New CDC guidelines for speech development - lowering standards

If you’re a Speech Therapist or Early Interventionist in the U.S., you’ve likely heard the buzz about the CDC’s recent updates to their milestone checklists for speech and language development.

How is the SLP community reacting to the updates? Well. Many professionals aren’t happy about them.

What are the specifics surrounding the updates to the CDC guidelines for developmental milestones? And what implications does this have for the world of Speech Language Pathologists?

Before we dive into the answers to those questions, let’s talk about why CDC guidelines are so important for therapists and educators.

Importance of CDC guidelines for therapists

The CDC (Centers for Disease Control and Prevention) provides an abundance of guides and checklists that cover several areas of a child’s development in their “Learn the Signs. Act Early” initiative.

These guidelines are intended to help parents and professionals track a child’s developmental milestones. The guides help them compare a child’s current skills to those skills that are typically expected at certain ages.

Caregivers can follow along with checklists, and even download a Milestone Tracker app through the CDC. It’s a way for them to keep tabs on everything from when their child should start crawling to when they are expected to say their first word.

Pediatricians often follow CDC guidelines when deciding whether referring the child to an evaluation with a specialist might be necessary.

Many parents and Pediatricians decide to seek services from a Speech, Occupational, or Physical Therapist for a child when he or she is not meeting milestones at ages outlined by the CDC.

Another purpose of CDC guidelines is to improve early identification of developmental delays.

According to the U.S. Department of Education which lists CDC developmental screening goals, “With regular screenings, families, teachers, and other professionals can assure that young children get the services and support they need as early as possible to help them thrive”.

Pediatric therapists can all agree how important early identification is.

When parents and professionals identify motor or language delays early, that can lead to early intervention. And that can result in improved outcomes for the child.

Even once a child is enrolled in Speech Therapy, CDC guidelines continue to have an important role in treatment. These milestones can help guide a therapist’s treatment plan and assist the SLP and parent in determining when continued therapy is indicated.

If a child appears to have reached milestones as outlined by the CDC, it may appear to some parents that their child has reached an age-appropriate level with speech and language skills and no longer requires Speech Therapy. 

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Why the CDC updated milestones

On February 8th, 2022, the CDC updated the developmental milestones for their “Learn the Signs. Act Early” initiative, and published them in the American Academy of Pediatrics. Many milestones for Speech and Language development were lowered, and checklists for ages 15 months and 30 months were added.

The milestones had not been updated since the regulations were first released in 2004 - almost 2 decades ago.

There has been some speculation that the CDC lowered milestones due to an increase in speech and language delays due to mask mandates and social distancing during the Coronavirus Pandemic.

However, some medical experts report that the changes were designed to discourage the “wait and see” attitude of some pediatricians with regards to when to refer a child for therapy services. They report that the new guidelines encourage early identification of developmental delays, and provide parents with clearer expectations. 

The previous milestones were based on the ages that 50% of children reach a specific developmental milestone. The milestones therefore showed the ages at which the average child achieves a certain skill.

The new markers appear lower because they now reflect the ages that 75% of children are expected to achieve a certain skill. This indicates the age that most children reach that milestone. The CDC hopes that this change will encourage parents and professionals to seek services more immediately if a child is not meeting these benchmarks.

Changes were also made to the guidelines with the intent to help increase early identification of Autism. This includes the addition of social-emotional markers such as smiling to get attention, which was added to the 4 month-old checklist.

Implications for Speech-Language Pathologists

So why are so many professionals in the SLP community up in arms about the updated CDC guidelines for speech development?

An overall concern is that the new milestones could result in fewer children receiving early intervention. That is because the ages listed for achieving certain speech and language milestones are now older than they were in the previous guidelines. 

For example, the previous CDC milestones stated a child should have a vocabulary of 50 words at 24 months. The new guidelines state that children should have a vocabulary of 50 words at 30 months.

This could mean delayed referrals for children who could benefit from Speech Therapy.

The American Academy of Pediatrics (AAP), which published the new milestones, reports that the new CDC guidelines do include changes intended to make the guidelines more clear to parents.

For example, vague language such as “may” or “begins” for certain milestones was removed, and so were duplicate milestones.

These changes, along with the addition of social and emotional milestones, could potentially increase early identification of markers for diagnoses such as Autism. That could lead to more immediate referrals for Speech and Language services at younger ages. 

Reactions to the new guidelines

The updated CDC milestones for developmental skills have been scrutinized by the media and SLP community since they were released last month.

In the media there have been many reports that the CDC “lowered the bar” to account for changes brought on by Covid-19, like mask mandates.

The American Speech-Language Hearing Association (ASHA) has issued a statement that the organization is in the process of analyzing the revisions and their potential effects. No Speech-Language Pathologists were involved in the development of the updated milestones issued by the CDC. ASHA has reached out to the CDC regarding the association’s concern with this, and urging the CDC to use SLPs’ expertise.

Another reason the CDC is receiving backlash from ASHA and the SLP community? Even accounting for the fact that the new milestones are listed for a different percentile range, they still don’t consistently line up to those reported by ASHA.

Both ASHA and SLPs are concerned that the discrepancies in milestones listed by some research studies and ASHA with those reported in the new CDC guidelines could mean more insurance denials and less children receiving the services they need.

Where do SLPs go from here?

What’s the expectation for Speech-Language Pathologists moving forward? How do SLPs react to parents’ questions about the CDC’s newly updated milestones?

SLPs should continue to use their clinical expertise and knowledge, along with standardized screening procedures and assessments, when diagnosing speech and language delays in children.

When speaking with parents and other professionals and pediatricians, SLPs should encourage them to look at various factors when considering when to refer a child for services. That includes any associated medical diagnoses, parent concerns, and the impact of speech and language difficulties on the child.

Similarly, when deciding whether continued Speech Therapy is indicated for a specific child, it is recommended that SLPs account for several areas of information, not solely referring to CDC milestones.

Therapists can refer to current research and information provided by ASHA to support their clinical opinion regarding the need for services for a certain child. Documentation such as treatment notes and evaluation reports can reflect this.