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Developmental screenings detect early problems

It wasn't until toddler Martin Thompson's developmental screening with the Child Development Programme (CDP) that his mother, Evelyn Simons, ever suspected that anything was wrong.

CDP on Palmetto Road in Devonshire gives a free screening to approximately 75 percent of children on the Island between 24 months and 30 months to check for developmental delays and difficulties. In addition to the screening, they provide many services to parents with children aged four and under behaviour management, speech therapy and family counselling; they have a programme for children with special needs and a support group for parents with premature babies.

During the screening, the parent is asked to fill out a questionnaire to learn how they feel about parenting. The children are asked to solve simple puzzles and testing is done to evaluate their motor skills.

In Martin's case, alarm bells went off when he could not name any of the animals in a picture book. He was called in for further evaluation at CDP.

“I have three older children,” said Ms Simons. “Until the screening we didn't really notice that anything was wrong. We thought he was just a normal little baby.”

In hindsight there were signs: Martin didn't make eye contact; he played with his train set in a repetitive way.

He was eventually sent to a local paediatrician and then to Boston Children's Hospital for a full evaluation. He was diagnosed with autism.

“I will tell you one thing, they are wonderful at CDP,” said Ms Simons. “They really did help us with Martin. I would advise any parent to have their child evaluated. If they don't have the evaluation and there is a problem when they start school, it is hard on the child.”

The CDP would like to increase the percentage of toddlers screened on the Island.

“We want the public to know that we are a resource here for every family in Bermuda between birth and four,” said CDP family coordinator Lovette Lovell. “That extra 25 percent who aren't screened tend to consist of families who have left the Island, families who have not heard of us, and also families that have moved since the birth. The address we normally have is the one given at King Edward VII Memorial Hospital when the baby is born.”

Approximately 20 percent of children screened need further attention from CDP, similar to figures in the United States. One of the most common issues that CDP uncovers is speech language delays. These can be caused by the child's genetic makeup, hearing problems, or even too much television in the background at home and too little verbal interaction between the parent and child. Usually, at the time of the screening, the child should be saying two or three words. Ms Lovell said there can be signs even earlier that a baby is having problems communicating.

“Suppose my baby doesn't babble?” said Ms Lovell. “What if they don't turn to sound? That may be a red flag that they are not typically developing. The smile might be next. Are they smiling? There are the verbal and non-verbal indicators. As toddlers, can they follow simple commands?”

What sometimes makes it difficult for parents to detect a problem is that development is a continuum. Some children are perfectly normal, and start speaking a little later than their peers.

“Sometimes it depends on if they have a sibling,” said Ms Lovell. “Sometimes younger children don't speak as early as their siblings, because the older child speaks for them. Sometimes twins have their own code or own language, so they will also speak at different stages. When there is a problem, a lot of time it will be someone outside the family that points it out. Parents or family members sometimes don't notice because they understand what the child is trying to say.”

CDP has a Verbal Interaction Programme (VIP) to deal with possible speech delays. It is a family literacy programme linked to the parent-child relationship. A core belief of the programme is that parents are a child's first teacher. The programme works to increase the amount of verbal interaction between parents and children, support and enhance the parent-child relationship and show how to improve parenting skills. It is based on an American programme started by Phyllis Levenstein to model techniques for parents and guardians on how to generally “talk and play” with their child.

The screenings can also pick up developing behaviour problems. Sometimes parents who are struggling to get their child under control contact CDP, or are referred to CDP by another agency. Gwendolyn Creary, behaviour management programme supervisor helps these parents.

“We talk about discipline,” said Ms Creary. “Typically, people start to ask us for help between a year and 18 months. This is when parents start to see more tantrums. They may start to realise that the bundle they brought home from the hospital is not quite what they had expected. In the behaviour management programme we rely heavily on the screeners. There are times when parents just feel frustrated.”

The behaviour management programme is delivered via regular home visits. The worker spends 45 to 60 minutes, or as often as is mutually practical in the child's home, with both the child and parent or with the adult alone. The worker first models the technique or skill with the child and then allows the parent a practice period. At the end of each session the worker leaves an assignment with the parent in which they can practice the skill each day in the home environment. A minimum of 12 sessions is needed for effective change. The service addresses parenting needs with regards to non-compliance, and teaches parents to “catch your child being good”. This means instead of always being on the lookout to punish bad behaviour, parents look out for good behaviour and note it or reward it.

CDP has two occupational therapists and two speech therapists so they are able to provide a lot of intervention on site.

“The message that we want to get out to the general public is that we can support you,” said Ms Lovell. “We want to support you to raise children that can reach their potential. We want to support you, guide you, and give you strategies. One thing that is important is that children learn best through the modality of play so enjoy yourself. Don't pressure them to read or write, because you might build in some frustration in terms of the joy of learning. If you want them to learn and build their vocabulary talk to them about the things you are doing. For the kids at this age, learning takes place best in their natural environment. That is why we offer our services in the home environment for the most part, if we can.”

For more information telephone 295-0746.

Photo by Mark Tatem Staff at the Child Development Project believe that toddlers learn best through play. Here parent support home visitor Alfreda Smith looks on while Amaria Brangman-Johnson plays on the slide with mother Raynelle Brangman.

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Published December 07, 2010 at 1:00 am (Updated December 10, 2010 at 10:23 am)

Developmental screenings detect early problems

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