A Therapists Guide to Fix the Developmental Delay of Baby Milestones

One of the many things I have learned as both a therapist and a parent is that it is often easier to accept a “disability” when it is visible.

As a matter of fact, I think that might be universally true. How many times have you watched a person park in a handicapped spot and watched them get out of the car and walk away with no apparent difficulty? And didn’t you wonder why on earth they needed to park in a spot that might be needed for someone in a wheelchair? Well, many people have heart and respiratory and other conditions that limit their ability to walk distances. We just can’t see the problem.

The same situation exists in children with any type of learning disability. The problem is not obvious. It is very real however, and can interfere with performance at school. That sometimes makes it hard to accept and understand.

 One of the biggest issues is that of executive functioning.

Essentially it is a set of mental processes which help children connect past experience with present action. These brain functions allow us to make plans, keep track of time, finish work, ask for help, wait our turn, engage in meaningful discussions and research information as needed. Without these capabilities, children are likely to be unable to interact appropriately in school and complete required schoolwork.

Child development skills such as executive functioning can emerge over time and in varying degrees with some children.

 Some of the components may develop and others may not. Some skills can improve with teacher guidance, practice and trial and error. Some may continue to need work throughout a lifetime.

Children with ADHD and autism spectrum disorder typically present with executive functioning issues. Until recently, it was assumed that inattention was the key problem in children with ADHD. It is now believed that ADHD is actually an executive function disorder. While it is true that all children will struggle with these skills at some point or another, children with ADHD and ASD have chronic problems with executive functioning.

In order to help a child improve their executive functioning skills, it is important to understand the specific components and why they are necessary for good school performance.

These components have overlapping characteristics because they inter-relate. When all the skills are present, they work together to produce a desired outcome. Here is a basic list of executive skills and their definitions.

• Impulse control – the ability to stop and think before acting

• Flexibility – the ability to alter or revise strategies when circumstances change

• Working memory – the ability to retain information and use it to complete a task

• Planning and setting priorities – The ability to determine what

goal to focus on and what steps it will take to attain

• Self-monitoring – the ability to assess your performance

Emotional control –the ability to control feelings by focusing on goal

• Task initiation – the ability to start a task when necessary and not procrastinate

• Organization – the ability to create and maintain methods of tracking materials and information

This group of skills works collectively to help your child interact appropriately, process information and learn.

When one or more is deficient, learning problems arise. If you read descriptions of children with ADHD and other learning disorders, they are often cited as lazy, forgetful, disorganized, unable to complete assignments, prone to outbursts and prone to impulsivity. They may not start homework or complete it, may be disruptive in class or may be combative with peers. They can be sensitive to criticism, unyielding and defensive. All these traits are associated with poor executive functioning.

Now that you have an idea of how this problem manifests itself in your child, you can try some strategies to help your child improve. It all boils down to management. Good management yields productivity in the business world. The same is true when applied to your child. Understanding and patience is also necessary. It is easy to get exasperated when you don’t understand why your child doesn’t “get it”.

1. One of the best things you can do is break tasks into manageable steps. It is easy for a child to give up when they believe the goal is beyond their ability to achieve. Make each step an easy success by keeping short and attainable.

2. Use visual and audio aids to reinforce the task. If a child has difficulty with tasks such as getting dressed, post a visual schedule of dressing steps. Written instruction should accompany all oral instruction.

3. Give your child breaks between activities and ample time to adjust to a new activity prior to starting.

4. Keep a consistent schedule as much as possible. Maintain the same bedtime. Schedule homework to be done at a specific time and keep to it. You can split homework assignments so there is a substantial break in between if they have trouble staying on task.

5. Keep activity charts and post them where they can be easily viewed.

6. Reduce all distractions. Give one thing at a time and keep all other tasks out of line of vision.

7. Label everything your child needs for their schoolwork and for home workspace. Have a specific spot for each item.

8. Review homework assignments and maintain a checklist. Have your child check each assignment as it is completed.

9. Keep open communication with your child’s teacher and get regular feedback.

Keep in mind that executive skill problems is not an indication of level of intelligence. Many brilliant people have experienced these problems. I believe Albert Einstein was considered learning disabled. However, if your child cannot get started, or cannot stay on task, learning is impacted. In addition to the above suggestions, it might be worthwhile to try some behavior modification strategies. Reward reinforcement is quite powerful. It can be implemented with children of any age and has been proven effective.

Please also remember that this is not something your child can control or is doing on purpose. You need to be clear in your expectations but sympathetic to the problem. Help your child by giving them the external cues because they lack the internal mechanism. Maintain structure and consistency. Keep requests simple and keep them timely. Don’t expect that if you tell your child to remember something in the morning that they will be able to follow through in the afternoon. When you enable them to be successful, they will start to build a repertoire of better coping skills.

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