Observing for disabilities

WHAT do you say to your family and friends when — after spending years telling them how you can't wait to have a baby, how you're going to do so much with your child and how you hope they'll be a doctor or lawyer — your child is not speaking or walking at two years old?

Some of your friends and family may be polite and not speak about it, so it becomes like an elephant in the room that nobody will acknowledge.

Others will try to reassure you that it's fine and they knew somebody whose child didn't talk until they were five and now that child won't be quiet. Others will offer you advice on how to make your child walk and talk and may imply that you're too lenient or too strict.

As if you aren't already worried enough and afraid that your child may never be able to function on their own, let alone play on the national football team or go to university, you seem to get no help from anybody and no answers as to why your child is not developing as expected. You try to put aside your own disappointments and fears and simply concentrate on what you can do for your child.

The causes of developmental delays, as discussed in last week's article, are many and varied. However, society has forged ahead is no longer satisfied allowing those with developmental delays to spend their days weaving baskets in an institutional setting. The objective is to help these children achieve their fullest potential for happiness, productivity and integration into society.

The means to achieving these goals are being rapidly improved and many children who would have been marginalised in previous decades are now seen as "recoverable" and are provided with appropriate evidence-based interventions.

Like any sort of illness for which you might approach your doctor, a developmental delay must be "diagnosed" before the appropriate intervention can be applied. A diagnosis in this case may be carried out by a doctor, paediatrician, psychiatrist, psychologist or any combination of these.

The first step is to rule out physical causes. Checking vision and hearing is very important and may identify the problem if a child's ears are blocked or the vision is impaired. Blood and urine may be examined with genetic, metabolic and molecular tests to determine whether abnormalities exist at these levels.

If doctors are unable to find an explanation for the developmental delay, a child may be referred to a psychologist or psychiatrist who will conduct an assessment focusing on the child's abilities, levels of functioning in several domains including verbal and non-verbal communication, social engagement, awareness of and response to the environment, development of play skills, activity levels, achievement of developmental milestones, development of fine and gross motor skills, adaptive skills and cognitive functioning.

To carry out such an assessment, a professional will usually interview the parents and other caregivers to learn the history of the child, when problems were first noted and whether the child has regressed at all.

The developmental history can provide valuable diagnostic clues because different kinds of developmental delays have specific ways in which they affect children and are like a fingerprint that can be identified.

An observation of the child provides valuable information that a trained professional can use to arrive at a diagnosis.

A psychologist will observe how a child behaves upon entering a new room or encountering a stranger, how the child interacts with their parents and a stranger and how the child acts when presented with various stimuli like toys, puzzles and sensory stimuli.

Central in many assessments is testing of a child's cognitive functioning, often done with the assistance of intelligence tests. These tests are extremely reliable and valid measures of a child's ability to reason, understand language, memorise, process information, store knowledge and generate correct responses.

While most children score relatively evenly across all the subtests, children with developmental delays may score low in one or more subtests, indicating areas of deficit, yet score very high in other areas. The peculiar pattern of high and low scores can also be useful in arriving at a diagnosis.

Taking into account all the relevant information a psychologist can usually arrive at a diagnosis to explain a child's developmental delays. The information will be captured and presented in a report that can assist other professionals in designing the correct intervention for that child. The report will usually present recommendations that parents and professionals alike can use to help the child achieve their fullest potential.

When parents learn why their child is developing atypically they can finally explain things to their family and friends, stop blaming themselves, and begin the process of intervention that will best help their child.

Even if a will never achieve the parents' dreams, having a child fit in with peers and smile happily is sometimes enough.

The writer is a private psychologist at Brunei's Riverview Medical Clinic.

The Brunei Times