Developmental Differences in Children
Parents’ Guide to Variation and Exceptionality
From Our Specialist Dr. Charles Mike Rios, MD.
To begin, I would like to suggest some ways to look at the big picture and prepare your mind to understand the text you are about to read. Some of us are able to comprehend text by just reading and others benefit from some strategies to visualize the subject. I would like to suggest a couple of visual strategies. One can visualize overlapping circles, sometimes referred to as Venn Diagrams. Each circle can represent a separate ability and a separate problem or differences. When circles can influence other circles, they overlap.
Another visual metaphor is a car. Having driven a 1966 Mustang as my daily vehicle from 1978 to the mid-1990s, this is an excellent visualizer for me regarding parts working and not working and how one affects the other. A dead battery can stop you cold, but a frayed battery cable or a gunky battery terminal can as well. Also, all three parts of the battery can malfunction: the battery, the cable, and the battery terminal.
Whatever visual metaphor works for you, remember your child’s developing abilities and difficulties are all working together and influencing behavior and development. Understanding these individual factors and how they work together is essential to creating a plan to ensure your child can thrive. Let’s get started by looking at the seven main aspects of development:
Language is the ability to receive another’s words for understanding (Receptive Skill) and the ability to string your own words together for expression (Expressive Skill). There are many subparts associated with these two main facets of language. When Language is strong, we see kids who can persuade, tell stories, argue, and perhaps, read at an early age. When Language is weak, children may be more aggressive as they learn to be more demonstrative because their ability to use words to argue and persuade is not strong. There are also several other areas that are not typically associated with language skills that do impact your child’s abilities, including phonological awareness, pragmatic language, and auditory memory.
Phonological awareness is the understanding of the beat or rhythm to language. Examples include rhyme/onset, syllable separation, and recognizing words that are separated by one small sound difference like bat and cat. This understanding in a four to five-year-old child predicts success with reading. Pragmatic language overlaps with social skills and refers to the use of language to facilitate social relationships. The developmental area of memory also has a language component and is referred to as auditory memory.
Visual Spatial Ability
Visual spatial ability allows the child to recognize and manipulate shapes and designs as well as understanding and conceptualizing spatial difference like right, left, top, and bottom. When this ability is strong, we see the puzzle masters, future artists, and engineers. Children with visual spatial weaknesses struggle with differentiating between their left and right. They have great difficulty with learning conventional rotation of letter and number forms. Often, they have handwriting weaknesses due to weak visual spatial awareness. Handwriting weaknesses can also overlap with other developmental areas like memory for fine motor movements or in the motor area itself, for example, poor eye-hand coordination. Children who are weak in math often have difficulty visualizing the number line (0-10) and its order of magnitude (10 to100 is the same number line just increased by 10)
Social Ability allows us to use nonverbal social skills like gestures (shrugging shoulders, using hands for describing); making eye contact when spoken to; making eye contact to express oneself (for example looking at parent and pointing); reacting appropriately to conversation (hearing, “Look it’s raining,” and covering head); using inanimate objects to represent real people like appropriate play with “little people” or action figures. Strengths in this area act like a magnet for peer relationships and weaknesses foster isolation and misunderstanding. Good social ability is aided by strong language skill and worsened by language weaknesses. Strong impulse control and memory skill aids social abilities. Obviously, children with Autism Spectrum Disorders have weaknesses here but so do impulsive children and those with ADHD and mood disorders.
Memory partially consists of visual memory, auditory memory, factual memory, procedural memory, memory for events, motor memory, and phonological memory. There are a lot of different types of memory. A child can remember family events, movies, and vacations but has difficulty recalling dry facts like math tables and dates in history. A child can talk forever about Thomas the Tank Engine or Star Wars, but they cannot follow a two step instruction. There are two main types of memory, short term and long term. Memory has its tentacles in all the developmental areas. Think back to the overlapping circles or interworking of a car battery here. Examples include good auditory memory for stories or sounds in words, which relates to language. A good visual memory for shapes, forms, and directions in space are examples of visual-spatial strength. Motor memory allows one to write an “E” and make it look the same every time and make it quickly, which feeds into motor skills areas to be discussed below.
Motor Skills refer to balance, coordination, strength, and memory (motor). These components are used for fine motor skills like handwriting and needlework and gross motor skills like running, jumping, throwing, and dancing.
The motor skills area, in recent years, also includes one’s ability to regulate their sensory relationship to the world. One learns to differentiate taste, texture, and pressure as they apply to the sensory centers of touch, taste, smell, hearing, and visual modalities. Many young children who will later be identified as struggling with autism spectrum disorders, ADHD, mood disorders, and learning differences have sensory interpretation difficulties when they are very young. They may overreact in the form of fear and irritation with certain noises like vacuum cleaners, dish washers, airplanes flying overhead, or even car engines. They may reject certain foods due to their textures. They may insist on certain types of clothes like shorts and sweaters when it is inappropriate due to the temperature.
Attention is the ability to focus, use planning, monitor oneself, learn from experience, and reduce or turn up our activity or energy level according to what is called for each and every second in the present. Many young children as they approach early childhood are suspected of having attention problems, like ADHD, due to their hyperactivity when they are compared to their peers for the first time in preschool or daycare settings. They are very restless, constantly on the go, and seem very impulsive. They often place themselves in danger. Examples include jumping from high places or running away from parents in malls or on the street. The ability to modulate your energy level according to the situation and use your experience from past mistakes is the issue here. Thus, memory is a strong component as well. Children with Attention problems do not learn from experience. Weak social skills are often seen when they interact with peers. They are considered “loose cannons” as they often intrude on a peers’ personal space. They forget the “rules” of the school room by failing to ask permission to leave, blurting out constantly, or ignoring teacher reminders to transition to another activity.
Later, as children age, other subtypes of attention disorders may be recognized. Many non-hyperactive children with ADHD may not be recognized until middle school when their daydreaming, procrastinating ways, and poor planning skills result in missed homework and last minute attempts to complete projects that have been on their to do lists for weeks. This developmental difference often does not come alone. This means it is often associated with other issues like language, mood, memory, sensory, and social differences (remember our overlapping circles or car battery examples).
Mood is determined by one’s ability to control fears, worries, irritability, obsessions, and anger. Young children, experts are beginning to understand, do not manifest adult-like symptoms of depression, anxiety, or bipolar disorders. However, it is becoming clear that children who will later develop these mood differences, are different, even at an early age. Often these children have sensory issues. The length of and severity of tantrums can actually provide clues to emerging mood differences. Potentially mood-disordered children often have tantrums that last more than 30 minutes, and they may have several tantrums per month that last over an hour. This is in contrast to children without mood disorders who stay upset for less than 20 minutes, tops.
Synthesis of How these Seven Areas Impact Development
Okay, these seven developmental areas, language, visual-spatial, social, memory, motor/sensory, attention, and mood, all of which are deep and complex, will help you understand your child’s strengths and weaknesses. This understanding gives you the power to stoke the embers of strengths and both attempt to fix (remediate) and/or bypass the weaknesses. Success in life for all of us is about developing the ability to strike a balance between our strengths and our weaknesses. Our short lives are a reflection of this duality. Great minds have referred to the light and the shadow; ying and yang, and they challenge us to find balance to achieve happiness and peace. You are saying “AH HA” the “Game is Afoot” to coin a great detective. Through assessment, you are beginning to untangle those threads that are so interwoven around each child.
Important Concept #1:
These developmental areas are often seen in groups that overlap. That being said, let us look at some specific examples that are often revealed through assessment. Autism spectrum disorders (ASD) consisting of autism and pervasive developmental disorders (PDD), typically have three of the above developmental areas involved: a group of three overlapping circles involving language, motor and sensory skill, and social differences define this disorder.
Attention deficit hyperactivity disorder (ADHD) has involvement of attention, memory, and in 30 to 40 percent, language and/or mood issues. Dr. Daniel Amen a Psychiatrist has used brain imaging scans to show six different ADHD brains. When one reads his description of the different types of ADHD you can visualize overlapping circles. Types 1, 2, and 3 are combinations of core ADHD symptoms for example with or without hyperactivity. Types 4, 5, and 6 appear to also include varying aspects of mood disorders.
The prodromal bipolar, mood disordered, child will tend to destroy property and physically attempt to harm others through choking, hitting, kicking, and biting. Some mothers have told me the child destroyed her collection of figurines, or I have even been told that parents fear for younger siblings or family pets when the mood disordered child is in a severe meltdown. It is becoming clear that children with these mood disorders may later suffer from depression, anxiety, or bipolar disorders, so be sure to discuss these situations with us when you bring your child in for assessment.
Children who are later identified with learning differences like dyslexia (a reading disorder) often have issues with fine motor skills involving eye-hand coordination or motor memory causing a handwriting weakness and struggles with the ability to combine speed with accuracy. We call this dysgraphia. Up to 30 percent of those diagnosed with learning differences also have attention issues.
Mood disorders, characterized by explosive anger, aggression, and irritability, often overlap with learning differences, ADHD, autism spectrum disorders, and even other complex mood issues like obsessive compulsive disorder.
Important Concept #2
A question we hear often from parents is, “At what age can children be diagnosed?” Many nationally recognized experts like Dr. Stanley Greenspan and Dr. Terry Brazelton recommend paradigms that stress individual developmental differences rather than a label early on. For example, describing levels of social ability, attention, and sensory issues rather than trying to fit a diagnosis like ADHD or Bipolar. Eventually, as a child ages, the inevitable label, if developmental differences are still present, will be applied, but at a young age of two to four years, we may be observing early stages of developmental disorders or maturation issues that will resolve with time. Many developmental stages have varying timelines of normality. Some children are reading at age 4 and others will not read until age 8. So. a developmental description approach seems to make great sense for young children. That being said, we do offer assessments and descriptive reporting for toddlers and children, beginning at 18 months.
Do Not Take a Wait & See Attitude!!!!
If evidence seems to be mounting, for example, the child is not consistently responding to his/her name when you address him/her or if daycare facilities are commenting about the level of hyperactivity and aggression, then you must intervene. Parents of multiple children are often quick to pick up on differences. We hear parents saying things like, “None of my others were anything like this,” and they are likely to seek professional guidance. Even if you only have one child, look into your family tree. If many of your nieces and nephews have needed speech-language therapy and your child is not talking like peers, seek intervention. If your child is having severe meltdowns where he destroys property and puts himself or others in harm’s way and there are many adults in the family who have been diagnosed with bipolar or depression, seek help.
Two Essential Facts
Finally, there are two important issues I want you to read and reflect here: it’s not your fault and you are not alone.
It’s Not Your Fault!!
All of us have our issues. Sometimes, we can trace these to our family tree (genetics), but sometimes, we simply cannot know. It’s your job to refrain from blame or guilt and help your child move forward to achieve balance, which is the key to happiness. All of us are going to have successes and failures. How we handle the failures is probably more important than the successes. So, no blame!
You Are Not Alone!
There are thousands of parents who have children with your child’s same exact concerns. So, seek out a parent support group. Go to the meetings, ask questions, and network. You don’t have to reinvent the wheel. You will always meet someone ahead of you that has already experienced what you are going through right now and can help give advice to get you past the present circumstances.
Copyright. All rights reserved. Dallas, TX 2010.
What Do You Need to Bring with You to the Developmental Appointment?
Prior to your appointment, we will provide a ratings scale for parents, guardians, and/or educators to complete. Additionally, we recommend you bring the following documents and information that are similar to what you would bring when you visit the pediatrician.
Ask your parents and grandparents for information regarding developmental issues among family members. Especially important are family members with intellectual delays, mood disorders, ADHD, and learning disorders.
Were there issues in the prenatal period like hypertension, diabetes or bleeding. Was oxygen required at birth for the newborn and was time spent in a Neonatal Intensive Care Unit? Were there any feeding problems or seizures at birth? Were X-rays, CT scans, or MRI’s performed? Be prepared to describe the gestation and birthing experience.
When did you first become concerned regarding your child’s development and why? Was there regression of skills (seem to unlearn things they already mastered)? Have there been intolerances to foods. Has the infant or young child received any previous services like Early Childhood Intervention (ECI)? Write out notes, talk to teachers and other family members, and be prepared to offer as many details as possible.
Previous Test Results and Reports
Results from other professionals like school assessments, speech and language assessments, and occupational therapy assessments. Even if we reevaluate using the same or similar testing batteries, past results are a valuable point of comparison.