Today I want to discuss the importance of early intervention, a sensitive topic everywhere but made more complicated in India because of social constraints.
If parents are concerned about their child’s development, what do they do? Who do they go to for information? They start by looking for input from friends, relatives, medical professionals, or even Facebook groups.
That period, when parents begin to see differences in their child’s behaviour or delays in their milestones, is stressful, to say the least. In other countries, the pediatrician is usually at the start of a system of identification and assessment. In India, we haven’t yet got to that level of organized identification and intervention. So, parents turn to familiar people for reassurance. In the process, they come across much misinformation.
The trouble is this misinformation is coupled with limited access to support during this confusing and tense period. In the Indian context, it is primarily the mother who must deal with family and social pressure. So when she notices a delay in her child’s development, many questions run through her mind.
- How will my spouse react?
- What will the in-laws say of a not so perfect child?
- How will extended family treat the child?
- What will schooling look like for the child with special needs?
- What does the future hold for my child?
As a result, many parents try to ignore any warning signs in their child’s development.
When the parent finally opens up about their child’s development or behaviour, the most common responses they hear include, “I was like that, and I’m fine now. My child was like that, but he is fine now. Enjoy your motherhood, mama. All children are like that. Don’t compare your child, don’t judge your child.”
Why do people rush to dismiss this parent’s concern? For some, it is the belief that denying the problem will make it go away. For others, it is because they are worried about their child’s development. Reading or listening to another parent share similar anxieties feels very threatening. If they can convince the other parent that there is no such thing as a delay, then they feel better about one’s own child. Let’s be honest! That’s an unhealthy emotional dependence! It’s a case of “I deny a problem, and I want you to deny the problem so that I can feel better about my situation.”
Let’s be honest! Will children indeed be fine without any support from us? Do children really catch up on their own?
Why is early intervention so crucial? Suppose a child gets help when they begin to show developmental delays or behavioural outbursts. In that case, you are taking care of your child’s needs before it blows up into something unmanageable! Early intervention is not to make your child like other kids. It is to enable your child to meet the milestones of typical development to the best of their ability.
As a special education teacher, one of the most annoying pieces of advice I hear is, “Every child is unique.” The second part of that statement should be, “Let’s find what your child needs to succeed.”
That statement that ‘Every child is unique’ is taken as an authorization to do nothing about the possible delay. That’s child endangerment. Every child has the right to play, participate and thrive to the best of their abilities. Deciding that the child doesn’t need services to meet their milestones or behavioural goals without a professional assessment denies them their fundamental right to a happy childhood.
The commonly asked questions are about eating habits, delayed speech, and behaviour. How does the ‘This is normal’ advice impact the children?
Sometime back, the parents of a second grader consulted me about their child’s behaviour. About thirty minutes into the discussion, I learnt that this 8-year-old did not like to eat. The only nutrition she got during the day was a bag of potato chips. When she got home, she had multiple behavioural outbursts, and no one in the family could manage her. Naturally this child also had trouble sleeping. The parents reported that the little girl would occasionally wake up famished in the early hours of the morning and gobble up a tray of solid food that they got ready. On other days, the parents gave her Bournvita or any other milk-based drink in a feeding bottle, and that too without waking her up!
What happens if the parents of this child don’t assess why she has trouble eating? Will an eight-year-old have the energy to function in school with that amount of food? Can the child concentrate in school? Of course, this child is acting out! She is hungry! What about the nutritional requirements and healthy growth? How will this child thrive?
Parents mash rice, dal, and vegetables in a mixie and feed the pureed mix to their three- or four-year-old kid. How long will they do this? Sure, it gives the mother some control over the situation because she feels she is feeding her child. But when does that stop? Is mashing food a viable option for a ten-year-old? When does the child learn to eat independently? Think about the family dynamics affected by the child’s eating habits. Grandparents, uncles, and aunts have suggestions and comments, the mother feels self-conscious and stressed, the dad is annoyed, and the child is not enjoying the attention. Any social event that includes eating can be highly stressful for the child and parent. The family can’t go anywhere because of the child’s behavioural outbursts when hungry. I doubt that any parent enjoys these challenging dynamics.
There are picky eaters who don’t like certain foods, and then there are children with sensory processing difficulties. Children can be over or under-sensitive to certain textures and tastes of foods. As a result, they may struggle to bite or chew hard foods, murukku, for example, or gag with slippery textures like curd, malai, or even mangoes. These kids want the same food every day and struggle when they go to new places.
Do we really want to tell the parent not to be concerned because the child will eat once they see other kids eating? Should the kid continue to be hungry without all the necessary nutrition until then?
Sometimes, there may be an emotional component when children refuse to eat. Stressful family lives, domestic violence, and generalized anxiety can affect the child’s appetite and ability to eat. In these instances, adults can provide emotional support to manage stress. No matter the reason, parents can always do something to help their child.
Take the case of a child who is not hitting the speech milestones. What does this parent hear? “Don’t worry, it is normal. Boys speak late!” Or “My child didn’t speak until 4, and now I can’t get him to stop speaking.” The most disturbing comment I heard at a parent get-together was, “Don’t waste your money and time taking your child to therapy! My child watched YouTube videos and is speaking very well.”
Here is the thing: Boys don’t speak late. They may fall in the latter end of the age range for speech milestones. And language development happens in an interactive environment. When the child watches youtube or TV shows, there is no interaction happening unless you are making it an interactive session. Going to speech therapy is not a waste of money or time.
Parents may pick up on their child’s difficulties with talking, but they won’t know the cause of the difficulty.
- delayed speech,
- an underlying language disorder,
- an auditory processing disorder, or
- a motor disorder like childhood apraxia of speech?
A speech therapist is trained to identify most of these disorders. An audiologist identifies auditory processing difficulties. So why would going to a speech therapist be a waste of time and money? Research has shown that late talkers show problems in learning to read. Late talkers also have difficulty communicating and having their needs met. As a result, they have challenging behaviors and trouble with social interactions. When we advise parents to ignore their child’s speech delay, we disregard the child’s frustration at being unable to communicate.
What if the parent is concerned about the child’s behaviours? When a child doesn’t sit in class or follow directions, it could be due to unrealistic expectations or other organic reasons. What is the outcome if a six-year-old cannot sit for 15- 20 minutes or follow directions given to the group? At that age, children learn foundational skills in reading and maths. But if the child cannot attend, initiate, and complete age-appropriate tasks, they will lag in their learning. Poor social skills impact the child’s ability to make friends, leaving them out of peer activities. At some point, the child will pick up on his difficulties, affecting their self-esteem. It is not a picnic for the parents either. Challenging behaviours not only drain our energy, but also cause tremendous stress. Ignoring these behaviours leads to unhealthy family dynamics.
Challenging behaviours may be learnt or due to developing mental health problems. Why is it important to seek professional help as early as possible? Professional guidance teaches parents how to manage the behaviours and leads to a better outcome for the child, siblings, and the family as a whole. Children who have mental health needs understand that there is something different about their struggles. It is not only the parents who worry. The children do too. So what do they do? They learn to hide how they feel— children don’t want to worry their parents; they don’t want the stigma of being labeled ‘weak-minded.’ Many parents, even when they are aware of their child’s mental health needs, don’t take them to a counselor, let alone a psychiatrist. They believe that they can talk their child out of difficulties. But hiding takes its toll on kids. Yoga, meditation, and mindfulness are good coping strategies when the individual can follow them appropriately. It may take time for the child to grasp the usefulness of these practices. Until then, the child may need regular therapy and /or medication. No, homeopathy medicines don’t do anything for mental health conditions. Blanket statements like, “Don’t give any medications,” “It is all in the mind,” and “It’s just arrogance” endanger the child.
If we want to support parents when they are worried about their child, there are many things we can do. Listen to them without rushing to tell them what to do. Cook a meal for the family. If you have kids, ask them to include the other child in play or other activities. If you don’t have kids, offer to watch the kid while the parents go out for a while. Some parents may need help taking their child to an evaluation. Go with them. But do STOP telling them to do nothing about their concerns.