Developmental Milestones - when to evaluate

I sure wish I had known about this when my kids were little.

Developmental Red Flags that Should Prompt Assessment

• Rolling prior to 3 months (evaluate for hypertonia)
  
• Persistent fisting by 3 months (evaluate for neuromotor dysfunction)
  
• Failure to alert to environmental stimuli (evaluate for sensory impairment)
  
• Head lag when pulled to sit after 4 months (evaluate for hypotonia)
  
• Failure to reach for objects by 5 months (evaluate for motor, visual, or cognitive deficits)
  
• Inability to tripod sit by 6 months (evaluate for hypotonia)
  
• Absent smile by 4-6 months (evaluate for visual loss, attachment problems, maternal major depression; consider child abuse or neglect in severe cases)
  
• Persistence of primitive reflexes after 6 months (evaluate for neuromuscular disorder)
  
• Absent babbling by 6 months (evaluate for hearing deficit)
  
• Absent stranger anxiety by 7 months (may be related to multiple care providers)
  
• W-sitting and bunny hopping at 7 months (evaluate for adductor spasticity or hypotonia)
  
• No back-and-forth sharing of sounds, smiles or other facial expressions by age 9 months or thereafter (evaluate for autism or pervasive developmental disorder)
  
• Lack of tool use (crayon, spoon) by 12 months (fine motor or cognitive delay)
  
• Lack of imitative play by 18 months (hearing deficit or cognitive/socialization deficit; evaluate for autism)
  
• Hand dominance prior to 18 months (may indicate contralateral weakness with hemiparesis)
  
• Lack of protodeclarative pointing by 16 months to 18 months ( problem in social relatedness; evaluate for autism)
  
• No first word, other than mama/dada, by 18 months (auditory expressive language)
• Persistent poor transitions by 24 months (evaluate for pervasive developmental disorder)
  
• No two-word sentences by 2 years (auditory expressive language)
  
• Advanced non-communicative speech (echolalia) or not understanding simple commands by 24 months (evaluate for autism or pervasive development)
  
• Any loss of speech, babbling or social skills at any age (evaluate for autism or pervasive developmental disorder)
  

Adapted from Family Practice Notebook www. fpnotebook. com

Review: All Your Worth - A Lifetime Money Plan

So I wrote about The Two Income Trap a while back - and now I'm writing again, with a review about the follow-up book, All Your Worth: A Lifetime Money Plan by Elizabeth Warren and Amelia Warren Tyagi. This book was written by the authors of "The Two Income Trap" when readers began asking them for help - and when they found that there really weren't any books on how ordinary people should manage their money.

The thesis of the book is this: you should spend 50% of your after-tax income on "Must Haves" (things you need), 20% on "Savings" (the money you save for emergencies and for the future), and 30% for "Wants" (the stuff that's just for fun.) The authors take you step-by-step through figuring out what you are spending in each category, and make excellent, concrete suggestions about how to get costs under control.

MUST HAVES

The "Must Haves" are expenses that you are required to spend money on each month - food, housing, medical care, transportation, insurance, and legal obligations. Things you can do to get these costs under control include: (a) researching insurance costs and getting the best deal on insurance you can, (b) getting a discount on any student loans you have, (c) reshopping your mortgage when it makes sense, and (d) eliminating any long term contracts (e.g., gym memberships, cell phone agreements, etc.) They also talk about more drastic measures like getting a roommate, renting your house out, selling your current car and buying a cheaper one, getting rid of any rentals (except your abode), and finding cheaper medical insurance. They also talk about how necessary medical and disability insurance are, as well as giving suggestions for finding good deals on health insurance, and child care. For those in truly dire straits, they talk about downsizing your home and taking on another job.

SAVINGS

The chapter on "Savings" is probably the hardest chapter. The idea here is to start building your dreams a little at a time. Starting now, put 20% of each paycheck towards the following goals (in order.)

(1) Save $1000 so you can pay for life's little emergencies (i.e., flat tire, broken window, etc.) without having to go into debt to do it.

(2) Pay off your "steal-from-tomorrow" debt. If you are like most of us, you have some debt. Student loans, medical bills, car loans, credit card bills... you get the idea. Any money that you owe to someone else is debt that you need to pay off so you can start saving for *your* future. The chapters on eliminating debt repeat many of the themes from "The Two Income Trap" - that the rules of loaning money have changed, and that banks no longer try to protect you from borrowing money you cannot ever hope to repay. It's up to each of us to protect ourselves now, and the first step is to get rid of all our debt. They take you through the steps of figuring out how much you owe, and then through a repayment plan that will get you back on track. They do not recommend home equity loans (ever!), nor do they recommend credit counselors, debt consolidation, and credit repair kits (in fact, they think these are bad ideas.)

(3) After you pay off your "steal-from-tomorrow" debt, you need to save money for your "security fund". This is a savings account that has enough money in it to cover 6 months of your "must have" expenses. This should be in liquid form so that you can access it easily in times of emergency, but difficult to access, so you only touch it when it truly is an emergency.

(4) Last, but not least, start saving. You should put 10% towards retirement, the rest should go towards paying off your house, and saving for your dreams. Here the authors make good, concrete suggestions about how to invest your money and which types of investments make good sense.

WANTS

"If you can't afford fun, you can't afford your life". This is the thesis of the section on "wants". The money you can spend on the things you want is the money left over after you have paid for the "must haves" and put 20% into savings. The remaining money is play money. Once you know how much you can spend on fun, you can spend it on anything you want, as long as you stay in budget. The authors make some great suggestions for keeping your "wants" spending in control, including my favorite, which is to pay for everything with cash. The section on the psychology of credit cards is great, driving home the point that it is much easier to spend money with your credit card than when you pay with cash straight from your wallet.

The last part of the book talks about how to work with your life partner to get your finances in order (and frankly, this section should be required reading for all couples!), how to purchase the home that is right for you, and strategies for dealing with a financial crisis.

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I've worked through the exercises in this book, and am working on getting everything in balance. I feel so much calmer now that I understand where my money is going, and in particular, what I need to do to get it under control. It is a long process, but each day I move a step closer, and each day I feel a little less worried about the future.

Buy this book and use it well. It is what I've been looking for to help me manage my money for nearly 20 years since I graduated from college.

My Favorite of the How-to-Manage Books

Hands down, my favorite book about managing was First, Break All the Rules: What the World's Greatest Managers Do Differently by Marcus Buckingham and Curt Coffman. It is fabulous with concrete and usable advice, based on interviews with 2 million employees and 80,000 managers.

The thesis of the book is that you should figure out what your employees' talents are and place them in positions where those talents will shine, instead of trying to force them to improve skills for things they will never be good at.

Below are 12 things employees need to rate highly if a business is to attract, focus, and keep the most talented employees. The first six questions have the strongest links to the business outcomes of productivity, profitability, retention, and customer satisfaction.

WHAT DO I GET?

(1) Do I know what is expected of me?

(2) Do I have the materials and equipment I need to do my work right?

WHAT DO I GIVE?

(3) At work, do I have the opportunity to do what I do best every day?

(4) In the last seven days, have I received recognition or praise for doing good work?

(5) Does my supervisor, or someone at work, seem to care about me as a person?

(6) Is there someone at work who encourages my development?

DO I BELONG HERE?

(7) At work, do my opinions seem to count?

(8) Does the mission/purpose of my company make me feel my job is important?

(9) Are my co-workers committed to doing quality work?

(10) Do I have a best friend at work?

HOW CAN WE ALL GROW?

(11) In the last six months, has someone at work talked to me about my progress?

(12) This last year, have I had opportunities at work to learn and grow?

Good managers address these issues in order. If you work on question (7) before your employees rate their jobs highly on issues (1) and (2), it is wasted effort.

The book also gives some good ideas about interviewing for talent, as well as concrete suggestions for creating good working environments where excellence at any job is rewarded equally. The idea is to to create an evironment that rewards excellent engineers, secretaries, and managers equally, rather than forcing those who are excellent at one type of activity to move into another type of activity in order to get a raise.

I LOVED this book.

Who Wants to Make this Choice?

Alan sent me a link to testimony a woman gave to the Texas Legislature on why she decided to have a late-term abortion in the 22nd week of her pregnancy. Her son Stephen had severe birth defects, and she and her husband knew that if he lived, he would be in severe pain for his entire short life. They decided that the only humane choice was to end his life before he suffered any longer. Be warned: the testimony is absolutely heart-wrenching.

More than anything I've read, this story drove home the point that the people who should make such decisions are doctors and their patients. Politicians should not be in this business.

I was also struck by the profound consideration given to Stephen's quality of life. It matters terribly. I salute Stephen's parents, and hope that others faced with a similar choice will have the courage to face their fears about death directly, while considering the quality of this life.

Theories: Evolution and Others

Alan's father sent me the following letter written on March 21st, 2005 to the Fort Worth Museum of Science and History, in response to an article he read in the New York Times reporting that the museum had decided against showing the IMAX Movie "Volcanoes of the Deep Sea" because it mentioned the theory of evolution. This letter is the best statement I've yet seen on why the argument against the THEORY of evolution is so ridiculous.

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To: webmaster@fwmsh.org
From: James C. Thompson
Subject: For the Museum director (if any)

Sir,

I am appalled and frustrated to read in the NY Times that your museum has caved in to a group of ill-educated and ill-informed knownothings and cancelled showing of the IMAX Volcanos movie because it mentions the THEORY of evolution.

I'm sure that you will shortly be closing your optical exhibits as they depend on the THEORY of electromagnetism, and you'll shortly quit using these machines that make communication so easy since they are designed with the THEORY of condensed matter physics, and all that astronomy must go (poor old Charlie Noble) as the THEORY of gravitation is also doomed, and then there is the THEORY of nuclear physics and an explanation of where our sun generates its energy (a theory by the recently deceased Hans Bethe), and then there is the THEORY of plate tectonics, and so on.

You have missed a great chance to explain how scientists use the word "THEORY" and why evolution is as much a fact as gravity. And why none of the above has any thing to do with religion. But if you do not, then I suggest you chisel out the word "science" in the name on the museum.

Born and perhaps educated in Forth Worth (AHHS 1948; TCU 1952) I am doubly outraged at this move back to the dark ages.

You should be ashamed.

James C. Thompson

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He requested that I post the museum's response with his letter.

From: "FWMSH1"
To:
Subject: IMAX Film on Volcanoes
Date: Thu, 24 Mar 2005 15:24:21 -0600

On behalf of the Fort Worth Museum of Science and History, we are writing to let you know how much we sincerely appreciate your interest in the Museum and the programs and films we show at the Omni Theater. In light of the current interest in the film, Volcanoes of the Deep Sea, the Museum will be showing the film, which will open soon. Please check our website, www.fortworthmuseum.org, for specific show times.

The original decision not to show the film for a variety of reasons received coverage in The New York Times and in the Star-Telegram on Saturday, March 19, 2005. The articles focused on IMAX theaters not showing movies that mention evolution for fear of offending people who would object. Readers of the articles understandably gained the impression that the Museum lacks the willingness to present scientific viewpoints in an uncensored environment, which is incorrect.

The results of a survey taken after prescreening Volcanoes revealed that several individuals were concerned about its references to evolution; however, the Museum would like to set the record straight: Those concerns were not the determining factor as to why we did not show the film. The survey indicated that the film simply did not have the potential for broad audience interest compared to other films under consideration at the time. Importantly, we also want you to know that the Omni Theater has also shown Cosmic Voyage and is currently showing Aliens of the Deep, which presents much of the same science as Volcanoes of the Deep Sea.

We want to ensure that you know the Museum supports the position that evolution is a major unifying concept of science. We use scientific evidence in our wide-ranging presentations and interpretations of how life has changed over time. But we also want you to know that the Museum respects the beliefs of its guests and acknowledges that they are able to make their own decisions about science-related programs.

Again, thank you for your interest in the Museum. We welcome you to come and see Volcanoes of the Deep Sea this April.

Sincerely Yours,

Your Friends at the Fort Worth Museum of Science and History

Progressive Principles

This is exciting! John Paul Rollert, a political activist who says his aim is the long-term revival of progressive politics, is one of the leaders of an effort called the "Principles Project," which recently completed an online convention designed to define and promote what Democrats believe.

Six weeks of e-mail debate and balloting ended earlier this month with "A Declaration of Progressive Principles."

You can read an article about the process that appeared in the Washington Post in an article titled Activists Use Web To Nudge Party: Principles Are Drafted for Democrats

Let's tell Howard Dean!

The Two Income Trap

I've just finished reading a book so enlightening that I have to share: The Two Income Trap, by Elizabeth Warren & Amelia Warren Tyagi, Basic Books, 2003.

In this book, the authors report on a large-scale study they did in 2001 on Consumer Bankruptcy. They compare the characteristics of families that apply for bankruptcy (and those that don't) from 1971 to the present.

The findings reflect things I have observed among my friends, but never hear from financial and political pundits. The ramifications for our society, and for planning for financial security are profound.

Some of the most startling results:

1) Having a child is now the single best predictor that a woman will have to declare bankruptcy.

2) This year, more children will live through their parents' bankruptcy than their parents' divorce.

Less startling:

3) The average middle-class family can no longer afford to buy a home unless both parents work. (Those of you who are single, or living with a single-income, have already come to grips with this in a way that two-income families may not have.)

The basic arguments presented in the book are that:

1) Most families actually have less disposable income now than they did in the 1970s when only one parent worked. This means they are spending more on housing, day care, pre-school, health insurance and cars than they did in 1970. (Interestingly, the car expenditure is not because cars cost more these days; in fact, families spend 20% less per car (inflation adjusted) than they did 30 years ago. They are spending more on cars because they have two cars now, as opposed to the one car most families had in the 70s.)

2) There is no financial slack when both parents work to pay these fixed expenses. If one parent loses a job, the family loses its ability to pay its fixed expenses.

3) Deregulation of the credit industry has resulted in predatory lending practices that routinely give more credit (at worse terms) to people who shouldn't get it. This means that when a family member loses a job, has a medical crisis, or leaves the family (i.e., divorce), credit companies give credit to the family in crisis with outrageous terms (e.g., high interest rates), and when the family can't make payments, the lender takes everything (i.e., house, car, posessions) unless the family gets protection by declaring bankruptcy. There's even a term in the industry for this: "Loan to Own".

The authors argue that as a nation we need to return to regulating the amount of interest lenders can charge. They also argue that we need to leave bankruptcy protection in place so that families don't lose everything when crisis strikes.

They also discuss the emotional impact of financial distress on families. Bankruptcy is at least as difficult as divorce on children, if not more so, because of the social stigma. This means that children cannot talk to their friends about what is going on with their families. Indeed, their parents are often so ashamed that they encourage their children to lie about what is going on. This means that children of divorce can talk, but children experiencing a bankruptcy cannot. Yet it is *more* likely that children will experience a bankruptcy!

Last, the authors recommend that everyone perform a financial fire drill. The drill includes the following:

1) Can your family survive without one income? It typically takes 6 months to find a new job. If the answer is no, you need to take steps to insure that you can.

2) Are you having trouble making ends meet now? If so, you need to downshift your current fixed expenses. This does NOT mean cutting back on "luxury expenses". Most of us are doing that already anyway. The point is that if, when you are not in crisis, you are having a hard time making ends meet, you must change your fixed expenses so you can survive a job, medical or marital crisis. Confront the issue now, while you are not in crisis, and you will be better able to weather a crisis when it comes. One thing they urge you to evaluate is "long term commitments". They advise you to always aim for taking the shortest loan period you can, be it for car, house, whatever. That will reduce your fixed expenses after the period of the loan is up.

3) Create an emergency backup plan. Play the game of "what if" and figure out what you would do. What if your health fails? What if you lose your job? How will you handle it?

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I hope you've actually read this to the end-- I found this book and its arguments profound, and wish more people understood the claims made therein. I feel moved to action both on a legislative level and a personal level. I hope you do too.

How *do* you manage people effectively?

I recently hired two people to help me design voice user interfaces at work, LogicTree. My helpers are perfectly wonderful, but I find I don't know the first thing about managing. Alan heard my pain, and forwarded a link to a discussion about managing from slashdot. (I set my threshold so I read nothing below a "3", I find this eliminates some of the more frivolous posts while retaining the worthwhile ones.)

Here are some choice excerpts from this discussion:

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Book recommendations:

• Peopleware : Productive Projects and Teams, 2nd Ed. - Lister and DeMarco


• First, Break All the Rules: What the World's Greatest Managers Do Differently - Buckingham


• Becoming a Technical Leader: An Organic Problem-Solving Approach - G. Weinberg


• How To Win Friends And Influence People - Dale Carnegie

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Here's a description of a truly amazing manager. The Superhero Of Middle Management: Ron

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Here's a discussion of what a manager should do.

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Finally, a little ditty that I'm rather fond of quoting now:

Work is like a tree full of monkeys.
If you are on top you look down and see nothing but smiling faces.
If you are on the bottom you look up and see nothing but *ssh0les about to [poop] on you.

(I didn't find the rest of the post this came from to be all that helpful....)