Friday, April 13, 2007

Tracking Developmental Progress

As part of our consulting business specializing in the movement through the developmental milestones, we needed a method for demonstrating movement through the developmental milestones over time. The result is our free Developmental Checklist. Our clients use it to track the movement through the developmental milestones of their children. It is useful for parents of children with developmental difficulties to see and understand the status of their children’s movement through the developmental milestones. It is also appropriate for all parents to understand and to track the movement through the developmental milestones of their children, whatever the developmental situation.

Developing this checklist

When we began consulting with parents about their children’s movement through the developmental milestones, we found out that many parents do not understand much about the movement through the developmental milestones. Families would tell us stories about what their child did new this week, but they had little understanding that their child was providing data about the developmental step on which the child was working.

Helping parents understand the movement through the developmental milestones

We needed something that helped parents understand the movement through the developmental milestones. We needed something that guided parents to watch for important developmental signals. And, we needed something that would quantify a child’s movement through the developmental milestones. We tried several different forms, looking for something that was appropriate for parents and caregivers, ourselves, and to other service providers who worked with the children.

We did not want to develop a diagnostic tool. We wanted something to help parents understand and to track movement through the developmental milestones of their children.

One of the objectives we had for the format was to have a better way of describing the overview of the status of the child’s movement through the developmental milestones. The standard method is to describe the child’s developmental age as a single number of months or years.

What about this developmental age?

There are numerous difficulties in this way of doing things. For example, what are the developmental steps used to decide the ‘age’ of the child? Do we use walking or talking? Do we use gross motor, fine motor, social/emotional, sensory (, etc. . .) steps? Which of these steps is better at showing the child's age?

Even more of a problem is that for each milestones (commonly established at 12, 18, 24, 36, 48, and 60 months), a child with developmental difficulties will have completed some tasks and not completed others. These children have begun some tasks and not completed them. They have begun some other tasks and completed them. And, they have not even started some tasks.

Broad-based developmental improvement

In our program the clients close the empty places in their movement through the developmental milestones. When we reported to the parents the status of the child’s movement through the developmental milestones we wanted to give a visual representation of that broad spectrum developmental improvement.

If we are only using some narrow, limited set of developmental steps to define the developmental ‘age’ of a child, in one month’s progress we might miss movement through the developmental milestones in areas not used to calculate that ‘age.’ In one month a child might not make progress in the steps used to define the ‘age’ and make a lot of progress in other developmental steps. We decided our task was to show the broad spectrum developmental improvement that children were making, so we wanted something to describe that.

What about developmental warning-signs?

In the 12-month and 24-month milestones, there are some items which are not developmental tasks. There is also an additional group of items, shown in our Developmental Checklist as “6+ years.” These sections are developmental warning-signs.

These items are thought to be warning-signs of likely developmental difficulties. By themselves, when a child is demonstrating behaviors shown in these items, this does not mean that there is a developmental problem. If a parent sees multiple of these items, the parents might think about testing and diagnosis. Our Developmental Checklist is no used for diagnosis, only a professional can do that kind of testing and diagnosis.

Visual Overview

We wanted to give parents the big picture of the broad spectrum developmental improvement. Our Visual Overview page provides a method for seeing that. It shows the current state of the child’s movement through the developmental milestones across each of the milestones. It also shows any of the developmental warning-signs the parents has identified.

Line-items details

Our free Developmental Checklist report also shows how the parent responded to each of the items, from each of the milestones. If parents want to use the checklist on a monthly basis, or to use it at the end of each milestones, these items specifics makes it easy to keep track of the answers marked the last time they used it.

Other service providers

We designed the checklist report to be appropriate for medical, psychological, and educational service providers. They will find the information appropriate for tracking children's movement through the developmental milestones.


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Thursday, April 12, 2007

What about Developmental Disability/Delay?

Developmental Disability includes Autism, Asperger's, Pervasive Developmental Disorder and other diagnoses. Developmental Delay includes Attention Deficit Hyperactivity Disorder, LD, Dyslexia, and more. Then there is GDD and Auditory Processing Disorder, and I don't know where they fit in the official structure of diagnostic categories, but I know they are a developmental problem.

I have been working with children with developmental difficulties for a few years. I use the terms developmental difficulties to encompass everything from Developmental Disability to Developmental Delay, and even more. In our consulting program we consider them all fundamentally the same. They differ only by degrees. We have developed protocols which succeed with all of the developmental difficulties. Our approach assists the client’s inherent proficiency for developing.

What is the magnitude of this problem?

All of these developmental difficulties add up to an estimated 28 million children in America. The Census Bureau tells us there a total of 85 million children in America. The APA (American Pediatric Association) calculates that one in every six children have a diagnosis for some developmental problem (16.7%). The different associations for all of the individual diagnostic categories of developmental difficulties all agree when they tell us that about 50% of the children with these problems obtain a diagnosis for their problem (for a total of 33%). And, 33% of 85 million is 28 million children.

That means that 33% of all the children in every classroom have some degree of developmental problem. Maybe it shows up as a lack of capacity to focus or control impulses. Maybe it shows up as a lack of capacity to learn arithmetic. Maybe it shows up as an inability to kick a ball. Maybe it is so severe, the children never learn to walk. Maybe it is mild and only an inconvenience to the child and the parents.

In whatever form, developmental difficulties seem to be growing in sheer volume. We are certainly getting better with our diagnoses. And, we are certainly advanced as a country so that we offer those testing services to more people who otherwise could not afford it. But, I am not sure this is the reason we have a third of our children with developmental difficulties.

When I was a child in school, many years ago, I do not remember a third of the children having these types of difficulties in my classrooms. I remember that maybe 5% to 10% could have had these kinds of difficulties, but I do not think it amounted to a third.

What is a developmental problem?

Quite simply, it is some blockage in the developmental process. All living things move through a life cycle. Much of the early phases of that life cycle are spent in maturing. From conception to maturity, all living entities progress through a series of stages. For us humans, we call them our developmental stages.
For those with developmental difficulties, they do not progress through their stages appropriately. They get stuck at some of the stages. They skip some stages. So, many of the basic learning processes needed for appropriate maturity, are missed. And, in some cases a child is held in a step and does not pass out of it on to the next developmental step.

In my opinion, all of the different diagnostic categories are related to some simple factors. In which developmental stages did the child get stuck or which stages did the child lose? How intense is the ‘stuckness?’ And, how many stages did the child lose?

What can be done about it?

All of the different diagnostic label associations in the field of developmental difficulties are clearly speaking on one voice when they say that the 1) developmental process is stuck and that 2) there is no cure.

Researchers in this field do not know what to do to fix developmental difficulties. Nothing that they attempt involves the developmental process. For decades clinicians have tried everything they can think of to do and nothing works.
After all these frustrating years, they have finally reached an accord that there is no cure. And, now it is officially agreed. All of the diagnostic associations and all of the committees creating the diagnostic specifications agree that there is no cure. Now, they invest all of their research dollars on finding causes instead of searching for fixes for 28 million children with these developmental difficulties.

They have attempted many things, but they have not attempted everything.
With our method children fill-in the holes in their developmental progress. Our approach assists the client’s inherent proficiency for developing.


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Thursday, April 05, 2007

The developmental process is stuck.

Child development professionals agree. Many children are suffering from developmental problems. They also agree that all the problems that parents and teachers see in these children are related to the instinctual movement through the developmental stages being out-of-gas.

That is what the diagnoses of Developmental Disability and Developmental Delay really means. It is what Pervasive Developmental Disorder and Global Developmental Disorder means. This is the basis for Autism (HFA & LFA), Asperger's, Attention Deficit Hyperactivity Disorder, Dyslexia, Learning Disability, CAPD, and many other diagnoses that we talk about as developmental problems. All of these problems are based in the instinctual movement through the developmental stages being blocked.

The Mystery

One of the great present-day mysteries is that many children are not growing up appropriately. They are not following the instinctual developmental process appropriately. They are not following the normal developmental milestones. Not all children are having developmental problems, but the percentage of those with problems is significant.

Professionals estimate that as many as 25%-30% of children (in the USA) are suffering from some developmental problem. Maybe not all of them have enough symptoms to obtain a diagnosis. The American Pediatric Association (APA) tells us that one of every six children in the USA receives a diagnosis for some developmental problem.

The associations for each of the different developmental diagnostic groups publish estimates of the percentage of children that should have a diagnosis for their diagnostic group. They tell us there is a lot of overlap between one diagnostic category and another (for instance, many APD children also have LD and/or Dyslexia). Even assuming there is a lot of overlap, there are still an estimated 17% of children who have enough symptoms that they receive a diagnosis. This matches the APA estimate.

Those associations estimate that only about 50% of those who qualify for a diagnosis actually go and get that diagnosis. If these estimates hold up, this means that (in the USA) there are an estimated 28 million children who are not growing up appropriately.

Diagnosis

Humans are good at studying and creating structures. Professionals have studied and categorized all of the different ways that children are not moving through their normal developmental process. From this, they have developed long lists of symptoms which are organized into diagnostic groups. You know these groups as those diagnostic labels listed before.

Professionals are putting their focus on getting more accurate in the diagnostic methods. They are getting better and better at knowing precisely which diagnosis to apply for a specific set of symptoms. All of these diagnostic groups are used to organize different sets of symptoms. All of these symptom sets have two things in common:

1) There is no cure and
2) The instinctual movement through the developmental stages is out-of-gas


What is the treatment?

Parents are usually left on their own to create a treatment approach. They usually have to start a trial-and-error process of examining various training options to find what works for their child. Because of the slow processes of the unique services, it may take years to discover if a program is working for their child.

In some cases, doctors might offer medications. This is also a trial-and-error process until they find some medication which helps in some way. Most of this 'help' from the medications is for the parents and teachers to moderate the behavior of the child to a acceptable level. In some cases, the medications help the child attend, but they do not get the clients to close the discontinuities in their developmental process. Many children say that when taking their medications they become "zombies" or they stop eating or have some other unpleasant side-effect.

Other treatments include psychologists, occupational therapists, physical therapists, special education teachers, and the list goes on. These treatments are designed to deal with the child's symptoms. None of these professionals are trained to get the clients to close the discontinuities in their developmental process.

"There is no cure."

This statement is the most difficult concept to understand and it is an important concept in each of the definitions of all the unique developmental difficulty diagnoses. Professionals in the field know that there is no cure. People in the field are resolved to provide the best services possible, but this knowledge is a weight being carried by everyone. People try to put on a happy face. People want these children to have the most fulfilled life possible. But, because there is no cure, there is little that can be done, and that is a heavy burden everyone carries when teaching children with developmental problems.

The statement is that there is no cure. This is a present-tense statement that at the current time, there is no (known) answer. It is not a statement about the future or the past. It is simply a statement that no one has developed a answer, researched that answer to prove that it works, and published that answer to the world so that others can deliver that answer for their students.

Over many decades, with hundreds of clinicians, academics, and researchers working with many different modalities, no one has found the answer. No one has found the answer for these developmental problems. The field has become so compartmentalized that researchers are rarely searching for something to get the clients to close the discontinuities in their developmental process. They are only working on the symptoms of learning disability or whatever is their speciality. Because of this compartmentalization, they cannot see that all the different diagnoses are all based on the same problem: the instinctual movement through the developmental stages is out-of-gas and something needs to be done to get the clients to close the discontinuities in their developmental process.

People in the field have confused the present-tense phrase, there is no cure, to mean that there never was a cure (past), there is no cure now (present), and there never will be a cure (future). This paradigm, that a cure does not exist and is not possible, is crippling any search into the cure for these developmental problems. There is little funding for finding, developing, or delivering a answer for these developmental problems. One of the problems of any paradigm is that it defines the limits of possibility. In this case, if the prevailing paradigm is that there is no cure, a possible answer will never be found because it is not possible in the minds of the professionals in the field. As a paradigm in this field of developmental problems, there is no cure, is a self-fulfilling prophecy.

Teach as much as possible to an un-teachable child

There is little or no program delivered to solve your children's developmental problems. Almost all services are designed to teach as much as possible to an un-teachable child. Because there is no cure, there is little work being done in research to find the answer.

Floor Time is the most promising concept in the field. This is an attempt to reach the child at their developmentally out-of-gas place and work with the developmental tasks that are out-of-gas. It is a good idea, because it tries to go beyond the symptoms and get to the processes at that developmentally out-of-gas place. It falls short because it is not addressing what caused the developmental blockage and it is not working on the brain circuits needed for a smooth, instinctual movement through the developmental stages (after the blockage is removed).

ABA therapy is one of the more popular therapy services available. Many children make some behavioral improvements using ABA. This is one of those approaches which is deeply seated in the paradigm that there is no cure. ABA Therapy has no concept of a person using ABA to become age-appropriate; their patients will continue being developmentally disabled after working with them. ABA does nothing to get the clients to close the discontinuities in their developmental process.

Summary

Normally, when we have medical or psychological problems we get a diagnosis and then some treatment. For developmental problems there is strong emphasis in the diagnosis, and little to provide for treatment.

The basic problem for all developmental problems is that the developmental process is out-of-gas. None of the services commonly in use in this field are focused on, or are successful at, getting the clients to close the discontinuities in their developmental process. The normal services for children with developmental problems are designed to teach the children how to become an adult with developmental problems.

The paradigm of there is no cure, is so strong that you are not encouraged to have hope for your child to have a normal life. The future for your child, based on the common paradigm, is to learn as many behaviors as possible to survive as an adult with developmental problems. Special education and ABA and most other programs are designed to prepare your child for transition into adulthood with these problems, but not for transition away from developmental problems.

These services need to become something which prepares their students for a normal life. That is what we offer with our consulting program. We get the clients to close the discontinuities in their developmental process; we offer the opportunity for these children to transition to a normal life.


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