'Red Flags' in Child Development

January 17, 2021 Dr.Srinivas Gada 0 comment

‘Red Flags’ in Child Development

Just like in many aspects of life, there are ‘red flags’ in the field of child development too. ‘If you ignore the red flags, then embrace the heartache to come’, said Amanda Mosher. Sadly, the pain of missed opportunities for your child will not be easy to ignore. So what are these warning signs in a child’s development that need our prompt attention and action? It is essential to know these red flags, as forewarned is forearmed.

However, a lack of ready accessibility and awareness of these warning signs in children’s development is hampering early identification and appropriate intervention, for conditions such as ASD, ADHD, Dyspraxia and more. To complicate these matters further, many parents wait for over 12 months from the time they first raise concerns regarding their child’s behaviour or development, to the time they receive an assessment or a diagnosis. This was the finding from the Autism and Developmental Disabilities Monitoring Network of USA. Such prolonged waits would be no different in the UK, because of several reasons.

Firstly, the neurodevelopmental assessments are time and labour intensive that cannot be carried out in a typical clinic appointment. Secondly, parents’ concerns regarding their child’s behaviour and development can be vague, making these challenging to be identified sooner. Moreover, the signs and symptoms of ASD or ADHD can be remarkably diverse and varied, making them difficult to be diagnosed quickly without undertaking an in-depth assessment. Most importantly, there is a significant scarcity in the availability of expertise to diagnose these conditions while the demand is growing, among other things.

I have categorised these ‘red flags’ under individual spheres of a child’s functioning. But a note of caution before you read. Whilst each item or red flag listed below would be of some concern in the absence of anything else, they may just need continued observation or a discussion with your health visitor. However, the presence of multiple red flags in an individual domain or across more than one field, deserve prompt attention, exploration and or an assessment. So, here they are:

Social Interaction & Communication Development

Avoids eye contact with others
Lack of reciprocal social smile
Inability to communicate using pointing, facial expressions, and gestures,
Poor attention or inability to stay focused on an activity
Focuses on unusual objects for extended periods or observes them from unique angles
Enjoys these distinct activities more than interacting with other children or parents
Does not seek love and approval from a caregiver or parent
Lack of sharing interest or enjoyment with others
Preference to play alone
Withdraws or spends time ‘in a world of his own’.
Does not respond to his/her name being called
Gets unusually frustrated when trying to do simple tasks
Difficulty in seeing a coherent whole, instead focus on small features in a picture
Dislikes hugs, kisses, cuddles and close physical contact
Mis-judges personal space
Frequently interrupts or intrudes on others

Behaviours / Personality Development

Unusual motor mannerisms, e.g., hand flapping, spinning, staring into space, rocking, or tiptoeing
Restricted range of interests and activities, e.g., playing with a single toy or minimal range of toys
Difficulty to cope with change or abnormal reaction to a change in routine
Displays aggressive or uncooperative behaviours
Is significantly overactive or oppositional for his age
Displays temper tantrums or violent behaviours daily
Shows unusual attachments to toys, objects, or parts of objects
Does not play with the toys in a way they are designedfor
Spends a lot of time lining things up or putting things in a particular order

Hearing & Language Development

Does not startle to loud noises
Resists loud sounds, e.g., hand dryers by covering hands over ears
Ears appear small or deformed
Talks in a very loud or incredibly soft voice
Seems to have difficulty responding when called from across the room
Does not make sounds in response to others after 12 months
Turns body so that the same ear is always turned toward the sound
Has difficulty understanding simple sentences after 3 years of age
Fails to develop sounds or words that would be appropriate at his/her age
Dribbles excessively
Cannot chew or choke on food or drink.
Little variation in tone, intonation, pitch, or rhythm of speech

Gross Motor Development

Has a floppy or limp body posture compared to other children of the same age
Has stiffness in arms and or legs
Reduced movements of arms or legs
Uses one side of the body in preference to the other, especially under 18 months
Is very clumsy or poorly coordinated when compared with peers of the same age
Difficulties in keeping balance while sitting, walking, playing or frequent falling

Fine Motor & Vision Development

Turns tilts or holds head in an unusual position when trying to look at or follow an object
Seems to have difficulty finding or picking up small objects dropped on the floor
Lacks pincer grasp even after 10-12 months of age
Has tremor in limbs
Rubs eyes frequently
Eyes appear to be crossed or turned in or out
Closes one eye when trying to look at distant objects
Brings objects too close to eyes to see
One or both eyes appear abnormal in size
Difficulty in manipulating small objects after 3 years of age

ASD specific red flags

Lack of response to their name by 12-15 months
Lack of pointing to indicate interest by 12-15 months, instead leads adults by hand
Preference to play alone or be alone
Lack of pretend play, e.g. feeding the dolly, by 18-24 months
Uncomfortable with eye contact and hence active avoidance of eye contact
Recurrent meltdowns or tantrums
Difficulty in understanding other’s feelings or thoughts
Inappropriate response to social situations
Insistence on routine or distress with a change in routine
Intense interests or obsessions with a particular toy, object, a game, or a topic
Motor mannerisms, e.g. rocking back and forth, tip toe walking, hand flapping, spinning
Intense like or intense distress with certain sensations of sound, light, texture, taste, or smell
Echoing words or phrases heard, repeatedly
Giving inappropriate or unconnected answers to questions
Lack of back-and-forth conversation or conversations only related to their interests

As they say, a stitch in time saves nine. This cannot be truer when it comes to children’s development. Early identification is crucial in optimising outcome. Moreover, timely neurodevelopmental assessments can prevent the emergence of secondary problems such as anxiety, low self-esteem, low mood, school refusal, disengagement in learning, a feeling of helplessness, despair, self-harm and even being excluded from school.

Early identification of the child’s difficulties can help receive appropriate educational interventions, family support, medical treatment of associated conditions such as sleep, attention, and anxiety. Finally, it prevents the child and family receiving distressing social labels.