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Backstory: My name is Brandi and my partners name is Brenden. I was raised by my biological family while he was adopted 2 weeks after birth. He has no contact with his biological family nor does he know where to even find them. We are trying to start a family but there are a few things that concern me about the life our child may have without the knowledge of his genetic background. This is a picture of us. 

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Backstory: My name is Brandi and my partners name is Brenden. I was raised by my biological family while he was adopted 2 weeks after birth. He has no contact with his biological family nor does he know where to even find them. We are trying to start a family but there are a few things that concern me about the life our child may have without the knowledge of his genetic background. This is a picture of us. 

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My first concern with hereditary diseases is Alzheimer's disease. My family is carriers of the brain disease so not knowing if my husband also carries that is very worrisome to me. The photo linked below on the left is the healthy brain, and on the right is the brain of someone who suffers with Alzheimer's. Also below is an article linked that explains how a persons background and ancestors can affect their chances of developing Alzheimer's. At some point before we have our first child we will get him tested to see if he carries it. 

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My first concern with hereditary diseases is Alzheimer's disease. My family is carriers of the brain disease so not knowing if my husband also carries that is very worrisome to me. The photo linked below on the left is the healthy brain, and on the right is the brain of someone who suffers with Alzheimer's. Also below is an article linked that explains how a persons background and ancestors can affect their chances of developing Alzheimer's. At some point before we have our first child we will get him tested to see if he carries it. 

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The difference in APOE expression between African and European local ancestry carriers. University of Miami Leonard M. Miller School of Medicine

Genetics contributes to the risk of developing Alzheimer's disease, and the APOE gene is the strongest genetic risk factor, specifically the APOE4 allele. However, it has been known for a while that the risk due to the APOE4 allele differs considerably across populations, with Europeans having a greater risk from the APOE4 allele than Africans and African Americans.

"If you inherited your APOE4 allele from your African ancestor, you have a lower risk for Alzheimer disease than if you inherited your APOE4 allele from your European ancestor," said Jeffery M. Vance, M.D., Ph.D., professor and founding chair of the Dr. John T. Macdonald Foundation Department of Human Genetics, professor of neurology, and director of the Center for Genomic Medicine at the John P. Hussman Institute for Human Genomics (HIHG).

Dr. Vance and his colleagues-co-senior author Juan Young, Ph.D., an associate professor in the Department of Human Genetics and HIHG, and lead authors Anthony J. Griswold, Ph.D., research assistant professor of human genetics and associate director of the Center for Genome Technology, and Katrina Celis, M.D., postdoctoral fellow-have led a new Miller School genetics study following up on this observation. They have found that among individuals with the same high-risk APOE4 allele, those with European local ancestry in the APOE region have a significantly higher expression of APOE in specific cell types in their brains than those with African ancestry, suggesting this contributes to the difference in risk.

The article, "Increased APOE4 Expression is Associated with the Difference in Alzheimer Disease Risk from Diverse Ancestral Backgrounds," was published February 1 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

The Miller School study involved RNA sequencing of more than 60,000 individual cell nuclei taken from the brain tissues of Alzheimer's patients carrying the APOE4 with African or European local ancestry.

"The brain is an organ made up of many different cell types. To properly understand the effects of changes in gene expression you should look at each cell independently, rather than as a mixture," Dr. Griswold said. "In this study we used single cell processing and sequencing to look at brains of African and European APOE4 carriers at a higher resolution than had been done previously."

Dr. Griswold noted that the APOE gene was expressed significantly higher in the brains of the people with European ancestry. In addition, European ancestry individuals had high numbers of a cell type resembling reactive astrocytes, brain cells that are formed under stress and are toxic to neurons. "This suggests a possible linkage of APOE4 with inflammation response, which is another risk factor for AD," he said, adding that those astrocytes were not observed in any of the African ancestry individuals.

"The data from our study suggests that finding a way to block the increased expression of the APOE4 allele could have potential therapeutic benefits," said Dr. Vance. "It also supports the importance of knowing the ancestral origin of the APOE4 allele when predicting the risk of AD for any individual carrying the APOE4 allele."

More information: Anthony J. Griswold et al. Increased APOE ε4 expression is associated with the difference in Alzheimer's disease risk from diverse ancestral backgrounds, Alzheimer's & Dementia (2021). DOI: 10.1002/alz.12287

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Genetics study finds ancestral background can affect Alzheimer's disease risk

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Genetics contributes to the risk of developing Alzheimer's disease, and the APOE gene is the strongest genetic risk factor, specifically the APOE4 allele. However, it has been known for a while that the risk due to the APOE4 allele differs considerably across populations, with Europeans having a greater risk from the APOE4 allele than Africans and African Americans.

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My second concern is genetic high blood pressure. Most times while getting a routine check up my husbands blood pressure is through the roof. He claims it is because of nervousness from going to the doctor but it worries me because what if it is genetic and we just don't know that. He isn't obese or unhealthy so it concerns me because it is normally very high. Below I linked an article about genes that can cause high blood pressure and how doctors are helping their patients. 

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My second concern is genetic high blood pressure. Most times while getting a routine check up my husbands blood pressure is through the roof. He claims it is because of nervousness from going to the doctor but it worries me because what if it is genetic and we just don't know that. He isn't obese or unhealthy so it concerns me because it is normally very high. Below I linked an article about genes that can cause high blood pressure and how doctors are helping their patients. 

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Scientists have found 107 new genes linked to high blood pressure, potentially enabling doctors to identify at-risk patients and target treatments.

The study, led by Imperial College London and Queen Mary University of London (QMUL), suggests that by using genetic testing, doctors could target medication to certain high blood pressure (hypertension) patients and advise on appropriate lifestyle changes to reduce the risk of heart disease and stroke. The findings are published in Nature Genetics.

Hypertension affects around one in three adults in the UK (15 million), and is a leading risk factor for heart disease, stroke and death worldwide. It is caused by a complex interplay between genetics and lifestyle factors such as diet, weight, alcohol consumption, and exercise.

The researchers tested 9.8 million genetic variants from 420,000 UK Biobank participants and cross-referenced these with their blood pressure data. Of the 107 new gene regions, many were expressed in high levels in blood vessels and cardiovascular tissue, and could be potential new drug targets for hypertension treatments.

The team also developed a genetic 'risk score' by linking health and hospital data from UK Biobank participants with their blood pressure genetics, and showed that the score could be used to predict increased risk of stroke and coronary heart disease.

The higher a patient's risk score, the more likely they were to have high blood pressure by the age of 50. Those on the top end of the risk scale were likely to have 10mmHg higher blood pressure than patients with lower risk scores. For every 10mmHg a person's blood pressure is above normal, the risk of heart disease and stroke is increased by around 50% or more.

If such a genetic risk score could be measured in early life, it might be possible to take a 'personalised medicine' approach to offset a person's high risk of stroke and heart disease. This could involve lifestyle interventions such as changing sodium and potassium intake, weight management, reducing alcohol consumption and increasing exercise.

Professor Paul Elliott, co-lead author of the study and Chair in Epidemiology and Public Health Medicine at Imperial's School of Public Health, said: "Ultimately, blood pressure in the general UK population is too high, and we encourage everyone to maintain healthy lifestyles by eating properly and exercising enough, as this will reduce the risk of all sorts of diseases. However, our new findings may help doctors to identify earlier those who are most at risk of high blood pressure in mid-life and intervene to prevent that occurring."

Forward thinking

Professor Mark Caulfield, co-lead author from QMUL, said: "Finding 107 new genetic regions linked to blood pressure almost doubles the amount of genes we can evaluate to target for drug treatment. These exciting genetic regions could provide the basis for new innovative preventative therapies and lifestyle changes for this major cause of heart disease and stroke."

Genetic testing to provide risk scores is not available widely for any of the common diseases so far, but it could one day become routine. Professor Elliott added: "We cannot help our genetic makeup, but we can help our lifestyles and, in the future, we may be able to alter our lifestyles while knowing whether we are at a genetic advantage or disadvantage. Doctors might eventually be able to determine a child's genetic risk of diseases such as high blood pressure, diabetes, and maybe even cancer, so that they can live well enough to try to counteract the genetic input."

First author Dr Helen Warren from QMUL said: "This analysis highlights the benefits of using very large studies, such as UK Biobank, with high quality data where all participants have had measurements done in exactly the same way, to enable the discovery of many new genetic signals associated with raised blood pressure."

For 10 years, UK Biobank has gathered a wealth of high quality information from hundreds of thousands of people across the country. Participants have donated blood, urine and saliva samples, provided detailed health, lifestyle and environment information, and agreed to allow the Biobank to follow their GP and hospital records throughout life.

The study was funded by the National Institute for Health Research.

" Genome-wide association analysis identifies novel blood pressure loci and offers biological insights into cardiovascular risk: The UK Biobank Cardio-metabolic Traits Consortium Blood Pressure Working Group.", published 30th January 2017 in Nature Genetics.
See the press release of this article

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Over 100 new blood pressure genes may provide targets for treating hypertension | Imperial News | Imperial College London

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Scientists have found 107 new genes linked to high blood pressure, potentially enabling doctors to identify at-risk patients and target treatments. The study, led by Imperial College London and Queen Mary University of London (QMUL), suggests that by using genetic testing, doctors could target medication to certain high blood pressure (hypertension) patients and advise on appropriate lifestyle changes to reduce the risk of heart disease and stroke.

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My last big concern is cancer. We have had a few scares with finding some lumps on him that were tested and turned out to be nothing and were not to be worried about but what if it leads to something more and our baby could develop some types of cancers. I would feel more at ease to have some tests done on not only him but me as well to see if we are carriers for some cancer genes. 

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My last big concern is cancer. We have had a few scares with finding some lumps on him that were tested and turned out to be nothing and were not to be worried about but what if it leads to something more and our baby could develop some types of cancers. I would feel more at ease to have some tests done on not only him but me as well to see if we are carriers for some cancer genes. 

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Our decision: We have both decided to take DNA testing to give a glimpse of what our DNA might have in it. You can order them online and send in your DNA and they can send you back what they find out. No matter what we will love our baby and do whatever we can for him/her. We know we cannot prevent or know every little thing that  could go wrong with bringing in a child so finding out the basics is a good start. Here are some examples of what we used. 

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Our decision: We have both decided to take DNA testing to give a glimpse of what our DNA might have in it. You can order them online and send in your DNA and they can send you back what they find out. No matter what we will love our baby and do whatever we can for him/her. We know we cannot prevent or know every little thing that  could go wrong with bringing in a child so finding out the basics is a good start. Here are some examples of what we used. 

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So for our birthing plan there was a couple of options we had to choose from and they were, using a doula at home before going to a hospital, water birth at home with a midwife, a natural birth in the hospital, and a C-section. In this post I will share which one I chose and the reasons why I chose it, and also why I decided against the others.  

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So for our birthing plan there was a couple of options we had to choose from and they were, using a doula at home before going to a hospital, water birth at home with a midwife, a natural birth in the hospital, and a C-section. In this post I will share which one I chose and the reasons why I chose it, and also why I decided against the others.  

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Using a doula at home before going to the hospital: This was a close one with the one I was going to choose but I decided against it because my husband was not fond of the idea of someone being the big supporter of me before the hospital birth. Also if something went wrong before the doulas aren't as trained as doctors or nurses that could help. 

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Using a doula at home before going to the hospital: This was a close one with the one I was going to choose but I decided against it because my husband was not fond of the idea of someone being the big supporter of me before the hospital birth. Also if something went wrong before the doulas aren't as trained as doctors or nurses that could help. 

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Doulas can help you if you have your heart set on a "natural birth" (without an epidural). Doulas are a good option to advocate for you (especially if you have a hard time fighting for yourself) and helping you feel supported. Should you hire a doula? Using a doula has many pros and cons. We're going to talk the advantages and disadvantages of hiring a doula and if you really need one, or if they will be a waste of money.

In fact, I thought this was so important, I brought in one of my favorite doula friends on a recent podcast to talk about what a doula can do for you!

What is a Doula?

A doula is someone you hire to supoport you through labor - a labor coach. Sometimes they teach prenatal classes or meet with you during your pregnancy to give you tips and tricks, there are even postpartum doulas to help you transition to your new life.

Their services vary pretty widely. There is an organization for them called DONA (there is more than that one, but it's the one I've been most familiar with), where you can certify. Many of them help you match internships with experienced doulas.

Doulas can be certified, but many aren't. It isn't regulated like an RN - which is a license vs a certificate. In fact, in my podcast I learned that some doulas would prefer not to certify (especially if they also work in a birth center).

It can be confusing to navigate the world of hiring a doula.

As a labor nurse since 2001, I have met and worked with many doulas. I am going mainly off my experience with them for almost 20 years in the field.
Before you write a nasty note in the comments:
As a nurse for 20 years I have seen a LOT of doulas. A good doula is worth her weight in gold. Patients and nurses LOVE them. They are helpful and know a lot of shortcuts to helping moms have their best birth. BUT, the truth is most doulas are not good doulas. I've seen a LOT of bad ones, and I feel like people look to save money, and instead just waste it.

A good doula is worth their weight in gold. I've just seen a lot of bad doulas over 20 years.
Hilary Erickson

What do doulas do?

You can really boil it down to someone to support women in labor. They're very hands-on in helping you cope with the pain.

Pain management

Helping you make healthcare choices

Encouraging you to keep going!

Mostly they're your educated cheerleader, as well as a translator that can help you know what is happening.

I think most Doula's hearts are in a lovely place. They really are working to empower women and show them that they can have a wonderful labor. I think that is great.

Pros and Cons of Doulas

Advantages of a doula

There are many benefits of having a doula - let's talk about them!

Can be a support

If you are delivering a doula, I would really recommend getting a doula.

There are women out there who don't have a person to support them during the labor. The reality is that I can't be in your room all the time. I have to pee, grab supplies, chart, and I may have another patient. BUT, you could also grab a friend whom you love and trust.

I had a patient who hired a doula. She didn't want her mom in the room (the father wasn't involved) and that doula was REALLY helpful. The woman was a mess. I had other patients, I couldn't put this woman's pieces back together. Again, super helpful doula. And this woman REALLY needed her as she had no other support system.

They have a basic knowledge of labor and delivery

With most things, this varies widely.

If they are certified they should have some basic knowledge that is correct (although, there is no way to know how correct their knowledge is).

It's nice to have someone constantly at your side who has educated answers.

She has hopefully seen many births and will be able to help you navigate your birth choices with a bit more ease.

Doulas can be especially helpful at home before you go to the hospital and can answer questions, and discuss what you're feeling.

She is there just for you!

Your labor nurse won't be in the room all the time, and the doula can be. This is easily one of the biggest perks to doula!

FYI, nurses can have up to 2 patients, and we also often run into other rooms for emergencies, etc.

Can be familiar with your provider

That means, they know how your doctor likes to do things and that could be helpful to educate you since sometimes your doctor doesn't have time.

She can also provide support to you during things like IV's or painful vaginal exams.

Doulas may decrease your chances of interventions.

There are a lot of studies that show doulas can help lower birth risks and interventions. There is even an ACOG article that says (ACOG is the professional organization for US OB's):

Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.
ACOG Approaches to Limit Intervention During Labor and Birth

That all being said, in my experience, I see a variety of reasons for the decreased interventions (they tend to have clients with good prenatal care, are likely college graduates, well off - etc). I'm not sure that I've seen a doula change anything, except for epidurals, if a patient has a strong desire to go natural.

They are good at supporting you through the pain. Some things doulas do to help with pain/stress

Find a comfortable position

Take your mind off the pain

Massage or other pressure

Help your spouse provide you relief.

Provide stress relief during hard labor

They can also help you labor at home (using tools like heating pads) to decrease your hospitalization time.

Explain what's going on so that you're not caught off guard (but I would 100% also recommend taking a prenatal class)

And, because they help you to relax that can help decrease your overall labor time.

** As I have said, a great doula is such a win. However, you have to remember that in the vast majority of cases people who use doulas are more well-off because they can afford a doula (they are not part of routine hospital care). Hence, I take the studies with a bit of grain of salt. Correlation does not mean causation.

Disadvantages of a doula

There are also man con's to hiring a doula - let's talk about those:

Doulas can get in your husband/partner's way.

I really believe that God created labor to bring husband and wife together in the pain/effort that culminates their start in parenthood.

If you want your husband playing candy crush in the chair while she does the hard work. By all means, hire a doula. { note: sarcasm font - not every delivery is like that - but I have certainly seen husbands hire doulas, so they could check out}. BTW, I have a post on my best tips for dads in labor.

I love seeing supportive husbands. It shows me that woman will have the support in her next journey, raising the child. If you and your husband really want to prepare for this - I have the answer!

How much do they REALLY know?

Yes, they have a basic understanding of labor, but my job is to know ALL about labor. It's what I do, it's my job. I go to classes, I went to five years of nursing school, I discuss it with doctors when we're at the nurse's station, we read articles.

I am ACLS, BLS, NRP and AWHONN fetal monitoring certified and do a lot of continuing education.

Nurses are up to date on the most current info. My job is to KNOW labor, and especially the complications of labor.

You're already paying me. Ask me questions, let me help you understand.

Ask your doctor questions, they're not free either!

Their Skill/Knowledge Varies Widely

Again, I don't mind doulas (I really don't, you might guess otherwise with this article) but sometimes you get ones who are so early in their practice that they aren't helpful to the patient and they're in your way or questioning you.

To me, It's super annoying. New doulas are not helpful. In fact, I often find them a deterrent. It takes more of my time to correct them or to talk through misinformation.

There are a few I've worked with who are WONDERFUL. I'd say if you're looking for one, I'd get a LOT of references and ask how much they felt the doula helped. I'd ask how many deliveries they've been to.

Experience is going to be key in finding a good doula.

Doulas May Want to Support YOUR Birth

If you switch to an epidural mid-labor - will your doula be upset and be unable to support you? What about going to a c-section?

Some only want to support home birthers or people birthing the way they think is best. So, when you interview your doula, ask how they support in a variety of ways!

They Can Be Expensive

A good doula is expensive. And, if they're not expensive, they probably aren't that good. This is their job. They make money doing it.

In reality, I think good doulas probably make more for a labor than I do.

It's hard work. A good doula earns her money.

I guess you just need to ask if you could use that money more efficiently in your child's college fund. I know for many parents the money isn't the issue, so this won't matter. BUT, if money is tight, I think it's time to step back and re-evaluate your finances.

Real quick - let's talk about supportive partners.

If you're looking to have a partner who supports you more during labor, I have a course I totally recommend. It's done in the privacy of your own home on your own timeline, and is meant to be done AS A COUPLE! Be SURE to check it out - you can even save 10% with code PC10.

People love all the experience, how quick it is to get JUST the right info on your own schedule, and I keep it simple and understandable. I think you'll love it - I even guarantee it.

What is the Difference Between a Doula and a Midwife?

There are different types of midwives. In the hospital, only Certified Nurse Midwives (CNM) are allowed to practice.

In Arizona within a few years, that person has to have a doctorate of nursing, along with a master's in midwifery (plus, a bachelor's in nursing, and most practiced as L&D nurses before they became midwives). So, essentially - you could also call them doctor. 🙂

There are also lay midwives who go through other training. I'm not familiar with them/that training, so I can't comment on that.

BUT, Certified nurse-midwives are AWESOME. They really do the work of a doula, but they may also have several patients, so again - they may not be able to be in your room all the time either.

The midwife will also deliver your baby (as long as things go according to plan).

I want to be very clear that doulas should not, nor are they trained, to do any medical intervention at all.

Certified Nurse-Midwives can do many of the things that doctors can do, and are great for a low-intervention labor (read: not high risk).

Is a doula necessary?

Absolutely not.

You WILL have a labor nurse who should be willing to answer questions and help guide you along your L&D path.

However, she won't be in there constantly, and hands-on natural pain management isn't really her job as she is consumed by many other things (but is a willing teacher to your support team)

If you want 1 on 1 involvement, a doula might be your best choice.

Should I hire a doula?

I think if you feel like your husband might get overwhelmed, you're wanting to go natural or you lack trust in your MD (and are unable to change) it might be a good plan.

I 100% think you need to talk it through with your partner. It is just as much their delivery as yours. If the thought of having a stranger there bothers them, you need to take account for that.

People who should consider a doula:

If you have your heart set on a "natural birth"

Hoping to not get an epidural or can't for a medical reason

You aren't a strong advocate for yourself, and neither is your partner

You are uncomfortable with your provider, and for some reason are unable to switch

Tips if you are hiring a doula:

1. Get references. I would ask for SEVERAL references. Many doulas are recently out of training and don't actually have much experience of their own.

2. Only hire a doula who is prepared to be flexible and support you no matter the choices you make during your labor.

3. Talk to your provider I would also ask your MD if they have recommendations (as having your doula and your MD at odds is a very awkward situation).

4. Decide what services you'll need - many doulas provide care before delivery and after delivery - and clearly, all those services cost extra.

Things to consider in your doula:

Training

Certification(s)

Experience

Hours of availability (and what do you do if she can't come)

What types of services they provide

How comfortable you feel with her (if she's a good fit with you!)

The cost

Sidenote: Many doulas offer placental encapsulation, but if they're pushing it you might want to steer clear of them as it is strongly discouraged anymore.

Birth Doula FAQ's

Should I hire a doula

What is an end-of-life Doula?

Is a Doula a waste of money?

They CAN be, and I've seen some 100% be SO helpful and really make the birth extra special.

But my own personal opinion, after almost 20 years as a labor and delivery nurse. In a perfect world - the people who were there when the baby was conceived should be there when the baby comes out. Plus a doctor and 2 nurses. Possibly a mom, if that's important to you.

I also really thought this Salon article of a women who didn't appreciate her doula to be an eye-opener (because a lot of people end-up feeling this way but don't talk about it - I find).

I think you should only become pregnant if you feel like the other person empowers and supports you. Of course, this is a perfect world. And most babies aren't born into a perfect world.

I really think you need to weigh the doula negatives with the positives and decide what works best for your family.

Do I really need a doula?

I thought this video was really great. She seems like a wonderful doula. She's honest about what she can do and how she supports. Hopefully, she gives you some ideas if you want to doula or not.

I hope, if you're pregnant, you have a wonderful labor and delivery experience - grab my birth plan template to get centered on what you'd prefer on your delivery day:
Hilary is a labor and delivery nurse who has worked in various medical fields over the past 18 years. Please don't take any advice you read on this blog over something your doctor tells you. Trust your doctor, or find a new one. This post was originaally written in 2015, and has been updated since then.

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Doulas can help you if you have your heart set on a "natural birth" (without an epidural). Doulas are a good option to advocate for you (especially if you have a hard time fighting for yourself) and help you feel supported. Should you hire a doula? Using a doula has many pros and cons.

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Waterbirth at home with a midwife: We decided against this option because if there was something wrong during the pregnancy that carried on throughout it there would be a big possibility of the hospital turning us down for the waterbirth. There are also just a lot of negatives about being in the water while giving birth, for example, like the umbilical snapping, and a higher risk for infection. 

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Waterbirth at home with a midwife: We decided against this option because if there was something wrong during the pregnancy that carried on throughout it there would be a big possibility of the hospital turning us down for the waterbirth. There are also just a lot of negatives about being in the water while giving birth, for example, like the umbilical snapping, and a higher risk for infection. 

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What is a water birth, and is it safe for a mother and her baby? Get the facts about this natural delivery experience.

During a water birth, a woman experiences labor and delivery in a tub of warm water. They're usually done at home or in birthing centers, and with the assistance of midwives rather than hospital-based OBs.

Moms who desire a natural childbirth-one without medication or epidurals -sometimes choose water birth because it can provide "a gentle, natural experience," says Ami Burns, a Chicago-based childbirth educator and writer and owner of Birth Talk. "They find being submerged in a tub provides more comfort during contractions than being 'on land.'"

But that doesn't mean water births are pain-free. In fact, " labor pains are just as present in the water birth pools as they are anywhere else, but the environment is more relaxing and soothing therefore offering a more pleasurable experience," says David Ghozland, M.D., an OB-GYN practicing in Santa Monica, California.

Water births also come with a host of risks and potential complications, some of which can be serious. These range from infection to meconium aspiration to drowning. To clear common misconceptions, here's everything parents-to-be need to know about giving birth in water.

Who Can Have a Water Birth?

An uncomplicated pregnancy (low blood pressure, over 37 weeks gestation, baby with a head down, etc.) is required for a water birth. "High-risk conditions or complications in labor often necessitate continuous fetal monitoring or immediate intervention, which is better accomplished outside of the water," explains Edwin Huang, M.D., an OB-GYN practicing in Cambridge, Massachusetts, and an assistant professor at Harvard Medical School.

There are certain circumstances in which women should not choose water birth. Marra Francis, M.D., a gynecologist practicing in San Antonio, specifies that women with "Group B Strep positive cultures, gestational diabetes, preeclampsia, macrosomia, intrauterine growth restriction, prematurity, and an unproven pelvis" should opt out of water birth.

Of course, always talk to your health care provider to understand the full risks and reality of your choices. Water birth is a very personal decision, one that requires much thought and research-because there's more to water birth than the tub.

Water Birth Pros and Cons: Is It Safe?

In 2016, the American College of Obstetricians and Gynecologists (ACOG) advised against water births, given a lack of available data on the topic. The organization said that while immersion during the first stage of labor may have benefits, "there are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water," according to a November 2016 Commitee Opinion by ACOG.

However, professional organizations like the Royal College of Obstetricians and Gynaecologists and the American College of Nurse-Midwives support water births in certain situations. "Researchers indicate that women who experience uncomplicated pregnancies and labors with limited risk factors and evidence-based management have comparable maternal and neonatal outcomes whether or not they give birth in water," the American College of Nurse-Midwives said in a 2014 position statement. "Women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their health care providers. This process includes ongoing maternal and fetal assessment as labor progresses"

What's more, a December 2019 study from the University of Michigan compared 397 water births with 2025 land births. It found that the birthing practices were equally safe, "and that women in the water group sustain fewer first and second-degree tears," according to the statement. Land births and water births also had comparable postpartum hemorrhage rates and neonatal intensive care admissions.

The Benefits of Water Birth

Contrary to lingering misconceptions, water birth is not just a fad among celebrities. It's a birthing option that's in growing demand. "One doesn't have to be a hippie to have a water birth," explains Burns.

Many mothers claim that natural water births lessen the pain of labor and delivery, thanks to the buoyancy of the water. "For women who are skeptical about water births, I always ask if they have ever taken a hot bath to relieve terrible menstrual cramps. That is usually the aha moment for most of them," says Amber Ford Cottrell, a doula who practices in New York City.

Barbara Harper, R.N., founder of Waterbirth International, a nonprofit organization that helps make giving birth in water an available option for moms-to-be, and Michelle Collins, C.N.M., an assistant professor of nursing at the Vanderbilt University School of Nursing who specializes in nurse-midwifery, explain why water may lessen labor pain. When women get into the deep water of a birth pool, not just a shallow bathtub, there is a chemical and hormonal response that adjusts the level of the hormone oxytocin, which pumps from the brain and helps regulate the intensity of the contractions. So, as the body becomes buoyant in the deep water and more oxytocin is released, more pain-inhibiting endorphins flood the mother's brain, putting her more quickly into an altered state of consciousness and allowing her body to do the work that it needs to do. What's more, Harper and Collins say, water causes the perineum to become more relaxed, which can reduce the severity of vaginal tearing.

Water Birth Risks and Complications

"Anyone thinking about delivering at home needs to think through the worst-case scenario for the ultimate safety of their baby and themselves," says Sharon Mikol, M.D., an OB-GYN practicing in Cleveland. Even though steps are taken to avoid serious outcomes, and advocates state that home water birth is safe, Patrick Weix, M.D., Ph.D., an OB-GYN practicing in Irving, Texas, and contributor to the medical website healthtap.com, reveals "no adequate randomized controlled studies have been done on water births to demonstrate this."

Water births themselves are not significantly more dangerous than birth out of water, but when they take place at home-and most of them do-there is an increased risk. That's because there's no immediate medical help with home water births. Here are some important water birth risks to know.

Risk of Infection

Water birth means sitting, pushing, and delivering in a tub-which often includes feces in the tub. A baby born in that environment could possibly swallow the contaminated water, increasing their risk of infection. Depending on whom you ask, the likelihood of an infection differs because data is limited. However, "there is no way to make the water contaminant free,"says Dr. Francis. That's because the tub becomes contaminated with vaginal and rectal flora the minute a mom sits in the tub, even if the water is sterile.

A baby that swallows tub water is at risk for infection. Babies are genetically and physiologically programmed to take their first breaths of air, not water, within seconds of their head being delivered. They do have a "dive reflex" that instinctively closes their airway and prevents them from breathing in water, but a few scenarios may still cause them to inhale water:

They are startled during birth

The head is brought to the surface before the rest of the body; this overrides the dive reflex

Their oxygen supply from the placenta is affected in some way

It is important to know, however, that even as infectious bacteria is expelled outward during birth, nothing is moving up and inward. Therefore, the risk of infection occurs only if the baby breathes too soon (midwives and OBs are trained to minimize that risk) or if the equipment (tubs, filters, pumps) is not sterilized properly.

Risk of Meconium Aspiration

This medical term means a baby has had its first bowel movement before birth and inhales the contaminated amniotic fluid, which causes respiratory problems. Doctors and midwives are able to tell if this has happened when the water breaks because meconium is typically green, sticky, chunky, and thick. Extra precautions have to be taken when the first bowel movement occurs prior to delivery. A doctor or midwife needs immediate access to the baby to be able to clear his airways, which often means delivering on your back.

Risk of Pneumonia

Although significant studies have yet to show the exact percentage of pneumonia cases in natural water birth, it is one of the risks. To prevent pneumonia, the water must remain between 95 and 100° F and the baby must be brought to the surface immediately upon delivery. Pneumonia usually develops within the first 24 to 48 hours after birth, and it is caused by meconium aspiration, fecal contamination, and bacteria from tub water. "There are also case reports of babies dying of pneumonia post-water birth that was a direct result of ingesting water with fecal contamination. As most water births are done at home or in a freestanding birth center, there is little 'research' done as a collective group," Dr. Francis says.

Risk of Drowning

Where there is water, there is a risk of drowning. A 2004 study from the Journal of Pediatrics lists "drowning and near-drowning, asphyxiation...as fetal risks of water birth." Owing to complications, the baby could possibly stay underwater too long and his lungs can fill up with water. Medical professionals do everything to prevent this by placing the baby with his head above water so he can get enough oxygen to breathe as soon as he is born.

Risk of Tearing the Umbilical Cord

Dr. Weix reveals that "short umbilical cords can tether the fetus underwater or tear, leading to fetal blood loss. Maternal tears can be difficult to assess [underwater], and patients may bleed excessively." The good news is that a cord short enough to cause such an incident is rare.

During a water birth, a baby is usually brought quickly to the surface, head first. This swift movement will enable them to start breathing as soon as possible, but there's a risk that the umbilical cord may snap. "A snapped umbilical cord can be life-threatening, as the fetus can bleed freely until it is stopped. It is usually easily managed by clamping the cord. It leads more often to neonatal anemia than anything else," Dr. Weix explains.

Where to Have a Water Birth

Although some hospitals allow natural water births, the majority occur at home or at stand-alone birthing centers (these are typically independent facilities, though a growing number are affiliated with and often housed inside of traditional hospitals). Water birth centers are equipped with IVs, oxygen, medication, and infant resuscitation equipment, so if need be, emergency care can be started while Mother and Baby await transport to the hospital.

Even though birthing centers are not as common as hospitals, a quick search for "water birth centers near me" will give some results. The Birthing Center Locator ( birthcenters.org) can show ones in close proximity to you.

Choosing a Water Birth Tub

The key to achieving buoyancy, and ideally pain relief, is in the choice of water birth tub. Most birthing tubs are inflatable and similar to a kiddie pool. Their pliable sides are softer than those of a regular bathtub, so they allow women to labor in different positions. Unlike a kiddie pool, however, the tubs are wide and deep enough to fully submerge a pregnant belly and, if desired, a partner as well.

Birthing tubs can be rented or purchased on the Internet or through a midwife, and they average $250 with liners and filters. If you don't want to rent or buy a birthing tub, you may use your own home bathtub; just make sure your belly can be fully submerged in water and your midwife has easy access to you to assist with labor.

Water Birth Cost

Delivering at a birthing center is usually less expensive than a hospital because women typically stay for a shorter time and use fewer interventions. The majority of insurance companies cover births in a birthing center, but only some providers cover home births. Check with your insurance provider to understand your birth coverage.

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Water Birth: Pros, Cons, and What You Need to Know

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What is a water birth, and is it safe for a mother and her baby? Get the facts about this natural delivery experience. During a water birth, a woman experiences labor and delivery in a tub of warm water. They're usually done at home or in birthing centers, and with the assistance of midwives rather than hospital-based OBs.

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C-Section: Of course if something happens and it is an emergency that the baby must come out then this is the option we would choose but it is not one I want to plan for. The recovery is longer after birth, it is more risky for the mother and the child because it is major surgery. Also the more you have them the more dangerous they are and the longer it takes to bounce back and be able to have another baby. They also are performed a lot less than the other birth options. Overall it is just not something that I want to go through so we decided not to choose this option. 

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C-Section: Of course if something happens and it is an emergency that the baby must come out then this is the option we would choose but it is not one I want to plan for. The recovery is longer after birth, it is more risky for the mother and the child because it is major surgery. Also the more you have them the more dangerous they are and the longer it takes to bounce back and be able to have another baby. They also are performed a lot less than the other birth options. Overall it is just not something that I want to go through so we decided not to choose this option. 

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For many years, there has been criticism that the rates of cesarean births are too high because higher rates have not resulted in improvements in maternal or child health.

Many expectant moms feel strongly about having a natural vaginal birth, and want to do all they can to avoid a cesarean section. But for some, a C-section may seem like a good option for a range of reasons. And for others, a cesarean may be essential to protect the health - or life - of mom and baby.

In parts of the world where C-sections are not readily available, complications of vaginal birth often lead to serious consequences, including loss of life for mother and baby. In contrast, quick access to cesareans has its own problems. Over all, cesarean delivery is a very safe procedure. But it carries higher risks than vaginal delivery, including a three-fold higher rate of infection, hemorrhage, and organ damage. It also has a longer recovery period.

So how many cesareans we're doing is a number worth paying attention to.

Finding the optimal C-section rate

As it turns out, there is a sweet spot - a certain "rate" of cesareans needed to prevent the terrible suffering and aftermath that can occur when a baby can't move though the birth canal, or when there's an emergency requiring immediate delivery.

Recently, a study from researchers at Harvard Medical School and the Stanford University School of Medicine found that the ideal rate of childbirth by C-section appears to be about 19% of all births. This number is higher than previous guidelines have recommended, but lower than the rate in most US hospitals - which can be as high as 70%.

How did the researchers come to this number? They looked at C-section rates from 194 countries and compared them to maternal and infant mortality rates. Their analysis suggests that babies and mothers don't fare better when cesarean rates are above 19%. Cesarean rates below 19% were associated with more birth-related complications and poorer outcomes.

This research also suggests that some of the reasons commonly cited for high C-section rates - moms who are older or obese, or who've had multiple previous births, along with doctors' fear of being sued - may be only a small part of the bigger picture. In particular, these examples don't account for why some doctors and hospitals simply do more (or fewer) C-sections than others do.

Dr. Neel Shah is one of the co-authors of the study and an obstetrician in my department at Harvard-affiliated Beth Israel Deaconess Medical Center. Dr. Shah has uncovered some previously unrecognized factors that help explain the variation in C-section rates. For example, his research suggests that time pressures in some hospitals may lead to more C-sections, since in comparison, vaginal birth can take a great deal of time and staff resources. Providing the clinical team with access to better data and technology can help them make better decisions based on patient volume, staffing, and the overall resources needed to support safe care.

What this means for expectant parents

If you are a healthy woman and have a low-risk pregnancy, the hospital you plan to use may determine the likelihood you'll have a C-section more than any other factor. So find out the C-section rate at the hospital where you plan to deliver your baby. Talk to your doctor about this as well. If you are early in your pregnancy, you might opt to choose your doctor based on where he or she practices.

Finally, it's important to remember that there are times when a C-section is the only safe way to deliver a baby. When that happens, a woman may feel a sense of loss for the birth experience she had hoped to have. But doing your homework about quality of care can help assure you that your method of delivery was determined for the right reasons.

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C-section rates: Consider this when deciding where to have your baby - Harvard Health Blog

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For many years, there has been criticism that the rates of cesarean births are too high because higher rates have not resulted in improvements in maternal or child health. Many expectant moms feel strongly about having a natural vaginal birth, and want to do all they can to avoid a cesarean section.

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A natural birth in the hospital: We chose to pick this one because in this most of the options you get to decide, whether you want medications, epidurals, hospital choice and other things like that. Also with natural births you get to have more of them with less complications because it is what the woman's body was made to do. We decided on this because it has a faster rate of recovery, and we are also surrounded by medical professionals who do what they are doing all the time. It makes us feel more comfortable in the birthing process this way. 

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A natural birth in the hospital: We chose to pick this one because in this most of the options you get to decide, whether you want medications, epidurals, hospital choice and other things like that. Also with natural births you get to have more of them with less complications because it is what the woman's body was made to do. We decided on this because it has a faster rate of recovery, and we are also surrounded by medical professionals who do what they are doing all the time. It makes us feel more comfortable in the birthing process this way. 

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Dr. Elwell-Silver's 5 tips for natural childbirth
By Kyler Elwell-Silver, M.D.
As an Ob/Gyn, I've delivered many babies through natural childbirth - I wanted firsthand experience in what my patients go through. I'd had a low-risk pregnancy, so I was unlikely to need a cesarean section (C-section) or operative delivery. And this was my third baby, so labor would likely go quickly.

If you and your doctor agree natural childbirth is safe for you and your baby, here are five tips to help you prepare for the big day.

1. Make a 'natural' plan with your Ob/Gyn provider

Once you've decided you'd like to have a natural childbirth, talk to your Ob/Gyn or midwife. Let the provider know what you mean by "natural childbirth," and ask about the options their facility offers to support you.

For example, William P. Clements Jr. University Hospital is uniquely set up to be supportive of many childbirth options - from pain relief to emergency care. We have a certified nurse-midwife and a doctor on the floor 24 hours a day, seven days a week to help whether you are in labor for hours or you deliver 10 minutes after arriving.

2. Find a support person or doula

The key to a successful natural childbirth is having a solid support person to distract you from the pain, talk you through what's next, and cheer you on. This could be your partner, your mom, or a friend who has been through labor before.

Along with my husband, I had a doula with me during my natural childbirth. A doula is someone trained to support a woman through labor. Their goal is to help women achieve the childbirth experience they envision.

Doulas provide a range of services before, during, and after labor and can cost anywhere from $500 to $2,500.

Related reading: What role does a doula play during and after childbirth?

3. Get educated

Labor and delivery can last several hours, and it is painful. The more you know, the better prepared you'll be.

I recommend taking childbirth classes, which cover everything from deep breathing and pain relief to C-sections. Every labor is unique, and sometimes things don't go exactly as planned. Being prepared for any situation is important - childbirth classes can give you realistic expectations and instill confidence.

You may want to find a class that teaches the Bradley Method, which breaks down the different stages of labor, what to expect, and how your support person can help coach you through the natural birth process.

Related reading: Class is in session: The many benefits of prenatal education

4. Prepare mentally

In the Western world, people are less accustomed to tolerating intense pain. We associate pain with something being wrong that should be fixed, often with medication.

But pain during childbirth is normal and necessary. It signals that your body is doing what it needs to do. Every wave of pain gets you closer to the goal: your beautiful baby.

My doula helped me get in the right headspace before labor started. Like a professional athlete, I visualized my baby's birth often during my third trimester and returned to that scene during the labor process. She helped me keep my eyes on the prize throughout the pains of labor and delivery.

5. Learn natural pain management techniques

There are many alternatives to medication when it comes to pain relief. Talk with your health care provider about what is allowed and available where you'll give birth. You'll also want to practice your techniques before the big day, so they are second nature when you need them most.

Some natural pain management methods include:

If you don't want an epidural, but aren't opposed to other forms of medical pain relief, you might consider trying nitrous oxide. The nonflammable, colorless gas does not actually reduce pain or take away the sensation of a contraction, like an epidural. Instead, it relieves anxiety, which helps you tolerate the pain.

One piece of advice from my doula that I really appreciated was to focus on other things. My husband and I were scheduled to look at new houses the day I went into labor. So, that's what we did - even though it make our realtor a bit nervous!

Then, we went home and I sat in my warm, soothing bathtub until my husband (who's also a doctor) finally convinced me it was time to head to Clements University Hospital. I checked in, then walked around and chatted with some of my colleagues. My baby was born just minutes after my water broke, not long after we arrived.

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5 tips on natural childbirth from an Ob/Gyn who experienced it | Your Pregnancy Matters | UT Southwestern Medical Center

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By Kyler Elwell-Silver, M.D. As an Ob/Gyn, I've delivered many babies through natural childbirth - I wanted firsthand experience in what my patients go through. I'd had a low-risk pregnancy, so I was unlikely to need a cesarean section (C-section) or operative delivery. And this was my third baby, so labor would likely go quickly.

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We had our baby! We have a beautiful boy named Lane Matthew Cain. He is now two years old and has been the light of our lives. We have learned over these past two years that his brain is doing amazing things and he is learning so much it is incredible! 

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We had our baby! We have a beautiful boy named Lane Matthew Cain. He is now two years old and has been the light of our lives. We have learned over these past two years that his brain is doing amazing things and he is learning so much it is incredible! 

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Something that we have found really important for his little brain development is how much sleep he gets. In the beginning when he was just born we let him sleep whenever he wanted because we knew that newborns sleep a lot which is very true. Especially because his sleep was never taking place all at one time we tried our best to keep track of when he was sleeping but overall he just kind of slept when he wanted to help grow his little brain. We learned that a good nights rest as he grew older was super important because it helps him dream and fall into the REM sleep which is a good reset for his body overall. Charts like the one linked below really helped us out.

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Something that we have found really important for his little brain development is how much sleep he gets. In the beginning when he was just born we let him sleep whenever he wanted because we knew that newborns sleep a lot which is very true. Especially because his sleep was never taking place all at one time we tried our best to keep track of when he was sleeping but overall he just kind of slept when he wanted to help grow his little brain. We learned that a good nights rest as he grew older was super important because it helps him dream and fall into the REM sleep which is a good reset for his body overall. Charts like the one linked below really helped us out.

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Our parenting choices- We aren't introducing any screen time yet because we want him to grow his brain using experiences instead of watching everything through a screen. We try to do something that will really stimulate his brain at least a couple times a week (bike rides, parks, colorful places, etc.) to keep him mind constantly fired up from what he is seeing. We also read to him and have a ton of books that he can view and touch to help prepare his mind for later on. 

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Our parenting choices- We aren't introducing any screen time yet because we want him to grow his brain using experiences instead of watching everything through a screen. We try to do something that will really stimulate his brain at least a couple times a week (bike rides, parks, colorful places, etc.) to keep him mind constantly fired up from what he is seeing. We also read to him and have a ton of books that he can view and touch to help prepare his mind for later on. 

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Lastly something we wanted to help stimulate his brain is to have little to no battery operated toys, instead have toys where he is responsible for making the sounds that they produce. It really helps with his motor skills because he physically has to make the toy make the sound and he doesn't rely on a button to push. It makes him be able to figure more things out and problem solve a little better to get what he wants.

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Lastly something we wanted to help stimulate his brain is to have little to no battery operated toys, instead have toys where he is responsible for making the sounds that they produce. It really helps with his motor skills because he physically has to make the toy make the sound and he doesn't rely on a button to push. It makes him be able to figure more things out and problem solve a little better to get what he wants.

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The fleeting distraction they provide isn't worth the surprising costs.

Walk into any toy aisle and you'll be bombarded with flashing lights, shrieking sirens, and blaring music. Battery-powered toys are hugely popular, promising distraction and entertainment for young children, even if these toys drive parents a bit crazy with their incessant noise.

Just because something is popular, however, does not mean it's a good choice. Beyond their glitzy facades, battery-powered toys have a number of serious shortcomings that should make any parent reconsider walking down that aisle. Here are some things to think about.

1. They can cause hearing damage.

All noise-making toys are required to meet acoustic standards set by the American Society of Testing and Materials. These state that a toy cannot exceed 85 decibels at a distance of 50 centimetres from the ear. But how often do kids play like that? Michelle Woo wrote for Lifehacker, "Kids get much closer than 50 cm to their toys. Arm's length is about 25 centimeters (or 10 inches)." Those cute little Luvimals pictured at the top, for example, have a decibel level of 88.1 at the ear. To be safe, check the Sight & Hearing Association's annual list of noisy toys.

2. They don't challenge kids enough.

The vast majority of battery-powered toys excel at distraction and entertainment, but this only lasts temporarily. A kid needs to feel inspired or challenged, but a battery-powered toy with the same repetitive functions cannot provide that. Focus, instead, on buying toys that are open-ended, that don't decide what or how the kid is going to play. As Jenn Choi wrote for Quartz, "The best toys focus on what the child can do, rather than what the toys can do."

3. They are wasteful.

From an environmental perspective, battery-powered toys are a nightmare. They're all made from brightly colored molded plastic, which is difficult to recycle (it isn't even accepted in my small town). These toys require endless batteries that are expensive, come in non-recyclable plastic packaging, and then must be replaced and recycled themselves.

4. They can be dangerous to health.

A 2018 study from the UK found that the plastic in second-hand plastic toys made overseas often does not meet current international safety standards, and most battery-powered toys are plastic. Health Central reported:

"Many of the products - typically those that were yellow, red, or black - contained high concentrations of hazardous elements that can be toxic to children over an extended period, even at low levels. These elements included antimony, barium, bromine, cadmium, chromium, lead, and selenium."

Better options include natural materials, such as wood, metal, rubber, leather, wool, and paper; or stick with non-battery-powered plastic toys whose eco credentials you can trust.

Favorite toys at my kid-filled house include some plastic, but lots of other materials, too: Lego, Magformers, wooden marble run, a mini china tea set, an indoor tent, puzzles, wooden train tracks. We have heaps of metal Tonka trucks outside and shovels for digging. Metal watering cans, buckets, and a tap transform the play area into a mud zone that delights the kids as much as it exhausts me. Balls, sticks, bicycles, and winter sleds are other great sources of entertainment.

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The fleeting distraction they provide isn't worth the surprising costs. Walk into any toy aisle and you'll be bombarded with flashing lights, shrieking sirens, and blaring music. Battery-powered toys are hugely popular, promising distraction and entertainment for young children, even if these toys drive parents a bit crazy with their incessant noise.

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Overall we are super excited about his development throughout this time we love seeing how he is growing from the beginning of his life from everyone making silly faces at him to get a response, to now seeing him be able to play music and like what he is doing. We are constantly trying to stimulate his brain with games or songs with motions he can learn to keep him going. We are so excited to see what else he can do as he gets older!.

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Overall we are super excited about his development throughout this time we love seeing how he is growing from the beginning of his life from everyone making silly faces at him to get a response, to now seeing him be able to play music and like what he is doing. We are constantly trying to stimulate his brain with games or songs with motions he can learn to keep him going. We are so excited to see what else he can do as he gets older!.

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Little Lane has adapted so much in the way he speaks. It started off when he was about two months old with his normal baby cooing and it only went up from there. We learned early on when they start doing that they like to try and repeat what they hear so we would play sounds in hopes he would try or come close to what he was hearing. The article linked is something we researched and studied as soon as Lane started making sounds. It made it so much easier for us to understand what he was doing, and why he was doing it.

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Little Lane has adapted so much in the way he speaks. It started off when he was about two months old with his normal baby cooing and it only went up from there. We learned early on when they start doing that they like to try and repeat what they hear so we would play sounds in hopes he would try or come close to what he was hearing. The article linked is something we researched and studied as soon as Lane started making sounds. It made it so much easier for us to understand what he was doing, and why he was doing it.

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Newborn Communication

Do newborns communicate? Certainly, they do. They do not, however, communicate with the use of language. Instead, they communicate their thoughts and needs with body posture (being relaxed or still), gestures, cries, and facial expressions. A person who spends adequate time with an infant can learn which cries indicate pain and which ones indicate hunger, discomfort, or frustration.

Intentional Vocalizations: Cooing and taking turns: Infants begin to vocalize and repeat vocalizations within the first couple of months of life. That gurgling, musical vocalization called cooing can serve as a source of entertainment to an infant who has been laid down for a nap or seated in a carrier on a car ride. Cooing serves as practice for vocalization as well as the infant hears the sound of his or her own voice and tries to repeat sounds that are entertaining. Infants also begin to learn the pace and pause of conversation as they alternate their vocalization with that of someone else and then take their turn again when the other person's vocalization has stopped. Cooing initially involves making vowel sounds like "oooo". Later, consonants are added to vocalizations such as "nananananana".

Babbling and gesturing: At about four to six months of age, infants begin making even more elaborate vocalizations that include the sounds required for any language. Guttural sounds, clicks, consonants, and vowel sounds stand ready to equip the child with the ability to repeat whatever sounds are characteristic of the language heard. Eventually, these sounds will no longer be used as the infant grow more accustomed to a particular language. Deaf babies also use gestures to communicate wants, reactions, and feelings. Because gesturing seems to be easier than vocalization for some toddlers, sign language is sometimes taught to enhance one's ability to communicate by making use of the ease of gesturing. The rhythm and pattern of language is used when deaf babies sign just as it is when hearing babies babble.

Understanding: At around ten months of age, the infant can understand more than he or she can say. You may have experienced this phenomenon as well if you have ever tried to learn a second language. You may have been able to follow a conversation more easily than to contribute to it.

Holophrasic speech: Children begin using their first words at about 12 or 13 months of age and may use partial words to convey thoughts at even younger ages. These one word expressions are referred to as holophrasic speech. For example, the child may say "ju" for the word "juice" and use this sound when referring to a bottle. The listener must interpret the meaning of the holophrase and when this is someone who has spent time with the child, interpretation is not too difficult. They know that "ju" means "juice" which means the baby wants some milk! But, someone who has not been around the child will have trouble knowing what is meant. Imagine the parent who to a friend exclaims, "Ezra's talking all the time now!" The friend hears only "ju da ga" which, the parent explains, means "I want some milk when I go with Daddy."

Underextension: A child who learns that a word stands for an object may initially think that the word can be used for only that particular object. Only the family's Irish Setter is a "doggie". This is referred to as underextension. More often, however, a child may think that a label applies to all objects that are similar to the original object. In overextension all animals become "doggies", for example.

First words and cultural influences: First words if the child is using English tend to be nouns. The child labels objects such as cup or ball. In a verb-friendly language such as Chinese, however, children may learn more verbs. This may also be due to the different emphasis given to objects based on culture. Chinese children may be taught to notice action and relationship between objects while children from the United States may be taught to name an object and its qualities (color, texture, size, etc.). These differences can be seen when comparing interpretations of art by older students from China and the United States.

Vocabulary growth spurt: One year olds typically have a vocabulary of about 50 words. But by the time they become toddlers, they have a vocabulary of about 200 words and begin putting those words together in telegraphic speech (I think of it now as 'text message' speech because texting is more common and is similar in that text messages typically only include the minimal amout of words to convey the message).

Two word sentences and telegraphic (text message?) speech: Words are soon combined and 18 month old toddlers can express themselves further by using expressions such as "baby bye-bye" or "doggie pretty". Words needed to convey messages are used, but the articles and other parts of speech necessary for grammatical correctness are not yet used. These expressions sound like a telegraph (or perhaps a better analogy today would be that they read like a text message) where unnecessary words are not used. "Give baby ball" is used rather than "Give the baby the ball." Or a text message of "Send money now!" rather than "Dear Mother. I really need some money to take care of my expenses" You get the idea.

Child-directed speech: Why is a horse a "horsie"? Have you ever wondered why adults tend to use "baby talk" or that sing-song type of intonation and exaggeration used when talking to children? This represents a universal tendency and is known as child-directed speech or motherese or parentese. It involves exaggerating the vowel and consonant sounds, using a high-pitched voice, and delivering the phrase with great facial expression. Why is this done? It may be in order to clearly articulate the sounds of a word so that the child can hear the sounds involved. Or it may be because when this type of speech is used, the infant pays more attention to the speaker and this sets up a pattern of interaction in which the speaker and listener are in tuned with one another. When I demonstrate this in class, the students certainly pay attention and look my way. Amazing! It also works in the college classroom!

Theories of Language Development

The first two theories of language development represent two extremes in the level of interaction required for language to occur (Berk, 2007).

Chomsky and the language acquisition device: The view known as nativism advocated by Noam Chomsky suggests that infants are equipped with a neurological construct referred to as the language acquisition device or LAD that makes infants ready for language. Language develops as long as the infant is exposed to it. No teaching, training, or reinforcement is required for language to develop.

Skinner and reinforcement: Learning theorist, B. F. Skinner, suggests that language develops through the use of reinforcement. Sounds, words, gestures and phrases are encouraged through by following the behavior with words of praise or treats or any thing that increases the likelihood that the behavior will be repeated.

Social pragmatics: Another view emphasizes the child's active engagement in learning language out of a need to communicate. The child seeks information, memorizes terms, imitates the speech heard from others and learns to conceptualize using words as language is acquired. Many would argue that all three of these dynamics foster the acquisition of language (Berger, 2004).

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Do newborns communicate? Certainly, they do. They do not, however, communicate with the use of language. Instead, they communicate their thoughts and needs with body posture (being relaxed or still), gestures, cries, and facial expressions. A person who spends adequate time with an infant can learn which cries indicate pain and which ones indicate hunger, discomfort, or frustration.

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As Lane got a little older and started to pronounce sounds and letters (at around 8 months) we started working on his babbling and trying to have him make more sounds or even words out of it. It really helps to do this early on so that their speech becomes more developed. We really try to talk with our mouths as well so that when he sees our mouths moving he will do the same thing, and hopefully the right sound will come out. Linked are some examples of games that  we played with him and learned to do.

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As Lane got a little older and started to pronounce sounds and letters (at around 8 months) we started working on his babbling and trying to have him make more sounds or even words out of it. It really helps to do this early on so that their speech becomes more developed. We really try to talk with our mouths as well so that when he sees our mouths moving he will do the same thing, and hopefully the right sound will come out. Linked are some examples of games that  we played with him and learned to do.

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Baby Games | Games for 7-9 Month Old Babies | Pathways.org

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Even young babies can play! Use our list of motor, sensory, communication, and feeding baby games and activities to help you bond and play with baby.

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We started baby sign language very early on in his life, at like 5 months old when he started to use his hands for stuff. This help us as the parent understand what he needs or wants, and it also helps him communicate to us. We really love it, and now that he has gotten the hang of it it's made it a lot easier on all of us. 

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We started baby sign language very early on in his life, at like 5 months old when he started to use his hands for stuff. This help us as the parent understand what he needs or wants, and it also helps him communicate to us. We really love it, and now that he has gotten the hang of it it's made it a lot easier on all of us. 

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One of the challenges we faced was, early on Lane didn't really react as well as we thought he would to certain sounds that we made, or to the things around him. We thought that maybe he couldn't hear as well so we took him to get his hearing looked at by the doctor. The doctor told us that he was fine with his hearing, he just might be a little delayed in that area. As we worked on it more he got better and better until it was no longer an issue. We are so glad that it got better and we didn't have to go through any developmental tests with him.  

# data[].attributes.subject
One of the challenges we faced was, early on Lane didn't really react as well as we thought he would to certain sounds that we made, or to the things around him. We thought that maybe he couldn't hear as well so we took him to get his hearing looked at by the doctor. The doctor told us that he was fine with his hearing, he just might be a little delayed in that area. As we worked on it more he got better and better until it was no longer an issue. We are so glad that it got better and we didn't have to go through any developmental tests with him.  

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Before you bring your newborn home from the hospital, your baby needs to have a hearing screening.

From birth, one important way babies can learn is through listening and hearing. Although most infants can hear fine, 1 to 3 of every 1,000 babies born in the U.S. have hearing levels outside the typical range.

Newborn screening and diagnosis helps ensure all babies who are deaf or hard of hearing are identified as soon as possible. Then, they can receive early intervention services that can make a big difference in their communication and language development.

​The American Academy of Pediatrics (AAP) recommends hearing screenings for all newborns. The goal is for all babies to have a newborn hearing screening by one month of age, ideally before they go home from the hospital; identified by 3 months of age and enrolled in early intervention or treatment, if identified as deaf or hard of hearing, by the age of 6 months.

Why do newborns need hearing screening?

The hearing screening is a first and important step in helping understand if your baby may be deaf or hard of hearing. Without newborn hearing screening, it is hard to know when there are hearing changes in the first months and years of your baby's life.

Babies may respond to noise by startling or turning their heads toward the sound, for example. But this doesn't necessarily mean they can hear all the sounds around them and everything we say. Babies who are deaf or hard of hearing may hear some sounds but still not hear enough to understand spoken language.

Infants who are deaf or hard of hearing need the right supports, care, and early intervention services to promote healthy development. If the hearing status is not identified, it may have negative effects on the baby's communication and language skills. Longer term, a missed hearing loss can also impact the child's academic achievement and social-emotional development.

How is the newborn hearing screening done?

According to the most recent Centers for Disease Control and Prevention (CDC) data, over 98% of newborns in the United States receive newborn hearing screening.

There are two screening methods that may be used:

Automated Auditory Brainstem Response (AABR)-This screen measures how the hearing nerve and brain respond to sound. Clicks or tones are played through soft earphones into the baby's ears. Three electrodes placed on the baby's head measure the hearing nerve and brain's response.

Otoacoustic Emissions (OAE)-This screen measures sound waves produced in the inner ear. A tiny probe is placed just inside the baby's ear canal. It measures the response (echo) when clicks or tones are played into the baby's ears.

Both screens are quick (about 5 to 10 minutes), painless, and may be done while your baby is sleeping or lying still. One or both screens may be used.

What if my baby does not pass the initial hearing screening?

If your baby does not pass the hearing screening at birth, it does not necessarily mean that she is deaf or hard of hearing. Fluid or vernix inside the baby's ear, for example, or too much noise in the room can affect results. In fact, most babies who do not pass the newborn screening have typical hearing. But to be sure, it is extremely important to have further testing done.

About 1 or 2 in every 100 babies will not pass the initial hearing screening at birth and will need tests with an audiologist who has experience working with babies. This testing should include a more thorough hearing and medical evaluation.

Be sure to talk with your baby's pediatrician about scheduling further tests if your baby does not pass the initial hearing screening at birth. The additional testing should be done as soon as possible, but before your baby is 3 months old.

Follow-up testing may start with one more screening similar to the type done in the hospital. Some hospitals or clinics may complete a diagnostic test at the time of follow-up, instead of re-screening. In young infants, the follow-up testing may be able to be completed while the baby naps.

If my baby is identified as deaf or hard of hearing, what are the treatment and intervention options?

If your baby's audiologist confirms hearing changes, treatment and early intervention with a team of providers should start as soon as possible. Just like hearing children, children who are deaf or hard of hearing can achieve many things. Studies show your baby will have the best chance for spoken language development―on par with that of hearing peers―if any hearing changes are discovered, and support and intervention begins by 6 months of age. The earlier, the better.

In addition to your pediatrician and audiologist, every baby who is deaf or hard of hearing should be seen by a pediatric otolaryngologist who specializes in the mechanics of the ear. Your pediatrician should also recommend seeing a pediatric ophthalmologist, because some children can also have problems with their vision, and children who are deaf or hard of hearing are dependent on their vision for language input. Many children are also seen by a geneticist to determine if there is a hereditary cause of hearing changes.

Your state Early Hearing Detection and Intervention (EHDI) program can help provide you and your pediatrician with more information. Babies who are deaf or hard of hearing should be referred to Early Intervention for evaluation and services. Additionally, the Individuals with Disabilities Education Act (IDEA) supports intervention programs for children who are deaf or hard of hearing within early intervention and school programming.

The audiologist, together with the otolaryngologist, can tell you the type and degree of hearing change and what the next steps are. These next steps can vary depending on your family's choices, as well as the type and degree of hearing change.

If my baby passes the newborn hearing screening, does it mean he or she will not have hearing loss later?

Unfortunately, no. Some babies may develop hearing loss later in childhood. Causes of late onset or progressive hearing loss in children can include genetics, frequent ear infections, other infections like measles or meningitis, a head injury, exposure to damaging levels of loud noises, and secondhand smoke. Newborns who need an extended period of neonatal intensive care may also be at an increased risk for hearing loss later.

​Even if your baby passes the newborn hearing screening, you should still watch for possible signs of hearing loss as your child grows. Talk with your pediatrician if your child:

Doesn't startle at loud noises by 1 month or turn toward sounds by 3-4 months of age.

Doesn't notice you until he sees you.

Concentrates on vibrating noises more than other types of sounds.

Doesn't seem to enjoy being read to.

Is slow to begin talking, hard to understand, or doesn't say single words such as "dada" or "mama" by 12 to 15 months of age.

Doesn't always respond when called, especially from another room.

Seems to hear some sounds but not others. (Some hearing loss affects only high-pitched sounds; some children have hearing loss in only one ear.)

Has trouble holding his or her head steady or is slow to sit or walk unsupported. (In some children with sensorineural hearing loss, the part of the inner ear that provides information about balance and movement of the head is also damaged.)

Wants the TV volume louder than other members of the family.

If my baby passes the first hearing test, why is more screening needed?

Even if your child shows no signs of hearing changes, the AAP recommends they be screened again at ages 4, 5, 6, 8 and 10. Additional screenings are recommended sometime between ages 11-14, 15-17, and 18-21--or any time there is a concern. More frequent follow-up screenings may be recommended for children who have a higher risk for hearing loss. Hearing loss sometimes is gradual and hard to notice at first. Routine screenings can catch hearing changes early, when providing support and resources can have the most impact on the child's development.

Remember:

Timing is everything. The sooner hearing changes are identified in a baby, the more likely interventions can help her reach her full potential. Talk with your pediatrician if you have any concerns about your child's hearing.

Additional Information & Resources:

American Academy of Pediatrics Early Hearing Detection and Intervention (EHDI) Program (Copyright © 2018)

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Although most babies can hear normally, 2 to 3 of every 1,000 babies are born with some degree of hearing loss. Without newborn hearing screening, it can be difficult to detect hearing loss in the important first months and years of your baby's life.

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A little after Lane was born I was diagnosed with postpartum depression. It was very hard at first but it was more baby blues, but as time went on it turned into postpartum depression. 

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A little after Lane was born I was diagnosed with postpartum depression. It was very hard at first but it was more baby blues, but as time went on it turned into postpartum depression. 

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Asynchronous is something that became all too familiar to us at the beginning of Lane's life. It started to affect Lane because he wasn't getting the attachment from me that he needed from me, it was mainly coming from his dad. I just couldn't bring myself to do almost anything that means spending quality time with my new baby. I mainly just did the things that he absolutly needed and then didn't do much else for him.

# data[].attributes.subject
Asynchronous is something that became all too familiar to us at the beginning of Lane's life. It started to affect Lane because he wasn't getting the attachment from me that he needed from me, it was mainly coming from his dad. I just couldn't bring myself to do almost anything that means spending quality time with my new baby. I mainly just did the things that he absolutly needed and then didn't do much else for him.

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Postpartum Depression and Its Long-Term Effects on Children

Anyssa Garza, PharmD, BCMAS

Some women begin to feel anxious and depressed within a few days of giving birth. Many also experience crying spells for no clear reason, have trouble making decisions and sleeping, lose their appetite, and become angry at their newborn, other children, or significant other. These feelings, often referred to as the baby blues, typically last a few days to 2 weeks. 1,2 Affecting up to 80% of mothers, the baby blues are usually not severe enough to require treatment. ¹⁻³

On the other hand, postpartum depression involves intense feelings of anxiety, hopelessness, or sadness that last much longer, affecting the mother's day-to-day life. Women who have postpartum depression develop symptoms an average of 1 to 3 weeks after childbirth, but the onset can be anytime during the first year after childbirth. 1,2 Postpartum, or postnatal, depression is estimated to affect 10% of women in wealthier countries, and an even higher percentage in countries that are less wealthy. ⁴

RISK FACTORS
Some women are at a higher risk of developing postpartum depression. Women who experience depression during pregnancy tend to be at a greater risk of depression after giving birth. About 50% of women with postpartum depression experienced depression before or during pregnancy. 2,5 Other mental disorders during pregnancy, such as anxiety or obsessive-compulsive disorder, are associated with a higher risk of postpartum depression. Risk factors include a lack of emotional support; medical complications during childbirth, such as premature delivery; and mixed feelings about the pregnancy. 2,5

CAUSES
Although the cause of postpartum depression is not known, it is believed that hormonal changes may play a role. Connected to this is that researchers suspect that changes in 2 genes may play a role in increasing the risk of developing postpartum depression. This belief is supported by findings from a small 2013 study. These genes are thought to be involved in the activity of the hippocampus and appear to respond to estrogen.5 Estrogen comes into play because, during pregnancy, estrogen and progesterone levels increase, only to rapidly return to normal within 24 hours of childbirth. It is this rapid change in hormone levels that is thought to be related to postpartum depression. ⁵

EFFECT ON CHILDREN
Netsi et al looked at the long-term effects of persistent, severe postpartum depression and its effects on children. To evaluate the impact, the researchers used data from the British Avon Longitudinal Study of Parents and Children. 4,6 For details of the study, see the table. 4.6

Evidence suggests that both persistent and severe postpartum depression increase the risk of adverse outcomes in children. ⁴ Research has listed an association between postpartum depression and delayed cognitive and language development, disorganized or insecure attachment, higher rates of behavioral problems, and lower grades. In addition, there is a documented link between postpartum depression and higher rates of depression in children during the latter teen years (16 to 18 years old). ⁴

Women who met the criteria for moderate and severe postpartum depression at 2 months and at 8 months post delivery made up the most vulnerable group and were found to be more likely to experience depression 11 years later. ⁶

Myrna M. Weissman, PhD, analyzed the study, conducted by Netsi et al, and concluded that children born to women in the most vulnerable group have a 2-fold increased risk of having lower math scores at 16 years, a 4-fold greater risk of having behavioral problems between ages 3 and 4 years, and a 7-fold higher risk of depression at 18 years. 4,6 She said that these findings suggest extending the universal screening for depression in all pregnant women to screening beyond pregnancy, possibly up to a year after delivery and during baby wellness visits. ⁶

This study was not free of limitations. One was the high rate of attrition, which may have led to an underestimation of the proportion of women who experience persistent and severe postpartum depression. 4,6 Another was that the study could not determine the effects of treating postpartum depression using antidepressants or psychological treatment in the women and whether that reduced postpartum depression and improved child outcomes. 4,6

OTHER RESEARCH
Shen et al found that though maternal and paternal depression can negatively affect child development, the paternal effect is less compared with the maternal effect. ⁶ Another study found that reducing the symptoms of depression in a parent to remission can reduce adverse effects on the child. ⁶

IN THE NEWS
Sage Therapeutics said that brexanolone (formerly SAGE-547) achieved primary end points in 2 phase 3 clinical trials in moderate (Study 202C) and severe (Study 202B) postpartum depression. The primary end point was a mean reduction from baseline in the Hamilton Rating Scale for Depression total score at 60 hours. ⁷

Brexanolone is listed as an allosteric modulator of both synaptic and extrasynaptic GABAA receptors and is a proprietary formulation of allopregnanolone, a naturally occurring molecule that is known to modulate GABA receptor activity. ⁸ Its mechanism of action leads to varying degrees of desired activity versus complete receptor activation or inhibition. ⁷ Available in an intravenous formulation, brexanolone has been granted breakthrough therapy status by the FDA. ⁷ Sage is planning to file a new drug application with the FDA later this year for brexanolone and is seeking approval for its use in treating postpartum depression. Its plan is to bring brexanolone to the market in early 2019. ⁹
Anyssa Garza, PharmD, BCMAS, received her doctor of pharmacy degree from The University of Texas at Austin. She is the vice president of Content and Patient Education Programs at Digital Pharmacist and an adjunct assistant professor at The University of Texas at Austin College of Pharmacy.
References

1. American College of Obstetricians and Gynecologists. Postpartum depression. ACOG website. acog.org/Patients/FAQs/Postpartum-Depression. Published December 2013. Accessed April 21, 2018.

2. Office on Women's Health. Depression during and after pregnancy. Office on Women's Health website. womenshealth.gov/publications/our-publications/fact-sheet/ depression-pregnancy.html. Updated June 12, 2017. Accessed April 21, 2018.

3. National Institute of Mental Health. Postpartum depression facts. NIMH website. nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml. Accessed April 21, 2018.

4. Netsi E, Pearson RM, Murray L, Cooper P, Craske MG, Stein A. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry. 2018;75(3):247-253. doi: 10.1001/jamapsychiatry.2017.4363.

5. Postpartum depression. In: Longe JL, ed. The Gale Encyclopedia of Psychology. 3rd ed. Farmington Hills, MI: Gale; 2016:902-905.

6. Weissman MM. Postpartum depression and its long-term impact on children. many new questions. JAMA Psychiatry. 2018;75(3):227-228. doi: 10.1001/jamapsychiatry.2017.4265.

7. Sage Therapeutics announces brexanolone achieves primary endpoints in both phase 3 clinical trials in postpartum depression [news release]. Cambridge, MA: November 9, 2017. investor.sagerx.com/news-releases/news-release-details/sage-therapeutics-announces-brexanolone-achieves-primary. Accessed April 22, 2018.

8. Sage Therapeutics. Our programs. Sage website. sagerx.com/programs.php. Accessed April 22, 2018.

9. Keown A. Sage Therapeutics looks to file NDA for postpartum depression treatment later this year. BioSpace website. biospace.com/article/exclusive-sage- therapeutics-looks-to-file-nda-for-postpartum-depression-treatment-later-this-year/. Published January 12, 2018. Accessed April 22, 2018.

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Postpartum Depression and Its Long-Term Effects on Children

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Postpartum Depression and Its Long-Term Effects on Children Anyssa Garza, PharmD, BCMAS Some women begin to feel anxious and depressed within a few days of giving birth. Many also experience crying spells for no clear reason, have trouble making decisions and sleeping, lose their appetite, and become angry at their newborn, other children, or significant other.

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Getting to the place of synchrony was pretty easy after a while. I slowly started to get over the post partum depression on my own. I talked to a lot of people about my thoughts and feelings and it really helped with it. Me and Lane slowly got back into interacting and me being his number one care giver again, and always being in his life. After a few weeks of having no depression symptoms we were back to full synchrony, and he was developing normally. 

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Getting to the place of synchrony was pretty easy after a while. I slowly started to get over the post partum depression on my own. I talked to a lot of people about my thoughts and feelings and it really helped with it. Me and Lane slowly got back into interacting and me being his number one care giver again, and always being in his life. After a few weeks of having no depression symptoms we were back to full synchrony, and he was developing normally. 

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Early infant-caregiver interactions

Since Itard's description of the wild child [1], parent-child interactions and the social environment have been widely acknowledged as playing a central role in early developmental processes [2]. Aside from serving as a response to basic infant needs (e.g., feeding), the quality of parent-child relationship has been implicated in children's social, emotional and cognitive development for years [3], [4]. Studies have shown significant correlations between the quality of the parent-child relationship and children's developmental outcomes (e.g., social competence [5], [6] and emotion regulation [7]-[9]). As a consequence, dysregulation in parent-child interactions has been implicated in the development of children's problematic behaviors [9], [10]. Additionally, atypical parent-child interactions are suspected to provide initial evidence of pervasive developmental impairments, such as autism, among infants [11]-[14].

Aside from individual behaviors and characteristics, understanding parent-child interactions is at the heart of early childhood psychopathology. Perinatal clinicians and researchers have conducted experiments and developed theories about early parent-child interactions. Initial studies focused primarily on mother-infant interactions, however the role of father-child (or other caregiver-child) interactions is now widely accepted. Interactions between infants and their partners occur at three different levels: behavioral, affective, and fantasy [15]. The behavioral level is the level most often studied due to its experimental accessibility, however it is not a simple task to describe parent-child behavioral interactions because there are multiple modalities of interaction to explore and classify. First, the interactive partnership between an infant and caregiver (usually called a "dyad") has to be defined and explored as a single unit. Second, given that the relationship between an infant and his caregiver is bidirectional in nature, the dyad should be thought of as a dynamically interacting system [16]. An infant can influence the care he receives from the caregiver by the ways he behaves [17], [18]. Third, given the dynamic relationship between an infant and his caregiver, a specific interest in the flow characterizing the exchange of information during infant-caregiver interactions has emerged [19], [20], leading to the study of rhythm ( meaning balance between partners) [21]-[23], reciprocity ( meaning partners' ability to show adaptation to each other) [24], [25], and synchrony ( meaning the dynamic and reciprocal adaptation of the temporal structure of behaviors between interactive partners) [26]. The recent discovery of both biological correlates of behaviorally synchronic phenomena [27] and statistical learning [28], [29] has validated the crucial value of studying synchrony during child development [2], [26].

Synchrony

Synchrony is an important concept relevant to diverse domains in physical, biological and social science. The construct of synchrony has been applied to a range of phenomena, from the micro-level of cells, neurons, and genes [30], [31] and intermediate-level of interactive partners' brains [27], to the macro-level of population growth and weather change [32] in addition to the mental realm [33]. In the field of mother-child interactions, the dynamic and reciprocal adaptation of the temporal structure of behaviors between interactive partners defining synchrony implies the following [34]: (i) behaviors include verbal and non-verbal communicative and emotional behaviors (e.g., gestures, postures, facial displays, vocalizations, and gazes). (ii) Synchronous interactions entail coordination between partners and intermodality. Caregivers and their children are able to respond to each other using different modalities starting from birth [35], [36]. Thus, synchrony differs from mirroring or the chameleon effect. Instead, synchrony describes the intricate 'dance' that occurs during short, intense, playful interactions; it builds on familiarity with the partner's behavioral repertoire and interaction rhythms; and it depicts the underlying temporal structure of highly aroused moments of interpersonal exchange that are clearly separated from the stream of daily life [23], [25], [37]-[39].

Despite the similarities between synchrony and other established constructs in the mother-child relationship, synchrony is different in a number of meaningful ways. Synchrony encompasses both the mother's and the child's responsivity and their emotional capacity to respond each other. During early development, synchrony involves a matching of behavior, emotional states, and biological rhythms between parents and infants that together forms a single relational unit (dyad) [26]. Affiliative bonds, defined as selective and enduring attachments, are formed on the basis of multiple genetic, hormonal, brain, autonomic, epigenetic, behavioural, and mental processes that coordinate to establish the parent-infant bond [40]. Oxytocin, considered to be the bonding hormone, appears to enhance physiological and behavioral readiness for social engagement in parent-infant interactions [19]. Its biology is not fully elucidated but is, in part, related to epigenetic mechanisms. Oxytocin (OT) is synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. OT is released into both the peripheral circulation and the extracellular space, resulting not only in local action but also in diffusion through the brain to reach distant targets. OT receptors are localized in different areas including the amygdala, hippocampus, striatum, supra-chiasmatic nucleus, and brainstem. The fact that OT has peripheral and central functions does not imply that the central and peripheral release are necessarily associated [41].

Understanding the dynamics of mother-infant interactions and identifying synchronic patterns within mother-child dyads are important to promoting healthy relationships [42]. In typically developing children, the quality of social interactions depends on an active dialogue between the parent and the infant and is based on the infant's desire to be social and the parent's capacity to be attuned [43], [44]. Synchrony can therefore be defined as the temporal coordination of micro-level relational behaviors into patterned configurations that become internalized and serve to shape infant development over time and repeated experience [45]. Bernieri [46] proposed classifying definitions of synchrony that involve some notion of behavioral adjustment or entrainment to one another, into three categories. The first category is based on biological rhythms and defines synchrony as the degree of congruence between infant-caregiver behavioral cycles. The second category operationalizes synchrony as the quantity of simultaneous behaviors. The third category defines synchrony as a perceptual social phenomenon where the essential feature is the apparent unification of behavioral elements into a meaningful described "whole" (i.e., a synchronous event as a perceptual unit).

Originally conceptualized and studied by developmental psychologists, the concept of synchrony is now relevant to many different fields of study including social signal processing, robotics and machine learning [47], [48]. According to its conceptual framework, synchrony can be defined in many ways. However, Delaherche et al. [34] recently proposed that, in most cases, one should distinguish between what is assessed (i.e., modalities such as body movement, gaze, smile, and emotion) and how the temporal link between partners' different modalities of interaction are assessed (i.e., speed, simultaneity, smoothness). Therefore, synchrony has been measured in many different ways due to its broad range of theoretical applicability and has been applied to the study of parent-child interactions among both typically developing infants and clinical populations. In this study, we systematically review how the concept of synchrony has been defined in the study of early human interactions, limiting our review to studies involving infants and toddlers aged two months to 5 years and mothers, and what the associated main findings and contributions have been for understanding early child development.

Searching and selection of studies

An electronic search was undertaken, covering the following databases: ERIC; FRANCIS; MEDLINE; PASCAL; PsycARTICLES; PsycCRITIQUES; PsycEXTRA; Psychology and Behavioral Sciences Collections; and PsycINFO. This ensured that a range of psychology references with multiple theoretical background were included. We searched the literature for research articles published between 1977 and 2013 using the following key-words: " synchrony ", " mother-child " and " interaction ". All articles were peer-reviewed. We examined the mother-child dyad because this dyad type has been the most thoroughly examined with respect to synchrony. A diagram summarizing the literature search process is provided in . We used the following criteria: (1) studies investigating synchrony during mother child interaction; (2) studies using a specific tool for quantification of synchrony; (3) studies including children aged between 2 months and 5 years of age. (4) Finally, we excluded single case reports. Out of the 92 articles found through our initial search using criteria 1, 2 and 4, we selected 61 studies which included children aged between 2 months and 5 years of age. This age window was selected based on the following: (1) this age group represents a significant developmental period of communicative abilities with care-giver; (2) children greater than 2 months of age possess a greater capacity to respond with multiple modalities; and (3) this age group is awake for longer periods of time. We added 2 studies which were found by checking the reference lists of the selected studies. Several studies with mixed age samples (those including both children within our age inclusion criteria as well as infants younger than 2 months and/or children over 5 years of age) were excluded from our study. We also excluded 4 studies because synchrony did not appear relevant to the studies (e.g. not focused on synchrony, or theoretical) [45], [49]-[51]. Of note, we did not find other reviews sharing our goals.

Data extraction

A three-step process was undertaken to review the studies evaluating synchrony in caregiver-child interactions. All information was gathered in an electronic database. Two of the study co-authors (CL and SV) blindly extracted the study information. Disagreement between raters was examined, and final extraction was validated through consensus with a third co-author (DC, CA or MC). Each of the two study co-authors (CL and SV) first provided a general description of the articles and systematically extracted the following data: authors and year; study design (e.g., prospective; selected population); number of subjects/dyads; mothers' characteristics (age, socio-economic status, parity and ethnicity); children's mean age; assessment modalities (e.g., behavioral annotation); and main findings including those regarding synchrony. Second, we examined how synchrony was characterized in terms of definitions and terms used in each of the articles. This was done to better capture how synchrony was conceptualized by authors according to their theoretical background. Third, we systematically detailed how synchrony was assessed, differentiating between both the method of annotation used (e.g., specific grid) and computation (e.g., time-series analysis). Other information was extracted from each article to provide detail on assessment conditions: setting of interactions (place, duration, order, video recording) and measurement components.

General comments

Among the 63 studies selected for this review, we found that 84% of the articles focused solely on mother-child interactions. This is not surprising given our inclusion criteria. The number of dyads examined in the selected studies varied from 2 [52] to 153 [53] with a mean of approximately 50 dyads (mean (±SD)  = 49.2 (±36.29)). Children in the study had a mean age of approximately 1 year (mean (±SD)  = 15.67 (±18.01) months). Characteristics of the mothers were not always reported even for age or parity, two parameters that have been implicated in quality of parenting [15]. Among studies with exploitable data (n = 27), mean age was nearly 30 years (mean (±SD)  = 29.25 (±3.18) years). Most studies did not distinguish primiparous and multiparous women.

Regarding synchrony, about half of the articles (n = 31) focused primarily on synchrony or a similar concept such as reciprocity. The other half (n = 32) concerned mother-child interactions more globally: 20 of these studies included specific questions about synchrony in their methodology and 12 studies provided data detailing the extent to which child and caregiver were synchronized on specific behaviors in the results section. The characteristics of synchrony have been described in several previous works ([54], [55]; see introduction section); we found several definitions of for synchrony which did not always use the same words and which seemed to vary mainly with respect to the theoretical framework of the authors (e.g., cognitive psychology, developmental psychology, psychoanalysis, interaction and engineering). Our reading of the literature indicated that synchrony includes the following components: (1) A dyad: an interactive unit/system; (2) Mutuality: the partners are mutually regulated; (3) Reciprocity: the partners show reciprocity, adaptation, flexibility, and conformity to each other; (4) Rhythmicity: the partners maintain balance in the system; (5) Harmonious interaction: mother and infant frequently share or experience similar behavioral states and affect; and (6) Maintained engagement: the partners experience prolonged social engagement characterized by mutual attention and turn-taking. Reciprocity, a widely operational construct in clinical field, has a large overlap with the concept of synchrony. The main difference applies to the time scale. Reciprocity implicates by definition a large time scale, whereas synchrony can be applied to both macro and micro time scale (see below).

Synchrony has been studied in two different settings: laboratories and natural settings (2/3 vs. 1/3 of the studies, respectively). In most of the cases, interactions were video-recorded. The mean duration of interactions was 11 (±13.13) minutes. The most common types of interactions were (in decreasing order): free play (n = 36), daily routines (n = 10), structured tasks (e.g., specific order) (n = 9), and experimental settings (e.g., still-face) (n = 7). For the studies that indicated a time-frame (n = 38), two primary time scales were used: 10-seconds (n = 10) and 1-second (n = 10).

To simplify the overall presentation of the literature on synchrony, we first summarize synchrony measurement methods. We distinguished three categories of measurement: (1) global interaction scales; (2) synchrony scales; and (3) micro-coded time-series analyses. In the following two sections, we divided the articles according to the targeted population: 39 articles examined early interactions in typically developing populations, whereas 23 articles examined early interactions in clinical populations.

Synchrony measurement methods

During the last twenty years, there have been several attempts to measure synchrony during early parent-child interactions using an operational coding system (). We propose distinguishing between synchrony assessment methods as follows:

Global interaction scales include 9 instruments that assess infant and mother behaviors during interactions and include dyadic parameters. The following 4 scales integrate dyadic items: the Coding Interactive Behavior (CIB) scale ([5] French translated version by [56]); the Qualitative Ratings for Parent-Child Interaction scale [57], [58]; the Coding System for Mother-child Interactions (CMSCI)[59]; and the NCAST Feeding and Teaching PCI Scales. This last instrument was used by Keefe [60] to observe and score maternal-infant synchrony on behaviors associated with feeding. These 4 scales give information about the quality of dyadic interactions, but do not directly refer to "synchrony". In contrast, the following two scales use the term "synchrony" but vary in their method of assessment: the eight-scale CIB parent-infant synchrony[61] and the Belsky Parent-Child Interaction Coding System[53] (modified version [62]). Contrary to the quality score given by Abraham's eight-scale CIB, scores on Belsky's scale are assigned based on the frequency and intensity of verbal and nonverbal behaviors. Then, appropriate sequential behaviors between partners are coded as synchronous or asynchronous according to the details of the interaction [63], [64]. The last three scales from the global interaction group assess engagement, involvement, mutual synchrony, and shared states and apply a statistical measure to each partner's results. These three scales include: the Infant Caregiver Engagement (ICE) scale [65]; the Rating Scale of Interactional Style (RSIS)[66] (modified version [67]); and (3) the Behavior State Coding scale [68].

Global interaction scales were used in a variety of observational settings and among children of various ages. Free-play was the most common setting used to observe interactions. The NCAST used a teaching moment procedure while the ICE used a still-face procedure. The CIB and the NCAST can be used to observe feeding, and the Belsky scale can be used in the observation of a daily routine, such as bathing. Global scales included in this review assessed children from birth (CIB) to 48 months (CMSCI) of age.

1. Synchrony scales include various assessment designs. Despite being global scales, they differ from the previous ones by being their core focus on synchrony and the absence of subscores regarding each partner's behaviors. Eight global rating systems assign a global score to the parent-child dyad. Bernieri's Scale[46] and the Synchrony Global Coding System[69] are based on coders' perceptions and judgments of synchrony and are supplemented by item definitions. These two scales treat synchrony as a global concept. After viewing the entire interaction session, the assessment of synchrony is determined by coders' clinical judgments. Video sessions can also be split into several units, based on listed behaviors or time-sampling. Scores are then compiled or averaged to provide an overall assessment of synchrony. This is the case for the Dyadic Mutuality Code (DMC)[70], The Taxonomy of Interactional Synchrony[71], the Coding Scheme[72] (adapted version [73]), and The Rocissano and Yatchmink Taxonomy[74]. The last scale, the Maternal-Infant Synchrony Scale (MISS)[75] is an observational assessment tool designed to assess synchrony during parent-child feeding interactions by investigating the similar concept of engagement.

2. Micro-coded time-series analyses are methods based mainly on statistical approaches. The most commonly used method of measuring synchrony involves frequency counts of infant and maternal behaviors. Coders use a list of pre-determined behaviors and divide mother-infant observations into brief units of time for assessment. The Monadic Phase Manual proposes quantifying maternal and child behaviors by first annotating the videos and then cross-correlating two corresponding time-series to determine the degree of coherence between the two. Maternal synchrony is indicated by the presence of a positive lead-lag between the mother's and infant's time-series [76], [77], or by a correlation between the second-by-second affective state codes given to infants and mothers [78]. Coding is generally assisted by a software system such as The Observer or Elan. Mother-infant synchrony is quantified by the first-order correlation between mother-infant targeted behaviors for every few seconds of interaction [79]. Synchrony may also be assessed by calculating proportions, frequencies, mean durations and latencies of specific relational behaviors [45], [80] or by measuring the correlation between partners' behaviors [81]. Another proposal was to measure synchrony as the percentage of time during which the mother and infant looked at each other's head simultaneously [82]. An example of a frequency score is summing the number of attempts a mother and child make to engage to each other. Similarly, Isabella [83] gathered information on the frequency of a more limited set of maternal, infant and dyadic behaviors by observing mother-infant interactions over successive 15-second intervals. To assess the mean duration of synchrony, Gratier [84] analyzed acoustic segments of interaction. A spectrogram - a visual representation of an acoustic signal - and pitch plot provided information regarding onset, end time, and duration of vocalizations and periods of silence between them; energy; loudness; and the pitch of acoustic signals. Groups of vocalizations bounded by pauses lasting more than 500 milliseconds were called "phrase units". Expressive timing refers to the degree of variation from a strictly regular "pulse" or "beat". Interactions were coded as "interactional synchrony" when vocalizations occurred simultaneously (overlap), were successive (turn-taking) or were imitative, with respect to matching pitch and rhythm.

Studies investigating synchrony in normal populations

summarizes the main characteristics and findings for the studies investigating synchrony during early parent-child interactions in normal populations. Articles were sorted into 6 categories: validation of synchrony assessment tools (n = 6); variation in age and gender (n = 7); variation between parents (n = 6); micro-interest (synchrony is observed for a specific behavioral modality; n = 12); associations with physiological data (n = 5); and other (n = 3).

The main results can be summarized as follows: (1) Synchrony during early mother-child interactions has neurophysiological correlates [85] as evidenced though the study of vagal tone [78], cortisol levels [80], and skin conductance [79]; (2) Synchrony impacts infant's cognitive processing [64], school adjustment [86], learning of word-object relations [87], naming of object wholes more than object parts [88]; and IQ [67], [89]; (3) Synchrony is correlated with and/or predicts better adaptation overall (e.g., the capacity for empathy in adolescence [89]; symbolic play and internal state speech [77]; the relation between mind-related comments and attachment security [90], [91]; and mutual initiation and mutual compliance [74], [92]); (3) Lack of synchrony is related to at risk individuals and/or temperamental difficulties such as home observation in identifying problem dyads [93], as well as mother-reported internalizing behaviors [94]; (4) Synchrony has been observable within several behavioral or sensorial modalities: smile strength and eye constriction [52]; tonal and temporal analysis of vocal interactions [95] (although, the association between vocal interactions and synchrony differs between immigrant (lower synchrony) and non-immigrant groups [84]); mutual gaze [96]; and coordinated movements [37]; (5) Each partner (including the infant) appears to play a role in restoring synchrony during interactions: children have coping behaviors for repairing interactive mismatches [97]; and infants are able to communicate intent and to respond to the intent expressed by the mother at the age of 2 months [98]. Additionally, children are sensitive to synchronous parental behaviors such as maternal synchronous turn-taking and giving of instructions [74]; and (6) Synchrony also depends on parental characteristics and/or skills such as maternal sensitivity [64], [99]. Although synchrony shows similar patterns within the mother and father dyadic contexts, father-child interactions (compared to mother-child interactions) exhibit less synchrony in the triadic context [71]. Moreover, no inherent differences are found in the parental caregiving context as a function of the parent's sexual orientation [61]. In general, same-gender parent-infant dyads seem to experience more synchrony [76], however one paper found that mother-daughter dyads spend less time in coordinated states compared to mother-son dyads [37]. Mothers interacting with an unfamiliar child show less synchrony [46]. Lower parent-infant synchrony was observed among triplets compared to twins or singletons [100]. Finally, it appears that synchrony is not an uninterrupted process, as changes in synchrony occur over time [51]. Yet, even if dyads increase in their degree of coordination over time, the proportion of time they are synchronous remains small. These results suggest that interactions may be characterized both in terms of movement from coordinated to uncoordinated states as well as the degree of coordination during interactions [37].

Studies investigating synchrony in clinical populations

summarizes the main characteristics and findings of the studies investigating synchrony during early parent-child interactions in clinical populations (n = 33). We found 12 studies investigating infant psychopathology or developmental impairments, 6 studies comparing mother-child interactions among normal control mothers compared to mothers presenting with a mental or medical condition, and 5 studies investigating the subtypes of child attachment styles.

The main study objectives were to describe and/or evaluate parent-child interactions through micro-interest or validation of synchrony assessment tools; to compare the quality of interactions according to infants' characteristics: term vs. pre-term or typical development vs. pathology (aggressive behavior; ADHD; Down syndrome; autism); and to compare the quality of interactions among parents experiencing pathology (depression; psychosis) vs. healthy controls.

The main results can be summarized as follows: (1) Among children with externalizing behaviors, synchrony is associated with the level of child functioning and plays a protective role in the development of ADHD [59]; the association between externalizing behaviors and synchrony is not gender dependent [59]. Lower levels of synchrony were found during early interactions among parent-child dyads with children who had higher levels of parent-rated physical aggression [101] and infant irritability [60]; (2) Among pre-term infants, authors found lower coherence during interactions led by the infants [102], less mother and infant responsivity [81] and shorter episodes of gaze synchrony [103]. Additionally, lower cognitive abilities were correlated with lower levels of synchrony [104]; (3) Whereas no differences in synchrony were found during early parent-child interactions among children with Down syndrome compared to typically developing children [105], synchrony was lower among children with autism [106]. Participation in a nursery program was shown to improve synchrony among parent-child dyads where the child had autism [107]; (4) Among high-risk, low-income, toddler boys, synchrony was positively associated with maternal nurturance and language skills, and negatively associated with child emotional negativity [69]. First-time mothers who engaged in a therapeutic program evinced higher levels of synchrony [108]; (5) Studies with depressed mothers found that more negative and less positive affective behaviors were shared during mother-infant interactions [68], a trend which corresponded with less synchrony/coherence [109]. Males with depressed mothers appeared to be more vulnerable than females with depressed mothers [110]. Additionally, with respect to vocalizations, depressed mothers were less responsive and predictable [111]. As with depressed mothers, authors found less synchronous parent-child interactions among psychotic mothers [63]; and (6) In terms of attachment styles, synchrony during interactions (high vs. low) predicted children's profiles (secure vs. insecure) [53], [83]. Synchrony was also related to the quality of maternal representations of attachment relationships [109].

Summarizing the results

Whatever the assessment method, it appears that synchrony should be regarded as a social signal per se as it has been shown to be a valid concept in both normal and pathological populations. Better mother-child synchrony is associated with familiarity (vs. unknown partner), a healthy mother (vs. pathological mother), typical development (vs. psychopathological development), and more positive child cognitive and behavioral outcomes. Within normal populations, studies have shown that synchrony varies developmentally, mirroring children's communicative abilities that allow them to be increasingly interactive with their first caregivers and others [67], [88], [97], [112], [113]. During the first year of life, synchrony is often intermodal, characterized by a mother's voice and a child's movements, for example. As children get older, synchrony may be characterized by more symmetric modalities, increased child initiation and turn-taking. A synchronous interaction may not be interpreted as a perfect symmetric timing exchange. Breaks and variations are important to improving adaptation, creativity and stimulation.

Synchrony is also a criterion for distinguishing between normal and pathologic interactions. In the case of maternal pathologies that have been extensively investigated (e.g., depression), mother-child interactions demonstrate lower levels of synchrony [110], [114]. More generally, interactions are poorer each time one of the partners is impeded by internal (pathological) or environmental distractor. As such, parent-child interaction may be poorer when maternal sensitivity and empathy is impeded (i.e., during maternal depression) or when child pathology does not permit a child to answer his mother. From the view of studying synchrony, it appears that there is an interest in studying clinical populations, not with respect to specific symptomatology, but rather more broadly as an indicator of a maternal or child trait that may signal a reduced capacity to be interactive. Synchrony is not an all or nothing concept; rather, it may be more valid to think about dyadic interactions as approaching or moving away from synchrony [3]. Additionally, all studies that focus on child development demonstrate a link between synchrony and attachment, on one hand [83], and child cognitive and behavioral development, on the other [26], [89].

Limitations

Given our study design focusing on synchrony in the context of early interaction, the current review cannot be considered as an exhaustive review. We decided to focus on mother-child because this dyad has been the most closely examined for synchrony. Interacting studies relative to synchrony may not be reviewed by our methodology. However, because of our inclusion criteria some interesting studies about specific dyad [115]-[117] were not included. Additionally, given the number of concepts close to synchrony, we had to limit them to keep focusing on synchrony only. In consequence, the Care-index [118] was not included in our review, even if it proved its validation. The Care-index is a qualitative scale that has been used widely. However, it does not allow synchrony assessment and rather gives affective tone of the interaction, interactive style and strategies of each partner. It is especially based on turn-taking.

Also, interpretation of the studies may be related to inerrant limitations of the different methods that were used. First, as exposed in the synchrony measurement section and discussed in section 4.3, many scales were not properly validated. Second, one major difficulty in measuring synchrony is identifying and defining critical behaviors that are specific enough to capture the variations in individual behavior yet broad enough to account for maturational changes. Some behavior can be considered positive or negative depending on the frequency of occurrence [3]. Third, another difficulty is to determine interaction rhythm and to order initiations and break out. The video recording of mother-infant interaction poses certain technical challenges. The angle of the camera has to be set so that the mother and infant could be seen clearly. Behaviors may have changed due to the influence by the observation camera and the chosen setting [51]. Fourth, besides definition of synchrony construct and quality of clinical tools and recording, a striking observation is that many studies neglected to properly describe and take into account mother characteristics such as age, parity, socio-economic status or ethnicity (see and ). Future studies should improve mother characteristics reporting.

Finally, given the heterogeneity of the studies' definitions and methods, we cannot exclude that our review methods based on consensus may introduced biases in the result synthesis. We consider this work as a starting point for fruitful discussion among the field and across disciplines.

Comments on definition and assessment methods

The main objectives of the present review were to understand how synchrony in early mother-child interactions has been defined and measured in the literature and to determine which contributions the concept of synchrony increase our understanding of the nature of mother-child interactions. The results revealed differences in the theoretical backgrounds and the methodological assessments used to study synchrony. We distinguished three different types of assessment tools. The first type are global interaction scales which include a dyadic assessment (sometimes clearly called synchrony) and provide a global and qualitative description of interaction. The second type are specific synchrony scales. Some synchrony scales are specifically constructed for one study and therefore were not externally validated (e.g. [69]). Some synchrony scales are global and qualitative while others are constructed with listed behaviors which allow for the assessment of synchrony using statistical measurements (e.g., frequency, duration, co-occurrence). Similar to the global scales, the specific scales do not always use the term synchrony in the assessment tool. The third type of assessment tool includes evaluation and statistical tools which describe synchrony on specific behaviors and focus on the temporal component of parent-child interactions. In sum, it appears that the lack of common evaluation methods in the study of synchrony may introduce bias in the interpretation and comparison of study results between studies.

Studies investigating synchrony in early interactions include closed concepts such as reciprocity [23], [53], [101], [119], [120], shared affect [23], [121], attunement or mutuality [70], [79], [98], rhythmicity [83], [84], [86], [102], [122], harmonious interaction [121], [123], [124] and maintained engagement [82], [97]. These components appear to be relevant to the assessment of synchrony. However, examination of the dyad system and its associated interactional behaviors along with temporal patterns may be the most relevant way to measure synchrony. Yet, the challenge of finding an objective and shared method of measuring synchrony remains. The measurement of synchrony should not be dependent on the number of parent-child interactions but rather on the number of interaction attempts compared to successes. Moreover, an effective measure of synchrony should differentiate between initiated behavior and response behavior [11]. Even if the method is grounded by specific behaviors, what remains important is the sequence or pattern of these behaviors and their relationship to each other within the dyadic exchange [51]. A useful measure of synchrony should also control for any bias on the part of the observer. Moreover, it should allow for individual differences. It is important to refer to a synchronous interaction rather than a synchronous relationship, because the observable patterns of dyadic interactions provide a "window" to the social relationship of the interacting partners [72], [125]-[127]. The number of concepts related to synchrony further suggests that interactions may be best characterized in terms of their movement from coordinated to uncoordinated states rather than solely in terms of their degree of coordination during interactions [37]. We can therefore define synchrony, inspired by Delaherche [34], as the dynamic and reciprocal adaptation of the temporal structure of behaviors and the sharing of affect between interactive partners.

Proposals to improve assessment methods

Synchrony is a complex phenomenon requiring the perception and integration of multimodal communicative signals. It has not only been investigated in the field of early parent-child interactions and developmental psychology but also in the fields of social psychology, neuroscience [27], engineering, and robotics [34], [47]. We propose that combining several approaches within a multidisciplinary perspective at the intersection of social signal processing, computational neuroscience, developmental psychology and child psychiatry may efficiently address some of the challenges faced in better understanding synchrony in terms of its neurophysiological and psychological correlates [48]. By providing automatic, detailed and objective measures of multimodal socio-emotional behaviors, we believe that our proposal will become a valuable tool for examining early language, emotional and social interactions in both normal and clinical populations.

In the field of autism spectrum disorders (ASDs), we already applied this approach with some novel findings. When studying home movies with computational methods combined with behavioral annotation and temporal synchrony, we demonstrated the following: (1) infants who will develop autism could be differentiated from both infants with intellectual disabilities and typically developing (TD) children as early as the first year of life [11]; (2) parents adapted the way they interacted with infants who will develop autism by being more supportive and by using more parentese [13], [128]; (3) fathers of infants developing autism spoke to their infants more than fathers of TD infants during the 12-18 months period [13]. To conduct these studies, we first developed an automatic computerized tool to differentiate parentese vs. normal speech [129]. Other studies using a prospective approach in at risk samples also found results highlighting the importance of emotional synchrony and caregiver adaptation to infant lack of inter subjective behaviors when developing autism. Recently, the British Autism Study of Infants' Siblings reported that early dyadic interaction between at-risk infants and their parents was associated with later diagnosis of autism [14]. Also, in infants with West syndrome (an early onset epileptic encephalopathy with high risk of autism during outcome), the lack of synchronic interaction during the first year of life predicted those who will develop autism and intellectual disability [130]. Together, with the studies summarized above [106], [107], all these evidences suggest that impaired parent-infant interaction during the first year of life may be an early marker of autism.

Aside from natural settings (e.g., home movies), this approach can also be applied in the laboratory as well as more experimental settings. By studying motion with computational methods, Weisman et al. [131] showed that oxytocin shaped parental motion during early infant-parent interactions. Similarly, using a specific algorithm for speech turn tracking (STT) during a still-face experiment with typically developing infants, Weisman et al. [132] found the following: (i) infant vocalization and STT were key social cues used to regulate interactions during still-face and during reunions after still-face, with infant vocalizations leading interaction dynamics; (ii) father pause (more so than father vocalization or fatherese) was the main adaptive behavior for fathers after still-face; (iii) oxytocin did not modulate infant STT or father STT/fatherese; (iv) however, salivary cortisol increased after still face confirming the stressful contribution of the experiment.

Computational methods can also be suitable for studying emotional communication [133]. Messinger [134] applied machine-learning to face-to-face interaction to explore the predictability of infant and mother smiles. The results measuring facial action [52] showed that (1) infant and mother smile activity exhibited changing (non-stationary) local patterns of association, suggesting the dyadic repair and dissolution of states of affective synchrony and (2) the duration of gazes at and away from the mother's face were positively predicted by the durations of the two previous gazes [135]. Together, results revealed that infants exhibit distinct and temporally stable levels of interest in social and non-social features of the environment.

In the context of an ongoing treatment study for neglected mothers ( http://synedpsy.isir.upmc.fr/), we propose to study early interactions in synchronous and dyssynchronous dyads with a similar multidisciplinary approach using social signal processing. The parent and child will be video-recorded during free-play at baseline, after 6 months of treatment and at 1 year follow-up. The video recording of the free-play interaction will be coded with several computational tools able to measure motherese [129], speech turn-taking [132], joint attention [136] and movement coordination through skeleton extraction from a RGB-D sensor (Kinect) [137]. In parallel, clinical assessment tools including the CIB will be utilized to provide a global and valid assessment of synchrony. Components such as 0-3 diagnosis, social support or maternal insightfulness will also be assessed.

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Why Synchrony Matters during Mother-Child Interactions: A Systematic Review

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Since Itard's description of the wild child [1], parent-child interactions and the social environment have been widely acknowledged as playing a central role in early developmental processes [2]. Aside from serving as a response to basic infant needs (e.g., feeding), the quality of parent-child relationship has been implicated in children's social, emotional and cognitive development for years [3], [4].

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We personally feel like because of the asynchrony that we had early on he was delayed a little like we talked about with his hearing but luckily things worked out in the end and they weren't that bad overall. I feel like if it had lasted any longer there could have been lifetime effects on it. Since we got to such a good place so fast after we were able to connect and build the relationship between son and mom.

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We personally feel like because of the asynchrony that we had early on he was delayed a little like we talked about with his hearing but luckily things worked out in the end and they weren't that bad overall. I feel like if it had lasted any longer there could have been lifetime effects on it. Since we got to such a good place so fast after we were able to connect and build the relationship between son and mom.

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Over the years watching Lanes physical capabilities over the years has made me so proud of him. He has grown, and now is able to do so much from when he was just a little baby to one year old. I will be describing each year mark he's had, and how his capabilities have grown with him.

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Over the years watching Lanes physical capabilities over the years has made me so proud of him. He has grown, and now is able to do so much from when he was just a little baby to one year old. I will be describing each year mark he's had, and how his capabilities have grown with him.

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Age 2-3: This was one of Lane's most "interesting" stages. Terrible two's are a very real thing. Lane started running all throughout the house, he must have just found his marathon legs, and once and starts going there is no stopping him. In the book it says that their frontal cortex is really starting to develop and it will only continue to grow for many more years. The brain is "present and functioning" according to the book by the age of 2. Specifically, when they are this age their memory, and learning skills are kicking in so they remember a lot of things, good and bad. He mimics us walking up and down the steps or saying certain words. We really had to start baby proofing the house because he gets into everything. Their brains are maturing and they are taking everything in, they are very curious about the world around them at this age. By the age of 3 we learned that most of the time the brain is at about 80% of the adult weight it will be. He is picking up everything in the world around him. 

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Age 2-3: This was one of Lane's most "interesting" stages. Terrible two's are a very real thing. Lane started running all throughout the house, he must have just found his marathon legs, and once and starts going there is no stopping him. In the book it says that their frontal cortex is really starting to develop and it will only continue to grow for many more years. The brain is "present and functioning" according to the book by the age of 2. Specifically, when they are this age their memory, and learning skills are kicking in so they remember a lot of things, good and bad. He mimics us walking up and down the steps or saying certain words. We really had to start baby proofing the house because he gets into everything. Their brains are maturing and they are taking everything in, they are very curious about the world around them at this age. By the age of 3 we learned that most of the time the brain is at about 80% of the adult weight it will be. He is picking up everything in the world around him. 

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Cow & Gate™ Pregnancy, Baby Advice, Weaning | Join C&G baby club

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Your toddler's emotional and brain development from 2-3 years - C&G baby club

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Advice from C&G baby club about your toddler's emotional and brain development between 2-3 years. Read about how your toddler is learning, what milestones to expect and which foods are important for healthy brain development.

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Age 3-4: At this age Lane is trying to be as independent as he can. He wakes up every morning and wants to dress himself, "Mama I do" is his favorite phrase, and he even if he does it wrong he still wants to do it. He wants to make his own breakfast and he has really gotten good at eating by himself and using his silverware instead of his hands. At this age their brain is starting to recognize their environment around them. Places that they go to often are familiar, they can say the names of people that the see on a regular basis. The neuro processing of the brain at this time is working harder than someone who is in their 20's. 77% of the neurons are in the cerebral cortex at this time. The cerebral cortex controls language, memory, and attention so those are still developing in a child this age. So many things, and a lot of new information is flooding the Childs brain which can cause an overload leading to meltdowns, tears, anger, and all the yelling. 

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Age 3-4: At this age Lane is trying to be as independent as he can. He wakes up every morning and wants to dress himself, "Mama I do" is his favorite phrase, and he even if he does it wrong he still wants to do it. He wants to make his own breakfast and he has really gotten good at eating by himself and using his silverware instead of his hands. At this age their brain is starting to recognize their environment around them. Places that they go to often are familiar, they can say the names of people that the see on a regular basis. The neuro processing of the brain at this time is working harder than someone who is in their 20's. 77% of the neurons are in the cerebral cortex at this time. The cerebral cortex controls language, memory, and attention so those are still developing in a child this age. So many things, and a lot of new information is flooding the Childs brain which can cause an overload leading to meltdowns, tears, anger, and all the yelling. 

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Good news, parents. If this sound eerily like your preschooler, don't fret. Neuroscientists do not regard the shrieking lamentation as proof that your child is a "spoiled brat." A more accurate definition of the garden-variety tantrum is that the preschooler's still-developing brain is overwhelmed by mental demands.

In other words, it is part and parcel of their cognitive stage.

The grey matter of three to five year olds is a rapidly-growing, dynamic, fluid, spontaneous, amazing work-in-progress that is . . . still quite unreasonable. We can't ask preschool children to "think" like mature adults and we'll actually delay development of their intelligence if we stress them out with unrealistic expectations.

Let's dive deep into the preschooler's skull and see what is biologically happening . . . Yikes! Whooa! Slow down! The neurological processing in the three-to-five-year old's brain is twice as busy as that of a college student, and perhaps three times busier than an adult's. A preschooler has 100 billion brain cells (neurons), with 77 percent in the cerebral cortex - the territory that handles language, math, memory, attention, and complex problem solving. The neurons are forming connections via their dendrites, skinny octopus arms that slither out to receive information from up to potentially 15,000 other cells, and axons - which transmit information from neurons to other cells. The connections between neurons - called synapses - eventually total up between 1,000 trillion (estimates vary).

The result of this massive mental exertion? Raging typhoons of bewildering data storm and flood the preschooler's brain. Dikes break, emotions are swamped, tears cascade, screams explode. We all wept like preschoolers when we were in the same overloaded circumstances. Although we've forgotten our own meltdowns, we can help our children survive and thrive in this astonishing epoch of brain growth. Start by following these brain-booster guidelines.

Activate their minds

A youth human brain is a chaotic jungle of neurons getting "wired" together into intricate circuitry patterns. Early experiences have an enormous influence on children's absorbent sponge-like brains and also strongly affect the way they mature. By providing everyday activities that arouse your child's curiosity, you're helping to create neural pathways that will increase their learning efficiency and capacity. Expose your preschooler to a variety of stimuli and allow your child hands-on interaction with three-dimensional materials. Cooking, finger-painting, clay construction, musical instruments, and going to festivals, petting zoos, museums, tide pools, concerts, and outdoor natural areas are all sensory-rich activities.

Be gentle

Children need to feel safe and confident. Stanford University research indicates that traumatic stress and fear can release toxic levels of the hormone cortisol, which can destroy neurons in the hippocampus, a region that supports factual and episodic memory. You can minimize stress by giving your child positive, loving, sensitive, and encouraging feedback. Keep reprimands and threats to a minimum, avoid unnecessary power struggles, and shouting or spanking in discipline. Also, be patient about bedwetting, be sympathetic about fear of nightmares, the dark, and thunder-and-lighting storms, and allow your child to have a security object like a cozy blanket or a stuffed toy.

Chatter time

Preschool is prime time for auditory brain development. Supporting your child's hearing and speaking helps construct strong neural circuitry for absorption of more language acquisition. Ideally, talk, sing, and read to your child in a voice that varies in pitch and rhythm and emphasizes important words. (If we mumble in a flat drone your child will get bored and not focus.) Try to ask open-ended questions that initiate thinking, explain "how things work," use high-level vocabulary, and regularly include your child in conversations that will help expand their vocabulary. Protect your child's hearing by treating ear infections promptly, and encourage her to "use her words" instead of throwing tantrums. Preschool is also an ideal time to introduce a second language since the young, "plastic" brain absorbs language quickly.

Social graces

If possible, enroll your child in a quality preschool or schedule regular play dates with friends. Encourage your child's fantasy play with friends - "pretend" games develop the brain's verbal zones and enhance social skills in sharing, communication, and conflict resolution. Allow your child to have "imaginary friends" for the same reason, but remember, preschoolers have difficulty separating reality from make-believe, so don't call them "liars" if they insist that their stories are "true."

Focus and the preschooler's brain

A three- to five-year-old child might pay attention for five to 10 minutes, at best. Demanding sustained concentration on a task will frustrate both of you, but you can help your child improve his brain's working memory via games and activities that demand attention control. Recommended are checkers, tic-tac-toe, Candy Land, Chutes 'N' Ladders, age-appropriate puzzles, and concentration - the card game in which you flip over face-down cards and try to match pairs. Praise your child for hard work, and model self-control in your own behavior.

Categorize the world

By the age of four, many circuits in the brain's cortex are formed for math and logic. To develop this center, encourage your child to compare, collect, and label objects and events in the world that she's curious about. Do counting games, and teach the methods of classification, like big/little, long/short, shapes, colors, weight, height, and temperature.

Digest this

For optimal brain growth, feed your child a balanced, nutritious variety of vegetables, fruit, whole grains, dairy, and meat. Perfect brain food includes egg yolk, fatty meat, and soybeans contain choline, the building block for the neurotransmitter acetylocholine, which is crucial in memory function. It's also crucial to limit their intake of candy, cookies, fruit juice, and sugary, and salty junk food that is only "empty calories" devoid of essential nutrition. A recent Bristol University study indicated that young children fed junk food developed IQs up to five points lower than healthy eaters, because they consumed insufficient vitamins and minerals for optimal brain growth. Learn more tips on great brain food for your child.

Body building

Ideally, young kids should get at least 30 minutes a day to run and play outside. John Ratey MD, author of Spark, calls exercise "Miracle-Gro for the brain" because it elevates neurotransmitters and stimulates neuron growth. Swings, rocking toys, and spinning equipment are developmentally productive by stimulating different parts of the brain at the same time; building new pathways; and enhancing learning potential, spatial awareness, and rhythm. Full-body sports like soccer, swimming, yoga, gymnastics and dance are also valuable brain-building exercises.

Rare TV

An article published in the journal Pediatrics by University of Washington researchers concluded, "early television exposure is associated with attentional problems . . . efforts to limit television viewing in early childhood may be warranted." Deleterious results can be hyperactivity and shortened attention spans. Avoid this by limiting TV to one hour per day, and don't enroll in preschools that place kids in front of a screen. Positive programs can be found on National Geographic, Discovery Channel, and many short, easily-absorbed clips on YouTube.
More resources:
Your Child's Growing Mind: Brain Development and Learning From Birth to Adolescence, by Jane M. Healy, Ph.D
Intelligence and How to Get It, by Richard E. Nisbett
Help Your Preschooler Build a Better Brain: Early Learning Activities for 2-6 Year Old Children, by John Bowman
Seven Times Smarter: 50 Activities, Games, and Projects to Develop the Seven Intelligences of Your Child, by Laurel Schmidt
Updated: September 18, 2019

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Inside the preschooler's brain | Parenting

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Good news, parents. If this sound eerily like your preschooler, don't fret. Neuroscientists do not regard the shrieking lamentation as proof that your child is a "spoiled brat." A more accurate definition of the garden-variety tantrum is that the preschooler's still-developing brain is overwhelmed by mental demands.

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Age 4-5: Lane went from being able to barely brush his teeth by himself to now bathing all by himself with little to no help. He traces shapes and writes letters, he loves to read words on cards and little books as well. During this time in his life the brain is reaching close to 90% of the weight his adult brain will be. He is retaining things well and using big words that he picks up on. Just because he has all of the  brain cells he will need when he is born doesn't mean he has all the connections. That is why his brain is learning things everyday because his connections are forming to the brain cells, and developing every single day. The sooner these are made the better, because once  they get out of the early stages of life it is a lot harder to form new connections. 

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Age 4-5: Lane went from being able to barely brush his teeth by himself to now bathing all by himself with little to no help. He traces shapes and writes letters, he loves to read words on cards and little books as well. During this time in his life the brain is reaching close to 90% of the weight his adult brain will be. He is retaining things well and using big words that he picks up on. Just because he has all of the  brain cells he will need when he is born doesn't mean he has all the connections. That is why his brain is learning things everyday because his connections are forming to the brain cells, and developing every single day. The sooner these are made the better, because once  they get out of the early stages of life it is a lot harder to form new connections. 

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Age 5-6: Now Lane is as independent as he can be. He gets up, gets dressed, brushes his teeth, and ties his own shoes. His favorite thing now is baseball he loves playing catch, and running around. He wants to be like the ones he sees on T.V. so bad. His brain is now making social skills with the kids from school and his leaders, and he is also emotionally developing too. He is learning how to control when he gets angry or upset, or when he gets too excited and jumps around the room. He is learning to contain it all now. The fine motor skills in the brain are taking off and most of the things they couldn't do before like brushing teeth, tie shoes, and using scissors are all things that the childing is doing really well. This is the end of the significant maturity in the prefrontal cortex and things will start to slow down but for the next few years will still be developing at a high rate. 

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Age 5-6: Now Lane is as independent as he can be. He gets up, gets dressed, brushes his teeth, and ties his own shoes. His favorite thing now is baseball he loves playing catch, and running around. He wants to be like the ones he sees on T.V. so bad. His brain is now making social skills with the kids from school and his leaders, and he is also emotionally developing too. He is learning how to control when he gets angry or upset, or when he gets too excited and jumps around the room. He is learning to contain it all now. The fine motor skills in the brain are taking off and most of the things they couldn't do before like brushing teeth, tie shoes, and using scissors are all things that the childing is doing really well. This is the end of the significant maturity in the prefrontal cortex and things will start to slow down but for the next few years will still be developing at a high rate. 

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At 5-6 years, expect tricky emotions, friendships and social play, lots of talk, improved physical coordination, and more. Get tips for child development.

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To monitor Lanes social and language development we chose to go with a Montessori styled school. This type of schooling focuses on the child as an individual and specializes on language development, which is something Lane was not getting in his other programs. This helps ensure that Lane should be on track for his age with a more personal teacher to student relationship. 

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To monitor Lanes social and language development we chose to go with a Montessori styled school. This type of schooling focuses on the child as an individual and specializes on language development, which is something Lane was not getting in his other programs. This helps ensure that Lane should be on track for his age with a more personal teacher to student relationship. 

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Maria Montessori observed that the child rapidly acquires language from birth until six years of age without ever being taught, and she believed that this phenomenon provided evidence for her theory on the Absorbent Mind (Montessori, 1949, p. 94). The Absorbent Mind states that children from birth until three unconsciously take in their environment and shape themselves from any information and stimulation they can come into contact with. The child from three to six years of age is consciously using specific things in his environment to build up his mental and physical faculties. Hence, as linguists today found, language seems to be learned almost intuitively and the child is born with the instinct to decipher and acquire the language of their culture (Chomsky, 2000).

Children are able to absorb language from their environment and easily learn how to speak, read and write if language in its various forms is present in their environment during the period of the Absorbent Mind (Montessori, 1949). This window of opportunity for learning Maria Montessori called a Sensitive Period. "So language like vision and most other brain functions, is bounded by a critical period, an early phase in which a child must experience language, or else its hardware won't wire up right" (Eliot, 1999, p. 354). The quality and quantity of language a child is exposed to during the sensitive period directly affects his language skills and brain organization (Eliot, 1999). Therefore, it is critical that parents of young children talk to them often and give them a multitude of vocabulary. The television is also an unacceptable substitute for giving language because it has been found that language should be connected to emotion and for a child to acquire the language they must be spoken to directly (Eliot, 1999, pp. 385-386). Children's early experiences with language in their environment greatly affect their social, emotional, and intellectual development; "Language should begin very early: by just three years of age, children are already headed down vastly different paths of verbal achievement as a result of their cumulative experience with language" (Eliot, 1999, p. 386).

Language in the Classroom

Much evidence has been provided for Maria Montessori's theory on the Absorbent Mind since it has been observed that children, without ever being taught, seemingly explode into language, reading and writing. Within the Montessori primary environment, language is given in all the areas and throughout the day at Language, Reading and Writing in the Montessori Classroom 2 any opportunity. Enriching the child's vocabulary expands his capacity to clearly communicate to others and express himself. Once the child is able to better express himself, his personality begins to truly surface and shine.

Language in the Montessori Language Area is taught with the Three Period Lesson. With this lesson the teacher can evaluate the child's understanding without pressure or stigma, so that his intrinsic motivation is not thwarted. "The three periods might be thought of as association, recognition, and recall" (Lillard A. S., 2005, p. 178). The adult first states the name of an object. Next, the adult asks the child to hand her or point to the object when she states the name. Lastly, the child is asked when the adult points to a particular object to recall that object's name. If a child cannot complete a certain stage of the lesson, the Guide stops and resumes it from the beginning another day. With this lesson the Guide is able to see if the child comprehends the presentation's concept and language.

The Language Area of the Montessori Primary Environment

The child has an urge to learn his language in this particular period because from birth to age six, he is undergoing a critical period for language acquisition (Lillard P. a., 2003, p. 390). During this time, the child can learn his language effortlessly and without fatigue. After the age of six, when the sensitive period has passed, it becomes much more difficult for the child to learn to read and write (Pinker, 1994, p. 298). Therefore, in the Montessori environment, the child undergoes mastering his language before the elementary years. The Language Area in the Montessori Primary environment, consisting of Spoken Language, Enrichment of Vocabulary, Written Language, Area of Reading, Reading Classification, Word Study, Function of Words, Reading Analysis, Interpretative Reading, and Language Extension provides the child with many forms of language to help satisfy his desire to clearly communicate and more fully adapt to his culture.

Vocabulary

The Enrichment of Vocabulary section within the Language Area of the Montessori environment is for giving the child new words for objects in his world. From two years old and on until elementary, the child is continually absorbing new vocabulary at an amazing rate, "By the time a child is six, it's been estimated that he understands some 13,000 words, although he doesn't speak nearly that many" (Eliot, 1999, p. 373).

Writing

Written Language in the Montessori environment is given as early as age two and a 3 half with Sound Games. The Guide might state to a group of children, "I am thinking of an object that starts with the sound 'A'," and have the children look around the environment and guess 'A' words. With this knowledge the child can begin to analyze word sounds, and recognize that each word is made up of these sounds. It has been said that writing is one of the first academic obstacles a child must overcome, however in the Montessori environment the different obstacles this task is made up of are broken down, so that the child overcomes them one at a time when working with other materials (Montessori, 1967). In this way when the child is finally presented with the task of writing when he is prepared, and can meet this challenge with success. In Montessori education, the child learns the phonetic sounds of the letters and learns to write in cursive. With fluid cursive writing, the child can more easily create the letters and connect them to form words. After the child knows about 10-12 letters, including the vowels, he can begin creating words with the moveable alphabet. Although writing with a pencil at this time may present too many obstacles, the child of 3 ½ can easily take the cursive letters of the moveable alphabet and begin connecting them to create words that he has analyzed. With some practice, the child will then be able to move on to using a chalkboard to write, and then paper. Maria Montessori deemed this sequence of learning to write "the method of spontaneous writing" (Montessori, 1967, p. 194).

Reading

In Montessori education, the child commonly learns how to write before he reads. The child has less difficulty constructing a word that he is analyzing and thinking of than reading, because reading has an additional dimension of difficulty; it is a synthesis of the sounds in a word that are in the mind of someone else. In the Area of Reading, the child has learned through many Sound Games that words are made of sounds, he knows the sounds and symbols of the letters, and is beginning to break down many words into sounds. After some time working with the movable alphabet, the child is ready to be shown the first presentation in this area: the Phonetic Object Box. The Guide takes out small replicas of objects, they are identified, and then the Guide writes the name of one of the objects down and gives it to the child. This is the first time the child reads; he first makes the sound of each letter, and when instructed to make them faster the sounds blend and the child can identify the word. The child is then instructed to place the label next to the proper object. With this exercise, the child learns that reading is silent communication.

Reading Classification

Now that the child is reading, he is introduced to the Reading Classification, Word Study, Function of Words, Reading Analysis, Interpretative Reading, and Language Extension areas. In Reading Classification the child is given a set of cards with a picture on each which relates to one specific category (such as rainforest animals), a set of labels, and control cards that have both picture and label on them. The child names and lays out the cards, and then reads each label and matches them to the correct card. When finished, the child is able to use the control cards to check his own work. It is at this point that the child is intensely interested in reading and labeling his environment (Montessori, 1967).

Word Study & Function of Words

The child then enters into the areas of Word Study and Function of Words. Here the child is able to recognize the deeper meaning behind words, guiding him closer to Total Reading, which is the ability to fully comprehend and actively interpret the meaning of what another has written. These exercises are more like games and provide the child with a simple and fun experience with grammar.

Reading Analysis & Interpretive Reading

Reading Analysis and Interpretive Reading take the child into Total Reading. These exercises help the child further recognize that reading sentences and stories give him a glimpse of another's thoughts and feelings.

Written By: Mrs. Monroe

Chomsky, Noam. (2000). New Horizons in the Study of Language and Mind. Cambridge: UK. Cambridge University Press.

Eliot, Lise, PhD. (1999). What's Going on in There?: How the Brain and Mind Develop in the First Five Years of Life. New York: NY. Bantum Books.

Lillard, Angeline S. (2005). Montessori the Science Behind the Genius. New York: NY. Oxford University Press, Inc.

Lillard, Paula and Lynn Jessen. (2003). Montessori From the Start: The Child at Home, from Birth to Age Three. New York: NY. Schocken Books.

Montessori, Maria. (1949). The Absorbent Mind. Madras: India. Publishing House.Montessori, Maria. (1967). The Discovery of the Child. Fides Publisher.

Pinker, Steven. (1994). The Language Instinct. New York: NY. Harper Perennial.

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Language in the Early Years - Kinderhouse Montessori

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Maria Montessori observed that the child rapidly acquires language from birth until six years of age without ever being taught, and she believed that this phenomenon provided evidence for her theory on the Absorbent Mind (Montessori, 1949, p. 94).

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2-3: With the help of teachers and peers children this age should know about 500 words. At this age they use short sentences with words missing out of them, like a, but, did, too, etc. They are trying to get their point across using only what they know. Lane has developed his language by now being able to speak sentences that most of the time make sense but missing out things like adjectives and and adverbs. He and the other children his age are learning up to six words that they haven't learned before per day and the are beginning to recognize what the words mean and sort through them. 

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2-3: With the help of teachers and peers children this age should know about 500 words. At this age they use short sentences with words missing out of them, like a, but, did, too, etc. They are trying to get their point across using only what they know. Lane has developed his language by now being able to speak sentences that most of the time make sense but missing out things like adjectives and and adverbs. He and the other children his age are learning up to six words that they haven't learned before per day and the are beginning to recognize what the words mean and sort through them. 

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4-5: By this age the knowledge of words they know has expanded so much. They speak fluent sentences and are mastering their language. They are asking a lot of "why" and "how" and "where". They are becoming very curious and starting to want to be a lot more independent. They are learning match words with what they mean even more. When they were just two it was simple words like mom and dad are associated with caregiver, but now they are using big words like red is associated with fire truck, or fly is a type of bug. They are starting to understand how to make words plural with adding the "S" sound at the end, even when it is not always correct. Even though it is not correct they are still understanding that making something multiple the sound at the end is sometimes "S". 

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4-5: By this age the knowledge of words they know has expanded so much. They speak fluent sentences and are mastering their language. They are asking a lot of "why" and "how" and "where". They are becoming very curious and starting to want to be a lot more independent. They are learning match words with what they mean even more. When they were just two it was simple words like mom and dad are associated with caregiver, but now they are using big words like red is associated with fire truck, or fly is a type of bug. They are starting to understand how to make words plural with adding the "S" sound at the end, even when it is not always correct. Even though it is not correct they are still understanding that making something multiple the sound at the end is sometimes "S". 

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4- to 5-Year-Old Developmental Milestones: Cognitive, Language, and Motor Skills

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WebMD discusses the developmental milestones reached by 4- to 5-year olds, including language and cognitive development.

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5-6: By this age the child's vocabulary has expanded almost 3x as much as the previous year. They are starting to use complex grammar, and they are picking up on every language they have heard and seen. They are using word association to understand what words mean, and why they belong when describing certain things. By the age of 6 it is said that it can be time to start learning a new language, and they will pick it up most easily at this age. Everything that the child has learned before this age shapes them into where the continue to develop from this age. If they missed the critical period then learning things after this age may be a lot harder for them than another child who did develop at the right speed. 

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5-6: By this age the child's vocabulary has expanded almost 3x as much as the previous year. They are starting to use complex grammar, and they are picking up on every language they have heard and seen. They are using word association to understand what words mean, and why they belong when describing certain things. By the age of 6 it is said that it can be time to start learning a new language, and they will pick it up most easily at this age. Everything that the child has learned before this age shapes them into where the continue to develop from this age. If they missed the critical period then learning things after this age may be a lot harder for them than another child who did develop at the right speed. 

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During the early school years, children learn more and longer words. They become more skilled at putting words together in new and imaginative ways. At this age, they also become more familiar with how language sounds, and how sounds combine to make words.

Here are some of the ways your children's language and communication skills develop in the early school years.

Language sounds

By 5 years, children are aware of the sounds that make up words. They can identify words that rhyme. They might even play rhyming games and sing out a list of words that rhyme (bat, cat, fat, hat, mat...).

Children begin to learn the sounds that go with the different letters of the alphabet. This is important for the development of reading skills. Children also become aware that single sounds combine into words. For example, when the "t", "o" and "p" sounds are put together, they make the word "top".

Did you know?
When starting school, children might still have problems saying a few sounds. An example is the "r" sound, particularly in words like "truck", "drain", "bring" and so on.

Developing vocabulary

By 5 years, children will usually use the correct form of verbs to talk about past events. For example, "I jumped", or "I played". But it will take a few more years for them to get used to the many exceptions in the English language - for example, "broke", "threw" and "ate" rather than "breaked", "throwed" and "eated". Even at eight, children might find the past tense of some verbs tricky.

From the ages of 5-6 years, children understand that single words might have different meanings. They start to rely more on the context of a word to find a particular meaning. For example, "cool" means something different when you say, "It's a cool day", compared with when you say, "That's a really cool robot you've built". They begin to understand non-literal meanings - for example, "make up your mind".

Your child will understand that new words can be formed by joining two words - for example, "bookshelf". "Compound" words like this become more frequent in children's speech from 5-6 years. Your child will also use longer words as she gets to know endings that change the meaning of words. For example, when you add "er", it changes a verb into a noun. So "teach" becomes "teacher".

Your child will also start to understand that words don't always need an "s" to become plurals - for example, "feet" and "mice" rather than "foots" and "mouses".

From 6 years on, children start to use prefixes (word beginnings) and suffixes (word endings) to make more words. So they can use "ness" (as in "happiness") and "un" (as in "unwrap").

Using sentences

By 5 years, children can combine words to form active and passive sentences. But they will often have difficulty understanding passive sentences.

For example, they might understand an active sentence such as "The dog followed the boy". But they might think that a passive sentence such as "The cat was chased by the dog" actually means "The cat chased the dog". When describing pictures, they might also mix up who is doing what to whom. By 6 years, this understanding of sentence construction improves.

At this age, children might also have trouble understanding who pronouns refer to - for example, who "she" refers to in the sentence, "The woman told the last girl to arrive that she was late". This understanding improves gradually with age.

Storytelling skills

From 4-8 years, children's narrative skills improve and they get much better at telling stories. Their stories get longer and more detailed. The stories might be made up, or about things that have actually happened. It also becomes easier to work out who children are talking about when they're telling a story, and how the events in their stories fit together.

In these years, children learn to:

use different linking words in the right way (for example, "then", "now", "when", "before", "while" and "although")

establish connecting links and causes for events (for example, "the boat sank, so everybody had to swim to the beach")

use different sentence types to present the same information

use appropriate pronouns (for example, "he", "she" or "they") instead of names when it's clear from the narrative who's being referred to

leave out less important details from the story and focus more on the setting of the story and the plot.

Did you know?
Children grow and develop at different rates. The information in this article is offered as a guide only. If you're at all concerned about your child's language development, speak with your child's teacher, doctor or public health nurse.

© Raising Children Network Limited, reproduced with permission.
Resources & Links:
HealthLink BC: Speech and Language Milestones, Ages 3 to 5 Years
HealthLink BC: Encouraging Language Development in Your Preschooler
HealthLink BC: Speech and Language Development: Red Flags
HealthLink BC: Speech and Language Delays: Common Misconceptions
HealthLink BC: Speech Problems: Normal Disfluency (stuttering)

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During the early school years, children learn more and longer words. They become more skilled at putting words together in new and imaginative ways. At this age, they also become more familiar with how language sounds, and how sounds combine to make words.

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2-3:At this age children can't regulate their emotions as well as children that are older. They have frequent outbursts of different emotions from happiness to anger. To help with this if the tantrum was deemed irrational for example not having a cookie or not getting what they want the tantrum was ignored or they were to be distracted with something else they could have. One thing I read was that to a child that young something tiny that causes an outburst could be one of the worst things that has happened in their young life. To deal with this they were distracted or were given more attention to stop the outburst. This is why they call this age the terrible two's. 

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2-3:At this age children can't regulate their emotions as well as children that are older. They have frequent outbursts of different emotions from happiness to anger. To help with this if the tantrum was deemed irrational for example not having a cookie or not getting what they want the tantrum was ignored or they were to be distracted with something else they could have. One thing I read was that to a child that young something tiny that causes an outburst could be one of the worst things that has happened in their young life. To deal with this they were distracted or were given more attention to stop the outburst. This is why they call this age the terrible two's. 

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Beginning at about 17 months, toddlers discover the joys of flexing their vocal muscles. (Earplugs, anyone?)

Why it happens:

It may look like mischief, but at this age, children are just having fun experimenting with yet another thing they've discovered they can do - in this case, create sound (admit it - sometimes yelling is just plain fun!). Compounding the toddler-screaming problem: The fact that tots have poor impulse control (not to mention volume control) and little idea of how to behave in public. Little ones also have very limited communication skills, so some times the only way to be heard is to yell (in a toddler's brain, a scream says a thousand words).

What you need to know:

This too shall pass. As with many other annoying toddler behaviors, your little sound machine will grow out of this phase.

What to do about it:

Control the general volume in your house. That means no blaring TV, radio or other background noise, and - most importantly - no screaming at your toddler to stop screaming. Remember, monkey see (or hear, in this case), monkey do.

Turn on the tunes. When your toddler starts screeching up a storm, play some music and suggest he sing or join you in a sing-along. Not interested? Ask him about animal sounds he can make, or bring out some musical instruments. Sure, it may still be noisy, but at least it'll be easier on the ears than toddler screams.

Lower your voice. Challenge your screaming toddler by looking him in the eye and whispering. That may catch his attention and may make him curious enough to listen (and hopefully quiet down so he can hear).

Teach the concept of an "inside voice" and an "outside voice." Give a demonstration and examples of where and when they can be used ("You use your inside voice in the house and your outside voice in the backyard").

Make it a game. Another way to encourage quiet - when your toddler's not screaming, invite him to a whispering match. Young children have a hard time whispering (it sounds sort of like a stage whisper) but that won't stop them from trying, especially if you make a game of it ("Can you whisper like Mommy?").

Take him outside. If you're in a public place, say a restaurant, and your noisemaker refuses to use his inside voice, go outside with him - where his outside voice belongs. Try to do this without raising your own voice and making a fuss. (This trick also may tame a toddler tantrum.)

Provide positive reinforcement. When your toddler uses his inside voice at the appropriate time and place, be sure to shower him with praise.

Dealing with Tantrums? Here's What to Do:

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Beginning at about 17 months, toddlers discover the joys of flexing their vocal muscles. (Earplugs, anyone?) It may look like mischief, but at this age, children are just having fun experimenting with yet another thing they've discovered they can do - in this case, create sound (admit it - sometimes yelling is just plain fun!).

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3-4: At this age their language has begun to develop even more and the child can start to ask for what they want or need. The prefrontal cortex is starting to regulate more emotions and they are getting the help of their caregivers to help regulate them even more. They start to control their hitting, fighting, yelling, screaming, and tantrums. This is when things they like such as toys become a privilege and not something that is given to them. If they throw a fight over a toy or game then it gets put away until they calm down and realize that it is not okay to do that. They clean up after themselves and learn that they have responsibilities to do if they want fun things. 

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3-4: At this age their language has begun to develop even more and the child can start to ask for what they want or need. The prefrontal cortex is starting to regulate more emotions and they are getting the help of their caregivers to help regulate them even more. They start to control their hitting, fighting, yelling, screaming, and tantrums. This is when things they like such as toys become a privilege and not something that is given to them. If they throw a fight over a toy or game then it gets put away until they calm down and realize that it is not okay to do that. They clean up after themselves and learn that they have responsibilities to do if they want fun things. 

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4-5: Children are playing with their friends and becoming more social at this age. They like to play imaginary games with each other and live in a make believe world with each other. They live for praise and to be told that they are good at things, which makes them believe in themselves. It is important to instill confidence in them from an early age so that they don't grow up doubting themselves. Without playing socially children are not happy to be learning or sitting by themselves, they don't want to be left alone or left out of the group. Common things that happen at this age is the idea of sharing and being kind. If these are not being followed then the play time can be taken from the child until the realize they needed to share or the apologize for not being nice. 

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4-5: Children are playing with their friends and becoming more social at this age. They like to play imaginary games with each other and live in a make believe world with each other. They live for praise and to be told that they are good at things, which makes them believe in themselves. It is important to instill confidence in them from an early age so that they don't grow up doubting themselves. Without playing socially children are not happy to be learning or sitting by themselves, they don't want to be left alone or left out of the group. Common things that happen at this age is the idea of sharing and being kind. If these are not being followed then the play time can be taken from the child until the realize they needed to share or the apologize for not being nice. 

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What’s the Best Way to Discipline My Child?

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As a parent, it is your job to teach your child the difference between acceptable and unacceptable behavior. But getting your child to behave the way you want is not as hard as you think.

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5-6: At this age it is important to put a balance of boys and girls to play together. Boys can be rowdy and aggressive, while girls can be caring and calm. Helping them find the balance is important to show them that they have the opportunity to play both ways as long as it is safe. With the help of the teachers and parents children are learning to share and let other students borrow their things and increase their emotional maturity by helping the child understand why they need to share and take turns. Reactive aggression is also happening at this age, when a child gets hurt they can turn and hit or kick another kid just because they are upset. As they keep getting older and the prefrontal cortex keeps regulating these emotions the outbursts happen a lot less. It is the same thing as bullying or not being nice to the other kids. The best way to get this to stop is to get to it before it gets to the other kids. Explaining why we shouldn't talk like that or be that way to other people just because they might not like them is important for their development because their brains are still working on it. 

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5-6: At this age it is important to put a balance of boys and girls to play together. Boys can be rowdy and aggressive, while girls can be caring and calm. Helping them find the balance is important to show them that they have the opportunity to play both ways as long as it is safe. With the help of the teachers and parents children are learning to share and let other students borrow their things and increase their emotional maturity by helping the child understand why they need to share and take turns. Reactive aggression is also happening at this age, when a child gets hurt they can turn and hit or kick another kid just because they are upset. As they keep getting older and the prefrontal cortex keeps regulating these emotions the outbursts happen a lot less. It is the same thing as bullying or not being nice to the other kids. The best way to get this to stop is to get to it before it gets to the other kids. Explaining why we shouldn't talk like that or be that way to other people just because they might not like them is important for their development because their brains are still working on it. 

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Family

When your child is the bully, how do you handle it? One grandma shares her story.

My daughter called me upset one day on her way home from work to tell me about a problem she'd been having with her 6-year-old son, my grandson. He'd been acting out at school, she said, behaving aggressively towards his classmates. She mentioned pushing, grabbing toys, and after a fun classroom activity, she said he announced to the entire class, "That was so boring!" My daughter says his first-grade teacher told her, "It was as if he just wanted attention all of a sudden."

It was only the second week of school and already they'd met with the principal and feared expulsion. "We don't know what to do," my daughter told me.

According to new research, about one in four kids experience chronic bullying - in elementary school. If it's a regular event, imagine if the 6-year-old doing the bullying was yours, what would you do?

When Your Child Is the Bully

Brenda LoPresto, principal at Pioneer Elementary School (not theirs) in Glendale, Arizona, says my daughter already did two things right. She initiated open dialogue with both her child and with the school.

That's the beginning of a fix. It might be a quick one or it might take several months, according to the experts. But what you don't want to do is take the problem personally. LoPresto says recognize it exists and understand at that age it's most likely a stage.

Experts agree that some pre-kindergarten through first grade level kids need a little extra help transitioning from home to school. If it's yours, don't expect much more of a response from the child than, "I don't know why I did that."

Dr. Russell Horton, a pediatrician with Banner Health Center in Queen Creek, Arizona, said it's a common problem at the start of the school year, and it's one he's dealt with at home with his own son.

"Change is especially hard [for 5- to 7-year-olds]," he says, "and they may respond with aggression. It's normal for their age."

A few situations he says that could cause problems at school: the child himself is being picked on, he's not clicking with the teacher, his best friend isn't in his class, or he's experiencing some developmental issue.

"Boys might be even more aggressive than girls, because they bond by touching and interacting physically with each other," says former teacher/school administrator Katey McPherson, executive director of the Gurian Institute, an educational consulting firm that focuses on brain development and learning.

"Boys like to take risks. They're impulsive. But kids [this age], in general, don't know how to set their own limits yet. Their brains are not fully developed."

While the natural qualities used to get what you want in childhood - control and manipulation - are the same qualities that make excellent leaders, it can be difficult to deal with, and the really smart kids are master manipulators, McPherson says. "They know exactly how to maneuver the adults in their lives...to see what they can get away with."

Beware of Labels

But McPherson, who is also co-founder of a bullying prevention program called BE THE ONE, is wary of labels. Kids internalize labels, such as "bad" or "bully," she says, which only encourages more of the behavior you don't want.

Instead, she says, spend time working with your children at home on how to solve and cope with problems. This could include simply discussing how the child is doing with the character-building programs schools now use to foster safe and responsible behavior. Of 39 scientifically studied, 33 were found to be effective. LoPresto's school district also shares a "Parent's Guide to Bullying" pamphlet that offers tips. One tip for the young kids having trouble transitioning, it suggests setting a timer for practice. They get a set number of minutes to work on one project or activity before moving on to the next, just as they would at school.

One-one-one attention at home helps make sure parents are meeting the child's need to be seen, heard and loved, says McPherson.

"If he's missing out on any of these attachment needs, that can show up in behavioral issues at school... All children need one-on-one attention, but some need more than others until they move on to other things that interest them more, or they outgrow this developmental phase."

Dr. Horton agrees. Behavior that might be deemed " bullying " is complicated. "There's not always a quick fix," he says, "You have to dig in to find out what's happening at school. Is the child hitting, yelling, insisting on being first all the time?"

He encourages parents who may get the ominous written note from school to reach out to the teacher and other school officials right away to discuss what's going on.

McPherson says a face-to-face meeting gives parents the opportunity to advocate for their child and share insight on any changes at home that might be the root cause of the problem at school. Is there a recent divorce, a move, a new baby? Is the child behaving like this at home?

"It's going to be different for each child," says the pediatrician.

When Your Child Is Accused of Bullying: What to Ask

"There's a reason for every single behavior. The parent's job is to find out what it is," McPherson says. Questions to ask during a parent-teacher meeting include:

* What exactly was the behavior?
 * When did the behavior occur?
 * How often has it been occurring?
 * With whom did it happen?
 * Is this before lunch or after lunch?
 * Who is supervising?
 * How was it handled?

To get the clearest picture, she recommends working in tandem with the school to chart what's happening on campus 10 days in a row. Then you can take that information to the pediatrician for a proper assessment.

Horton says these issues are definitely part of his profession's wheelhouse. Pediatricians have insights into child development that parents and teachers may not have. They can offer suggestions and strategies for improvement, initiate tests and make recommendations to take back to the school for further evaluation and assistance, if needed.

"The problem is never about the behavior itself," says McPherson, agreeing with Horton to look beyond behavior in order to get to the root cause. With clear data, parents can determine if the child is angry, frustrated or afraid, and about what. Perhaps he's lashing out because he doesn't understand a project and is embarrassed. The child could be fatigued, have a food allergy, low blood sugar issues, problems with eyesight or eye-hand coordination that slows him down. It could be hormonal. Kids might even be spending too much time on tech devices, not getting enough sleep or eating right. There could be an acute crisis going on at home that the teacher's unaware of, or an undiagnosed disorder that might require treatment. And don't rule out a classroom management problem.

McPherson says the documentation and evidence will help the entire team find a positive solution.

"If it's a simple fix, it can be corrected in a week," says Horton, "but if it's developmental, it could take months...If it's a recurring problem, I recommend a child therapist to work with the family for long-term success."

One of the biggest challenges LoPresto sees with kids these days is too much time on their "tech toys."

"Time on technology means not having meaningful conversations with others, both peers and adults," she says, recommending you shut down the toys, especially at dinnertime. Instead, use that time at the dinner table to discuss what's going on. Find out what the incident looked like to your child and also what it might have looked like to the other person involved. "This is one way we learn empathy," says the school principal.

Bullying Behavior May Not Last

"It's also important for families to understand that an experience in school like this is not a lifelong sentence. It's a learning opportunity," LoPresto says.

Developmentally, kids this age don't reasonably handle every challenge, and you can't expect them to," says Horton. They may not deal with disappointment well, either, especially if they are catered to at home. At school, they won't always get the toy they want, win the game or understand an assignment right away.
This article was written by Jackie Dishner.
"They have to learn to deal with let-downs," he says. Parents, teachers, pediatricians, therapists and principals can work together to help the child move on from these disappointments without letting emotions take over. The good news is a lot of this is age-related. As they mature, Dr. Horton says, kids generally outgrow the problem.
What Teens Wish Their Parents Knew - From a Therapist Who Hears It All My In-Laws and I Aren't the Same Kind of People, and We're Both at Fault for the Mess We're In An Open Letter to My Teenage Son After I Survived Cleaning His Room
More from FIRST

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How to Handle It When Your Kid Is the Bully

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Family When your child is the bully, how do you handle it? One grandma shares her story. My daughter called me upset one day on her way home from work to tell me about a problem she'd been having with her 6-year-old son, my grandson.

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Over the years it is more common to be diagnosed with ASD. In our case Lane was diagnosed with mild ASD the least severe type. 1 in every 68 children are diagnosed with autism spectrum disorder (ASD). There is a lot of help out there for him and treatment plans that he can go through to receive help with learning and speech. It means to me that he may experience more trouble learning and keeping up with the rest of his class but there are so many kids just like him that are able to do it. Now that it's not looked down upon and is a lot more accepted it is easier to find the help he needs. 

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Over the years it is more common to be diagnosed with ASD. In our case Lane was diagnosed with mild ASD the least severe type. 1 in every 68 children are diagnosed with autism spectrum disorder (ASD). There is a lot of help out there for him and treatment plans that he can go through to receive help with learning and speech. It means to me that he may experience more trouble learning and keeping up with the rest of his class but there are so many kids just like him that are able to do it. Now that it's not looked down upon and is a lot more accepted it is easier to find the help he needs. 

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Autism spectrum disorders (ASD) can vary in severity of symptoms, age of onset, and the presence of various features such as language and intellectual ability. The manifestations of ASD can differ considerably across individuals. Even though there are strong and consistent commonalities, especially in social deficits, there is no single behavior that is always present in every individual with ASD and no behavior that would automatically exclude an individual from diagnosis of ASD.

How can I tell if someone I know has autism?

Individuals with ASD interact with others differently. They often appear to have difficulty understanding and expressing emotion, and may express attachment in a different manner. Individuals with ASD report that they want to have social relationships with others and build friendships.

Many individuals with ASD do not develop effective spoken language and rely upon other methods of communicating such as pointing to pictures or using a tablet computer with special language applications. Others have echolalia, the repeating of words or phrases over and over. Individuals with ASD often have difficulty understanding the nonverbal aspect of language such as social cues, body language and vocal qualities (pitch, tone and volume).

Individuals with ASD often have a great need for "sameness" which can make them upset if objects in their environment or time schedules change. Children with ASD may not "play" with toys in the same manner as their peers and may become fixated on specific objects. Persons with ASD have a different reaction to sensory stimuli seeing, hearing, feeling or tasting things with more or less intensity than others.

Children with ASD often have a different rate of development especially in the areas of communication, social and cognitive skills. In contrast, motor development may occur at a typical rate. Sometimes skills will appear in children with ASD at the expected rate or time and then disappear.

Download our Autism Spectrum Disorder Fact Sheet (PDF*)

Autism Spectrum Disorder is a lifelong disability that is generally diagnosed before the age of three years old. However, often children are misdiagnosed or not diagnosed until later in life. The American Academy of Pediatrics suggests parents consider the following questions:
Does your child...

Not speak as well as his or her peers?

Have poor eye contact?

Not respond selectively to his or her name?

Act as if he or she is in his or her own world?

Seem to "tune others out?"

Not have a social smile?

Seem unable to tell you what he or she wants, preferring to lead you by the hand or get desired objects on his or her own, even at risk of danger?

Have difficulty following simple commands?

Not bring things to you simply to "show" you?

Not point to interesting objects to direct your attention to objects or events of interest?

Have unusually long and severe temper tantrums?

Have repetitive, odd, or stereotypic behaviors?

Show an unusual attachment to inanimate objects, especially hard ones (e.g., flashlight or a chain vs. teddy bear or blanket)?

Prefer to play alone?

Demonstrate an inability to play with toys in the typical way?

Not engage in pretend play (if older than 2 years)?

What to do if you think your child has autism

Autism Spectrum Disorder affects each individual differently and at varying degrees - this is why early diagnosis is so crucial. ASD is a lifelong condition, but early intervention contributes to lifelong positive outcomes.

Get a diagnosis. If you're concerned, see a doctor who's familiar with ASD. Don't assume the child will catch up. The American Academy of Pediatrics offers an online pediatrician referral service, searchable by specialty and location.

Get help. Education, intervention and speech therapy are often critical. Contact Easterseals for services or assistance locating service providers in your area.

Know your rights. Children with autism can be eligible for early intervention and special education services that are free starting at age 3. Your health insurance may include coverage for the medical services your child needs. Easterseals can help you navigate these systems.
*This document is in the Adobe PDF format. You will need to download free Adobe Acrobat Reader software to view these documents. If you do not have Acrobat Reader, you can download it for free by clicking on the Adobe graphic below.

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Autism spectrum disorders (ASD) can vary in severity of symptoms, age of onset, and the presence of various features such as language and intellectual ability. The manifestations of ASD can differ considerably across individuals.

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Treatment for 6-8: For treatments we want to figure out exactly what his diagnoses was. Many kids are over medicated to keep them quiet according to some psychologists mentioned in the book. Even thought there is no cure for it there are learning treatment plans to help minimize some of the symptoms, as well as having him improve his learning and functional ability. It is important to get him help this early so that he can have a better chance for a more normal development by starting as early as possible. 

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Treatment for 6-8: For treatments we want to figure out exactly what his diagnoses was. Many kids are over medicated to keep them quiet according to some psychologists mentioned in the book. Even thought there is no cure for it there are learning treatment plans to help minimize some of the symptoms, as well as having him improve his learning and functional ability. It is important to get him help this early so that he can have a better chance for a more normal development by starting as early as possible. 

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Centers for Disease Control and Prevention

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Current treatments for autism spectrum disorder (ASD) seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs. Therefore, treatment plans usually involve multiple professionals and are catered toward the individual.

Treatments can be given in education, health, community, or home settings, or a combination of settings. It is important that providers communicate with each other and the person with ASD and their family to ensure that treatment goals and progress are meeting expectations.

As individuals with ASD exit from high school and grow into adulthood, additional services can help improve health and daily functioning, and facilitate social and community engagement. For some, supports to continue education, complete job training, find employment, and secure housing and transportation may be needed.

Types of Treatments

There are many types of treatments available. These treatments generally can be broken down into the following categories, although some treatments involve more than one approach:

Behavioral Approaches

Behavioral approaches focus on changing behaviors by understanding what happens before and after the behavior. Behavioral approaches have the most evidence for treating symptoms of ASD. They have become widely accepted among educators and healthcare professionals and are used in many schools and treatment clinics. A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA). ABA encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. Progress is tracked and measured.

Two ABA teaching styles are Discrete Trial Training (DTT) and Pivotal Response Training (PRT).

DTT uses step-by-step instructions to teach a desired behavior or response. Lessons are broken down into their simplest parts, and desired answers and behaviors are rewarded. Undesired answers and behaviors are ignored.

PRT takes place in a natural setting rather than clinic setting. The goal of PRT is to improve a few "pivotal skills" that will help the person learn many other skills. One example of a pivotal skill is to initiate communication with others.

Developmental Approaches

Developmental approaches focus on improving specific developmental skills, such as language skills or physical skills, or a broader range of interconnected developmental abilities. Developmental approaches are often combined with behavioral approaches.

The most common developmental therapy for people with ASD is Speech and Language Therapy. Speech and Language Therapy helps to improve the person's understanding and use of speech and language. Some people with ASD communicate verbally. Others may communicate through the use of signs, gestures, pictures, or an electronic communication device.

Occupational Therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people. Occupational therapy can also include:

Sensory Integration Therapy to help improve responses to sensory input that may be restrictive or overwhelming.

Physical Therapy can help improve physical skills, such as fine movements of the fingers or larger movements of the trunk and body.

The Early Start Denver Model (ESDM) is a broad developmental approach based on the principles of Applied Behavior Analysis. It is used with children 12-48 months of age. Parents and therapists use play, social exchanges, and shared attention in natural settings to improve language, social, and learning skills.

Educational Approaches

Educational treatments are given in a classroom setting. One type of educational approach is the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) approach. TEACCH is based on the idea that people with autism thrive on consistency and visual learning. It provides teachers with ways to adjust the classroom structure and improve academic and other outcomes. For example, daily routines can be written or drawn and placed in clear sight. Boundaries can be set around learning stations. Verbal instructions can be complimented with visual instructions or physical demonstrations.

Social-Relational Approaches

Social-relational treatments focus on improving social skills and building emotional bonds. Some social-relational approaches involve parents or peer mentors.

The Developmental, Individual Differences, Relationship-Based model (also called "Floor time") encourages parents and therapists to follow the interests of the individual to expand opportunities for communication.

The Relationship Development Intervention (RDI) model involves activities that increase motivation, interest, and abilities to participate in shared social interactions.

Social Stories provide simple descriptions of what to expect in a social situation.

Social Skills Groups provide opportunities for people with ASD to practice social skills in a structured environment.

Pharmacological Approaches

There are no medications that treat the core symptoms of ASD. Some medications treat co-occurring symptoms that can help people with ASD function better. For example, medication might help manage high energy levels, inability to focus, or self-harming behavior, such as head banging or hand biting. Medication can also help manage co-occurring psychological conditions, such as anxiety or depression, in addition to medical conditions such as seizures, sleep problems, or stomach or other gastrointestinal problems.

It is important to work with a doctor who has experience in treating people with ASD when considering the use of medication. This applies to both prescription medication and over-the-counter medication. Individuals, families, and doctors must work together to monitor progress and reactions to be sure that negative side effects of the medication do not outweigh the benefits.

Psychological Approaches

Psychological approaches can help people with ASD cope with anxiety, depression, and other mental health issues. Cognitive-Behavior Therapy (CBT) is one psychological approach that focuses on learning the connections between thoughts, feelings, and behaviors. During CBT, a therapist and the individual work together to identify goals and then change how the person thinks about a situation to change how they react to the situation.

Complementary and Alternative Treatments

Some individuals and parents use treatments that do not fit into any of the other categories. These treatments are known as Complementary and Alternative treatments. Complementary and alternative treatments are often used to supplement more traditional approaches. They might include special diets, herbal supplements, chiropractic care, animal therapy, arts therapy, mindfulness, or relaxation therapies. Individuals and families should always talk to their doctor before starting a complementary and alternative treatment.

There may be other treatments available for individuals with ASD. Talk to a doctor or healthcare provider to learn more.

For more information you can visit:

American Academy of Pediatrics Council on Children with Disabilities: https://pediatrics.aappublications.org/content/145/1/e20193447external icon

Autism Society: https://www.autism-society.org/living-with-autism/treatment-options/external icon

Autism Speaks: https://www.autismspeaks.org/treatments-autismexternal icon

Interagency Autism Coordinating Committee: https://iacc.hhs.gov/publications/publications-analysis/2012/treatments.shtmlexternal icon

National Institute on Child Health and Human Development: https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatmentsexternal icon

References

Hyman, S.L., Levy, S.E., Myers, S.M., & AAP Council on Children with Disabilities, Section on developmental and behavioral pediatrics. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447.

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Treatment and Intervention Services for Autism Spectrum Disorder

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Autism Spectrum Disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. CDC is working to find out how many children have ASDs, discover the risk factors, and raise awareness of the signs.

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Treatment for 9-11: We are continuing to do regular checkups to track his growth since being diagnosed. Lane is also working with a specialist who directly treats autism spectrum disorder. This is helping to improve his behavior, communication, learning, and also therapies for our family to ensure we are doing all we can for him. It is said that there could be a range of medical problems that go hand and hand with the autism so we keep an eye out for those as well such as sleep issues, bad eating habits, and social problems. 

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Treatment for 9-11: We are continuing to do regular checkups to track his growth since being diagnosed. Lane is also working with a specialist who directly treats autism spectrum disorder. This is helping to improve his behavior, communication, learning, and also therapies for our family to ensure we are doing all we can for him. It is said that there could be a range of medical problems that go hand and hand with the autism so we keep an eye out for those as well such as sleep issues, bad eating habits, and social problems. 

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Diagnosis

Your child's doctor will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you'll likely be referred to a specialist who treats children with autism spectrum disorder, such as a child psychiatrist or psychologist, pediatric neurologist, or developmental pediatrician, for an evaluation.

Because autism spectrum disorder varies widely in symptoms and severity, making a diagnosis may be difficult. There isn't a specific medical test to determine the disorder. Instead, a specialist may:

Observe your child and ask how your child's social interactions, communication skills and behavior have developed and changed over time

Give your child tests covering hearing, speech, language, developmental level, and social and behavioral issues

Present structured social and communication interactions to your child and score the performance

Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Include other specialists in determining a diagnosis

Recommend genetic testing to identify whether your child has a genetic disorder such as Rett syndrome or fragile X syndrome

Treatment

No cure exists for autism spectrum disorder, and there is no one-size-fits-all treatment. The goal of treatment is to maximize your child's ability to function by reducing autism spectrum disorder symptoms and supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional and behavioral skills.

The range of home-based and school-based treatments and interventions for autism spectrum disorder can be overwhelming, and your child's needs may change over time. Your health care provider can recommend options and help identify resources in your area.

If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child's needs.

Treatment options may include:

Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism spectrum disorder. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and generalize these skills to multiple situations through a reward-based motivation system.

Educational therapies. Children with autism spectrum disorder often respond well to highly structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.

Family therapies. Parents and other family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.

Other therapies. Depending on your child's needs, speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance may be beneficial. A psychologist can recommend ways to address problem behavior.

Medications. No medication can improve the core signs of autism spectrum disorder, but specific medications can help control symptoms. For example, certain medications may be prescribed if your child is hyperactive; antipsychotic drugs are sometimes used to treat severe behavioral problems; and antidepressants may be prescribed for anxiety. Keep all health care providers updated on any medications or supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.

Managing other medical and mental health conditions

In addition to autism spectrum disorder, children, teens and adults can also experience:

Planning for the future

Children with autism spectrum disorder typically continue to learn and compensate for problems throughout life, but most will continue to require some level of support. Planning for your child's future opportunities, such as employment, college, living situation, independence and the services required for support can make this process smoother.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

Because autism spectrum disorder can't be cured, many parents seek alternative or complementary therapies, but these treatments have little or no research to show that they're effective. You could, unintentionally, reinforce negative behaviors. And some alternative treatments are potentially dangerous.

Talk with your child's doctor about the scientific evidence of any therapy that you're considering for your child.

Examples of complementary and alternative therapies that may offer some benefit when used in combination with evidence-based treatments include:

Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy or music therapy, which focuses on reducing a child's sensitivity to touch or sound. These therapies may offer some benefit when used along with other treatments.

Sensory-based therapies. These therapies are based on the unproven theory that people with autism spectrum disorder have a sensory processing disorder that causes problems tolerating or processing sensory information, such as touch, balance and hearing. Therapists use brushes, squeeze toys, trampolines and other materials to stimulate these senses. Research has not shown these therapies to be effective, but it's possible they may offer some benefit when used along with other treatments.

Massage. While massage may be relaxing, there isn't enough evidence to determine if it improves symptoms of autism spectrum disorder.

Pet or horse therapy. Pets can provide companionship and recreation, but more research is needed to determine whether interaction with animals improves symptoms of autism spectrum disorder.

Some complementary and alternative therapies may not be harmful, but there's no evidence that they're helpful. Some may also include significant financial cost and be difficult to implement. Examples of these therapies include:

Some complementary and alternative treatments do not have evidence that they are beneficial and they're potentially dangerous. Examples of complementary and alternative treatments that are not recommended for autism spectrum disorder include:

Coping and support

Raising a child with autism spectrum disorder can be physically exhausting and emotionally draining. These suggestions may help:

Find a team of trusted professionals. A team, coordinated by your doctor, may include social workers, teachers, therapists, and a case manager or service coordinator. These professionals can help identify and evaluate the resources in your area and explain financial services and state and federal programs for children and adults with disabilities.

Keep records of visits with service providers. Your child may have visits, evaluations and meetings with many people involved in his or her care. Keep an organized file of these meetings and reports to help you decide about treatment options and monitor progress.

Learn about the disorder. There are many myths and misconceptions about autism spectrum disorder. Learning the truth can help you better understand your child and his or her attempts to communicate.

Take time for yourself and other family members. Caring for a child with autism spectrum disorder can put stress on your personal relationships and your family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse or partner - even if it's just watching a movie together after the children go to bed.

Seek out other families of children with autism spectrum disorder. Other families struggling with the challenges of autism spectrum disorder may have useful advice. Some communities have support groups for parents and siblings of children with the disorder.

Ask your doctor about new technologies and therapies. Researchers continue to explore new approaches to help children with autism spectrum disorder. See the Centers for Disease Control and Prevention website on autism spectrum disorders for helpful materials and links to resources.

Preparing for your appointment

Your child's health care provider will look for developmental problems at regular checkups. Mention any concerns you have during your appointment. If your child shows any signs of autism spectrum disorder, you'll likely be referred to a specialist who treats children with the disorder for an evaluation.

Bring a family member or friend with you to the appointment, if possible, to help you remember information and for emotional support.

Here's some information to help you prepare for your appointment.

What you can do

Before your child's appointment, make a list of:

Any medications, including vitamins, herbs and over-the-counter medicines that your child is taking, and their dosages.

Any concerns you have about your child's development and behavior.

When your child began talking and reaching developmental milestones. If your child has siblings, also share information about when they reached their milestones.

A description of how your child plays and interacts with other children, siblings and parents.

Questions to ask your child's doctor to make the most of your time.

In addition, it may be helpful to bring:

Questions to ask your child's doctor may include:

Why do you think my child does (or doesn't) have autism spectrum disorder?

Is there a way to confirm the diagnosis?

If my child does have autism spectrum disorder, is there a way to tell how severe it is?

What changes can I expect to see in my child over time?

What kind of special therapies or care do children with autism spectrum disorder need?

How much and what kinds of regular medical care will my child need?

What kind of support is available to families of children with autism spectrum disorder?

How can I learn more about autism spectrum disorder?

Don't hesitate to ask other questions during your appointment.

What to expect from your child's doctor

Your child's doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

What specific behaviors prompted your visit today?

When did you first notice these signs in your child? Have others noticed signs?

Have these behaviors been continuous or occasional?

Does your child have any other symptoms that might seem unrelated to autism spectrum disorder, such as stomach problems?

Does anything seem to improve your child's symptoms?

What, if anything, appears to worsen symptoms?

When did your child first crawl? Walk? Say his or her first word?

What are some of your child's favorite activities?

How does your child interact with you, siblings and other children? Does your child show interest in others, make eye contact, smile or want to play with others?

Does your child have a family history of autism spectrum disorder, language delay, Rett syndrome, obsessive-compulsive disorder, or anxiety or other mood disorders?

What is your child's education plan? What services does he or she receive through school?

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Autism spectrum disorder is a serious condition related to brain development that impairs the ability to communicate and interact with others.

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Language and academic progress 6-8: For age 6 to 7 they are ready to learn how to count to 100, they understand that one number is bigger than the other, and one number is smaller, and they are learning to add and subtract numbers with only one digit. From 7 to 8 they are learning to add and subtract numbers with two digits, as well as developing the skills to do simple multiplication and division along with some word problems that go with them. For reading they are learning sounds and consonants and vowels, using the sounds in the letters to figure out what the words are, and are reading short and simple words that they can sound out. 

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Language and academic progress 6-8: For age 6 to 7 they are ready to learn how to count to 100, they understand that one number is bigger than the other, and one number is smaller, and they are learning to add and subtract numbers with only one digit. From 7 to 8 they are learning to add and subtract numbers with two digits, as well as developing the skills to do simple multiplication and division along with some word problems that go with them. For reading they are learning sounds and consonants and vowels, using the sounds in the letters to figure out what the words are, and are reading short and simple words that they can sound out. 

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Language and academic progress 9-11: For academic progress at this age they are adding, subtracting, multiplying, and dividing more than one digit numbers. They are getting a better understanding of simple fractions and percentages, area and perimeters of shapes and objects. They are also using more than one variable word problems and learning how to solve that. For reading at this age they are starting to read paragraphs and chapters and actually understanding what they read and also the punctuation used in them. They are able to answer questions about the reading that aren't specifically written out for them in the reading. And they are reading more than one syllable words and knowing the meaning of them. They are also starting to read more fluently while still understanding what they are reading.  

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Language and academic progress 9-11: For academic progress at this age they are adding, subtracting, multiplying, and dividing more than one digit numbers. They are getting a better understanding of simple fractions and percentages, area and perimeters of shapes and objects. They are also using more than one variable word problems and learning how to solve that. For reading at this age they are starting to read paragraphs and chapters and actually understanding what they read and also the punctuation used in them. They are able to answer questions about the reading that aren't specifically written out for them in the reading. And they are reading more than one syllable words and knowing the meaning of them. They are also starting to read more fluently while still understanding what they are reading.  

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Directed instruction learning: This can alleviate challenges by having very controlled environment and a lot of structure that comes along with that. This could be very good for a child that has mild ASD so that they aren't overstimulated too much and they always know the plan and what is going on. This can aggravate challenges by the students becoming bored or there isn't as much one on one time with teacher and student. If that isn't helping then the student can become stressed and unmotivated and not want to do what they are told.  

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Directed instruction learning: This can alleviate challenges by having very controlled environment and a lot of structure that comes along with that. This could be very good for a child that has mild ASD so that they aren't overstimulated too much and they always know the plan and what is going on. This can aggravate challenges by the students becoming bored or there isn't as much one on one time with teacher and student. If that isn't helping then the student can become stressed and unmotivated and not want to do what they are told.  

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Although direct teaching is one of the most widely used teaching strategies, it has been criticized as ineffective and scorned as the teaching method chosen by teachers who are not prepared. However, I consider direct teaching a powerful teaching strategy that needs good preparation.

Brief History & Background

As a method of instruction in the classroom, direct teaching or direct instruction is probably the one that has the fewest flashes and sparkles. The students are not divided into groups. There are no experiments. And there is very little drama and student participation involved. But the effectiveness of direct teaching is evident. This is why the program called DISTAR or Direct Instruction System for Teaching Arithmetic and Reading was implemented by the US government for nearly three decades.

Direct instruction or direct teaching was first developed by Siegfried Engelmann and Wesley C. Becker. The purpose of the teaching method was to help the disadvantaged public schools. Then, direct teaching was espoused by Madeline Cheek Hunter, an American educator who created the Instructional Theory into Practice. It is a teaching model that is based on seven components of teaching, seven components of instruction, and seven components of behavioral objectives.

With its structure, direct teaching is considered one of the most powerful teaching methods. The procedure is systematic and grounded on sound teaching and learning principles. But direct teaching also has its disadvantages. There are situations that can make direct teaching ineffective.

The Disadvantages

The structure of direct teaching can be rigid enough to hinder the creativity of the teacher. There is very little room to improvise because this method follows a step-by-step procedure. The procedure usually starts with an introduction, followed by the rationale for the instruction, then by the instruction itself. The procedure ends with a summary and then followed by an assessment.

Direct teaching, if utilized by unprepared teachers, can be disastrous. For direct teaching or instruction to be effective, the teacher must have a mastery of the subject matter, must prepare a well-organized content, and must have excellent communication skills. Without these traits, a teacher could not effectively carry out direct teaching or direct instruction, nor could they develop higher order thinking skills in the students.

The Advantages

Direct teaching is best for learning specific concepts or skills. The specificity of the objectives or learning targets also makes it easier for teachers to create assessment tests of high validity and high reliability. Students, for their part, do not suffer much confusion in determining which part of the lesson is important and which part is not.

However, to take advantage of these benefits, the teacher must ensure that the contents of instruction are logically organized. The teacher must also ensure that the students already possess the prerequisite knowledge.

What is your opinion on direct teaching?

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advantages and disadvantages of using direct teaching or direct instruction in classroom instruction

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Some Advantages & Disadvantages of Direct Teaching

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Although direct teaching is one of the most widely used teaching strategies, it has been criticized as ineffective and scorned as the teaching method chosen by teachers who are not prepared. However, I consider direct teaching a powerful teaching strategy that needs good preparation.

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Guided participation learning: This is good for the child because it is a good way for the child to experience things hands on in was that directly involves the child. Boredom is less common and they are very interested in what they are learning. The negative side to this is for someone with mild ASD some sensory overloads can go off with their different senses. That can cause a meltdown of tears of anxiety for the child. But there is also a lot of one on one time with the teacher to help them through it when needed. 

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Guided participation learning: This is good for the child because it is a good way for the child to experience things hands on in was that directly involves the child. Boredom is less common and they are very interested in what they are learning. The negative side to this is for someone with mild ASD some sensory overloads can go off with their different senses. That can cause a meltdown of tears of anxiety for the child. But there is also a lot of one on one time with the teacher to help them through it when needed. 

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Ages 6-8: At this age children are resilient and often bounce back from things like parental fighting and strains in relationships from life. This is the age when the start realizing things and comparing their looks to others and how smart they are to others as well as a lot of other things. At this age how they view themselves is starting to match up with how mature emotionally they are. Having trouble making friends as a child at this age can make them feel less than everyone else that can carry on into adulthood if it starts early enough 

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Ages 6-8: At this age children are resilient and often bounce back from things like parental fighting and strains in relationships from life. This is the age when the start realizing things and comparing their looks to others and how smart they are to others as well as a lot of other things. At this age how they view themselves is starting to match up with how mature emotionally they are. Having trouble making friends as a child at this age can make them feel less than everyone else that can carry on into adulthood if it starts early enough 

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Every day, children ages 6 to 10 may face new challenges at home with their families and at school with their friends and teachers. At the end of one day, they may feel good about themselves. They have fun with their friends, have done well at school, and are happy at home.

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Ages 9-11: There are so many things that can influence a way that the child sees themselves, for example how they are treated at school and by peers, the relationship between them and their parents, their parents relationship, etc. Bullying in harsher way is more common at this age with teasing and physical violence. Hitting name calling, escalated arguments can make the child feel worse about themselves. All that on top of family stress with moving jobs causing the parents to focus more on fighting and financial situations than they are the kids. This can make the self doubt and the stress levels in the children rise astronomically. Kids during this age may have to be the "parent" to their siblings when the actual parents are too busy arguing and not being happy with each other. The older a child is especially at this age where they can remember more will cause them to be less resilient and not able to bounce back as fast. 

# data[].attributes.subject
Ages 9-11: There are so many things that can influence a way that the child sees themselves, for example how they are treated at school and by peers, the relationship between them and their parents, their parents relationship, etc. Bullying in harsher way is more common at this age with teasing and physical violence. Hitting name calling, escalated arguments can make the child feel worse about themselves. All that on top of family stress with moving jobs causing the parents to focus more on fighting and financial situations than they are the kids. This can make the self doubt and the stress levels in the children rise astronomically. Kids during this age may have to be the "parent" to their siblings when the actual parents are too busy arguing and not being happy with each other. The older a child is especially at this age where they can remember more will cause them to be less resilient and not able to bounce back as fast. 

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 What have you learned about influences on a child's development: I have learned how important it is that the child has a caring, strong, and knowledgeable parents or guardians surrounding them. Children learn a lot of things and develop specific habits, good or bad, that come directly from who is parenting them. I learned this throughout the chapter but is especially set in when doing my own and watching others presentations. Children do what their parents do, and they want to be exactly like their parents, that means it is so important that the influence of the child be good and caring. 

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 What have you learned about influences on a child's development: I have learned how important it is that the child has a caring, strong, and knowledgeable parents or guardians surrounding them. Children learn a lot of things and develop specific habits, good or bad, that come directly from who is parenting them. I learned this throughout the chapter but is especially set in when doing my own and watching others presentations. Children do what their parents do, and they want to be exactly like their parents, that means it is so important that the influence of the child be good and caring. 

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What have you learned about parenting; I have learned that even though children of the same age are similar in their developments, no two kids are exactly the same. There will always be differences and there will always be things other kids are doing at a certain age that yours is not and vise versa. Parent with a strategy but not a schedule is something my grandma used to tell my mom and us. Have an idea of what you may want or what you may see in the future but don't always stick to it and never go off course. Children need to see their parents make mistakes and they can't be forced into a routine or do things that aren't for them. All of the graphs and charts and pictures in the book were not ever 100% of kids developed like this or learn from that. There was always variances of things for different kids. There were different types of schools, teachers. settings. sleep arrangements, way of birth etc, that showed me no child is or ever will be the same. 

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What have you learned about parenting; I have learned that even though children of the same age are similar in their developments, no two kids are exactly the same. There will always be differences and there will always be things other kids are doing at a certain age that yours is not and vise versa. Parent with a strategy but not a schedule is something my grandma used to tell my mom and us. Have an idea of what you may want or what you may see in the future but don't always stick to it and never go off course. Children need to see their parents make mistakes and they can't be forced into a routine or do things that aren't for them. All of the graphs and charts and pictures in the book were not ever 100% of kids developed like this or learn from that. There was always variances of things for different kids. There were different types of schools, teachers. settings. sleep arrangements, way of birth etc, that showed me no child is or ever will be the same. 

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What did you do well: The past 11 years of raising Lane I feel like we really payed attention to what he needed, and what direction he was headed. We saw a problem with his learning abilities, brought it up as a concern, looked into it a lot more, and eventually came up with a diagnosis and a treatment plan. We were there for him whenever he needed, and we pushed him in the right direction to be his own person. And now he is a happy, healthy, and smart kid.

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What did you do well: The past 11 years of raising Lane I feel like we really payed attention to what he needed, and what direction he was headed. We saw a problem with his learning abilities, brought it up as a concern, looked into it a lot more, and eventually came up with a diagnosis and a treatment plan. We were there for him whenever he needed, and we pushed him in the right direction to be his own person. And now he is a happy, healthy, and smart kid.

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What could you have done differently: I'm sure almost all parents think of what they could have done better. We could have been there more, put him in more programs. caught his mild ASD sooner. Maybe the school he was going to was too advanced for him at that age but overall he turned out great. 

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What could you have done differently: I'm sure almost all parents think of what they could have done better. We could have been there more, put him in more programs. caught his mild ASD sooner. Maybe the school he was going to was too advanced for him at that age but overall he turned out great. 