Preschool

Developmental Delay in Infants, Toddlers, & Preschoolers:

As mentioned earlier, LD’s often present initially as developmental delays in infancy, toddlerhood, or the preschool years. A Language-Based LD may present as delayed talking or early difficulty following directions. Non-Verbal LD may present with delayed finger feeding, scribbling, drawing, or difficulty using scissors or learning how to hold a pencil or crayon the right way. In the past, much was made of “handedness” in the preschool years. While LD may be slightly more prevalent among left-handed individuals, this is a very weak association. There are many right-handed individuals with LD and the majority of left-handed individuals are not Learning Disabled. Attempts to change the handedness of a child early in life do not prevent (and may even exacerbate) any LD destined to develop in that child.

The most important thing in this age group is to pay attention to any delays in their development and address them with appropriate therapies and interventions as early as possible. Neurodevelopmental weaknesses are never as responsive to therapy as they are in infancy and the preschool years. This may be the one time in life where it actually may be possible to reduce the severity of such a weakness rather than just teach strategies for overcoming it. With this knowledge in mind, “Early Intervention” has developed as both a field and as a legal mandate over the last 25 years. Federal law requires that Early Intervention services (which may include Speech Therapy, Physical Therapy, and other developmental interventions) be paid for by health insurance. Children from birth until age 3y are eligible. They can qualify either because of actual developmental delay, or because of situations (e.g. prematurity or a particular medical diagnosis) which put them at higher risk for having developmental delays and/or LD later. Early Intervention has been proven to reduce the degree of later disability, and is available in most areas of the country. Children can be referred to Early Intervention by their parents, physicians, day care providers, or teachers. Government picks up the tab for people who lack health insurance.

Interestingly, the “conflict of interest” in the Early Intervention world tends to run in the opposite direction as it does for Special Education in the older age group. Public schools providing SPED services (age 3 & up) tend to operate on a fixed budget and need to divide their resources among all the children who need them. In contrast, Early Intervention has a guaranteed funding source due to it’s federal mandate for insurance coverage. Early Intervention programs tend to be private, non-profit corporations, at least in this part of the country. A director simply hires more staff when they find more children with needs. Indeed, the way they grow their program is precisely by finding more such children. Given the importance of Early Intervention, this is probably good. It does lead to something of a rude awakening for parents when their children reach age 3, however. Very often, children who were felt to have significant needs by their local Early Intervention program, when “handed off” to the public schools at age 3, experience severe cutbacks of services due to the differing financial and political circumstances of the two programs and resulting differences in criteria of “need”.

Despite the above, perhaps the most successful SPED model ever developed by public schools is the “Integrated Preschool” designed to serve the 3-4y age group. Nurses, Early Childhood Specialists, Speech & Occupational Therapists, Physical Therapists, and Psychologists in addition to Teachers staff such preschools. Generally a mixture of special needs and normal children are enrolled. They were the original example of “inclusion models” and can boast a fantastic success record at “turning around” many children with significant early developmental delays. Especially around this geographic area, the public Integrated Preschools are glowing examples of the best that Special Education has to offer.

One final note about early developmental delays. It is in this age group that developmental delays are most likely to be indicative of an underlying medical problem. Although the majority of developmental delays are NOT medically based, the younger they are when they present, the more likely there is to be a medical diagnosis underlying them. Therefore, all children who present with developmental delays in the early years ought to have a full medical evaluation as part of their assessment.