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  • 7 Possible Signs of Developmental Delay and the Experts You May Need

    Here is list of professionals you can turn to if you suspect your child has developmental delays.
7 Possible Signs of Developmental Delay and the Experts You May Need
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  • There are so many books and information about children’s developmental milestones that sometimes it can get overwhelming for parents to ask questions and seek help. While it is absolutely normal for parents to wonder whether their children are experiencing developmental delay, it is also vital to remember that every child is unique.

    “As a parent, you need to be very discerning. Every child is different. You cannot relegate your child to just any developmental case you read about online or in any book or forum. Every child develops at a different pace,” says Pickles Leonidas, school head of H.A.N.D. (Holistic and Nurturing Developmental) Preschool.

    She emphasizes, “There is no substitute for a one-on-one, face-to-face assessment with a developmental pediatrician or early-childhood specialist or educator.”

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    Mark Arejola, OTRP, an occupational therapist, agrees, “It is only natural for a parent to worry about a child’s development. If you do encounter red flags, see a developmental pediatrician and occupational therapist for professional guidance.”

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    “A child’s brain is more ‘plastic’ or teachable than older ages because, during the younger years, the brain is still growing and forming,” says Arejola. “Early intervention can be as early as 2-3 years old. Early intervention plays an integral role in introducing and building the foundational skills for the development of mature and advanced skills."

    The partnership between parents and pediatricians is also crucial in tracking developmental milestones. Later on, parents and pediatricians will partner with educators or their children’s teachers in reinforcing learning.

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    7 things to look out for and observe for developmental delay

    Wisdom, discernment, and keen observation should be exercised before jumping to conclusions regarding a child’s development and developmental delay. Here are some things you should look out for:

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    • Eye contact. As early as 6 to 7 months, a baby should be able to have eye contact with his parents.
    • Response to sounds
    • Response to verbal cues, like the child’s name
    • Your child’s ability to play. Observe how he plays with toys — is he able to progress to pretend play, and can  he play alone and with others? This is a foundation for social skills.
    • Interaction. Watch how your child interacts with others.
    • Behavior. Watch out for tantrums that are already uncontrollable or already a distraction in everyday living
    • Speech delays

    Arejola, who works at Bright Minds Speech and Occupational Center as its head therapist, has this advice for parents: “Keep in mind that some children may develop faster than others, and some may be little late than the rest, but this does not automatically imply that there is something wrong. If you do encounter red flags, seek people who can give you professional guidance.”

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    Who do I talk to about my child’s developmental delay?

    If you feel that there is something amiss in your toddler’s development, there are several professionals you can talk to about your concerns.

    Developmental pediatrician or developmental behavioral pediatrician

    A developmental pediatrician (dev ped) can diagnose a child in terms of any developmental delays. (Click here for a directory of practicing developmental pediatricians in Metro Manila.)

    The American Academy of Pediatrics (AAP) states that a developmental-behavioral pediatrician is a doctor to see if your child has (or you THINK may have):

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    • delayed motor skills (crawling, walking, eating, riding a bicycle)
    • delayed speech and/or trouble understanding language
    • poor social skills
    • trouble sleeping (including bedwetting)
    • trouble feeding or eating
    • sensory activities
    • trouble at school (paying attention, learning to read, write or do math)
    • Attention Deficit Hyperactivity Disorder (ADHD) or ADD (without hyperactivity)
    • Anxiety disorder
    • Cerebral Palsy
    • Learning disabilities
    • Depression
    • Tics or Tourette Syndrome
    • Spina Bifida
    • Autism Spectrum Disorder
    • Chronic conditions like complications due to prematurity
    • Intellectual disabilities

    After a dev ped’s diagnosis, parents proceed to follow the developmental pedia’s advice regarding the therapy their child needs to take to address his developmental needs and issues. A trained professional can provide further guidance and information.

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    Occupational therapist

    “An occupational therapist is someone who helps individuals with or without disabilities, either maintains or regains an optimal level of functionality and independence in order to participate in their daily ‘occupations.’ An occupation is anything that has meaning to a person. It can be as simple as brushing your teeth or doing your laundry or more advanced like driving yourself to work. In children, it is mainly playing and school,” explains Arejola.

    An occupational therapist caters to clients across the lifespan, meaning it could be from infancy to old age. Arejola explains that his role involves “helping them learn age-specific skills that will help them adapt and thrive in their environment. Depending on the age and needs of the child, it can be anything from sensory, physical/motor, behavioral, or social, or cognitive.”

    Some specific skills taught by an occupational therapist are:

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    • Teaching an infant to lift their head or strengthen their trunk for better posture or balance
    • Teaching a child to sit and attend to a simple task
    • Teaching a child to hold a spoon or pencil
    • Teaching to learn to imitate and copy
    • Teaching to learn to take turns and wait for their turn
    • Teaching how children can regulate their emotions instead of hurting themselves or others.
    • Anything and everything you would expect a child should be able to do at home, at school or outdoors
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    When asked when do parents bring their children to an occupational therapist, Arejola stresses that this happens when a developmental pediatrician shares his diagnosis to a child’s parents and the dev ped recommends that they take their child to therapy.

    “Parents usually bring their child in for assessment and/or therapy when they notice that certain age-specific skills are delayed or absent,” he says. “An example could be when a 2-year-old doesn’t speak or doesn’t relate to parents and peers like other 2-year-olds. Or it could be a 4-year-old who cannot sit still and pay attention to short tasks.”

    There are some first-time parents who might take longer before spotting red flags compared to parents who have more than one child. This is because they don’t have a baseline of skills for comparison. Those who don’t have experience in handling young children don’t easily get to observe red flags, and usually, it is their pediatrician or even fellow moms who might point out such delays to them.

    Felise Cruz, the owner of Bright Minds Speech, Occupational, and Physical Therapy Center shares that therapy sessions for children happen based on a developmental pediatrician’s recommendation. In occupational therapy, they deal with helping children by preparing them to handle the activities they need for their daily living.

    “A toddler’s activities would include their gross-motor skills and fine motor skills, their feeding activities like chewing and swallowing, their playing, and behavior, and these are addressed in occupational therapy. For bigger kids, it is processing and managing emotions, issues in defiance, and many others. There is also pediatric physical therapy, which is for young children who have issues with gross-motor skills like crawling, walking, balance, and coordination,” she describes. The scope of work of a pediatric occupational therapist starts from infancy to adolescence.

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    Speech pathologist / speech therapist

    Andrea Jurilla is a certified speech pathologist and therapist at St. Luke’s Medical Center in Bonifacio Global City. According to her, “We technically handle people with problems with communication. It includes language and speech. Language has more to do with the thinking, and can be separated into two, the Receptive Language which is how you would understand, and the Expressive Language which deals with how one expresses himself, whether in words or gestures.”

    Jurilla shares four aspects of speech that parents need to observe, namely: respiration or breathing, phonation, resonation, and articulation.

    “By the age of 1, if the kid still doesn’t have his or her first word, it would be best to consult a speech therapist. The child’s first word could be ‘mama’, but the child would have to know that ‘mama’ means his mother or mommy,” Jurilla explains.

    She adds, “I have a lot of cases where parents bring in their children because they are not talking, and then upon assessment, I find that some children need to address problems like sensory issues and behavioral concerns, and then when the children can establish focus, I am able to address the speech issues.”

    The goal for very young children is to increase their language, because you can’t expect them to articulate all the sounds right away. There are completely normal phonological processes like when a child says “wabbit” instead of “rabbit,’ which is a regular developmental pattern. At a certain age, that can be normal.”

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    What to look out for in your child in terms of speech development

    Response to sound
    Jurilla emphasizes that it is important for parents to observe if their child is not responding to sounds or names, which could indicate a hearing problem.

    Symbolic play or pretend play
    If a child is not able to perform symbolic play like “lutu-lutuan” or pretending play, this could indicate a lack of response to concepts.

    Precursory language skills
    These are skills that should be present before a child turns 1 year old or before they say their first word. It is a milestone list that you can search or request from speech therapists, which is a basis for parents and therapists alike. Parents can refer to this list as a developmental milestone guide. These skills are separated into content (what words the kids have, like nouns), form (words, gestures, grammar), and use.

    In addition, your child must be able to maintain eye contact and have turn-taking skills.

    “Children with speech delays and language delays don’t necessarily have conditions. It is still always wise for parents to bring their children to a developmental pediatrician and therapists for us to assess the skills of a child,” stresses Jurilla. “If a child is exposed to an environment where there is a lot of talking, a child learns how to be talkative. Some parents are just naturally quiet, and there are actually some parents who have come up to me and asked me ‘Kailangan bang kausapin ang anak ko para magsalita siya?’ The moment you start talking to your kid, exposing your kid to conversations, there is hope for him to talk more.”

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    Teachers and educators in a classroom-setting

    In many situations, teachers in early-childhood centers or preschools are able to point out and assess how a toddler’s language develops. Educators can offer feedback to parents and relay their observations, which are so important to share with the specialists who will be helping the child.

    According to Leonidas, with toddlers who are even as young as 1.5 to 2 years old, “The educator plays a significant role in the assessment of a toddler’s language development. In a structured environment where materials and peer interaction are both accessible, the educator may see indicators of communication issues that could possibly be overlooked at home.”

    She underlines the value of 2-way communication observed between children and teachers, and children and their peers. “The classroom provides a natural setting where there is a dynamic interaction between teachers and students on a daily basis. Hence, the child’s ability to communicate whether in terms of identifying objects, or answering simple questions like ‘What are you playing with?’ will organically be evident,” she says. “Lack thereof, will tell the educator if the communication skills need to be examined further by an expert. All this, of course, must be done in the classroom and over a period of time in order to achieve substantial assessment in terms of the child’s language development.”

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    Leonidas adds, “In the classroom, the child is provided with opportunities to interact with other children and with adults, the teachers. It is in this set-up that the educator gets a glimpse of the child’s behavior, especially when it comes to sharing, waiting for one’s turn, or listening to and following the teacher’s instructions.”

    “A trained educator will be able to discern whether misbehavior merits a visit to a developmental pediatrician or not. This could properly be communicated to the parents so that there is a strong support system, which is necessary to help a child with possible behavioral concerns.”

    Such is the case of Maja*, a working mother to two boys with special needs. She attests to the value of a classroom setting and to her son’s teachers who were able to recognize that he needed to see a developmental pediatrician.

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    Her eldest son Ozzie’s teachers were able to point out that he was exhibiting hyperactive behavior in his preschool classroom at age 3. He would punch his classmates without the intent to harm. And his teachers reported their observations of how Ozzie would never sit down in class activities. It was his teachers who recommended that his mom take him to a developmental pediatrician. His dev ped explained that the punching that Ozzie was doing was not to inflict harm but more to expend his energy. They went through the necessary assessments, and the dev ped was able to give a proper diagnosis.

    Because of early intervention, his mom Maja was able to get him occupational therapy sessions that he needed to address his ADHD (Attention Deficit Hyperactivity Disorder). “The social interaction in his preschool offered me the avenue to explore the reasons why my son was behaving the way he did,” says Maja.

    Ozzie received OT until he was 12 years old. At present, he is happily thriving in school and has been a competitive swimmer since he was 11 years old. He is now 13 years of age. He is able to manage his energy levels and remains high-functioning as a young man.

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    Parents need to be involved in addressing developmental concerns

    Maja narrates that she was able to go directly to a developmental pedia after observing how, at 1 year and six months, her youngest son, Morgan, would be continuously drooling, would always be fixated on the ceiling, and how he always wanted to be leaning against something, whether it was a wall or a back of a chair.  She observed that he was not speaking, as compared to her other children who were fast talkers from childhood. When she observed that early childhood milestones were not reached, and suspected developmental delay, she consulted a dev ped. After careful assessment, Morgan was diagnosed as a non-verbal with ASD (Autism Spectrum Disorder).

    Maja felt gratitude that she was able to have her son assessed as soon as she could. “Morgan does Occupational Therapy 3 times a week, Speech Therapy once a week (due to the limited availability of therapists in their area), SPED (Special Education) tutorial 2 times a week in a SPED school, Mondays to Fridays.” 

    “Early intervention is very important, especially with diagnosis and therapies to bridge the gap with milestones. Acceptance is the key. You simply don’t give up on your children,” Maja shares. “Special needs children are different, not less.”

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    Professional help is needed in addressing developmental delay

    With the help of the Internet, parents can research important information that can help in detecting developmental delay, however, Arejola cautions against it. “The availability and ease of accessing information on the Internet has definitely helped in providing parents with a sort of flowchart for monitoring their child’s development,” he shares. “On one hand, information on the Internet that may or may not be accurate can lead to self-diagnosis. Self-diagnosis leads to worry and paranoia. This worry can be a good thing because it brings parents to action. But miseducation also can result in procrastination and false hope.

    "There have been numerous times when a parent has told me ‘Nasa lahi kasi namin ‘yan,’ or ‘Sabi kasi ng tatay ko, bulol kasi ako noong bata ako, late din ako nagsalita.’These are valid points coming from people who actually went through the experience, but this experience is keeping them from being objective to information that is undeniable," says Arejola.

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    “The best way to address misguided parents is to re-educate and reassure them.  It is very important to me that, from the very beginning, I acknowledge their concerns and opinions. They need to feel that someone is there to listen to what they think and that I am there to help them through. Sometimes they simply just need a professional to clarify and validate their ideas,” Arejola declares.

    It truly takes a village to raise a child, and in this case, a team composed of the child’s parents, pediatrician, developmental pediatrician, therapists, and for school-age kids, teachers who have the children’s wellbeing and welfare at heart, striving to encourage and help them thrive and cope in their homes and community.

    *surname withheld upon request.

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