Opal replied: "I am, by far, an advocate of letting each child develop at their own pace. But what you've described above is definitely concerning and may warrant professional medical consultation and treatment. A 3 1/2 year old child should be able to do all of the above. However, since you noted that this isn't your child, are you certain that child does not, in fact, do these things but perhaps not in front of anyone other than her parents? For example, my 3yo daughter can be extremely shy, even in front of extended family who she's seen almost every day of her life! But in private when it's just us at home, she's extremely talkative and lively. Likewise, she didn't potty train until she was 3.5 year old despite the fact that we had begun training her at almost 2yo. She certainly knew how but she apparently wasn't ready. On the same note, she won't say her name when asked to anyone but family. So before thinking that something is wrong with the child you described, you should ensure that your concerns are based on what the child is like even when the child is not with you. The last thing you'd want to do is misdiagnose a child based on inaccurate and/or incomplete information. But based on face value, especially considering the history you mentioned of the mom's substance abuse during pregnancy, the child could be developmentally delayed for reasons beyond just preferring to operate at her own pace. I think the bigger issue then would be how to approach the parents with your concerns without seeming offensive, rude or nosy, especially since you said that her parents are doing nothing to help her. Maybe they feel she doesn't need help or maybe they don't know how to help. There is a big difference and some education via doctors, childcare professionals, trusted mothers and friends could really help them as parents to help their child. When seeking medical attention, ALWAYS get a second and even third opinion. I worked in a medical clinic for 5 years and was shocked and sickened by how many doctors were quick to medicate children for "developmental delays" and "social conditions" instead of being patient enough to find the real root of the problem and create natural and safe treatment plans. Doctors are people too and can make mistakes. So as parents and childcare providers, we must make time to educate ourselves in order to protect ourselves and loved ones from misguided information. In any case, I wish the child the very best."