More children are being diagnosed with neurological disorders. According to a recent New York Times article, up to 11 per cent of school-going children in the United States have been diagnosed with attention deficit hyperactivity disorder (ADHD). Among children aged six to 17 years, one in 50 has ASD, a Forbes article revealed. This increase over the last decade, the article says, is the result of diagnoses of children with previously unrecognised ASD.
The increase in detection and diagnosis of developmental disorders has led to the term “early intervention” being bandied about among parents and practitioners.
But what exactly is early intervention and how can this help a child with special health or learning needs?
Shelwyn Tay, a clinical psychologist in private practice for more than 10 years, says early intervention programmes are generally aimed at children aged six and below, with global or specific developmental delays.
These programmes may consist of a variety of different services, but typically include speech therapy, physical therapy, occupational therapy, and strategies to address behaviour.
Is Early Intervention Effective?
According to Shelwyn, research on the impact of early intervention programmes has been positive. The early years are optimal as the first few years of a child’s life represent a ‘window period’ when the foundations for key skills such as language are established.
“Intervening early, whether through exposure, therapy, the introduction of assisted technologies or the teaching of coping skills, allows a child the best chance of catching up or keeping pace with his/ peers in later years,” she adds.
For example, a child with high functioning ASD who receives help on his social skills early is less likely to struggle with confidence and anxiety compared to one who has tried unsuccessfully to make friends for years, she says.
Anita Leo, a paediatric occupational therapist who runs her own private practice believes that there are only benefits to early intervention. “With professional help, early intervention can do no harm,” she says. It can provide a leap to typical development by bridging the gap, improving self-image, self-esteem, and confidence.
A few years ago, Anita was treating a five-year-old child with sensory problems. His five-month-old sibling happened to be present at one session. While the mother was playing with the younger sibling, she mentioned that she did not use her right hand. The mother agreed to let Anita assess the child, and upon testing, Anita found that she displayed symptoms of brain injury. She recommended that she be examined by a neurologist, who did an MRI and found that there was injury to the child’s brain. Armed with this diagnosis, her parents spared no effort in early intervention. After a year of intensive therapy, the child is now developmentally on par with a typical child her age.
How Early Is Early Enough?
From the moment a parent notices anything different about her child, it is appropriate to seek a professional opinion. This could be as early as four to five months of age. Playgroup or play-school teachers are usually more tuned in to developmental differences. As the differences can be subtle and more behavioral, it usually requires a more in-depth analysis and understanding of the way a child engages with his environment, which can be missed during a brief doctors’ appointment.
When a developmental milestone has been missed by a few months, it indicates a delay for that specific milestone. Anita advises parents to be alert and seek help if they are worried that the child is not developing as well as his peers in physical development or in motor milestones. It is a sign of developmental disorder. There is no need to wait for an official diagnosis before seeking therapy, says Chithra Kathiresan, a speech therapist who has been running a private practice for 10 years. This is because neurological disorders like ADHD cannot be properly diagnosed until age six or seven. By then, valuable intervention time is lost and the child may develop unhelpful patterns of coping.
To Chithra, intervention need not be just a problem-solving solution. She says that it can also be a proactive measure to ensure the healthy, social-emotional-cognitive development of a child.
She explains: “The healthy development of a child goes back to the basic fundamentals: a stable, secure and supportive home environment, an engaging learning environment, a healthy body, and a happy mind.”
More children are at risk of developmental disorders today, she observes. Possible contributing factors include lifestyle choices such as child-raising being outsourced, an over-reliance on maids, the boom of the i-generation, lack of sleep, stress, and even dietary factors. Children are spending more time sitting in front of screens and less time engaging actively in the world around them.
Parents struggle to find the time to “just be” and play with their children. When they do, many are not sure how to play and engage their child. They focus on “teaching” their child. Many of the methods I apply in my practice focus on mutual engagement, supporting communication and facilitating development through that process.This could really be an extension of healthy parenting and can be part of pre-natal classes for all parents-to-be,” says Chithra.
What Has Play To Do With It?
Play, say practitioners, is the key. Play-based therapy helps the child to engage with an activity that he is interested in, and removes “performance-stress”. This pressure to perform to a certain standard causes stress to the child and inhibits his natural expression or learning ability.
Singapore is a very outcome-oriented society, Chithra points out. Children are taught from an early age that results are important and may thus feel the stress to produce positive outcomes in everything they do.
During playtime, she advises parents to focus on enriching their child’s experience by valuing their efforts, asking questions to expand their thinking and giving them words to describe the process, instead of trying to “force” a positive outcome (e.g., a nice drawing with all the right colours). “Don’t start with an agenda to teach and impart, just be genuinely interested in what they are doing and use words to add meaning and depth to their experience,” she suggests.
Making A Problem Out Of Mis-judgement
Anita recalls a five-year-old boy who would sit down and pay attention for the first two periods of his class, and then start to run around and disrupt the class. When Anita asked him to draw something, she noticed that the boy’s drawing skills were immature for his age and cognitive level.
She recommended an eye test, which showed that the boy had serious vision problems. The real reason for his behaviour was that he could not see clearly, and not that he was being defiant or exhibiting behavioral problems. After being fitted with the appropriate spectacles, the disruptive behaviour stopped.
Anita explained, “When a child is uncooperative, there is always a reason. It could be fear, fear of failure, pain, discomfort, anxiety, sensory issues or neurological conditions. Thus when handling young children, our aim is to understand the underlying cause of the behaviour and to rectify it.
The only problem is when people jump the gun and start labeling. There is a high chance that you might mis-label the child and do more damage, and everybody then perceives the child through the bias of that label,” she cautions.
How Can Parents Help?
- Take time to develop a strong, positive relationship with your child.
- Get down on the floor with them, allowing them to take the lead in choosing their choice of play and how long to play, etc.
- Don’t press them to create something or learn something.
- Read a lot to them and ask open-ended questions on the story.
While parents can and should take an interest in helping their children who have special needs, Anita warns that we should also be wary of applying our own methods or techniques gleaned from the Internet or from hear-say.
Especially for a child with a special need or developmental delay, she cautions, it is best to seek professional guidance and learn the right techniques to carry out at home.