Child Development for Behavior Analysts: The Foundations

Why a Child's Age Should Shape Every Treatment Plan

Most of us work with the same small group of kids all day. We see the delays up close. Over time, the baseline fades. What does a two year old really do? What does a four year old do? Kristen Byra opened the summit with that gap. She had one child growth class as an undergrad. She did not get one in her master's program at all.

Her fix is simple. Keep a map of typical growth in your head. Then hold each plan up against it. If a goal sits far above the map, pause. If it sits far below, pause too. A child's age should shape what you test, what you target, and how you judge gains.

The early years carry a lot of weight. Byra noted that the brain is the only organ not fully grown at birth. About 90% of key brain growth happens in the first five years. That is a big reason to push for early care. She also framed our job in blunt terms: for every client you serve, ten more are waiting behind them.

Keeping in mind that the first five years have so much to do with how the next 80 turn out

From the talk — Kristen Byra

Early Signs That Should Prompt a Referral Talk

Many of us work with families who have younger children at home. That puts us in a spot to notice things early. Byra listed signs worth watching. No response to their own name by 12 months. No pointing at objects or showing interest by 14 months. No pretend play by 18 months. Poor eye contact and a wish to be alone.

She kept going down the list. Trouble reading other people's feelings, or naming their own. Delayed speech and language. Words and phrases said over and over, which we call echolalia (repeating words you just heard). Odd answers to questions. Big upset over small changes. Narrow, intense interests. Repeated body movements. Strong reactions to how things sound, smell, taste, look, or feel.

Byra was firm on one point. None of this is a diagnosis. A screener (a quick check, not a test) only tells you to ask more questions. Your role is to help a parent bring a clear concern to the pediatrician. Early notice leads to earlier care, and earlier care tends to lead to better outcomes.

Keep in mind these. are potential warning signs.

From the talk — Kristen Byra

Why Diagnosis Still Comes Late for So Many Children

A solid diagnosis can be made as early as age two. That is not what happens for most kids. Byra walked through work on who gets seen early and who waits. Social factors predicted the age of diagnosis more strongly than how severe the symptoms were. Those factors included parent education, race, and maternal immigrant status.

The gaps she cited are large. A 2014 paper found that Latino children were diagnosed about two and a half years later than non-Latino white children. They were also more likely to have severe symptoms by the time they were seen. Named barriers included poverty and limited English. Others were little awareness of the signs and a confusing process. Families also said the process was hard to reach and rough on the child. One review of 406 Medicaid cases found a gap. White children were diagnosed near 6.3 years. African American children were diagnosed near 7.9 years.

There is some progress. In more recent data, the median age of diagnosis was fairly even across groups, between about 4.4 and 4.9 years. The youngest mean was 4.49 years in Asian children. The oldest was 4.97 years in white children. Black children sat near 4.89 years and Hispanic children near 4.77 years. More even, still late.

Where a family lives matters too. In rural areas, Byra cited a lag of 13 months or more between first concern and diagnosis. One study of remote evaluations found no real difference in reliability or accuracy. Parent reported symptoms and parent satisfaction held up as well. This matters if you serve rural or underserved families. Push for telehealth (care given over video) on the diagnostic side, not only for therapy.

most children are diagnosed at four or later.

From the talk — Kristen Byra

Free Tools That Map Typical Milestones

You do not need to buy anything to get a baseline. The CDC site breaks milestones down by age. The early ones go month by month: two, four, six months. Then the spans widen to one year, 15 months, 18 months, two years, 30 months, and three years. Each one opens as a PDF you can print and keep.

The CDC also has a free tracker app. It asks plain questions. Does the child repeat a sound or action to get your attention? Do they hand you a book when they want a story? Do they cry when a parent leaves? Parents answer yes, no, not yet, or not sure. That gives them something concrete to bring to the next well child visit.

Byra named several more. The M-CHAT-R (a short parent checklist for toddlers) covers ages 16 to 30 months. The Ages and Stages Questionnaire is free. The American Speech Language Hearing Association posts milestones for talking, feeding, and swallowing. She also pushed a smaller habit: read the VB-MAPP (a common early skills test) manual, not just the grid. The publisher offers a free self-care checklist that sorts toileting and dressing by age.

She built her own cross reference from the Ages and Stages Questionnaire, the speech milestones, and the CDC lists. It covers motor, communication, play, social, and adaptive skills (daily living skills like dressing) from six months to 48 months. One caution she repeated: most free tools thin out around age four or five.

There are lots of resources. available and many of them are free.

From the talk — Kristen Byra

The Working Map: Nine Months Through Five Years

Byra walked the group through each age across four areas: social and emotional, thinking, language, and movement. At nine months, a baby may fear strangers and cling to known adults. They watch an object fall, look for things you hide, and play peekaboo. They understand no, babble long strings of sounds, copy your gestures, and point. They sit without help, pull to stand, and crawl.

By 12 months, the picture shifts. They cry when a parent leaves and hand you a book for a story. They shake and bang things to explore. They find hidden items fast and look at the right picture when it is named. They use objects right, like drinking from a cup. They respond to simple requests, wave bye bye, say mama and dada, and copy your words. Many take a few steps.

At 18 months, tantrums enter the chart. They hand toys to others, hug familiar people, and feed a doll in simple pretend play. They point to body parts, scribble, and follow a one step direction with no gesture. They say several single words and say no. They walk alone, pull toys, drink from a cup, and eat with a spoon. By two years, they sort shapes and colors and build towers of four or more blocks. They follow two step directions and say two to four word sentences. They kick a ball, climb on and off furniture, and copy lines and circles.

Three brings sharing and big feelings. They take turns, show concern for a crying friend, and grasp mine and his and hers. They do three or four piece puzzles, copy a circle, and unscrew jar lids. They follow two to three step directions, use in, on, and under, and hold a short conversation. They pedal a trike. At four, pretend play gets rich and they name colors. They draw a person with two to four body parts and use scissors. They can tell you their first and last name. At five, they count ten or more things and print some letters. They copy a triangle and speak clearly in full sentences, using future tense. They can stand on one foot for ten seconds and use the toilet alone.

it can be difficult when you're only working with special needs population to kind of forget

From the talk — Kristen Byra

Choosing Goals: Prerequisites, Cusps, and the Grid Trap

One book chapter on program design sets the bar well. To keep a curriculum age appropriate and balanced, your assessments need to cover every area of human function. They should sample skills from infancy up through the child's chronological age (the child's age in years). The chapter sorts common tools by the areas they cover. The ABLLS and the Vineland (two more common skill checklists) do not cover the same ground as the VB-MAPP. No single tool fits every client.

Byra also pointed to work on early intensive behavior intervention (many therapy hours for young kids). A broad curriculum alone does not make a plan good. You cannot target every deficit, so you rank them. Give priority to prerequisite skills (skills needed before the next one). Also rank pivotal skills (skills that lift many others) and a behavioral cusp (a skill that opens new learning). Then weigh barriers to learning, current skill level, and how fast the child acquires new skills. Also factor in social validity (does the goal matter in life), hours available, your own skill set, and your resources.

Learning to learn skills come first. Can the child attend? Give back a reinforcer after it is delivered? Keep hands settled instead of grabbing everything? Wait? Respond to an instruction, shift based on feedback, learn from a prompt, and stay calm during teaching? Skip those and the rest stalls.

She then showed three ways plans go wrong, using real plans she has reviewed. Aim too high: a three year old without simple two step directions got a goal for three step directions. Unrelated three step directions do not typically show up until about 42 months. Aim too low: a four year old still ate with hands. Caregivers wanted utensils, but the plan had no goal, because the provider thought four was too young. Scooping with a spoon shows up near 18 months and fork use near 30 months. Then the third kind, which she calls too huh. A ten year old in school full time had only about 10 to 12 hours of care a week. Her plan gave her a goal to name community helpers. Meanwhile, she could not brush her teeth or wash her hands alone.

Based on functional needs. and not desire to fill in the grid.

From the talk — Kristen Byra

Caregiver Expectations Vary More Than You Think

Byra cited interviews with 250 mothers from Puerto Rican, African American, and West Indian Caribbean backgrounds. European American families appeared in the same chart. Each answered 25 questions about the age a typical child should reach a milestone. The spreads were wide. For being fed with a spoon, answers ranged from about 7.3 months in one group to about 4 months in another. For putting on shoes, the gap ran from 29.7 months down to 19.5 months. Naming colors showed a seven month spread.

Toilet training showed the same pattern across regions. The United States landed at two to three years. China came in at 12 to 18 months. Japan sat at 18 to 24 months and Russia at 12 to 18 months. Scandinavia matched the United States at two to three years. Africa varied by region, with many answers in the 12 to 18 month range.

This is not trivia. It changes who raises a concern and when. If a parent believes first words come at 18 months, they will say nothing at the 15 month visit. If they believe two and three word phrases come by 12 months, they may worry too soon. That worry can show up at the 12 month visit with no real cause. It also shapes your goals. A parent asking for recited phrases from a 14 month old needs a conversation first, not a goal.

it's really important. and to talk with your parents about what their expectations are

From the talk — Kristen Byra

Mastery Criteria for Tantrums and Compliance

All kids tantrum. Byra's point is that our mastery criteria often ignore that. On average, one year olds have about 2.7 tantrums a day. That is roughly seven and a half a week, lasting up to 15 minutes. Two year olds average about 2.9 a day. Three year olds drop to about 2.5, four year olds to about 1.9. Five and six year olds still have about one a day. Seven year olds have roughly one every other day. Duration data for older kids is thin.

Now compare that to criteria she has read in real plans. A three year old with one tantrum across four straight weeks. A five year old with zero tantrums for three months. A four year old with zero for six months. She is not saying leave tantrums alone. Excessive, long, or dangerous tantrums belong in a plan. She is saying do not hold a four year old to a bar most adults would miss.

Compliance runs the same way. The research is limited, but the numbers are steady. Two and three year olds comply about 72% of the time. Four and five year olds land near 79%. Six and seven year olds reach about 82%. Broken out by activity for kids 45 to 78 months: academics 88%, snack 86%, music and games 77%. Not one of those is 100%.

So a goal for 100% compliance across 100% of opportunities is not just unrealistic. It is unsafe. We do not want a child who follows any adult instruction in any setting. Some rules do stay at 100%, like looking both ways before crossing the street. Most do not. The same goes for a 15 second initiation criterion. Adults do not drop everything in 15 seconds either, unless the smoke alarm is going.

I don't know adults that go six months without having some kind of tantrum.

From the talk — Kristen Byra