For some children, the cause of developmental delays are known - exposure to trauma or toxins in utero, or birth trauma can impact development and cause delays. Trauma in the newborn and  infancy stage can also impact development, such as if there is a serious infection, exposure to toxins, or other traumas¹⁶. If this is the case, it matters most on what happens now - we can’t change the past, or what your child was exposed to. In the words of Ana from Frozen, we just have to do the next right thing. For other children, the causes are genetic - something that could not have been predicted or accounted for, and unable to be detected even in genetic screenings.  However, for many children with delays, the causes are unknown. It is very tempting to look for blame, cause, and reason - but the most important thing is what we do with the information we have - and to provide early intervention care if needed, because the outcomes are clearly beneficial.

While an evaluation will determine what your child’s individual needs and delays are, it likely will not include a specific diagnosis. This is because one of the main goals of early intervention is to prevent possible learning delays or diagnosable conditions later, when the child is school age. Many children enter into early intervention with a label already - they may have been identified prior to or at birth with a genetic condition, like Down Syndrome, or they may have received the referral to early childhood intervention after a diagnosis of something such as autism spectrum disorder, or hearing impairment. However, it is certainly not a certainty that a child who enters the early intervention process will come out with a medical diagnosis of some sort.

Children are perceptive, and they can tell if there is a difference.  For children who may have a disability or a difference, they may start to internalize and think that there is something “wrong” with them if they can’t keep up with friends, or if they don’t have access to the same privilege and opportunities as their peers.  Talking to children about their differences can be as simple as explaining “Your brain works differently than your sister’s” or “You see the world differently than your cousin.” Emphasize their strengths, and point to other examples of children that they may know with differences. Julia on Sesame Street has autism! Children like to know “why,” (as you may have noticed by the 100 times you’ve answered the “Why?” questions) and if they don’t receive this information accurately from you, they may start to inaccurately fill in the answers themselves. They may start to think that they have a broken brain, or that they aren’t as smart as their peers. It is empowering for them to have self-understanding, and is the beginning of self-advocacy, a necessary skill¹⁷!

The whole idea behind the natural environment is because children learn best when they are able to model the behaviors of family and peers, and when they are engaged in activities and objects with which they are interested. It is a reassuring setting that helps maximize and generalize the skills they are developing. This means services take place where you and your child would be anyways -at home, the library, the grocery store, with people your child would already be with - relatives, friends, siblings, neighbors. It means using toys you already have, materials familiar and in the home, and conducting activities that are developmentally and culturally important to your family. Essentially, early intervention is meant to build in supports for your child’s everyday life, not disrupt their or your life.

This is exactly why you are intervening now, to hopefully minimize and prevent any perception of being treated differently - and to learn about and embrace the differences we all have! In the early childhood period, children are learning about the world by noticing differences and similarities. There has been an ever-increasing push to integrate children with developmental differences and delays into more mainstream environments - in fact, schools are required to provide both the “least restrictive environment” that is safely available, as well as to maximize time with typically developing peers¹⁸. The goal of early intervention is so that when your child enters school age, they are able to access and engage with their peers and schoolmates to the maximum extent possible. Should your child continue to need services in school, this is offered within their school day - often unnoticed by peers, and even the child themselves! Speech services are integrated into the classroom lessons, physical therapy integrated into gym time, and the child may need a teacher to help with acquisition of educational material - this is what the “small group” learning of reading and math groups are designed for, to allow children to have the 1-1 attention needed while still learning with the rest of their class.

With the understanding that every diagnosis, condition, and child is different, the answer is “not necessarily.” For some children, medication and medical intervention is a part of life - think children with epilepsy, who need anti-seizure medication, or children who have immunological differences. For children with developmental disabilities, there is not a medication that will address the delays - targeted therapies to focus on development are more indicated and appropriate. Some parents will contact early intervention because they suspect ADHD or attention differences. For these children, behavioral supports and interventions will be the “first line” of treatment - providers typically like to address environment and behavior before going down a medical route. If there is no improvement with behavior, parent training, and supports - and there is a “moderate to severe” impact on the child’s life - only then is it indicated to look at medication intervention¹⁹.

The idea of turning your child over to a developmental specialist is nerve wracking, especially if your child is not able to tell you what took place during these appointments! You should absolutely be a part of these appointments - not only are you the expert on your child, but you are also a critical part of generalization, or helping make sure that the skills targeted in intervention are being developed at home. If there is a physical or occupational therapist involved, they may need to show you how to practice certain exercises. If there is a speech language specialist, they may have targeted goals to work on between sessions. If you are unhappy with the providers for your family, this should be communicated to your service provider or care coordinator - the most important thing is finding intervention that works for you and your family. 

If you’ve already started the ball rolling - talked to the pediatrician, reached out to your local early intervention provider - but you also don’t want to lose any of the critical developmental time while waiting for those appointments, you are probably already doing some informal early intervention practices at home. Essentially, going about your normal family life, incorporating developmental learning opportunities and social skills as much as possible. This means:

• Lots of narrating and talking to help develop language skills. If you are at the grocery store, talk about everything you and your child are seeing! “Here are the tomatoes, they are so good in a tasty salad. Tomatoes are red, just like your firetruck is red. They are round, just like your ball. But we shouldn’t throw the tomatoes! They are for eating, growing big and strong.”

• Opportunities for exploration and play. Public parks, play centers, libraries, etc. are all good places to practice motor skill development - with bonus opportunities for social skills, if other children are playing as well!

• Establish routines - children, especially children with language delays - can become anxious and dysregulated if they don’t know what to expect next. If there are specialist appointments on the horizon, you can start to prepare your child and your family for these schedule changes with routine development. Develop a routine for morning and night time, a routine for meals, and routines for leaving the house.

• Look for motivators. Children, like all people, have preferences, likes, and dislikes. They will be more excited and eager to learn and participate if they like the activity, or they have rewards they are working for. This will likely be a part of the assessment, figuring out what your child is most motivated or eager to work for, and having this information available will help the early intervention specialists, but will also help you as you build on our child’s strengths, and develop new skills.

Now that you know how important early intervention is, it can be excruciating to watch a fellow parent seemingly ignore their child’s delays and development. We don’t always know what conversations happen between parent and pediatrician, and it is possible that your loved one is addressing the delays, but hasn’t talked about it due to stigma and shame. This is a sensitive topic, and it can be hard to balance the respect you have for other families' parenting decisions with the love and concern you have for their child.

• Ask questions - it shows that you are curious, but non judgmental. Parents are more apt to respond to your empathy and curiosity than if you come from an authority position. “Are you happy with your pediatrician? Do you feel that they are looking at the big picture of your child’s development?” versus “You need to get Sam evaluated, he should be talking by now.”

• Remember that you aren’t necessarily in charge of the outcome - the goal is to connect your loved one with the right support - you may feel that Eva needs physical therapy, but a formal evaluation may suggest occupational therapy is a better fit for her fine motor delays and sensory processing struggles.

• Ask your friend if they want your input - they may not! “Are you open to hearing some of my thoughts and concerns? It is ok if you aren’t!” Emphasize that you are coming from a place of love and concern, not parenting judgment.

• Share your own experiences - showing that you are coming from a place of common understanding versus comparison and competition.

• Offer to help. This whole experience is daunting and overwhelming. Share a few of the articles mentioned in this guide, offer to watch the other kids during the well-child visit so that your friend can focus their attention, and suggest some of the activities that are mentioned above, if your friend is open to it.

• Repair the relationship. If the conversation doesn’t go well, don’t assume that it's a dead end. Ask how other conversations have gone. Ask if they are feeling judged, or overwhelmed. Continue to emphasize your position of support, care, and love. 

Likely the guidance and advice you are getting from friends and family are coming from a place of care and concern as well.  They may be offering reassurances, or their own perspectives, because they see your concern, and they want to help.  On the contrary they may offer unwanted opinions or suggestions that your child may need support. Here are a few ideas to keep in your back pocket!

What you might hear - Have you considered talking to your doctor about Joey’s toe-walking problem?

What you might say - (Take a few deep breaths first) Thank you for noticing and caring so much about Joey. I’ve talked to his doctor, and we have a plan in place. 

OR

I thought it was just me - you saying something has prompted me to ask his doctor about it.

What you might hear - Boys are just slower to talk - he will catch up!

What you might say - I’ve heard that too - I just want to make sure I”m not missing anything - better safe than sorry!

What you might hear - It's because she is the youngest, her sisters are all talking for her.

What you might say - That may be true, but I also want to make sure that she has the ability to express herself - especially now, when she is in this prime time for language development at age 2!

What you might hear - Kids don’t crawl anymore, it's normal that he isn’t crawling yet, he will walk any day!

What you might say - Yep, anywhere from 4-15% of kids don’t crawl - and outcomes appear to be fine²⁰. However, not crawling can also be a sign of other motor issues - I’d rather catch that early than have him fall behind!

What you might hear - Kids are over-diagnosed these days, you are overreacting.

What you might say - You might be right, but I”d rather know - an evaluation won’t hurt her, and will give me a lot of valuable information about her development so far!

What you might hear - It's a discipline issue. Have you considered spanking?

What you might say - We have actually learned that she responds so much better to praise, positive redirection, and time to calm down if needed. Spanking doesn’t teach her anything other than to be afraid of us - I want to make sure she always knows we are on her side. That's why we are taking this approach instead.