Dr. Tiegerman Speaks

Parents are often concerned at different points in their children’s lives that something is developmentally wrong.  “Is my child slow?  Does my child have a disability?  Should I see a specialist?”  These are all questions which parents typically ask but most frequently occur when children are very young.  Parents should always feel that no question is stupid and every question deserves an answer.  The issue is where do you start and who do you ask?

For parents who are concerned about their infant, toddler and/or preschooler, the American Speech Language and Hearing Association has a number of developmental charts which parents can print and then study.  The advantage of looking at a developmental chart is that parents can compare their children’s language and communication behaviors to expected levels of development at specific ages.  So, the parent who is concerned about her two-year-old who only has ten words can look at a developmental chart for comparison purposes.  Many two-year-olds have a vocabulary of 100 to 200 words and are beginning to combine words  to create short sentences.  Language is always combined with vocalizations and sophisticated gestures such as pointing to fill in when young children do not have the vocabulary to express their needs and ideas.  What if a parent is anxious about the difference between her child and the skills described on the developmental chart? 

Here, it is important for parents to understand that normal development does not have exact ages and stages.  Social environments and families as well as contextual experiences are so different that children’s learning is going to be affected by his environment.  There will be differences, the question is, is this a difference that signals a delay?  Most of the time a difference of three to six months does not mean that a child has a developmental delay.  When parents are anxious, they should look at not only the developmental chart but how their child functions with other children, particularly in social situations.  Early childhood studies have shown that children who are exposed to their peers in play groups, nursery school programs and daycare centers have more advanced social behaviors.  If at this point parents feel that their child is not speaking, communicating and/or socializing like other children, then the first professional to speak to is the pediatrician.  With the development of the early intervention system in the 1990’s, pediatricians have become primary care providers who make referrals directly to the Department of Health for an evaluation and/or services. 

If the pediatrician has concerns, then she can advise parents about clinical practitioners who can appropriately evaluate a young child’s hearing, language and social skills.  So, for example, if there are concerns about the child’s hearing, the pediatrician could make a referral to a local audiologist.  If there is a concern about the child’s language and communication skills, then a referral can be made to an independent speech language pathologist or a local speech and hearing center.  If there are behavioral concerns, then the pediatrician can identify a clinical psychologist who can evaluate the child’s social development.  Usually a developmental difference of 8 to 12 months signals the need for early intervention services.

So, with the first signs of anxiety parents should look for different materials such as developmental scales to help them determine if their child is developmentally different.  A developmental difference is not a developmental delay since most children have different learning styles and learn at different rates.  There are also many parent friendly guidebooks which provide valuable developmental information. If parents are still concerned, then the second step is to bring these materials to your child’s pediatrician.  Do not accept a response such as “Why are you looking for trouble?” or “Boys are slower than girls.”  If that little voice inside of you is telling you that something is wrong, search for answers.  Do not under any circumstances let a professional minimize your concerns, you know your child better than anyone else.  Go with your heart.

Tips for Parents:

http://www.asha.org/public/speech/development/language_speech.htm What is Language?  What is Speech?

http://www.asha.org/public/speech/development/communicationdevelopment.htm Your Child’s Communication Development: Kindergarten Through Fifth Grade

http://www.asha.org/public/speech/development/default.htm Typical Speech and Language Development

Beyond Baby Talk: From Sounds to Sentences, A Parent’s Complete Guide to Language Development by Kenn Apel, Phd., Julie Matherson, Phd.

The Late Talker:  What to Do If Your Child Isn’t Talking Yet by Marilyn C. Agin, Lisa F. Geng and Malcolm Nichol.

A Parent’s Guide to Developmental Delays:  Recognizing and Coping with Missed Milestones in Speech, Movement, Learning, and Other Areas by Laurie Fivozinsky LeCorner.

 The Portable Pediatrician:  A Practicing Pediatrician’s Guide to Your Child’s Growth, Development, Health and Behavior, from Birth to Age Five by Laura W. Nathanson.

Ellenmorris Tiegerman, Ph.D.

Founder and Executive Director

School for Language and

Communication Development

Families of children with disabilities experience unique problems that extend from one generation to the next.  Within the typical family, parents distribute their time between themselves and across their children in a fairly equitable manner.  But when there is a child with a disability, everyone within the family focuses a disproportionate amount of time away from themselves and away from each other to meet the needs of this specific child.  The imbalance within the family often creates a great deal of stress and tension, particularly for siblings who initially may not understand their parents’ behaviors and actions.  Siblings of children with disabilities may be ignored given the extraordinary needs of a child with a disability.  Typical children may experience ambivalent feelings towards their sibling, their parents and themselves.  They may also feel guilty as they grow older about their negative responses towards their parents and their family situation.  It is very difficult to understand as a young child why your parents do not have time and/or patience when they appear to have an unlimited amount of both for another child.  As the typical sibling grows older and becomes aware of why his parents have been so stressed, angry and/or frustrated, a sensitivity develops that goes beyond his years.  There are also greater expectations for typical children to grow up quickly, become independent and ultimately become responsible for the life-long care of the child with a disability.  Many siblings of children with disabilities are faced with the reality that they have not had either the same family life or childhood as their peers.  They have grown up in complex families in which the search to find appropriate social, educational and medical services becomes a “mission.”  The pressures within the family are unusually high and feelings follow the progress and development of the child with a disability.  Events at home may be chaotic and noisy when children with disabilities have behavioral problems and/or unusual sleep patterns.  In fact, most siblings of children with disabilities grow up and take on the responsibilities of their parents to manage the social, medical and financial decisions that an adult with a disability cannot make on his own.  Many parents are frightened and overwhelmed by the possibility of child as well as adult abuse in residential and institutional settings.  Parents ask, “What will happen when I’m not here?  Who will take care of and protect my child’s interests?”  Most typical children eventually commit to the care of a disabled sibling with love and understanding after watching their parents’ daily struggles.  Some siblings struggle with the difficulties of being an adult child and may be resentful about the loss of their own childhood.  As a result, it is important to provide family based services which include the siblings of children with disabilities.  Typical children need to learn to accept not only their own feelings but their family differences because the responsibility of caretaker is a life-long commitment.  It is important to include typical children in counseling and therapeutic services so that they can be part of the family’s decision-making process.  Their voices need to be heard and their feelings need to be factored into the family mix.  By empowering typical children, emotional growth about the family process is facilitated.  In an effort to keep families together, clinical and educational programs should work with community organizations to develop siblings’ groups.  Families today are faced with extraordinary social, emotional and financial pressures.  To create a family balance, every member of the family must be acknowledged as a participant and a contributor.  Typical children who assume the responsibilities of a sibling with a disability are a credit to their parents and a blessing to their families.   

            As the parent of a child with a disability, I have been faced with the dilemma of identifying medical and clinical experts to help my child and my family over the past two decades.  It is true that my son is an adult at this point but there is also a reality that his specialized needs have not changed just because he is older.  Families who are faced with either medical or clinical crises have long term needs that are presently not being met by insurance companies and the existing health care system.  This is not just a problem in the United States, it is a world wide issue for consumers searching for specialists and experts to meet their health care needs.  If you have medical insurance then you are provided with the standard health care directory which gives you name, address and telephone number.  If you have access to the internet and the time to do an online search you can certainly find more detailed information about clinical practitioners.  The problem that I see is that there needs to be a centralized data base of information which is much more comprehensive than the existing Blue Cross Blue Shield medical directory. 

            As a consumer, what would you want to know about a medical or clinical practitioner?  Many people that I interviewed indicated that they wanted more personalized information about therapeutic practices, techniques, and procedures.  Over 50% of the people interviewed, indicated that they wanted some background information concerning educational training and published research.  A smaller percentage was also interested in information concerning the practitioner’s personal interests and beliefs about patient care.  My generalized sense was that consumers wanted to know about the more personal side of the physician or therapist who would potentially be taking care of them.  To me, this highlights the importance of the interpersonal relationship between the practitioner and the client creating a working alliance which provides the frame work for clinical care.  Most consumers want to feel not only cared for but cared about.  So, the more comprehensive the information provided to consumers about their practitioners, the more comfortable people feel about the choices they make.   What kind of a choice do you have when the information you are provided with involves only name, address and telephone number? 

            Healthcare on the internet is going to explode within the next five years.  Consumers are addicted to information and some internet businesses are capitalizing on the growing trends within the healthcare industry.  Understand that healthcare represents one of the largest sectors in federal, state and local budgets.  Within healthcare, mental health services will continue to grow at an increasing rate given longer and healthier lifestyle trends in the baby boom population.  It is clear from the research data collected by healthcare professionals that mental health is a key component to physical longevity.  The growth of services within the area of gerontology highlights the increasing needs of consumers who are living, working and playing longer. 

There will be great opportunity for investment in businesses which are internet based and focus on healthcare information for consumers.  For example, Theramatch Registry is an interactive online service directory highlighting licensed professionals in communities throughout the United States.  If you cannot find a mental health practitioner, someone from Theramatch will help you.  A real person will actually get back to you in real time. The Theramatch Directory is the wave of the future and Blue Cross Blue Shield along with other healthcare providers would exercise good business sense by linking up with this kind of internet business.  In addition, from a public relations point of view most consumers do not have a positive opinion of their healthcare providers.  Consumers feel that insurance companies are not honest and forthcoming given many bad experiences with claims reimbursement.  It would help the insurance industry to promote information about medical care and clinical providers for consumers.  Helping consumers make clinical choices would change the image of the insurance industry. 

            Finally, as a parent of a child with disabilities, I have always traveled to find the right specialist.  At times of crisis most people will search and travel to connect a loved one with the best possible practitioner.  For the poor, the hospitalized, and the physically disabled, Theramatch Registry can also reduce barriers such as distance and weather.  There are many communities where the access to service providers is very limited.  With internet healthcare services, a soon to be reality will be telehealth by computer, television and cell phone.  The technological advances are around the corner.  Theramatch Registry is the future of the healthcare industry.  So check out this site for your family and email your friends with the information.  Someone is always looking for a mental health specialist.