner needs first) and pivotal skills and behavioral cusps (skills that open many doors). Round that out with paired skills, treatment hours, the provider's skill set, and available resources. She zoomed in on three: usefulness, social validity, and age. Run a nursery rhyme goal through those three and it falls apart.
A 2011 article made the same case. A broad curriculum is not enough on its own, because the plan still has to fit the child. You cannot target every skill deficit anyway. Priority goes to key skills, cusps, and pivotal responses that stay useful across settings and across a life. For method, she pointed to the CAPTAIN site. It is free and lists 28 evidence-based practices (backed by a strict research review) from 2020. Evidence-based does not just mean someone published a paper. That review kept peer-reviewed work in English. It left out dissertations and conference talks. Then it rated study quality against set criteria.
the road to hell is paved with data we never look at
From the talk — Kristen Byra
Ask Parents First: Culture, Priorities, and the Toileting Trap
A 1997 study asked parents from different groups when kids should hit 25 everyday skills. The answers spread wider than you would guess. Being fed with a spoon varied by about three months. Putting on shoes varied by about ten months. Naming colors varied by about seven. Toilet training spread the most. In the United States families often start at two or three, while in many other countries families start earlier.
Those beliefs shape what a parent reports at a checkup. Set the bar low, and no one raises a flag at 15 months with no words. Set it high, and a parent panics at 12 months over missing phrases. Beliefs also shape what a family is willing to work on at home.
Byra once took over a case where toileting was goal number one. The child was four, mobile, and had decent language. On paper it looked reasonable. In practice it was going badly, and the parent said it felt overwhelming. No daycare or preschool was asking for it. The goal was there because the last provider said it had to be. The family agreed because they feared losing services.
That is the part she asked people to carry out of the talk. Weak follow-through at home is data, not a character flaw. When a parent skips the data sheet, ask what else is crowding their week. To start that talk she built a Family Quality of Life Scale. It is 25 items on a Likert scale (rated from low to high). Run it alongside the Vineland or the VB-MAPP and repeat it every six months.
you need to start talking and listening to parents about what they need.
From the talk — Kristen Byra
Aiming Too High, Too Low, and Too Huh
The first miss is aiming too high. A three-year-old had a three-step direction goal in the plan. The same child had not mastered simple related two-step directions. The VB-MAPP places motor actions on command and two-part noun and verb directions around that level. Milestone charts put unrelated three-step directions closer to 42 months. The goal was not hard. It was early.
The second miss is the group goal that never moves. A plan says the client will sit with a small group for five minutes without leaving or disrupting. Six months later that is still the only group goal in the plan. Ask what quiet sitting is buying the learner. Then ask what the next step really needs. It needs a generalized imitative repertoire (copying new actions without prompts). It needs following adults and peers without prompts, choral responding (answering along with the group), and raising a hand. Those are the pieces people skip.
The third miss is aiming too low. A parent wrote on the plan that they wanted their four-year-old to stop eating with their hands. No utensil goal showed up anywhere in that plan. The provider said the child was not old enough at four. Typical development says otherwise. Scooping with a spoon shows up near 18 months. Picking food up with a fork shows up near 30 months.
The last one she calls too huh. A ten-year-old in school all day had a few hours of care after school. The plan targeted naming community helpers, because that item came back as a gap. The same child could not brush their teeth or wash their hands alone. Hours are limited and funding will taper at some point. Teeth and hands win that trade.
So when we are treatment planning, sometimes we aim too high.
From the talk — Kristen Byra
Setting Mastery Criteria for Tantrums and Compliance
Kids tantrum, and they tantrum often. Plans still ask for one tantrum in four straight weeks from a three-year-old. Or zero tantrums for three months at age five. Or zero tantrums for six months at age four. She has also seen a cap of 30 seconds on duration. Thirty seconds is barely enough time to get properly mad.
Typical data gives you a fairer bar. Three-year-olds average about 2.5 tantrums a day and 6.1 a week. Some run up to 15 minutes. Four-year-olds sit near 1.9 a day. Five-year-olds still have at least one a day. Byra noted a real gap in the research past age five for how often and how long they last.
Compliance criteria go the same way. Plans ask a child to start a task within 15 seconds of the instruction. Most adults would not meet that bar unless the house was on fire. Typical compliance data for two through six year olds varies by activity. Snack pulled a strong rate. Other parts of the day did not come close.
There is also a safety reason to stop short of perfect compliance. A child who follows every adult direction every time is exposed. Think about the ways an adult can misuse that. A kid needs room to refuse. Write your criteria so that room stays open.
100% compliance is not always a safe goal.
From the talk — Kristen Byra
Common questions
At what age can autism be reliably diagnosed?▾
Reliable testing can be done by age two. Most kids are still not diagnosed until four or later. A 2022 study put the average between 4.4 and 4.9 years across racial and ethnic groups. Earlier help tends to bring better outcomes, so that gap costs families real time.
What can I give a parent who is worried about a younger sibling?▾
Point them to the CDC Milestone Tracker. It is free and includes short videos that show what each milestone means. For kids 16 to 30 months, Autism Speaks hosts the M-CHAT in many languages. Tell the parent plainly that a screen is not a diagnosis. The goal is to walk into the next wellness check with data and ask about a referral.
How do I know if a goal is developmentally appropriate?▾
Check the target against a milestone chart before it goes in the plan. Then check the prerequisite skills that sit under it. A three-step direction goal makes no sense if two-step directions are not mastered yet. Unrelated three-step directions do not typically show up until about 42 months. A blank box on an assessment grid is not a reason on its own.
Is zero tantrums a reasonable mastery criterion?▾
No. Three-year-olds average about 2.5 tantrums a day, and some last up to 15 minutes. Four-year-olds run near 1.9 a day, and five-year-olds still have about one a day. Write criteria that move toward typical rates for that age instead of demanding none.
Why is 100 percent compliance a bad goal?▾
A child who complies with every adult direction every time has no way to refuse an unsafe one. Adults can misuse that kind of blind following. Byra asked practitioners to keep this in mind when they write compliance criteria. Typical compliance also varies a lot by activity, so a flat 100 percent does not match real kids.
Which assessment should I use for an older learner with big skill gaps?▾
Match the tool to the span of skills you need to see, not just to the learner's current level. The VB-MAPP covers zero to four. The Vineland covers zero to 90 and gives an age equivalency score. The ABLLS lists no target age range. Running a 12-year-old on a zero-to-four tool tends to produce goals like nursery rhymes. Use the assessment to inform the plan, then choose skills that stay useful across settings.
About the speaker
Kristen Byra holds a PhD in psychology from Western Michigan University. She is licensed as a behavior analyst in Arizona, Texas, and Massachusetts. She chairs the Arizona LBA. Her clinical decision-making models (tools that guide case decisions) help behavior analysts keep service quality steady across a full caseload. She also builds clinical decision support tools, including the Family Quality of Life Scale featured in this talk. Outside of that, she consults and teaches CEU courses.
This summary was generated from the recording’s transcript. Quotes are taken word for word from the talk.
What you'll learn
- 1Within this presentation, participants will:
- 2Be provided with an overview of key developmental milestones from 9 months to 5 years of age.
- 3Be introduced to literature that outlines the barriers to services based on several different demographics.
- 4Examine the clinical implications of delayed access to services.
- 5Gain access to a review of common rating scales and diagnostic tools used in the diagnosis of autism spectrum disorder.
- 6Be able to develop mastery criteria in alignment with typical child development.
Concepts in this CEU
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