Atypical child development


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Atypical child development

  1. 1. Atypical Child DevelopmentTypical Development: Child development refers to the biological and psychological changes that occur in human beings between birth and the end of adolescence, as the individual progresses from dependency to increasing autonomy. (wikipedia) By Rowan Anderson
  2. 2. Typical Motor Development 3 months 12 months• Lift head when held at your shoulder • drink from a cup with help• lift head and chest when lying on his stomach • feed herself finger food like raisins or bread crumbs• turn head from side to side when lying on his stomach • grasp small objects by using her thumb and index or• follow a moving object or person with his eyes forefinger• often hold hands open or loosely fisted • use his first finger to poke or point• grasp rattle when given to her • put small blocks in and take them out of a container• wiggle and kick with arms and legs • knock two blocks together • sit well without support 6 months• hold head steady when sitting with your help • crawl on hands and knees• reach for and grasp objects • pull himself to stand or take steps holding onto furniture• play with his toes• help hold the bottle during feeding • stand alone momentarily• explore by mouthing and banging objects • walk with one hand held• move toys from one hand to another • cooperate with dressing by offering a foot or an arm• shake a rattle• pull up to a sitting position on her own if you grasp her hands• sit with only a little support• sit in a high chair Information on this slide taken from:• roll over• bounce when held in a standing position
  3. 3. Red Flags/Motor; fine and grossGross Motor Fine MotorIf a child is... If a child is...• · Not rolling by 7 months of age • · Frequently in a fisted position with both hands after 6 months of• · Not pushing up on straight arms, lifting his head and shoulders, by age 8 months of age • · Not bringing both hands to midline (center of body) by 10 months• · Not sitting independently by 10 months of age of age• · Not crawling ("commando" crawling--moving across the floor on • · Not banging objects together by 10 months of age his belly) by 10 months of age • · Not clapping their hands by 12 months of age• · Not creeping (on all fours, what is typically called "crawling") by 12 • · Not deliberately and immediately releasing objects by 12 months months of age of age• · Not sitting upright in a child-sized chair by 12 months of age • · Not able to tip and hold their bottle by themselves and keep it• · Not pulling to stand by 12 months of age up, without lying down, by 12 months of age• · Not standing alone by 14 months of age • · Still using a fisted grasp to hold a crayon at 18 months of age• · Not walking by 18 months of age • · Not using a mature pincer grasp (thumb and index finger, pad to• · Not jumping by 30 months of age pad) by 18 months of age• · Not independent on stairs (up and down) by 30 months of age • · Not imitating a drawing of a vertical line by 24 months of age early intervention/developmental therapy referral may be • · Not able to snip with scissors by 30 months appropriate. early childhood intervention/development therapy referral may• be appropriate Here are some other gross motor "red flags":• · "walking" their hands up their bodies to achieve a standing Here are some other fine motor "red flags": position • · Using only one hand to complete tasks• · only walking on their toes, not the soles of their feet • · Not being able to move/open one hand/arm• · frequently falling/tripping, for no apparent reason • · Drooling during small tasks that require intense concentration• · still "toeing in" at two years of age • · Displaying uncoordinated or jerky movements when doing• · unusual creeping patterns activities• · any known medical diagnosis can be considered a "red flag": • · Crayon strokes are either too heavy or too light to see Downs syndrome, cerebral palsy, congenital heart condition etc. • · Any know medical diagnosis can be considered a "red flag": Downs Syndrome, cerebral palsy etc. From: checklist.html
  4. 4. Atypical Motor Development Autism Impact• Performs repetitive movements, such as rocking, spinning or hand-flapping• Moves constantly “I think the fluidity of access to various places in my brain is dependent• Clumsy upon neurological movement between places. Im no scientist, but have always been able to "see" this inside of me. Sometimes my• Fine motor difficulties: handwriting, buttoning a speaking is hindered, other times my thinking, and sometimes my shirt, holding a fork, typing shoelaces. physical movement. The hardest is when thinking is not working smoothly.” Judy Endow (2010) author with autism• Sometimes late to sit up, stand, or walk• Toe walking• Unusual gait
  5. 5. Typical Cognitive DevelopmentBirth: Beginning to develop concepts e.g. becomes aware of physical sensations such as hunger. Explores using his senses. Make eye contact and cry to indicate need.3 months: Takes increasing interest in his surroundings. Shows interest in playthings. Understand cause and effect, e.g. if you tie one end of a ribbon to his toe and the other to a mobile, he will learn to move the mobile.6 months: Finds feet interesting. Understand objects and know what to expect of them. Understand up and down and make appropriate gestures, such as raising his arms to be picked.9 months: Shows interest in picture books. Watches activities of others with interest.12 months: Responds to simple instructions. Uses trial-and-error to learn about objects.
  6. 6. Red Flags Cognition/Problem SolvingIf a child is...· Not imitating body action on a doll by 15 months of age (ie,kiss the baby, feed the baby)· Not able to match two sets of objects by item by 27months of age (ie, blocks in one container and people inanother)· Not able to imitate a model from memory by 27 months(ie, show me how you brush your teeth)· Not able to match two sets of objects by color by 31months of age· Having difficulty problem solving during activities incomparison to his/her peers· Unaware of changes in his/her environment and early intervention/developmental therapy referral maybe appropriate
  7. 7. Atypical Cognitive Development Down Syndrome Impact Memory development for individuals with Down syndrome– An overview Sue Buckley and Gillian Bird Working memory for children with Working memory is the system in the brain that supports the daily Down syndrome processing of visual and verbal information as individuals go about their lives. It has been described as ‘a mental workplace’, as it is not only essential for language processing, it also supports activities which involve• They have a specific impairment in short-term holding and manipulating information such as reading a text with memory for verbal information. comprehension, planning and writing text or messages, doing mental arithmetic, and holding temporary information like a telephone number while dialing it. In addition to being a temporary storage and processing• This will make processing verbal information system essential to everyday functioning and to mental abilities, part of the working memory system which is specialized for holding verbal information and, therefore, learning from - the phonological loop - is thought to be essential for learning a spoken listening, especially difficult for them. language. The phonological loop holds the sound patterns for words. In order to learn a first language a child has to be able to store accurate representations of the sound patterns of words in order to link them to• It will also impair vocabulary and sentence meaning and in order to be able to copy or produce the word when talking. learning, so is probably a major cause of their If the phonological loop does not function well, speech and language will be delayed. There is evidence that there is a basic impairment in speech and language difficulties. phonological loop functioning in children with Down syndrome. This is probably a major reason for their speech and language delays and difficulties and it also affects their ability to process spoken language and• Their visuo-spatial short-term memory is better carry out cognitive tasks. Memory training studies indicate that it is than verbal short-term memory. possible to improve the short-term memory skills of children with Down syndrome. However, the biggest gains in short-term memory skills reported are linked to reading instruction and to being in a mainstream• Their ability to learn from visual information is school. Reading activities may provide auditory training experiences which therefore a relative strength and can be used to actually improve phonological coding (the accurate representation of the sound patterns of words) in the phonological loop. Memory training support weaker verbal processing abilities activities and support for weak auditory memory skills are discussed. However, a range of activities to improve speech sound and wordInformation on this slide taken from: discrimination are included, as they may improve basic phonological loop function and therefore result in the greatest gains for spoken language abilities and working memory. • Buckley SJ, Bird G. Memory development for individuals with Down syndrome– An overview. Down Syndrome Issues and Information. 2001.
  8. 8. Autism Cognitive Development • ASD: The Invisible Disability ―You could teach a child with ASD the theory of relativity once and he’d get• Difficulty in … – Predicting it. But you’d have to tell him – Reading intentions the rules for lining up for – Understanding emotions – Explaining own behavior recess 500 times.‖ – Perspective or reference Brenda Smith Myles – Reading and reacting to others’ interests – Understanding social interactions 8
  9. 9. Birth: Cries vigorously. Respond to high-pitched tones by moving his limbs.3 months: Attentive to sounds made by your voice. Indicates needs with differentiated cries. Beginning to vocalise. Smile in response to speech.6 months: Double syllable sounds such as mama and dada. Laughs in play. Screams with annoyance.9 months: Babbles tunefully. Vocalises to attract attention. Enjoy communicating with sounds.12 months: Babbles 2 or 3 words repeatedly. Responds to simple instructions. Understands several words. Uses jargon.• babble, but it sometimes "sounds like" talking• say his first word• recognize family members names• try to "talk" with you• respond to anothers distress by showing distress or crying• show affection to familiar adults• show mild to severe anxiety at separation from parent• show apprehension about strangers• raise her arms when she wants to be picked up• understand simple commands 9
  10. 10. Language Development Red Flags – Shows two or more of these behaviors while speaking:• Speech and Language Development, Which Includes • hand clenching • eye blinking• Articulation (pronouncing sounds) • swaying of body• Dysfluency (excessive stuttering—occasional stuttering may occur in the • pill rolling with fingers early years and is normal) • no eye contact• Voice • body tension or struggle• Language (ability to use and understand words) • breathing irregularity• Red Flags • tremors • pitch rise• Articulation. Watch for the child • frustration – Whose speech is difficult to understand, compared with peers • avoidance of talking – Who mispronounces sounds – Is labeled a stutterer by parents – Whose mouth seems abnormal (excessive under- or overbite; – Is aware of her or his dysfluencies swallowing difficulty; poorly lined-up teeth) • Voice. Note the child whose – Who has difficulty putting words and sounds in proper sequence – Rate of speech is extremely fast or slow – Voice is breathy or hoarse – Who cannot be encouraged to produce age-appropriate sound – Voice is very loud or soft – Who has a history of ear infections or middle ear disorders – Voice is very high or low• Note: Most children develop the following sounds correctly by the ages – Voice sounds very nasa shown (i.e., don’t worry about a 3-year-old who mispronounces t). • Language (ability to use and understand words). Note the child who• 2 years—all vowel sounds – Does not appear to understand when others speak, though hearing is normal• 3 years—p, b, m, w, h – Is unable to follow one- or two-step directions• 4 years—t, d, n, k, h, ng – Communicates by pointing, gesturing• 5 years—f, j, sh – Makes no attempt to communicate with words• 6 years—ch, v, r, l – Has small vocabulary for age• 7 years—s, z, voiceless or voiced th – Uses parrotlike speech (imitates what others say) – Has difficulty putting words together in a sentence• Dysfluency (stuttering). Note the child who, compared with others of the – Uses words inaccurately same age, – Demonstrates difficulty with three or more of these skills: – Shows excessive amounts of these behaviors: • making a word plural • repetitions of sounds, words (m-m-m; I-I-I-I-) • changing tenses of verb • prolongations of sounds (mmmmmmmmmmmmmmm) • using pronouns • hesitations or long blocks during speech, usually • using negatives accompanied by tension or struggle behavior • using possessives • naming common objects • putting in extra words (um, uh, well) • telling function of common objects • using prepositions • Note: Two-year-olds use mostly nouns, few verbs. Three-year-olds use nouns, verbs, some adverbs, adjectives, prepositions. Four-year-olds use all parts of speech.
  11. 11. Down Syndrome Language Development Characteristics Impact Children with Down syndrome usually experience considerable delay and difficulties with learning to talk. • Most children and adults with Down syndrome understand more language• Summary of the speech and language profile of than their expressive language skills suggest and therefore their individuals with Down syndrome understanding is often underestimated. Their social interactive skills and non-verbal communication skills are a strength but speech sound• Speech and language skills are specifically delayed production (articulation and phonology) is a specific weakness. Vocabulary relative to non-verbal abilities learning, while delayed, is also a strength but grammar learning is a weakness, so that the children tend to talk using keywords rather than• Non-verbal communication is a strength in infancy complete sentences. and beyond • Children with Down syndrome show the same progression from one word to two word combinations, once they can say between 50-100 words, as• Use of gestures to communicate is a strength other children, and they show the same progression to early grammar in their speech when they have a spoken vocabulary of 300-400 words.• Vocabulary is understood slowly but steadily and Unfortunately the usual delay in reaching a productive vocabulary of 300- becomes a strength 400 words (at 5 to 6 years, instead of at 2 to 3 years) may compromise the ability to master fully sophisticated grammar and phonology in later• Spoken production of words lags behind speech. comprehension • Some of the reasons for the speech and language difficulties • Learning difficulties - need more examples to learn• Early grammar is learned slowly and is paced by • Anatomical differences - affect speech skills vocabulary size • Learning language from listening is affected by:• More complex grammar is specifically delayed – hearing loss – auditory discrimination relative to vocabulary – verbal short-term memory• Spoken production of grammar lags behind • Speech motor difficulties: comprehension of grammar – delay vocabulary and grammar development – affect the way a child is talked to and included in conversations• Difficulty with speech production – first words • Joint attention difficulties and slow development of speech will both delayed, strings of words difficult reduce language learning opportunities• Articulation and phonology are a challenge, • All these difficulties can be targeted with appropriate and effective intervention strategies therefore speech intelligibility is a weakness • Progress in comprehension and production of vocabulary is probably• Teenagers and adults often still communicate with compromised by hearing difficulties. It is certainly compromised by the childrens specific difficulty with speech sound production. Progress in short, telegraphic sentences sentence production and in later grammar learning is probably compromised by a weakness in the auditory or phonological short-term memory system.
  12. 12. Autism Language Development• Difficulties with nonverbal communication • Difficulty with the pragmatics of conversation• – inappropriate facial expressions • – problems initiating communication• – unusual use of gestures• – lack of eye contact • – difficulty using unwritten rules• – strange body postures • – inability to maintain conversation on a topic• – lack of mutual or shared focus of attention • – inappropriate interrupting• Delay in or lack of expressive language skills • – inflexibility in style of conversation, stereotypic style of• Significant differences in oral language, for those who do develop language speaking• – odd pitch or intonation• – faster or slower rate of speech than normal• – unusual rhythm or stress Impact• – monotone or lilting voice quality People with autism spectrum disorders often have difficulty• A tendency to use language to have needs met, rather than for comprehending verbal information, following long verbal social purposes instructions and remembering a sequence of instructions. The• Repetitive and idiosyncratic speech patterns comprehension of language may be context-specific. The extent• ―The student may be using echolaic utterances to rehearse what is of difficulty varies among individuals, but even those who have heard in order to process the information, or as a strategy for self- regulation.‖ Prizant and Duchan, 1981 normal intelligence, usually referred to as high-functioning, may• Echolalic speech, immediate or delayed literal repetition of the have difficulty comprehending verbal information. speech of others• – appears to be non meaningful, but may indicate an attempt to communicate• – indicates the ability to produce speech and imitate • Source: Teaching Students with Autism Spectrum Disorder• – may serve a communication or cognitive purpose for the student• Restricted vocabulary• – dominated by nouns• – often confined to requests or rejections to regulate one’s physical environment• – limited in social functions• Tendency to perseverate on a topic• —that is, to continuallydiscuss one topic and have difficulty changing topics
  13. 13. Typical Adaptive Skills Feeding Dressing • 15 - 24 months Learns to take off hat, socks, and shoes without laces• 8 months Learns to unzip large zippers Gums solid foods • 24 - 30 months Feeds self crackers Can pull pants down with assistance Holds own bottle Is beginning to unbutton large buttons Drinks from cup held by adult Anticipates the need to use the toilet Can put shoes on with help• 12 months Still needs help getting pullover shirts over head and pants up over Picks up small pieces of cereal to eat bottom Holds cup and drinks with some spills • 30 - 36 months• 24 - 30 months Puts on items such as shoes, socks, pants, shirts, and jackets Pulls pants up Drinks from a small cup, holding it with one hand Undresses and dresses with adult help Bites well through food Still needs help with tying Brings spoon to mouth with the palm facing up • 3 - 4 years Can eat a meal using a spoon with minimal spilling Uses toilet with adult help• 30 - 36 months Has daytime toilet control Learns to undo fasteners, such as snaps and laces Pours from a small cup Distinguishes between the front and back of clothes Begins to use a fork to spear food Zips front-opening clothes Can spread with a dull butter knife Still needs adult help with dressing Buttons large buttons• 3 - 4 years Puts on socks, may need help with heel placement Pokes food with a fork Zips and unzips jackets but needs help with starting Begins using fork more than spoon Puts shoes on, may have trouble telling which feet Holds spoon in fingers with palm up • 4 years Learns to cut soft foods with the edge of fork Puts on socks with heel placement Learns how to prepare a bowl of dry cereal with milk Puts on shoes with some adult help Buckles shoes and belts Uses napkin Serves self at table with little spilling • 5 years Put shirts on correctly Puts belt in loops Unties a tie on an apron Some can put shoes on correct feet and tie laces
  14. 14. Red Flags/Adaptive SkillsIf a child is...· Having difficulty biting or chewing food during mealtime· Needing a prolonged period of time to chew and/or swallow· Coughing/choking during or after eating on a regular basis· Demonstrating a change in vocal quality during/after eating (i.e. they soundgurgled or hoarse when speaking/making sounds)· Having significant difficulty transitioning between different food stages· Not feeding him/herself finger foods by 14 months of age· Not attempting to use a spoon by 15 months of age· Not picking up and drinking from a regular open cup by 15 months of age· Not able to pull off hat, socks or mittens on request by 15 months of age· Not attempting to wash own hands or face by 19 months· Not assisting with dressing tasks (excluding clothes fasteners) by 22 months· Not able to deliberately undo large buttons, snaps and shoelaces by 34 early intervention/developmental therapy and referral may be appropriate.
  15. 15. Red Flags/SensoryIf a child is... · Very busy, always on the go, and has a very short attention to task· Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)· A picky eater· Not aware of when they get hurt (no crying, startle, or reaction to injury)· Afraid of swinging/movement activities; does not like to be picked up or be upside down· Showing difficulty learning new activities (motor planning)· Having a hard time calming themselves down appropriately· Appearing to be constantly moving around, even while sitting· Showing poor or no eye contact· Frequently jumping and/or purposely falling to the floor/crashing into things· Seeking opportunities to fall without regard to his/her safety or that of others· Constantly touching everything they see, including other children· Hypotonic (floppy body, like a wet noodle)· Having a difficult time with transitions between activity or location· Overly upset with change in routine· Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.· Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, early childhood intervention/developmental therapy referral may be appropriate.NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists).Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.Possible visual problems may exist if the child...· Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes· Does not reach for an object close byPossible hearing problems may exist if the child...· Does not respond to sounds or to the voices of familiar people· Does not attend to bells or other sound-producing objects· Does not respond appropriately to different levels of sound· Does not babble
  16. 16. An Amazing and Extensive Sensory Processing Disorder Checklist: A children’s book
  17. 17. Creating Sensory Diets for children with Autism,Downs Syndrome and other sensory sensitive disorders. What is a sensory diet?Just as your child needs food throughout the course of the day, his need for sensory input mustalso be met. A “sensory diet” (coined by OT Patricia Wilbarger) is a carefully designed,Personalized activity plan that provides the sensory input a person needs to stay focused andorganized throughout the day. Just as you may jiggle your knee or chew gum to stay awake orsoak in a hot tub to unwind, children need to engage in stabilizing, focusing activities too.Infants, young children, teens, and adults with mild to severe sensory issues can all benefitfrom a personalized sensory diet.Each child has a unique set of sensory needs. Generally, a child whose nervous system is on“high trigger/too wired” needs more calming input, while the child who is more“sluggish/too tired” needs more arousing input. For examples of sensory diets, go to:
  18. 18. Social Emotional DevelopmentBy the end of 3 months Begins to develop a social smile Enjoys playing with other people and may cry when playing stops Becomes more expressive and communicates more with face and body Imitates some movements and facial expressionsBy the end of 7 months A happy baby, you tube! Enjoys social play Interested in mirror images Responds to other people’s expressions of emotion and appears joyful oftenBy the end of 12 months: Shy or anxious with strangers Cries when mother or father leaves Enjoys imitating people in his play Shows specific preferences for certain people and toys Tests parental responses to his actions during feedings Tests parental responses to his behavior May be fearful in some situations Prefers mother and/or regular caregiver over all others Repeats sounds or gestures for attention Finger-feeds himself Extends arm or leg to help when being dressed
  19. 19. Red Flags SoSocial/Emotional/Play SkillsIf a child is...· Not smiling by 4 months· Not making eye contact during activities and interacting with peers and/or adults· Not performing for social attention by 12 months· Not imitating actions and movements by the age of 24 months· Not engaging in pretend play by the age of 24 months· Not demonstrating appropriate play with an object (i.e. instead of trying to putobjects into a container, the child leaves the objects in the container and keepsflicking them with his fingers)· Fixating on objects that spin or turn (i.e. See n Say, toy cars, etc.); also childrenwho are trying to spin things that are not normally spun· Having significant difficulty attending to tasks· Getting overly upset with change or transitions from activity to early intervention program referral may be appropriate
  20. 20. The specific developmental profile associated with Down syndrome“Children with Down syndrome are all individuals and vary in their rates of progress - however,they tend to have a specific profile of strengths and weaknesses:Social development and social learning are strengths, right from infancy - the children enjoy andlearn from social interaction with adults and peersMotor development is usually delayed and may hold back progress in self-help skills, handlingtoys in play and in writing, though the use of gesture to communicate is a strengthSpeech and language development is usually the childrens area of most significant delay - it ismore delayed than non-verbal abilities. Most children understand more than they can say andsigning is an important bridge to speaking. Speech intelligibility is usually a difficulty. A highincidence of hearing difficulties is contributing to speech and language delay.Working memory development is specifically delayed relative to non-verbal abilities, particularlythe verbal short-term memory component - so that learning from listening is difficult for thechildren. Working memory also supports thinking, problem solving and reasoning. Visual andspatial processing and memory are relative strengths - so that the children learn effectively fromvisual information - they can be thought of as visual learners.Social behaviour- the children have strengths in social skills and in developing age-appropriatesocial behaviour, if this is encouraged and expected. However, their good social understandingand empathy leads them to pick up on non-verbal emotional cues, such as those for anxiety ordisapproval, very quickly. They are therefore sensitive to failure and may use behaviouralstrategies to avoid difficult situations.”
  21. 21. • Social deficits observed in children with autism may include:Autism SocialSkills Group • Difficulties understanding the facial expressions of others • Difficulties with or complete lack of initiating social interactions with others
 • Lack of responding to social initiations made by others (Hauck, Fein, Waterhouse, & Feinstein, 1995)
 • Lack of responding to the emotions of others (Sigman, Kasari, Kwon, & Yirmiya, 1992).
 • Deficits in showing (directing attention) (Stone, Coonrod, & Ousley, 2000)
 • Lack of interest in other children
 • Absence of or limited use of gestures such as pointing to share enjoyment with others
 • Absence of or limited imitiation skills
 • Lack of friendship seeking behavior
 The Center for Autism Spectrum Disorders at Binghamton University
  22. 22. March 01, 2010 Temple Grandin sees her autism as aA Gift gift, not a disability. The professor at Colorado State University, who has become a prominent animal rights activist, spoke at the recent TED Conference in California about how peoples brains work in different ways -- and how thats something that should be appreciated, not stigmatized. Grandin, for instance, thinks in pictures, "like Google for images," she said. She also grabs hold of details, a brain function she feels could help politicians. "I get satisfaction out of seeing stuff that makes real change in the real world," she said. "We need a lot more of that and a lot less abstract stuff."
  23. 23. States of Grief for Parents of Children with Special Needs By Kristin Reinsberg, MS, LMFTApril 23, 2010 Daily tasks, demands and challenges continually test a parent’s patience, problem solving skills, and flexibility. Timeto recharge, and relax is often in short supply as the responsibilities of parenthood pull for more of our energy. Stress can impact our health andcan greatly affect our relationships with partners, friends, and most importantly, our children. If you are a parent of a child with disabilities,stress can be a uniquely pervasive and isolating experience. Grief& Loss: Internal Contributors to StressAs parents, we develop hopes and dreams about who our baby will be in the world and how we will be as parents. This process of creating aninternal life for our baby and ourselves is a natural part of what all parents go through. We do not expect that our baby will be born with, ordevelop, a disability or special need; when that happens, much of what we imagined and planned is forever changed.For parents of children with special needs, feelings of stress are often compounded by a profound sense of grief that results from this loss ofone’s initial hopes, dreams and expectations. These feelings can be similar to those experienced when we encounter any other significant loss,such as a death or divorce. Recent research has indicated that parents of children with special needs may even experience feelings andsymptoms of traumatic stress, particularly at the time of their child’s diagnosis. These feelings of grief and loss are often experienced but rarelyspoken about or shared. Parents may be worried that expressing their feelings of anger, depression or fear may not be welcomed or tolerated bythose around them. They may even feel pressure from family and friends to be ―strong‖ or to remain positive, leaving those feelings of griefwithout a place for expression. It is important for families to understand and talk about these feelings, and to know that what they are feeling isnatural.States of GriefWe typically think of grief as having distinct ―states‖ (Moses, 1987). For parents of children with special needs, grief rarely happens in apredictable or linear fashion. Oftentimes, the sense of loss is on-going and it is very common for parents to re-experience various feelings ofgrief at many points throughout their child’s development. A parent who may have adjusted expectations for their child’s needs at home mayfind themselves again experiencing feelings of denial, fear or depression when presented with new challenges their child is facing at school.While these feelings are often difficult to sit with and even harder to talk about, it is important to remember that all of the feeling statesassociated with grief serve a purpose and help us to cope, manage and mobilize. The feeling states of grief that we all experience following lossare: •Denial •Anxiety • Fear • Guilt • Depression • Anger (Continued in next slide)
  24. 24. .Every parent is different, and grief is a uniquely individual process. There is no “right” or “wrong” way to experience grief; however, parents needto have the space to fully experience and express all of these important feelings. Letting go of the hopes and dreams that we originally had, andwhich no longer serve us, is an exceptionally complicated and complex process. Doing so can help us connect more fully with what is right in front ofus, and can enable us to develop and create new hopes, expectations and dreams for ourselves and our family.Outside Stressors Also Impact FamiliesParents also experience stress due to the challenging external realities of raising a child with special needs. Parents often find themselves juggling the dailyneeds of their family with medical and therapy appointments, teacher meetings and advocating for services Siblings may experience stress; feelingoverlooked or overly relied upon. Financial pressures may develop when parents are unable or choose not to work in order to care for their child, or whenfamilies need to pay for services that are not covered by insurance or other agencies.For many parents, support is limited. Agencies that once provided services have been impacted by state and local budget cuts. Supportive servicesfor families, such as respite care, are being greatly reduced or eliminated. Parents may experience long waitlists or delays in getting the necessaryand needed services for their children and for themselves.Support for Parents of Children with Special Needs•Take time for yourself. Carving out time to relax, read, talk to friends, or do whatever else that helps you to nourish yourself cannot be overstated. Wecannot care for others unless we also find ways to take care of ourselves. Taking time to rejuvenate and relax will help you respond to daily stressors and bemore available to your children and partner•Express and share your feelings of grief. Finding a way to share your story with trusted friends, family or professionals will help with feelings of isolationand hopelessness. It will help clear the way for new strengths and gains to be discovered. Additionally, it will help those around you to know and understandyour experience so that they may be able to offer support in more effective ways.•Seek out Parent and Peer Support Groups. Knowing that others ―have been there‖ can be a very comforting. Many early intervention programs offergroups; they can be specific to parents who have children with particular disabilities, or be more general support groups offering parents a chance to shareand to have an hour or so to just sit and relax. For parents in remote areas or for those who have difficulty leaving their home for extended periods of time,the internet offers many ―virtual‖ peer/support groups.•Seek out intervention programs or individuals who take a family- or relationship-based approach to serving your child. Working with agencies orindividuals who focus on the parent-child relationship, and on how to utilize this relationship to help promote the growth and development of your child, canhelp you feel included, supported, and confident. Interventionists who employ a relationship-based approach to providing services for your child can helppromote your feelings of connection and competence with your child and can reduce stress by providing another forum in which you can discuss yourexperiences, concerns and feelings.In my article on stress and mindfulness, I have explored a variety of ways to understand and manage stress that will be useful to all parents, and Iencourage you to look at those ideas Our website,, offers parents the opportunity to connect, chat, share information and gather information about a variety oftopics related to special needs and parenting.Links & ResourcesMoses, Ken (1987). The Impact of Childhood Disability: The Parent’s Struggle. WAYS Magazine, Spring. Evanston, IL.Foley, G. & Hochman, J., Eds. (2006). Mental Health in Early Intervention: Achieving Unity in Principles and Practice. Baltimore: Brooks Publishing.