DSM CHAPTER 12 DEVELOPMENTAL MILESTONES • Milestones are recognizable skills or abilities that have an expected range and order of appearance, such as a child taking his first step around the time of his first birthday. Identifying any significant variations from expected patterns, such as a child taking that first step near his second birthday, is a key task for any practitioner. Knowing when a significant variation in development has occurred improves diagnostic accuracy because DSM-5 specifically requires consideration of developmental stages • Five different milestone skill areas should be evaluated: gross/fine motor, visual motor problem solving, speech and language, social/emotional, and adaptive skills • Gross motor skills are the most obvious to recognize because they involve crawling, walking, running, and throwing • Visual motor problem solving describes a child’s physical interactions with the world. Fine motor skills (using one’s hands and fingers) rely on visual input and generally progress at a slower pace than gross motor skills. If the development of these milestones is delayed, it may be because of impairments in cognitive, sensory, or motor abilities. • To be able to communicate, a person first must be able to receive input (process what is seen and heard), understand the meaning of that input, then generate an expression of his thoughts (translate thoughts into words, then express fluently). Delays in expressive language milestones may be more apparent than receptive language delays, which may be more subtle but when present may worsen an expressive language impairment • Social/emotional skills are the core elements of psychiatric functioning. Social skill development is interactive and thus reliant on the presence of a responsive caregiver. A child’s temperamental traits influence how he responds to routine activities, which influences how his caregivers respond. Developing shared joint attention with another person by approximately age 1 year is a key social milestone. Normal social and emotional development is most closely linked with speech and language skills. • When you evaluate for the presence of an intellectual disability, adaptive milestones need to be investigated. Standardized intelligence testing is no longer considered the sole basis for diagnosing intellectual disability. Adaptive skills include infants learning to feed themselves or dress themselves. For older kids, it involves self-protection and self-direction.