Recognizing Atypical Development and the Referral Process

Why Recognizing Atypical Development Matters

As a preschool teacher, you spend more hours with young children than almost any other professional in their lives. That puts you in a unique position to notice when a child's development does not follow the expected pattern. Early identification of developmental delays or disorders leads to earlier intervention, and research consistently shows that intervention during the first years of life produces the best long-term outcomes. Knowing what to watch for — and what to do about it — is a core professional responsibility and is directly assessed on the CDA credential exam.

The Five Developmental Domains

Development is described across five domains. Red-flag indicators can appear in any one domain, or across several at once.

1. Cognitive development includes thinking, problem-solving, memory, and early literacy and numeracy. Red flags include a 3-year-old who cannot match simple shapes, shows no interest in cause-and-effect play, or cannot follow a two-step direction.

2. Language and communication includes receptive language (understanding) and expressive language (speaking). Red flags include a child who has no words by 16 months, loses previously acquired language at any age, or by age 2 does not combine two words spontaneously. Loss of language is always an urgent red flag.

3. Social and emotional development includes forming relationships, self-regulation, and reading social cues. Red flags include extreme difficulty separating from caregivers well past the typical adjustment period, persistent aggression or emotional outbursts that do not respond to consistent guidance, or a child who rarely makes eye contact or does not respond to their own name by 12 months.

4. Physical development — gross motor involves large-muscle movements. Red flags include a child who is not walking independently by 18 months, has an asymmetrical gait, or falls far more often than peers of the same age.

5. Physical development — fine motor and adaptive/self-help involves small-muscle movements and daily living skills. Red flags include a 4-year-old who cannot hold a crayon or spoon with any functional grip, or who shows no interest in self-care tasks such as pulling on clothing.

The CDC's Learn the Signs. Act Early. campaign provides free, evidence-based milestone checklists by age. These checklists are widely used tools in the field and are referenced in CDA preparation materials.

Federal Law: IDEA Part C and Part B

The Individuals with Disabilities Education Act (IDEA) is the federal law that guarantees eligible children the right to evaluation and specially designed services at no cost to families.

Part C covers infants and toddlers from birth through age 2 (the day before the third birthday). Services are coordinated through the state's Early Intervention (EI) system. If you are concerned about a child under age 3, the referral goes to the state EI program. A team evaluates the child and, if eligible, creates an Individualized Family Service Plan (IFSP).

Part B covers children ages 3 through 21. For preschoolers, services are typically coordinated through the local education agency (LEA), meaning the local school district. If eligible, the child receives an Individualized Education Program (IEP). The transition from Part C to Part B is a formal process that must begin well before the child's third birthday.

Knowing which part applies based on the child's age ensures that families are directed to the correct system immediately.

The Referral Pathway: Your Role as a Teacher

Teachers do not diagnose. Your role is to observe, document, consult, and communicate — not to label a child with a condition. The appropriate pathway is:

1. Observe and document. Record specific, objective observations with dates. Avoid opinion-based language. Write what you see and hear, not what you conclude.

2. Consult with your director or lead teacher. Share your documented observations. Your program may have a protocol for how concerns are escalated.

3. Initiate a conversation with the family. This conversation should be factual, supportive, and focused on what you have observed — not on a diagnosis. Use neutral language and provide information about available resources. A script template can help you prepare.

4. Refer to the appropriate system. Families have the right to request an evaluation at no cost under IDEA. You can help them understand that right and provide contact information for the state EI program (Part C) or the local school district (Part B).

5. Follow up. After a referral, continue your observations and maintain communication with the family within appropriate confidentiality boundaries.

Confidentiality and safety note: Information about a child's development and any evaluation findings is protected. Share it only with individuals who have a legitimate need to know and only with appropriate family consent. Separately, if during your observations you notice signs that may indicate abuse or neglect — unexplained injuries, extreme fear of specific adults, or severe developmental regression — you are a mandated reporter and must follow your state's mandatory reporting law. These obligations exist independently of and alongside the developmental referral process.

Deciding When to Act

A useful framework for decision-making is:

• Continue observing when a behavior is new, infrequent, and within the range of typical variation for the child's age.
• Consult with the director when a pattern persists across time and settings and you want guidance before speaking with the family.
• Initiate a referral conversation with the family when a concern is consistent, documented across multiple observations, and involves a recognized red-flag indicator.

When in doubt, document more and consult sooner. A concern raised and found to be within typical range causes no harm. A concern missed or delayed can affect a child's trajectory for years.