PIC Family Voices Podcast Episode 13: The Importance of Developmental Screenings

Robin (00:31)

Welcome back to the PIC Family Voices podcast. Today we’re diving into a topic that can make a big difference in understanding your screenings. What are they? Do they matter? And what should you as a parent or a caregiver know about them? Our guest is Meagan Galvin. Meagan has been working in the early childhood care and education field since 2008. She previously worked in infant and toddler care, preschool and home visiting. Meagan is currently a family worker at Head Start Center that recently opened up inside of Nashua Community College.

Over the past few summers, Meagan has also been a part of an initiative to provide developmental screening pop-up events in the greater Nashua area. Meagan, thanks so much for joining us.

Meagan Galvin (01:14)

Well, thank you for inviting me.

Robin (01:15)

Before we dive in, can you tell us a little bit about the developmental screening pop-up events that you do?

Meagan Galvin (01:22)

Sure, so that was a collaboration between the United Way of Greater Nashua’s, what they call the Smart Start Coalition for Early Childhood Success, a group of various service providers in the Greater Nashua area working with children, birth to eight actually.  It started because someone in one of the coalition meetings said, we wish that there was someone in the community that could provide ASQ developmental screenings at community events. And I jokingly said, well, if someone pays me, I’ll do it. And I learned not to say that to that group because that did turn into a rather large grant that I worked on the last two summers, providing events, events in the community, as well as going out and doing some trainings at childcare centers or even going out at a childcare educator summit, doing some small presentations out there in getting parents connected with the tool, as well as getting other childcare centers and preschools connected with those tools to then share with their families. Most of it was done at library story times or indoor playgrounds. And it was actually, it was a really fun experience. Got to meet a whole lot of different kiddos. And in addition to providing the ages and stages questionnaires, I was also giving out information on the CDC play-based activities just kind of letting everyone know also about what was available in the region.

Robin (02:39)

Yeah, great. I love that you are going out into the community to where families are already at, like library story hour. They’re right there. They’re going to go there anyway, right? Families are so great. It’s like so nice meet someone like you while they’re already doing something with their children. So I know you kind of like already talked a little bit about like the ASQ developmental screeners, could you tell us simpler terms so that everyone can understand what is a developmental screening?

Meagan Galvin (03:06)

Sure. So a developmental screening is more or less a questionnaire that gives a snapshot of a child’s development. And it gives both parents and professionals a rough idea of whether or not a child is most likely developing on track or whether or not that child would benefit from a more formal assessment and supports.

Robin (03:25)

Okay, great. What kinds of things do they look for on these screeners as far as measuring a child’s development? And we’re talking, to clarify, we’re talking early childhood here, birth to three or?

Meagan Galvin (03:31)

So, yes the tool that I most familiar with, which is the ages and stages questionnaires, they work with children birth to about age five. And that’s the one that I see the most used in childcare or preschool settings, which is my background. And so the ASQ3 is the developmental screening. And that one, it breaks development into a couple of different areas, communication, gross motor, fine motor, problem solving and personal social for each developmental domain, they ask a question on, for example, in the communication section, they will ask, is your child using sentences at least four words long? And the parent or caregiver will say, yes. Sometimes or not yet. And within each of those areas, we look at how many yesses versus how many maybes and how many not yet to see whether or not a child we think they’re on track or whether they might need more support. So yeah, in communication, can they have a conversation with you? If you ask them a question, do they answer appropriately? How many words do they know? Gross motor would be about their large muscle skills. Fine motor, more about their small muscle skills, pre-writing, being able to manipulate objects. Problem solving, it’s, one of my favorite problem solving questions is actually if your child wants something up on the counter, will they pull over a chair or something to climb up? 

Robin (04:51)

I love that. I think that’s a great example.

Meagan Galvin (04:55)

My favorite part of that question on whether or not a child can bring the chair over and climb up the counter is parents are oftentimes not thrilled that their child is grabbing furniture to climb up. And I will agree with them that is very frustrating when your child does, but really great. They had the idea and they were able to solve their problems.

Robin (05:12)

Problem solved. Yeah, okay. So we’re looking for like those critical thinking skills there. How do I accomplish what I set out to do? That thing.

Meagan Galvin (05:21)

Yeah, the critical thinking is great. We can work on also the safety and the how and when later.

Robin (05:25)

Yeah.  That makes sense. Great. So how are these tools used by childcare providers or like in your pop-up? Like who initiates? How does that kind of work?

Meagan Galvin (05:39)

I’ve seen it work a couple of different ways. Oftentimes in childcare settings, the staff or the teachers will be completing the screening and going through based on what they see in the classroom environment. It was actually written to be a parent-led tool, which is something that in my practice, I have increasingly involved the parents more and more. During the pop-ups, it was definitely completely from the parent perspective.

Robin (05:50)

Okay.

Meagan Galvin (06:04)

If they did not know whether or not a child has certain skill, I could talk with them a little bit more about it. We could pull up some materials to test it out or reframe the question to see if there’s another way to show the same skill. But for a lot of those, a lot of the questions can be done by either the education, early education staff or by a parent. I know they’re also used in doctor’s offices, which would be completed by the parent as well.

Robin (06:27)

Okay, so like a pediatrician at a well child checkup, might they hand the parent the questionnaire?

Meagan Galvin (06:32)

Yeah, the pediatrician could use know pediatricians have a couple of different tools that they use. ASQ is one of them. I’ve also seen pediatricians use something called an M-Chat and something called a PEDS screening, which are going to have a slightly different focus know M-Chat is primarily used to screen whether or not a child is possibly needing an evaluation for autism. The PEDs I’m not as familiar with and there might be other tools as well.

Robin (06:57)

Okay, great. But they’re generally that birth to five age range for development, all of them.

Meagan Galvin (07:02)

Yeah, I think there are some that are younger versus a little older. I want to say there’s some that are birth to eight, some that are birth to three.

Robin (07:06)

Okay, but just that general, like, early years.

Meagan Galvin (07:12)

Yeah, early years generally.

Robin (07:14)

Okay, that makes sense. How often should these screenings happen? Is there a recommendation?

Meagan Galvin (07:19)

Screening in the first place is recommended. So I know in Head Start settings, we are part of our national standards is that we do a developmental and a social emotional screening within 45 days of a child enrolling in our programs. We have children in Head Start that are anywhere between age three to five. 

Robin (07:37)

Okay, got it.

Meagan Galvin (07:38)

Ideally, I would love to see a lot of all of our kids start at age three and do the two years of preschool with us. Sometimes in reality, that doesn’t work out that way where, you we have a mid-year opening and someone who’s four comes in.

Robin (07:50)

How often do you all do them?

Meagan Galvin (07:52)

I know we do them once at the beginning of each school year with the child. In early head start, it might also run a little bit differently. I believe I did those once a year in early head start, but some people would use them more often.

Robin (08:04)

What is the age range for early head start?

Meagan Galvin (08:06)

Early head start is birth to three.

Robin (08:07)

Okay, got it.

Meagan Galvin (08:08)

And so repeating a screening after an initial screening also can be referred to as monitoring. In Head Start, we use a different monitoring tool. But I, in the past, did work in other child care centers where we use our ASQs, repeating them for monitoring. I couldn’t find a firm recommendation on this. I think generally, if we’re not concerned about the child repeating it every six months or so, I think will give you a good idea without overworking yourself. In the case where a child, maybe you’re a little bit seeing some signs of a delay or seeing them struggling or their previous score was kind of borderline, repeating it again two to four months later can give you that wait and see time without them slipping through the cracks and waiting too long.

Robin (08:52)

Okay, got that. Yeah, that makes sense. So what questions could parents ask their providers about the screenings they do? And why might a family want to ask about the screenings they do?

Meagan Galvin (09:03)

So I think a family asking why anybody who’s giving any sort of care for their child, it’s good to ask them so that they can be involved and informed. So if it was in a preschool or childcare setting, I would definitely recommend them ask why we’re screening. Ideally, it should be for getting like a baseline of the child’s development or to be helping them to guide supports, maybe figure out if the kid needs more services.

A developmental screening should not be used as a pass fail test. It should be used as a support. I do think sometimes parents will see that and think this is a test that their child could fail. But there is, there’s no failing. It’s to learn about the child and learn where their strengths are and learn where we want to guide our activities and support for them.

Robin (09:37)

Okay, so teachers or providers would use that to determine, how am gonna shape the learning in this classroom in my childcare?

Meagan Galvin (09:56)

Definitely. If you do a screening on your whole class and you are seeing, for example, some fine motor difficulties on a lot of the kiddos, you’re going to then into your curriculum and plans, incorporate a lot more fine motor than you might have naturally. If you are seeing developmental concerns on a single child, I would still want to be bringing that into the classroom and the curriculum, maybe even kind of guiding the kiddo towards those activities and as well as maybe even sharing with the families, here’s what I’m doing in here with us. And here are some activities that you can do at home if you would also like to support that.

Robin (10:29)

Okay, great. So now if your child is in a childcare setting or a private preschool setting, would they be notified necessarily if these screenings were being done? Or is that something families should ask about? Should they say, you know, do you do a screening this year or?

Meagan Galvin (10:44)

I would definitely recommend asking. It’s one of those things that I, was definitely a best practice to let families know and involve them. Not everyone is necessarily trained to do that piece. I think there are people out there who maybe have not had the full training on how to properly administer a screening and will just find the tool off the internet, print it off and maybe not do that family engagement piece.

Robin (11:08)

Okay, got it. And then, mean, sometimes it’s just really like part of the regular way things go. They screen everyone at the beginning of the year. It’s just kind of how they inform their classroom, right? So they may not. Right, right. So I’m thinking probably helpful for families to ask, you

Meagan Galvin (11:17)

Yeah, they might not think to involve parents.

Robin (11:25)

Is there a screening done and how are the results shared with us? You know, who gets these results? Is that appropriate?

Meagan Galvin (11:30)

Yeah, I think definitely asking is there a screening? How often, how are the results going to be shared with me and how are the results going to be used in the program? I think are all very appropriate questions. One thing to also ask would be if their screening shows there’s some larger developmental concerns, whether or not the child care or preschool is comfortable giving referrals out for additional services and whether or not they are able to support the family in going through the process of those referrals.

Robin (12:01)

Okay, great. So the importance of getting these early childhood screenings done, I assume, is to really help that child’s development in the long run. Am I correct about that? Like how should families be viewing this?

Meagan Galvin (12:14)

Yeah, no, it’s definitely, think, to… So if there is any sort of developmental delay, the younger you catch it, usually the smaller the delay is compared to a typically developing child. And the sooner you get help, the easier it is to catch up. So if you catch something at age three or four, rather than letting the child struggle until they’re in elementary school, it’s a little easier, again, with also even skills for babies.

Robin (12:28)

Got it.

Meagan Galvin (12:39)

If they are struggling to learn to walk or talk, getting them early intervention as a baby means they would likely to need supports in preschool.

Robin (12:46)

Okay, and are there benefits to doing these screenings across the board, even if children are developing typically?

Meagan Galvin (12:52)

Yeah, so first of all, it’s a nice way to make sure that you are taking a stronger look at each individual child and making time, you know, if you’re only screening the kids you’re worried about, you’re never really thinking about the general population.

Robin (12:59)

Okay.

Meagan Galvin (13:07)

And you know, even a kid who’s typically developing might have an area that they could use a little extra help. And that will inform me to know which, how to focus my efforts.

Also, there are children that at a glance will seem like they’re fine, and they’re not always fine. Some kids are very good at masking difficulties or they will avoid activities that they are not strong at. And for example, if a child is not very strong at gross motor activities, maybe on the playground, it looks like they’re just choosing to play more calmly.

But then if you actually are going out and seeing like, can they do the jumping, climbing, throwing? And you see that it’s not that they were choosing not to, it’s that they were struggling with it. It kind of catches those more subtle concerns.

Robin (13:50)

If a family or a child care provider is worried about a child’s development, what’s the first step they take? Like, I know that it sounds like the first step is to do a screening once a screening is done, if there are areas of concern, what happens next?

Meagan Galvin (14:07)

So at that point, the parent can have conversation with the childcare provider and the preschool. Everyone get on the same page about what the concerns are and whether or not we’re seeing them across the board. And if the child is age birth through just before their third birthday, they could reach out to early sports and services. And if they are age three to five, they would reach out to their local school district. Either of those programs can then complete a longer, more formal assessment of the child to determine whether or not they are eligible for services.

Robin (14:38)

Okay, great. And I think that’s an important thing for families or anyone to know the difference of. The screening is kind of that like first line of saying like, okay, is there anything that we should be flagging here or noticing here? And that assessment is a deep, much deeper dive and referral of like supports and services to help with that child’s development.

Meagan Galvin (14:54)

Yeah, a screening I think is more kind of an upper level idea, whereas the assessment is going to be in much more detail. Anyone who completes those assessments is going to have a much higher level of formal training and parameters that they complete. A screening also has a little bit more flexibility in it. When I complete an ASQ 3, I can reframe a question if need be, if I know the child kind of has the skill, but doesn’t show it in the exact way the question asks, you are allowed to reframe an ASQ-3. You in a formal evaluation or assessment done by early sports and services or the school district, there’s less flexibility there.

Robin (15:37)

Okay, got it. That makes sense. And just to mention too, in New Hampshire, they just kind of renamed themselves. So it’s birth to three early supports and services now where it used to be. I know. So I’m just putting that out there for like, just in case they’re gonna Google that, you know, and look for those. And I also think it’s important to mention that anyone can make a referral to birth to three services. So any parent, if they’re concerned, they can call birth to three.

Meagan Galvin (15:49)

You can call birth to three or you can call the school district even if you haven’t had a screening done, even if your child care provider has never screened them, even if they disagree, even if you have no child care provider, even if you had a lady at the library story time who handed you a screening and talked with you about it, you can self-refer. Some families with their concerns might feel more comfortable talking to their pediatrician first.

Robin (16:19)

Okay.

Meagan Galvin (16:25)

The pediatrician can also support them in getting a screening and connecting them with the appropriate resources. Last I knew also the family resource centers in New Hampshire also had access to screenings. So that is somewhere if you look up your local family resource center or FRC and talk to them, they could also be able to support you through completing a screening and the steps in the evaluation process.

Robin (16:35)

Okay.

In addition to the Family Resource Centers, you could also contact New Hampshire Family Voices. They’ll do screenings as well. I know you’ve worked with New Hampshire Family Voices.

Meagan Galvin (16:54)

Yeah, New Hampshire Family Voices was actually the ones that provided me with the free materials when I started doing the pop-ups supported by the United Way. I had always had whatever school or childcare I worked for had provided the materials. But when I went out into the community, I spoke with New Hampshire Family Voices and got connected with the Watch Me Grow program. And they actually have free training and materials that they can provide to anyone working with children and families in the state of New Hampshire.

They also have resource and activity guides that accompany them so that if there’s a child who maybe needs some extra activities to do in their home or classroom, while I’m sure a good preschool teacher could think of activities on her own, it was really nice having the booklet with handouts for ideas that I could both incorporate into my work in preschools, but also email those out to parents who completed a screening out in the community rather than having to reinvent the wheel.

Robin (17:52)

That’s great. You said this is a family-friendly, the ASQ, I mean, in particular, this is a family-friendly assessment where it was designed for families to be able to do with their children.

Meagan Galvin (18:02)

It was designed with families in mind. Some families might still need a little bit of extra support because not every family has a child development background. So sometimes having a professional available who can explain or reframe a question is handy, but families can also feel free to try it on their own, reach out for help if they need it. The ASQ-3 is also available in a lot of different languages. But it’s not available in every language. And so sometimes having a professional there who can provide interpretation support. So that way it’s available to families who may not have fluent English reading skills.

Robin (18:37)

Got it. Reach out to your family resource centers, reach out to New Hampshire Family Voices, and you can find out which way to go from there if you’re a parent that isn’t connected with preschool or childcare. Otherwise, I think you said you could ask your child care, you could ask your pediatrician.

Meagan Galvin (18:51)

Yeah, I think your pediatrician, they may not use the exact same tools I use, there’s pediatricians have access to interpreters. I, in my work in Head Start have hired interpreters to go through ASQs with families or go through, really I’ve worked with interpreters on a whole variety of meetings with families. And that’s something that might be challenging for some of the smaller independent child care or preschools. It’s still definitely worth asking. I think you will find a little bit more availability for that at a family resource center or your pediatrician or at a larger preschool or a head start.

Robin (19:28)

Okay, got it other resources you recommend for families just learning about those so they can kind of get a sense of where their child should be at any time between birth and five years old? Any developmental milestone resources or tools that you think they could use?

Meagan Galvin (19:46)

Yeah, so there’s the CDC developmental milestones where they have booklets that break it down by each age that you would go to a well child appointment. So your three month, your six month, your nine month appointment, all the way up through age five. They have a list of various skills that they would expect to see a child at that age. And you can go through those. They have the booklets. There’s also a free app online. So if you are the type of parent who’s not going to be able to keep a little booklet for the first whole five years of their child’s life, an app might be a lot more accessible. They don’t go to the same depth as a screening, but I think for the average person, I think it’s a very accessible, easy way to kind of jump in and get an idea.

Robin (20:25)

Yeah, definitely. Maybe even helpful before you have your child’s well visit to kind of just go through it and say, here’s an area I’m going to want to a question on.

Meagan Galvin (20:31)

I did that with actually, I have a four year old and definitely during her baby well child checks and early toddler years, I would go through the CDC list shortly before her well child checks and like, okay, is she stacking three blocks? No, she’s not quite stacking three blocks, but she’s doing this. But bringing whatever things that she is or isn’t doing and talking to the pediatrician on whether or not it’s something that they’re worried about, whether they’re comfortable waiting and seeing, whether it’s something that they’re not as concerned about, is really helpful.

Robin (21:03)

Okay, great. And then I just want to also mention these milestones aren’t exact pinpoints in time, right? Every child does develop a little bit differently, so we also need to have a little bit of a flexible mindset around. It doesn’t have to be hard.

Meagan Galvin (21:16)

Yeah. Yeah, it’s again, it’s not like a first of all, it’s not a child failing. And if so, for example, when I mentioned how I was worried about my daughter not necessarily stacking three blocks at the exact age range, I forget which it was. That was definitely something that the pediatrician is like, she’ll get there, she’ll figure it out. And just make sure that you are exposing her to building toys and materials.  So I think it was good for me to be mindful of the fact that, okay, I’m gonna make sure that she has those available to her during playtime, but not to stress it. And yes, eventually she started building with blocks.  So, yeah, the milestones are to kind of give you a vague idea and a conversation starter. They’re not worth panicking over right away before talking to an expert.

Robin (22:01)

Okay, got it. That makes a lot of sense to me. Well, as we wrap up, any final messages for parents who might feel nervous or unsure about developmental screenings in general?

Meagan Galvin (22:12)

So I want to remind the parents that the screening is a tool made for learning more about your kid. And not something that you’re passing or failing or that they are winning or losing. It’s just taking a snapshot of where they’re at. And so it’s just helping you learn more about your particular child. And if you are the one going through the list and trying out the activities, try to relax and have fun with it. And sometimes also kids can be really funny and you might need to try things two or three times. There’s a big difference between something your child can’t do and something your child just won’t do right now if they’re tired or cranky or just not feeling like it. I did actually work with a family and we were doing a screening recently and I think I asked him, whether or not the child could do three step direction unrelated. I was like, honey, could you walk over to the door, clap your hands and sit down? And he looked at me, rolled his eyes and said, I could.  And for that day, just kind of put the screening away and said, okay, we’re going to try this another day. But he was in no mood for, you know, thought it was a nonsensical direction. It was, you know, seeing whether not he could hold three directions in his mind, remember them and follow through, which is a useful skill. But in his mind, I was asking him to do something very useless and silly, and I’m not going to force it. And…me and mom just kind of said, okay, you know what? Glad to know that you could and let’s move on. And we tried it again when he was in a better mood and he did beautifully.

Robin (23:36)

Well, we so much appreciate your time. We hope to have you back on the podcast again. But really, thanks for explaining this. This something that I really didn’t know about when my children were younger. I had the books, I did like keep track of the milestones and things like that, but I didn’t know what a developmental screening was or that it was done. And I really would love to kind of had this type of information so that I could have engaged more or partnered more with my childcare or preschool. So I really just appreciate your expertise and sharing that with our families today.

Meagan Galvin (24:11)

Thank you so much, yeah, no, part of the reason I moved out of classrooms and into working with the families is I really enjoy that piece. Not every preschool and childcare has someone dedicated to family engagement. So the more we can empower and educate parents on what their options are, the more we can kind of get that going for those who want it.

Robin (24:28)

I love that. Thank you so much, Meagan.

Meagan Galvin (24:30)

All right, thank you so much.