• Educational psychologist Nilu Perera points out that identifying developmental delays in children at a very early age benefits quality of life

The early years of education are crucial, especially for children with developmental delays. Global estimates show that 52.9 million children under five years have developmental disabilities and that 95% of them live in low income families. In Sri Lanka, one in six babies are born with low birth weight, putting them at a disadvantage for growth, and physical and cognitive development. Hence, identifying developmental delays at an early stage can significantly benefit a child’s educational outcomes and overall quality of life. But, does this happen in Sri Lanka and is it possible to do? 

Educational psychologist Nilu Perera who has been working with children with developmental delays for decades joined ‘Kaleidoscope’ last week to delve into the reasoning and importance of children being diagnosed early.

Following are extracts from the interview:

Every child’s development is not the same. When you say early diagnosis, how early is early and how does that help?

When a child is born and when the child is growing up, every child does not grow the same way. You cannot compare two children’s development, but there are certain developmental milestones that we have to be aware of at the newborn, infancy, toddler, preschool, and school related stages. There are certain expectations designated to those developmental stages. It is important when a child is born that there are regular checkups, with the engagement of professionals if necessary, keeping an eye on the child’s development. 

As early as a few months old, we can identify children with developmental delays – those who are not following the mother, children who are not interacting with the mother, etc. But, it is actually at the age of one-and-a-half or two years that we can really identify developmental delays. This identification at an early age is really important because early intervention is something that we believe in strongly and will be the catalyst for the child.

What are the signs that a parent, guardian, or any adult for that matter should actually look out for and what are the development delays that we are looking at?

As a baby, check for the interaction with the mother and whether the child is following the mother, maintaining eye contact and responding to their name. Also, certain things like whether the child likes to stay isolated or is not socially interactive and when it comes to the school stage, whether the child can follow instructions and finish up the work. 

There could be an attention deficit – whether the child is completing the work on time, if the given task is completed, and if they are paying attention throughout. These are little things that you can just keep an eye on when they are developing, but, having one of these signs does not necessarily point to delays. If a child has difficulty at school, speech related delays, and interactive and cognitive development related delays, we can take these things together and check on the possibility of the child needing special intervention. 

When a child is disruptive or ‘naughty’, most often, a teacher or even a parent punishes them and puts them away; how do you know if a child is naturally just naughty or is actually experiencing developmental delays? 

Let us take a school setting or a Montessori or preschool kind of a level where there is a child who is very disruptive or has difficult to manage behaviour. He or she does not follow instructions or listens to direction or guidance. We have to definitely find out why the child is like that. 

It is a common thing where people say, ‘You are a naughty child’ and assume that the child is lazy because the child does not listen or follow instructions. The natural instinct is to ignore or punish them. That doesn’t really work now because there are so many resources available and many professionals to observe and identify the child’s developmental deficits, if at all.

It is important to find out why the child is disruptive. Maybe, there is an attention deficit, a communication difficulty even. Maybe, a social skill development related difficulty where the child cannot interact with other children and is disruptive in the classroom as a result or cannot cope with the work because development could be delayed cognitively. 

We can’t actually find great fault in the teachers and the educators in the classroom because they also have a syllabus to cover, complete tasks, and meet goals, so they prefer all the children working at the same level. When that does not happen, it becomes difficult. My advice is to find out why, inform the parents, and find out if the child behaves the same at home. When parents and teachers come together and identify and observe related issues, that is when you can get professional help, get an assessment done and make sure that you are aware of the ground situation.  

What about schools, kindergartens, preschools, Montessoris, nurseries, and playschools? What signs should the teacher be looking for?

Teachers should look at whether a child is not communicating with other children, not playing with the other children and isolating him or herself, not following instructions – sometimes as simple as doing a puzzle or fixing two things together. These are not definite signs of developmental delays, but they are little clues that we are looking at. 

One of the main things to look for is speech related delay which is connected to many developmental delays. Educators must check on those things and communicate with the parents. Once they have been informed, the issue must be taken up a level. Take the child to have his/her delays identified, diagnosed and assessed.

If that is not done, the child continues in the usual schooling system. Once they get to Grade One, the work gets harder, communication gets harder, and everything becomes more complex. From that age onwards, the child will face difficulties and as he/she goes along, things only become more and more difficult. The child then becomes isolated from their peers.

There has to be collaboration – it is not on just one person. They have to get together and support the child. 

There is a danger with early diagnosis. If the child is diagnosed early, what about school admission?

This is one of the biggest issues that we face. There are things that we can do, but the easiest thing is not to admit the child into school. When the child is diagnosed with a difficulty, let us say something like a specific learning difficulty, you can help the child with a special education plan. We call it an individual education plan. You assist the child and have a plan for the child and then work individually with the child. 

I know that it is not easy as I say to work with the child individually in the classroom but, I think that we have to give that chance to the child with one on one assistance or some assistance within the family background. We have to give that child the chance. That is the only way that the child can move forward. 

Otherwise, they go for interviews from one school to another and get rejected from each school. Where can the parents go? The next step is that they are sent to special schools, where they don’t get the typical social environment, which further stifles them. It is very important that these children are admitted to the typical schools.

What about social acceptance both for the child and the family?

We have come a long way as people are aware. I go to all schools, even outstation schools, and they are all very aware. The only thing is that we have very limited resources, very limited access to therapy, schools, activities, and even professionals in outstation areas.

Acceptance-wise I think that people have accepted to a greater degree right now that it is better for us to be more aware and pay attention to these children, especially when you know that a family has a child with special needs. Be supportive to the family, pay a little attention to that family where there are other children who are going to school and are getting interrupted with their education because of the child with developmental delays.

What are the challenges faced with early diagnosis and its accuracy?

It is the ‘wait and see’. I don’t think that you should wait and see. There is no harm in finding out early if a child has these issues. Let us take speech-related delay, for example. It has become very common to notice a speech-related delay, but many parents and grandparents will say, “Oh, my son also had a speech related delay when he was younger, so that is fine.”

It could very well be that the child will pick up the pace and speak well a little later, but, what if there is another issue related to neurodevelopmental delays? So, it is better to always get a professional’s help and get the right assessment done and then intervene and start the speech therapy or whatever that you need – be it occupation therapy or multidisciplinary therapy that we do together, because it is usually not one thing. It is always better to get help than to wait and see.

Any examples of children who had an early diagnosis and have experienced some kind of success?

The children who have been diagnosed early, who were identified early, and who have done the proper management and proper therapy have gone into typical schools. There are children who are now teenagers and working or going through vocational training. There are many who have succeeded in life with early diagnosis and proper guidance. 

Policy-wise, is Sri Lanka able to handle developmental issues?

We can to a great extent, but it is not implemented in most places. For example, if you put a child with a development delay into a typical classroom, it is difficult for the teachers to handle the child. The easiest thing to say is, "we can’t have this child” or "we don’t want to take the child". It is not that we don’t have special education teachers or caregivers – we have them – but, if a school can accept two to three children a term or year with developmental delays, then, we have a lot more children going to school than not going to school.

Where the schools in Sri Lanka are concerned, I think that they can make further efforts, because right now, not much is happening in the school sector.

(The writer is the host, director, and co-producer of the weekly digital programme ‘Kaleidoscope with Savithri Rodrigo’ which can be viewed on YouTube, Facebook, Instagram, and LinkedIn. She has over three decades of experience in print, electronic, and social media)