top of page

Why We Don’t Recommend “Wait and See”

Why We Don’t Recommend “Wait and See”: Brain Plasticity

Written by Kelsie Goller, MA, LPC-S, RPT

Clinical Director, KPS

Children’s development occurs across many domains; for example, there are established milestones for babies’ physical development, cognitive development, speech/language development, and emotional/social development.  At the same time, there can be a large age difference in the times in which children display different skills while still being in the “normal” range for skill acquisition.  In 2022, the CDC updated their developmental milestones for children after the American Pediatric Academy completed a large peer-reviewed study of appropriate age placement for each milestone (Zubler et al., 2022).  The milestones are placed at the age at which 75% of children have statistically achieved that milestone.  Previously, milestones had been set at the age at which 50% of children had achieved the milestone, which meant that many doctors encouraged parents to “wait and see”, as half of the children would reasonably be expected not to have completed the milestone.  Moving the milestones to the ages when 75% of children were expected to have completed the milestone was intended to discourage the “wait and see” method, indicating that children who have not reached that milestone by that age should receive further evaluation.  

But why not “wait and see”?  Because children’s brains are particularly plastic in the first years of life, meaning that the brain is able to make new connections and learn new information/behavioral patterns at this age better than at any other time.  There are 50% MORE connections between neurons in early childhood than there are by the time the person reaches adulthood.  LEARN Behavioral, a website focused on helping children and teenagers with Autism Spectrum Disorder, explains it this way:  “As an infant experiences something or learns something for the first time, a strong neural connection is made. If this experience is repeated, the connection is reactivated and becomes strengthened. If the experience is not repeated, connections are removed. In this way, the brain ‘prunes’ what is not necessary and consolidates the connections that are necessary. During infancy and the first years of childhood, there is significant loss of neural pathways as the brain starts to prune away what it doesn’t believe it will need to function. By the time your child reaches adulthood, the number of synaptic connections is reduced by half” (Brain plasticity & early intervention). 

This is why occupational therapists, speech therapists, and psychologists are in agreement that if you are concerned about your child’s development in an area, seek further evaluation.  As one Harvard article notes regarding seeking diagnosis and treatment for autism spectrum disorder: “Here’s the thing: ABA and the other treatments [occupational therapy, sensory integration therapy, and strategies to improve communication] are helpful for children with developmental problems, no matter what their cause. There is no downside to doing them even if the child ultimately is found to have a different problem — or no problem at all. They are good for the child with autism, the child with a language disability, or a late bloomer” (McCarthy, 2019).  The potential drawbacks for misidentification of the problem is far outweighed by the certain drawbacks of NOT interceding at a time when brain development is greatest.  Additionally, only a small percentage of children are misdiagnosed: there are sensitive tools for identifying global developmental delay, autism, or sensory integration needs.  One study of 1,200 toddlers who had two or more developmental evaluations between 1 year and 3 years old found that “[l]ess than 2% of the toddlers initially thought to have autism were subsequently thought to have normal development” (McCarthy, 2019).   While some parents may be fearful of “labeling” their child at an early age with autism, early identification of autism and support from a neurodiversity-affirming team “can promote understanding and create new opportunities to embrace the strengths of their neurotype and remove the barriers that are in the child’s way because they were born with a brain that processes information in a different way”, per Dr. Tiplady, a neurodiversity-affirming psychologist (The importance of early…).  

To sum it all up in two words, why should you not “wait and see” if you have concerns about your child’s development in any domain?  Brain plasticity.  The earlier the intervention, the easier it will be for the child’s brain to incorporate new information, whether in the form of speech, physical movements, or social interactions.  

More Resources:

Article from the Physical/Occupational Therapy perspective:  

Articles from the Speech Therapy perspective: 

Articles on the Importance of Early Diagnosis and Support for Children with Autism:


Brain plasticity & early intervention: “Neurons that fire together, wire together.” (2022, 

InBrief: The Science of Early Childhood Development.  (2007). Center on the 

Key points about CDC’s developmental milestone checklists.  (2023, June 6). Centers 

for Disease Control and Prevention. 

McCarthy, C. (2019, August 23). How early can you - and should you - diagnose 

The importance of early evaluation and neurodiversity-affirming care for autism. (2022, 

Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., 

Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022, February 8). Evidence-informed milestones for developmental surveillance tools. American Academy of Pediatrics. 


Featured Posts
Recent Posts
Search By Tags
Follow Us
  • Facebook Basic Square
  • Twitter Basic Square
  • Google+ Basic Square
bottom of page