Is Your Toddler Communicating With You?

General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

Discuss your child's treatment program with appropriate school personnel.
Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.
Schools may be willing to fax completed follow-up rating scales to your doctor's office.
Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.
Ask your child how he or she feels on the medication.
Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

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Your baby is able to communicate with you long before he or she speaks a single word!

A baby’s cry, smile, and responses to you help you to understand his or her needs. In this publication the American Academy of Pediatrics shares information about how children communicate and what to do when there are concerns about delays in development.

Milestones During the First 2 Years

Children develop at different rates, but they usually are able to do certain things at certain ages. Here are general developmental milestones. Keep in mind that they are only guidelines. If you have any questions about your baby’s development, ask your child’s doctor—the sooner the better. Even when there are delays, early intervention can make a significant difference.

By 1 Year Most Babies Will

Look for and be able to find where a sound is coming from.
Respond to their name most of the time when you call it.
Wave goodbye.
Look where you point when you say, “Look at the _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\__.”
Babble with intonation (voice rises and falls as if they are speaking in sentences).
Take turns “talking” with you—listen and pay attention to you when you speak and then resume babbling when you stop.
Say “da-da” to dad and “ma-ma” to mom.
Say at least 1 word.
Point to items they want that are out of reach or make sounds while pointing.

Between 1 and 2 Years Most Toddlers Will

Follow simple commands, first when the adult speaks and gestures, and then later with words alone.
Get objects from another room when asked.
Point to a few body parts when asked.
Point to interesting objects or events to get you to look at them too.
Bring things to you to show you.
Point to objects so you will name them.
Name a few common objects and pictures when asked.
Enjoy pretending (for example, pretend cooking). They will use gestures and words with you or with a favorite stuffed animal or doll.
Learn about 1 new word per week between 1 1/2 and 2 years.

By 2 Years of Age Most Toddlers Will

Point to many body parts and common objects.
Point to some pictures in books.
Follow 1-step commands without a gesture like “Put your cup on the table.”
Be able to say about 50 to 100 words.
Say several 2-word phrases like “Daddy go,” “Doll mine,” and “All gone.”
Perhaps say a few 3-word sentences like “I want juice” or “You go bye-bye.”
Be understood by others (or by adults) about half of the time.

When Milestones Are Delayed

If your child’s development seems delayed or shows any of the behaviors in the following list, tell your child’s doctor. Sometimes language delays occur along with these behaviors. Also, tell your child’s doctor if your baby stops talking or doing things that he or she used to do.

Doesn’t cuddle like other babies
Doesn’t return a happy smile back to you
Doesn’t seem to notice if you are in the room
Doesn’t seem to notice certain noises (for example, seems to hear a car horn or a cat’s meow but not when you call his or her name)
Acts as if he or she is in his or her own world
Prefers to play alone; seems to “tune others out”
Doesn’t seem interested in or play with toys but likes to play with objects in the house
Has intense interest in objects young children are not usually interested in (for example, would rather carry around a flashlight or ballpoint pen than a stuffed animal or favorite blanket)
Can say the ABCs, numbers, or words to TV jingles but can’t use words to ask for things he or she wants
Doesn’t seem to be afraid of anything
Doesn’t seem to feel pain in a typical fashion
Uses words or phrases that are unusual for the situation or repeats scripts from TV

Delays in Language

Delays in language are the most common types of developmental delay. One out of 5 children will learn to talk or use words later than other children their age. Some children will also show behavioral problems because they are frustrated when they can’t express what they need or want.

Simple speech delays are sometimes temporary. They may resolve on their own or with a little extra help from family. It’s important to encourage your child to “talk” to you with gestures or sounds and for you to spend lots of time playing with, reading to, and talking with your infant or toddler. In some cases, your child will need more help from a trained professional, a speech and language therapist, to learn to communicate.

Sometimes delays may be a warning sign of a more serious problem that could include hearing loss, developmental delay in other areas, or even autism spectrum disorder (ASD). Language delays in early childhood also could be a sign of a learning problem that may not be diagnosed until the school years. It’s important to have your child evaluated if you are concerned about your child’s language development.

What Your Child’s Doctor Might Do

Sometimes more information is needed about your child before your child’s doctor can address your concerns. The doctor may

Ask you some questions or ask you to fill out a questionnaire.
Interact with your child in various ways to learn more about his or her development.
Order a hearing test and refer you to a speech and language therapist for testing. The therapist will evaluate your child’s speech ( expressive language ) and ability to understand speech and gestures ( receptive language ).
Refer your child for evaluation through an early intervention program.

What to Expect After the Doctor’s Visit

If your child’s doctor tells you not to worry (that your child will “catch up in time”) but you are still concerned, it’s OK to get a second opinion. You can ask your child’s doctor for a referral to a developmental specialist or a speech and language therapist. You may also contact an early intervention program for an evaluation if your child is younger than 3 years, or your local school district if he or she is 3 or older.

If what your child says (expressive language) is the only delay, you may be given suggestions to help your child at home. Formal speech therapy may also be recommended.

If both what your child understands (receptive language) and what he or she says are delayed and a hearing test is normal, your child will need further evaluation. This will determine whether the delays are caused by a true communication disorder, generalized developmental delays, ASD, or another developmental problem.

When ASD is the reason for language delays, your child will also have difficulty interacting with other people and may show some or all of the concerning behaviors listed previously. If there is concern your child might have ASD, your child will usually be referred to a specialist or a team of specialists for evaluation and treatment of ASD or a related disorder. The specialist(s) may then recommend speech therapy and may suggest other ways to improve social skills, behavior, and the desire to communicate.

Programs That Help Children and Families

If your child has delays or suspected delays, your child’s doctor will probably refer you to an early intervention program in your area. The staff there might do additional evaluations and reassure you that your child’s development is normal or tell you that your child would benefit from some type of intervention. Your child does not need to have a diagnosis of a developmental problem to receive services through this program.

If your child is younger than 3 years, the referral may be to an early intervention program in your area. Early intervention programs are sometimes called “Part C” or “Birth to Three” programs. Early intervention is a federal- and state-funded program that helps children and their families. You may also contact the early intervention program yourself (see Resources to find a contact in your state).

If your child qualifies for services, a team of specialists will work with you to develop an Individual Family Service Plan (IFSP). This plan becomes a guide for the services your child will receive until 3 years of age. It may include parent training and support, direct therapy, and special equipment. Other services may be offered if they benefit your child and family. If your child needs help after 3 years of age, the early intervention staff will transition your child to services through your local school district.

If your child is 3 years or older, the referral may be to your local public school. You may also contact the local public school directly. If your child is eligible, the school district staff will, with your input, develop an Individual Education Plan (IEP) . This plan may provide some of the same services as the early intervention program but focus on school services for your child. The level of services also may be different. If your child continues to need special education and services, the IEP will be reviewed and revised from time to time.

Resources

American Academy of Pediatrics

www.HealthyChildren.org

www.AAP.org

Early Childhood Technical Assistance Center (ECTA Center)

http://ectacenter.org

(to find an early intervention program in your state)

Family Voices

www.familyvoices.org

Learn the Signs. Act Early.

www.cdc.gov/actearly

National Center for Medical Home Implementation

https://medicalhomeinfo.aap.org/tools-resources/Pages/For-Families.aspx

Remember

As a parent, follow your instincts. If you continue to have concerns about your child’s development, ask for a reevaluation or referral for additional formal testing.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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