Points for Concern: One Year to Two Years

The regression or loss of skills at any age is always a matter of concern and the child must be referred for clinical assessment.Between one and two, you will see very active children who love to move and experiment with moving. By two, a child should be running without support and climbing in and out of chairs. Look for issues with tone, balance and protective reactions and opportunities for movement in order to understand possible reasons for delays in these skills. Many of the delays that are seen in this period are often the result of poor early experiences and environments. Get an understanding of the child’s early experiences and see how you can enrich their experiences in realistic ways, keeping the family and the limitations of their routines and capacities in mind. 
 
There are specific signs that signal deeper issues – for example, children who are standing or walking on their toes are likely to have issues with tone or with sensory reception or tolerance. Look for other behaviours or patterns that could help you identify the root of the problem. Sensory tolerance and reception issues are seen most clearly with delays or issues in feeding and toileting with children being extremely fussy or those that don’t even notice that they need a change, for example. Refer to Disabled Village Children, Chapter 6: Guide for Identifying Disabilities and “Sensory Integration” & “Sensory Processing Disorder Checklist” to help identify the cause of this behaviour.  
 
If children are not using their fingers in exploring and manipulating toys, or are not holding, banging, pulling a stick or spoon, again, poor experience could be the simple reason. Look for other signs such children sitting hunched or poor grip when they hold your fingers to see if the underlying cause is the tone. Look at the article “Development of hand function in the first year” to see how posture, reaching and fine motor are all entwined and use it to see what experiences you may want to give the child. 
 
Children who are interested in interactions but are not speaking at all, speaking very few words or not speaking clearly should be assessed for hearing loss. Consider also the quality of interactions and exposure to language by checking the child’s routine interactions and if possible observing interactions using the “Observation of Partner Skills”.  Also note that children with frequent ear infections may have extended periods when they don’t hear or don’t hear well, thus interfering with normal development of spoken language. Such children may not fail a hearing test on the day they are screened, but may still have delays in spoken language. Use a variety of ways to make language more visible to children, like using gestures and simple signs, and pointing to pictures and objects. This will help build understanding of spoken language but also model other effective ways of supporting spoken language expression so that they experience successful communication.  Please refer  to Helping Children who are Deaf, Chapter 5: What can your child hear? for testing. Please also refer Chapters 2, 3, & 4 in the same book and “Communication Decision Chart” in the Communication Resources Folder for activity suggestions. If the child is not able to drink from glass or sip with a straw, the child would probably benefit from a referral to a speech therapist for further evaluation. 
 
If you see children unable to imitate actions, and other signs such as inability to attend to a task (any task) for very long, check to see if cognition is delayed or if the child has issues with focusing and maintaining attention. Those children who avoid interactions, prefer to be alone and do not show much change in emotion could have trouble with social & emotional development and should be assessed to understand the cause and recommended action. Please refer to resources and ideas from the Autism Information and Resource Centre on the National Trust website http://autismresourcecenter.in/Default.aspx#. Children may also be overly attached to a single caregiver. Encourage the caregiver to play hide and seek games with the child when at home and in a non-stressful situation, so the child can get used to the idea of separation in the spirit of a game and experience the absence followed by the fun of the return of the caregiver.