Changes to the Developmental Milestones Guidelines Cause Confusion and Conflict

By | NESCA Notes 2022

By Olivia Rogers, MA, CF-SLP
Speech-Language Pathologist, NESCA

Recently, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) updated guidelines for developmental milestones in the Learn the Signs. Act Early program for the first time since its initial release in 2004. This program provides free checklists of developmental milestones and outlines warning signs of developmental delays in the following areas: social/emotional, language/communication, cognition, and movement/physical.

One of the biggest CDC developmental milestone changes involves language development. Since 2004, the CDC has stated a 24-month-old should have a vocabulary of 50 words. Now, that milestone of 50 words has been pushed back to 30-months-old. This new standard clashes with the American Speech-Language-Hearing Association (ASHA) guidance, which states that saying fewer than 50 words at 24 months is a potential red flag for a language delay or disorder.

Confusion regarding the recent changes may impact the (already) difficult decision that many parents are faced with in the first few years of their child’s life: whether or not to seek professional support for their child.

Despite the changes to the outlined milestones, the intentions behind this checklist remain consistent—early identification and intervention is key. When it comes to your child’s speech and language development, we suggest not taking the “wait and see” approach. The first three years of your child’s life—when the brain is developing and maturing—is the most intensive period for acquiring key speech and language skills.

Though children vary in their development of speech and language skills, they do follow a natural progression for mastering these skills of language. If you’re worried your child isn’t meeting milestones and wondering when the right time or the best age is for speech/language therapy, take action sooner than later. Contact a local speech-language pathologist. The earlier a child is identified with a delay, the better, as treatment and learning interventions can begin.

We urge parents to follow their instincts and seek guidance when there is a concern. You will either get much needed help for your child or peace of mind, and your local speech-language pathologists are happy to help.

If your pre-school-aged child is having difficulty with any of the following, concerns can be addressed through a speech/language assessment and/or therapy:

  • Saying first words or combining words into sentences
  • Using gestures
  • Naming and describing objects, ideas, and experiences
  • Pronouncing words or being understood by family or others
  • Interacting socially or playing with others
  • Understanding words, concepts, or gestures
  • Listening, following directions, or answering questions
  • Knowing how to take turns when talking or playing with others
  • Using correct grammar, such as pronouns and verb forms


Centers for Disease Control and Prevention. (2022, January 31). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. Retrieved February 24, 2022, from https://www.cdc.gov/ncbddd/actearly/milestones/index.html

The National Institute on Deafness and Other Communication Disorders. (2000). Speech and Language Developmental Milestones. NIH Publication No. 00-4781.


About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.


Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.


To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.


Modern Parenting: Moving Beyond the Standards of Screen Time

By | NESCA Notes 2018


By: Jacki Reinert, Psy.D., LMHC
Pediatric Neuropsychology Post-Doctoral Fellow

Content is king. Not all content is created equal.

Recently I received a sweet, hand-made Mother’s Day gift from my son. On small pieces of paper, he meticulously filled in a series of incomplete sentences, ranging from “My mom can do many things. I think she’s best at making art” to “Did you know that my mom is a sicalligist (psychologist)?” and “My mom is super smart! She knows that kids should have two hours of screen time.”

“Two hours of screen time” has been successfully drilled into each adult responsible for monitoring a child’s technology use thanks to a successful media push by the American Academy of Pediatrics (AAP). Beginning in October of 2013, AAP held a firm stance on screen time, indicating that children over the age of two should be limited to two hours of screen time. Over time, the guidelines once again shifted in 2016 to ensure that no child under the age of 18 months should have access to screen time, referencing research that indicated technology could have a profound effect on brain development.

Despite these significant implications, screen use among 0 to 8-year-old children continues to grow. In a large-scale study of screen use in the United States, researchers at CommonSense Media (2017) found that on average, children under two spend approximately 42 minutes per day on “screen media use”. Of that time, approximately 58 minutes is spent watching television, 17 minutes are spent watching DVDs, 48 minutes are on a mobile device, 10 minutes on a computer, and 6 minutes on a video game player. For kids ages 2 to 4, total screen media use clocks in at 2 hours and 39 minutes; for 5 to eight-year old’s, 2 hours and 56 minutes.

AAP has once again shifted their policy regarding media, permitting the use of video chat, such as FaceTime and video conferencing to facilitate social communication with family members living far away. They encourage adults to provide a social context for little ones. Further, an emphasis on the type of content has been further reinforced; Sesame Street is different than Power Rangers,

Finding a balance is key; you should feel comfortable putting on a 20-minute show while you prepare dinner, whereas allowing kids to binge before bedtime is heavily frowned upon by pediatricians. According to parents surveyed in the research conducted by CommonSense Media, nearly half of all children 8 and under often watch television or play video games during the hour leading up to bedtime. While outcomes vary, researchers have found that using any device at bedtime is associated with a statistically significant increased use of technology in the middle of the night, compromising sleep quantity and quality (Fuller, Lehman, Hicks, & Novick, 2017). Further, research also suggests that excessive television viewing in early childhood has negative implications for cognitive, language, and social/emotional development (Conners-Burrow, McKelvey, & Fussell, 2011).

So how do we provide the structure and balance for kids, particularly for our youngest viewers? One of the best ways is to track current usage to better inform decision-making. One easy-to-use application is the “Media Time Calculator” developed by HealthChildren.org. This application allows adults (in English and in Spanish) to calculate the amount of time your child spends on various activities, such as school, reading, homework time, unstructured time, chores, etc. to better inform how much “extra time” is permitted in a child’s day for media time. https://www.healthychildren.org/English/media/Pages/default.aspx#calculator 

Most importantly, decide what is most appropriate for your family and stick with your plan. Avoid using technology as a bartering tool for compliance or tacking on “extra time” for good behavior.

Another easy way to determine what content should be emphasized first is to have discussions with kids about what should “count” towards screen time. In our household, playing a movement-based game on the Wii, such as Wii Sports, doesn’t count towards the daily “two hours,” neither is playing a chess app on the iPad or solving math problems on Prodigygame.com. Armed with this information, you can then develop a Family Media Plan for both adults, teens, and children in the home: https://www.healthychildren.org/English/media/Pages/default.aspx#wizard 


About the Author:

Dr. Jacki Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and will join the Londonderry office in March 2018. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma.


To book a consultation with one of our many expert neuropsychologists, complete NESCA’s online intake form.




Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.