DIR. S.I. Greenspan, M.D. . Figure 1 ‘THE FUNCTIONAL DEVELOPMENTAL GROWTH CHART Developmental Stages Bb. Creates Togical bridges between three or more emotional ideas fia. Creates logical bridges between ideas 5b, Uses ideas (words! Symbols) beyond expressing basic needs F Uses ideas (words symbols) ‘Child is making igh quicker progess than ihe to convey intentions or feelings (iB. Organizes chains of interaction (complex problem-solving) fia. Organizes chains of id Ts making slightly slower progres than thd interaction (simple problem- ‘expectable rate. solving) Interacts in purposeful manne] Engages in relation- ships ‘Developmental problems are becoming ‘eater asthe child becomes older i. Fosises and attends wo sights and sounds Age in Months 1TPIL 9 | [is] [as] [aa 30 -] [a8 T Copyright 2002 al rights reserved 1”on S. I. Greenspan, M.D. ‘The Functional Developmental Growth Chart One of the most important components of.a functional approach to intervention is to initiate the interventions at the earliest possible time. This minimizes ongoing functional impairments and missed opportunities for mastering critical functional skills. For example, we have observed that many children who are diagnosed between ages two and a half and four with autistic spectrum disorders begin evidencing a subtle deficit in complex preverbal interactive problem solving patterns between 12 and 18 months of age (Greenspan & Wieder, 1997). The children who are not helped to engage in complex social problem-solving imeractions at this time (e.g., taking Daddy by the hand to the toy area and pointing to the desired play object) miss an opportunity for mastering critical social, emotional, language, and cognitive skills. ‘There is mounting evidence that the absence of critical functional capacities is associated with increased likelihood of severe developmental disorders. For example, Baron-Cohen demonstrated at 18 months, the lack of a type of functional social pointing (which involves. complex social interaction and reciprocity) and early forms of pretend play are associated with autistic spectrum disorders (Baron-Cohen, et al., 1988). Dawson has shown that the lack of early forms of social reciprocity at 12 months is also associated with autistic capacities (Dawson, et al., 1982) and Tanguay has isolated social reciprocity as an essential dimension of autistic spectrum disorders (Tanguay, et al, 1998). Furthermore, early functional motor behavior patterns are being implicated in developmental disorders (Teitelbaum & Teitelbaum, 1999). Findings such as these, together with the growing road map of social, emotional, cognitive, language, and motor milestones provides the basis for a delineation of the essential functional developmental landmarks (Greenspan & Lourie, 1981; Greenspan, 1992). Copyright 2002 all igh reservedS.1. Greenspan, MD. ‘Therefore, just as we chart a child's physical growth, we should monitor functional developmental progress to help identify difficulties atthe earliest possible time. To facilitate this ‘goal, we have developed a functional developmental growth chart similar to the physical growth cchart (see Figure 1: The Functional Developmental Growth Chart). The Developmental Growth Chart enables clinicians to look at the pattern of a child’s growth, rather than simply a few items at acertain age. Patterns of change over time often provide the most useful information about a child’s abilities. ‘The functional developmental capacities are listed on the horizontal axis. The child’s age is on the vertical axis. A forty five degree line and shaded area show the expected age range for mastering each milestone. Historically, we have approached children’s development in terms of isolated areas, such as motor development, the functioning of the senses, aspects of language and cognition, spatial problem-solving, social functioning, etc. When looking at separate areas of development, we typically observe that a child can operate at relatively advanced level in one area, for example in motor development, and yet have significant challenges in another area (eg, language development). While specific aspects of development are very important to identify and assess, for screening purposes it is more useful to look at the child's functional capacities. These represent the way in which the child uses all his abilities together. ‘The child's functional emotional capacities require a coming together of the child’s motor skills, sensory processing capacities, cognitive and language capacities, under the guidance of his ‘emotional intent and proclivities. This includes, as described earlier, his ability to focus and attend, engage with others, communicate his needs intentionally (such as reaching to be picked up), move on to complex problem-solving interactions (such as taking the caregiver by the hand