1 Different, Yet Alike
Alyssa is excited about her first teaching position in a Head Start classroom with fourteen 4-year-olds. While Alyssa is planning for her new class over the summer, Mrs. Helman, the center director, tells her that one of the children, Chloe, has spina bifida and uses crutches to walk. Alyssa remembers learning some things about special education in college, but she isn’t confident that she knows enough to teach a child with a disability.
During the first few weeks of school, Alyssa spends a lot of time focused on Chloe. She watches every move Chloe makes around the classroom, concerned that she won’t be able to keep up—or even worse, that she’ll get knocked down by one of her classmates.
After the first few weeks, Alyssa relaxes a bit. Chloe is proficient at using her crutches to get around and keep up with the other children, and her cognitive skills are above average for her age. However, she has difficulty negotiating the playground, and this keeps her from fully joining her classmates in play. Alyssa determines to solve the playground issue.
Alyssa is also concerned about the development of a couple of the other children. Jamari easily follows the daily routines of the classroom and enjoys playing with several other boys, but his language skills seem to lag behind the other children’s. Leo, a pleasant child who immerses himself in sensory activities like sand and water exploration, has difficulty remembering some of the basic math and language concepts that Alyssa focuses on throughout the day.
Alyssa is proud that all of the children are learning new skills, and she knows that providing developmentally appropriate experiences benefits Chloe, Jamari, and Leo in many ways, but she feels the need to do more for these three children. She just doesn’t know where to start.
Nearly every early childhood educator has taught a child with a disability, but often the disability has not yet been identified. Children grow and develop at their own pace during the early childhood years, and many disabilities that impact learning start to become apparent but are not identified until later. Jamari and Leo, for example, show delays in particular areas at age 4, and each may or may not eventually be diagnosed with a disability. Early childhood educators are often the first professionals to suspect that there is a delay or a disability, and many times they are also the first to start interventions.
Even if a child has been identified as having a disability, she is first and foremost a child. And best practices for young children are best practices for all young children. All children thrive in programs with developmentally appropriate experiences and support for their individual strengths, interests, and needs. Chloe’s disability, for example, impacts her in some ways but not in all, and participating in a high-quality early childhood classroom fosters her academic and social development—areas that are not affected by her disability. Considering Chloe’s physical needs and how she can more fully participate with the other children will result in making the environment more accessible, giving her more opportunities for growth. Play and exploration, interaction with peers, and appropriate learning challenges are important for every child, opportunities that should not be limited or denied because of a disability or delay.
The Same Rights for All Children
Every child with a delay or a disability has the following rights:
The Right to High-Quality Programs
Children with delays or disabilities deserve the same high-quality education alongside their same-age peers who do not have a disability. Early childhood programs are often the first places children become engaged in group learning opportunities and social interactions with other children outside their homes. Many children with disabilities need specific adaptations to some routines and activities, and they may need more time to learn concepts and practice certain skills. In many ways, however, children with delays or disabilities have a great deal in common with every other child, and they deserve the same developmentally appropriate programs that are supported by research on how young children learn and develop.
The Right to Legal Protections Under the Law
Laws in the United States and many other countries provide rights and protections for children with delays or disabilities. The Individuals with Disabilities Education Act (IDEA) of 2004 (Public Law 108-446) was designed to help children with disabilities learn and participate in everyday routines and activities with their peers with the supports and services they need to be successful. IDEA also lists procedural safeguards that give families a voice in the educational decisions made for their children and protect their rights with regard to their children’s education.
The Right to Be Part of the Community
Children with delays or disabilities deserve to be educated in schools and programs alongside their same-age peers. Removing children from programs due to their challenging behaviors (without looking at what those behaviors are communicating) or segregating children into special programs or schools violates a core value of a community’s commitment to create programs that respect, value, and educate everyone.
The Right to Be Respected for Themselves
Children with delays or disabilities have a right to receive the individual attention and support they need to be successful. The effects of some disabilities may be lifelong, but children’s needs can be addressed with the appropriate supports and services. Programs, educators, and families must make decisions about each child as an individual and ensure that educational policies and practices do not unnecessarily impede children’s success.
Child Development, Delays, and Disabilities
Child development is commonly defined as the process children go through physically, intellectually, socially, and emotionally from birth until adolescence. Young children change, grow, and learn more during the first few years of life than they do at any other time. The brain uses the body as a tool to learn, and every time a child touches, hears, sees, smells, or tastes something new, her brain connects these actions to different concepts (Dotson-Renta 2016; UNICEF et al. 2010). When she has new experiences or encounters new situations, her body helps her brain interpret and bring meaning to these experiences by gathering information. As the brain makes these connections, children learn.
Developmental milestones
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) created a comprehensive list of expected developmental milestones from the age of 2 months through 5 years. This can be found at www.cdc.gov/ncbddd/actearly/milestones/index.html.
All children develop at their own pace. While no one can predict exactly when an individual child will develop certain skills, such as walking or talking, we have a general idea of when to expect these changes, referred to as developmental milestones.
Developmental Expectations
Understanding each area of a child’s development and the expectations for development at each age is key to identifying a possible delay in development or a disability. Development tends to follow a general pattern, and some children may seem late in developing in one area or in several. Since many developmental milestones typically occur around a specific time in a child’s life, some parents and teachers start to worry when those milestones are delayed or are not reached at all.
Childhood is a journey, not a race
This often-heard saying serves as a powerful reminder that while it is tempting to assume that reaching developmental milestones early—or ahead of peers—is desirable, that is not always the case. Children’s development is not a competition, and it is very important to look at the overall development of a child, not just his development in one or two isolated areas.
Parents are naturally concerned about the development of their child and instinctively compare their child to a playmate or another child in the family. They want to know if their child is walking early enough or saying enough words at a certain age. Sometimes they are reassured by family and friends that many children who do not speak or walk until later than expected eventually do develop these skills. Even doctors may tell parents that their concerns are nothing to worry about at this time.
Teachers also become concerned about the development of some of the children they work with. Experiences with many children around the same age give teachers the opportunity to observe what the stages of development look like across many different children. With that knowledge, the teacher may be one of the first professionals to identify a potential delay or disability.
Developmental Delays
Developmental milestones give parents a general sense of when their child will develop skills like walking, talking, feeding herself, and becoming toilet trained. Children develop at their own pace, but pediatricians use these developmental milestones to make sure children are generally developing on schedule and to catch any delay in development as early as possible (CDC 2017b).
Doctors routinely look at a child’s overall development as well as some specific developmental skills when they examine the child during regular office visits (CDC 2017a). Some of the common milestones doctors and families discuss during visits include
» Motor development: Is the child rolling over, sitting, or standing yet? Is he moving around by himself? How well does he use his fingers to manipulate small objects?
» Language development: How many words does the child say, and how clearly does she speak? How well does she understand what other people say to her?
» Social and emotional development: Does the child show interest in what is going on around her? Does she show a range of emotions and an increasing ability to regulate them? How does she interact with other children and adults?
» Cognitive development: Is the child curious? Does he explore toys and other materials in the environment? Does he understand cause and effect? Does he problem solve?
Again, developmental milestones are what most children can do at a certain age, but it is not an exact science. If a child develops a skill one month later than the developmental milestone chart indicates she should, that is usually not of concern. However, most doctors do become concerned if a child is several months behind. For example, most children start to walk unassisted between the ages of 9 months and 15 months. With this in mind, if a child is not walking at
» 16 or 17 months, that may be nothing serious to worry about, but the doctor will want to know about it.
» 18 or 19 months, that is of greater concern, and the doctor may want to look at the child’s development even further.
» 20 months, that is a significant concern, and a doctor or specialist should complete a formal developmental evaluation.
When there is a significant delay in development, doctors identify children as having a developmental delay. A child may show a developmental delay in just one area of development, or the delay can impact more than one area. A global developmental delay indicates a delay in at least two areas of development (AAP 2006).
Possible Causes for Developmental Delays
There are a number of reasons why developmental delays occur. A child may be born prematurely, or there could be an underlying genetic condition. In many situations, doctors and families do not know the specific cause.
Temporary conditions that can cause developmental delays. A delay in a child’s development might be due to a temporary condition. For example, ongoing or recurrent ear infections in young children can cause short-term hearing loss, leading to delays in speech and language (ASHA 2017a). Infections in the inner ear may also cause balance problems in young children and delay walking (Lawson 2015). When a developmental delay is caused by a temporary condition that can be resolved with time and medical interventions such as therapy, most children make significant improvements when treatment begins as early as possible.
Child Development Expectations Across Cultures
Families from all cultures want their children to learn and develop, but different cultures have different expectations and prioritize certain aspects of development over others. Considering the culture of each child and family is important when looking for specific milestones. What may look like a delay in language or social skills may be considered typical or even preferred development in some cultures.
For example, children in European, American, and other Western cultures are often expected to be independent as soon as possible. Other cultures, including Asian or Eastern cultures, often value interdependence, cooperation, and other skills that are important to being part of a group (Basu-Zharku 2011; Chen 2009). These diverse cultural expectations may result in a variety of social interactions and behaviors in classrooms. For example, children from a culture such as China tend to act less aggressively in group situations than children from Western cultures, like the United States (Rubin & Menzer 2010).
Other common early childhood experiences are also influenced by culture. Pretend play, for example, is not common in some Eastern countries like Korea, and when it does occur, a child is more likely to pretend to be a family member than a community helper, fairy-tale character, or action hero, which are common roles seen among children from Western cultures (Chen 2009).
Disabilities that can cause developmental delays. Often a delay in development is due to a disability, either known or not yet identified. Developmental delays can result from long-term medical conditions, such as
» Genetic disorders (Down syndrome, Tay-Sachs disease)
» Neurological disorders (muscular dystrophy)
» Trauma occurring before, during, or soon after birth (cerebral palsy) (CDC 2015a)
Some disabilities that are likely to cause developmental delays are identified at birth or even before, such as Down syndrome. In other situations, the cause for the developmental delay may be a disability that cannot be identified at a young age but is eventually diagnosed when a child is older. Such conditions include autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) (CDC 2015a).
When a developmental delay is caused by a disability, the delay usually continues throughout the person’s lifetime. Special education and related services that begin as early as possible are crucial for enhancing children’s development and learning.
Developmental Disabilities
The Americans with Disabilities Act (ADA) of 1990 (Public Law 101-336) defines a disability as a physical or mental condition that impacts the way the body works or develops, and significantly limits a person’s abilities in one or more major life activities, including walking, standing, seeing, hearing, speaking, and/or learning.
More specifically, the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Public Law 106-402) defines a developmental disability as a severe, chronic disability that
» Originates at birth or during childhood
» Is attributable to a mental or physical impairment or a combination of mental and physical impairments
» Is expected to continue indefinitely
» Substantially restricts the individual’s functioning in three or more of the following major life activities:
• Self-care
• Receptive and expressive language
• Learning
• Mobility
• Self-direction
• Capacity for independent living
• Economic self-sufficiency
Some examples of developmental disabilities are Down syndrome, cerebral palsy, fetal alcohol spectrum disorder, spina bifida, and brain injury.
Developmental disabilities have a high probability of impacting a child’s achievement of developmental milestones, so it is important that services such as special education and related services such as speech-language therapy begin as early as possible. Children with developmental disabilities may be eligible for supports and services even before the condition affects their development. For example, since it is probable that a child born with spina bifida will have difficulty with motor development (crawling and walking), he should be eligible for physical therapy from the early intervention system (see Chapter 2) even before he is expected to start crawling or walking.
Suspecting a Delay or Disability
Parents are often the first to notice that their child is not progressing at the same rate as other children the same age. In some cases, a teacher might notice a child’s delay, or a pediatrician might detect a medical issue during a regularly scheduled checkup. If parents think their child is developing a little slowly in an area or if he seems behind in development, it is essential to talk to a medical doctor. If a child continually lags behind in skills other children his age have acquired, it is time to assess the cause. Ongoing, significant delays in achieving developmental milestones may signal a disability.