NR 602 Week 4 Development Write-Up Example

Development Write-Up: A.B., 18 Months Old, Born at 32 Weeks, Assessed at a Corrected Age of 16 Months Across Four Domains, With Lost Words Read Differently

Student Name

College of Nursing, Chamberlain University

NR 602: Primary Care of the Childbearing and Childrearing Family Practicum

Instructor Name

Month Day, Year

Development Write-Up: A.B., 18 Months Old, Born at 32 Weeks, Assessed at a Corrected Age of 16 Months Across Four Domains, With Lost Words Read Differently

Corrected Age First

A.B. was born at 32 weeks, 8 weeks early. Chronological age today is 18 months. Corrected age, which subtracts the weeks of prematurity, is 16 months. Development is judged against the corrected age until 24 months chronological, because a child born 8 weeks early has had 8 fewer weeks of development since conception (Lipkin et al., 2020). Judging A.B. against 18-month milestones would label normal progress as delay.

Four Domains, Kept Apart

Gross motor. Walks independently across the room, observed. Squats to pick up a toy and stands again, observed. Climbs onto a low chair, reported by the parent.

Judgment for 16 months corrected: on track.

Fine motor. Stacks two blocks, observed. Picks up a raisin with thumb and finger, observed. Scribbles with a crayon, reported.

Judgment: on track.

Language. Says "mama," observed once during the visit. Understands "where is the ball?" and looks at it, observed. The parent reports that A.B. said "ball," "up" and "dog" at 13 to 14 months and no longer says them. No pointing to show the parent something of interest was seen during the visit; the parent says A.B. points to ask for things but "not really to show me stuff."

Judgment: behind for 16 months corrected, and with a loss of words.

Social and emotional. Smiles at the parent, observed. Plays peekaboo when the parent starts it, reported. Response to name: called by name three times during the visit, turned on the third, observed. Brings toys to show the parent: "not usually," reported.

Judgment: some concern, particularly response to name and showing.

Observed or Reported

Each skill above is labeled. Reported skills are not discounted, but they carry less weight than skills seen, and a skill the parent reports and that I could not observe is recorded as reported, not as present.

Lost Skills Read Differently

A child who is slow to gain words is a different concern from a child who had words and has lost them. Loss of language or social skills at any age is a red flag that calls for prompt evaluation, both for hearing loss and for autism spectrum disorder (Zwaigenbaum et al., 2015). The parent did not raise the lost words as a worry; I asked directly, "Are there any words A.B. used to say and doesn't say now?" and the parent listed three.

Screening

Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), completed by the parent at the visit: score 5, in the medium-risk range. The follow-up interview, done in clinic, confirmed failures on pointing to show interest, response to name and bringing objects to show. The tool's validation study found that children screening positive after the follow-up interview frequently received a diagnosis of autism or another developmental condition (Robins et al., 2014).

Ages and Stages Questionnaire, at corrected age: gross motor and fine motor above the cutoff; communication and personal-social below.

Assessment

Language delay with regression of words, and social communication concerns, at a corrected age of 16 months, with a positive autism screen after follow-up. Motor development on track for corrected age.

Actions With Dates

Today: referral to the state early intervention program, which assesses children under 3 at no cost to the family. The early intervention coordinator was called during the visit; the intake call is scheduled for 3 days from now.

Within 2 weeks: formal audiology assessment, booked before the family left, because hearing loss can cause both language delay and poor response to name.

Within 4 weeks: referral to developmental pediatrics for diagnostic evaluation. The waiting list is about 4 months; early intervention services can begin before a diagnosis.

4 weeks from today: follow-up visit with the parent to review the audiology result and the early intervention assessment.

What Was Said to the Parent

I told the parent that A.B. is moving and using hands well for age, that the lost words and some social skills need a closer look and that the earlier help starts, the better. I said that a screen is not a diagnosis. The parent asked whether being born early explained it. I said that prematurity raises the chance of developmental differences, which is one reason to look closely, but that using corrected age had already accounted for being born early.

Why Corrected Age Did Not Explain the Findings

Using corrected age moves every milestone expectation 2 months earlier, which explains why A.B. walks later than an 18-month-old born at term might. It does not explain losing words, which is not a feature of prematurity. Nor does it explain the social findings: a 16-month-old usually points to show interest and turns to a familiar voice saying their name. Correction answers the motor question and leaves the language and social questions standing.

What the Screens Can and Cannot Say

The M-CHAT-R/F is a screen for autism risk, not a diagnosis, and a positive result after the follow-up interview means the child needs a diagnostic evaluation. The Ages and Stages Questionnaire shows where development sits against age norms in each domain. Together they confirm what was observed: a child developing in movement and hand skills and behind in language and social communication. Neither can say why.

Why Act Before a Diagnosis

A diagnosis may take months, given the waiting list for developmental pediatrics. Early intervention services in the United States do not require a diagnosis; a documented delay is enough. The American Academy of Pediatrics recommends referral to early intervention as soon as a delay is identified, at the same time as any diagnostic referral (Lipkin et al., 2020). Waiting for a diagnosis before starting help would waste the months when therapy may matter most.

What the Parent Will Do Meanwhile

The parent was given three things to try at home before the early intervention visit: naming objects A.B. looks at, waiting a few seconds for A.B. to respond before helping, and reading picture books together for ten minutes a day. The parent was asked to write down any new words or any further words lost.

Limits

A single visit, with a tired child at the end of the morning. The parent's report of lost words is the most important finding and was not seen directly.

References

Lipkin, P. H., Macias, M. M., Council on Children with Disabilities, & Section on Developmental and Behavioral Pediatrics. (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), e20193449. https://doi.org/10.1542/peds.2019-3449

Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37-45. https://doi.org/10.1542/peds.2013-1813

Zwaigenbaum, L., Bauman, M. L., Fein, D., Pierce, K., Buie, T., Davis, P. A., Newschaffer, C., Robins, D. L., Wetherby, A., Choueiri, R., Kasari, C., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., McPartland, J. C., Natowicz, M. R., Carter, A., Granpeesheh, D., ... Wagner, S. (2015). Early identification of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136(Suppl. 1), S10-S40. https://doi.org/10.1542/peds.2014-3667C