Developmental Delays: The Signs, Tests, And Diagnosis

As a parent, it is natural to ask questions and be concerned regarding your child’s development. The possibility that she may have a developmental delay can be scary and confusing for even the most experienced parent.

Understanding the screening and diagnostic process can make a frightening situation more manageable. Below are the different steps you can expect if you are concerned that your child’s development is delayed.


Young children will visit the pediatrician’s office about nine times before the age of two; by age five, they will have had about 15 well-child visits. It is during this time that many parents express concerns regarding growth and development.

Questions such as, “My older child walked much earlier, is there something wrong with my baby?” or, “The other toddlers in my child’s class are talking a lot more than my child, should I be concerned?” are ones that can be answered with screening tools. Among the most common screening tools are the Ages and Stages Questionnaires, a collection of questions about your child’s behavior that should take 10–15 minutes to fill out and that a doctor analyzes. Other screenings may include the Early Screening Inventory-Revised and the Battelle Developmental Inventory Screening Test.

No matter the type of screening used, all are simply meant to identify children who need a more detailed evaluation or referral. Screenings serve only to answer the question “Is my child’s development on target right now?” They answer that question in one of three ways: Development is currently on track; there is a concern and further assessment is needed, or the results are unclear and child should be rescreened in X-amount of time (usually three months).

Instructional Assessments

Many children attending child care or preschool programs are assessed at regular intervals. Assessments are used by educators to support growth, learning, and development of young children. The child-care or preschool-based process is more involved than the pediatric screening process and requires observations, anecdotal notes, work samples, developmental checklists, and other documentation. Assessments are ongoing and, in early childhood, address the following developmental areas: physical and motor, social/emotional, approaches to learning, language and communication, cognitive, and general knowledge.

Instructional assessments are used to help educators plan their curricula and develop individual goals for children’s learning. The information gained is usually shared with families in the form of a portfolio during parent-teacher conferences.

Diagnostic Assessment

If screening tools or an instructional assessment indicates an area of concern, a child may need to undergo diagnostic assessments. The purpose of these evaluations is to identify and plan for appropriate intervention services for a child who has a developmental delay.

Diagnostic testing is more comprehensive and is performed by a variety of professionals according to the area or areas of concern. Diagnostic assessments help determine eligibility for programs such as infant/toddler early intervention, preschool special education, and mental health services.

The Process: Children Under Three

If there is a concern that your child has a developmental delay, and screening tools show that further assessment is warranted, parents or professionals will refer the child to the appropriate agency for further assessments. If your child is under the age of three, the testing and intervention is funded under the Individuals with Disabilities Education Act and handled by local agencies called regional centers.

The evaluation will either take place in an office or at your home, and will be conducted by a professional, known as an intake coordinator, who will gather information like prenatal and birth history. The purpose of this assessment is to collect data and determine what your primary concerns are, which the coordinator will then use to decide which diagnostic tests should be administered. This testing will then be conducted by specialists in fields such as speech or motor development.

Families who pursue early intervention are actively involved in the process, and the goals developed — called an Individualized Family Service Plan (IFSP) — are then centered around the family. If therapy is recommended for children under 3 years old, parents will likely be part of the process.

The Process: Children Over Three

After age 3, in most states, testing and interventions are performed by the local school district. The district will provide several diagnostic assessments administered by professionals including speech, occupational, and physical therapists, as well as an overall development assessment conducted by a school psychologist. Once all assessments are complete, school officials, therapists, and the family will meet to determine school placement and other intervention needs. Goals are recommended by each therapist and are reviewed annually, a process called the Individual Education Plan (IEP).

Final Notes

The screening and evaluation process for developmental delays can seem overwhelming at times; you will be given a lot of information, some of which may be confusing or difficult to take in. It is important to remember that a diagnosis is simply that — a label or an access to services. It does not define who your child is, or limit him or her in any way. As a parent, your voice counts. You will always know your child best.

Early childhood is a complex and dynamic time of development, and all development occurs along a continuum. The more information you share about your concerns for your child, the more effective the assessment process will be.