How Do I Know If My Child Needs Early Intervention?

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

During the first few years of life, parents and caregivers are often tracking baby’s exciting first milestones, such as their first steps or first words. Routine well-child visits at the pediatrician’s office will often include the doctor asking what new skills you have noticed since baby’s last visit—Are they sitting unsupported yet? Crawling? Saying Mama or Dada? It can be stressful when your child is not yet meeting their milestones. It can be especially challenging when you notice they may be behind their peers at childcare or when around same-aged children at family functions.

The Centers for Disease Control and Prevention is a great resource to utilize as reference for what is expected of children by age. You can access more information here: https://www.cdc.gov/ncbddd/actearly/milestones/index.html or through their developmental milestone checklist.

What are age-appropriate milestones?

At a glance, several notable milestones listed by the CDC are as follows:

6 months:

  • Recognize familiar caregivers
  • Reach for toys/objects of interest
  • Roll from their belly to their back

9 months:

  • Respond when you call their name
  • Smile/laugh in response to interactive games, such as peek-a-boo
  • Babble (mama or dada)
  • Bang objects together
  • Sit on their on

1 year:

  • Call their parent by name (e.g., mama or dada)
  • Pull themselves up to stand
  • Walk while holding on to furniture

18 months:

  • Point to show you something interesting
  • Following one-step directions
  • Imitating your actions (e.g., putting on makeup, vacuuming, hammering)
  • Walking unassisted
  • Climbing on and off couches and chairs without support

2 years:

  • Look to you for your reactions in new situations
  • Putting two words together, such as “more milk”
  • Using gestures like nodding/shaking their head
  • Running
  • Eating with a spoon

Should you have any concerns regarding your child’s development, talk to their pediatrician! Your baby may qualify for a referral to Early Intervention (EI), which can help them to gain the appropriate skills in a way that supports you, your child, and your family.

What is EI?

EI is a federal grant program that was established in order to identify children at risk for developmental delays and to help families meet their children’s needs and maximize their potential. EI serves children ages 0-3 and provides a multitude of services depending on a child’s needs. Referrals for EI can be made by caregivers and/or providers for children who are exhibiting delays in their developmental milestones OR for children who have a medical condition that places them at risk for a developmental delay. EI referrals can be made as early as birth for medical conditions, such as prematurity, low birth weight, and Down syndrome. Many children receive referrals for EI from their parents, pediatricians, and/or childcare providers when there are observable delays in meeting speech milestones, motor milestones, speech milestones, and/or social milestones.

Who qualifies for EI?

Once referred to EI, your child will likely undergo a developmental evaluation. They will qualify for services if they have a diagnosed medical condition with a risk for developmental delays OR a delay in one or more areas of development of at least 30% OR a delay in one or more areas at least 1.5 standard deviations below the norm OR there is a questionable quality of skills based on the informed clinical opinion of the multidisciplinary team. Children can also meet criteria if there is a risk for delays due to four or more child or family risk factors (e.g., NICU stay, feeding challenges, chronic illness of a caregiver, lack of social supports for the caregiver).

At the end of the day, you know your child best. If you have concerns, reach out to their pediatrician. You can also reach out to a local EI provider on your own. In MA: https://www.mass.gov/info-details/ei-program-contact-information. In NH: https://www.dhhs.nh.gov/family-centered-early-supports-services.


About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​


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 Dr. Miranda Milana, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.


The Path to Eligibility

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist

A child’s pediatrician is often the first professional who hears a parent’s concern that their child is struggling in school. It is comforting to know that The American Academic of Pediatrics has recently provided guidelines to pediatricians that outline the important role they can play when a child is struggling in school. The guidelines refer to pediatricians’ involvement in prevention (e.g. avoiding brain injuries, good nutrition, etc.), early recognition, diagnosis, treatment, advocacy/monitoring and referral. Regarding referral, pediatricians are asked to consider involvement of a number of subspecialties, including neuropsychologists, child psychologists, speech and language pathologists and others.

In my prior work as a Special Needs Advocate and now as a pediatric neuropsychologist, I understand how the referral to a neuropsychologist for a comprehensive evaluation can assist a parent in the Special Education eligibility process, but it is still too often an unknown for many others. To be eligible for Special Education services, a child must meet three basic criteria (1) present with a qualifying disability; (2) demonstrate a lack of effective progress in the general education setting; and (3) require specialized instruction or related services (e.g. Speech Therapy, Occupational Therapy, Psychological Services, etc.). The determination of eligibility is made by the school team that includes the parents. The school will conduct its own assessments which may provide the information needed to make a determination of eligibility. A private neuropsychological evaluation provided by the parents can also help to inform the process, by providing a diagnosis(es) as well as a deeper and more integrated look at the child’s cognitive, academic and social/emotional profile.

School evaluators do not typically provide what are considered medical diagnoses, such as ADHD, Autism Spectrum Disorders or Dyslexia. A neuropsychologist can make such a diagnosis, and a comprehensive neuropsychological evaluation should also provide an understanding of how the disability is impacting the child’s academic, social and/or emotional development. The neuropsychologist can then relate the diagnosis to the appropriate educational disability category for the school’s consideration. A neuropsychological evaluation can also assist in determining if a child is making effective progress within the general education setting. Data obtained through standardized testing, teacher reports and observation of the student in the school setting can provide information needed to determine if the child is making progress commensurate with their potential. Finally, delineation of specific skill deficits identified in an evaluation can provide information necessary for selecting appropriate specialized methodologies or the related services the child requires to make progress.

We often hear the phrase, “It takes a village.” It certainly “takes a village” of professionals to provide the coordinated and comprehensive care that a child who is struggling in school requires. With pediatricians providing the first line of support and referrals for parents, the outside professionals, including neuropsychologists, can work with the pediatrician and in conjunction with the school staff to provide the struggling student the range of services needed to foster their academic, social and emotional development.


About the Author

Combining her experience and training in both pediatric neuropsychology and educational advocacy, Dr. Reva Tankle has particular expertise in working with families who are navigating the IEP process. Having participated in numerous team meetings over the years, Dr. Tankle is especially knowledgeable about the many ways that schools can support and accommodate students with special learning needs, information that she clearly communicates in her evaluation reports and in team meetings, if needed. She also has a great deal of experience in articulating the reasons that a student may need a program outside of the public school.

Dr. Tankle evaluates students with ADHD, learning disabilities, high functioning autism spectrum disorders, and neurological conditions, as well as children with complex profiles that are not easily captured by a single diagnostic category.


To schedule an appointment with Dr. Reva Tankle in Plainville, MA, or any of our expert neuropsychologists, please complete our online intake form


Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and 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.