Need input/advice from parents of children with special needs...

[happymom]

I am a special ed teacher for 3-4 year old children. I teach an integrated class with half special ed children, and half regular ed children. I have been wanting to ask this question for a long time-

Very often, I notice issues or delays in children that their parents are not yet aware of. Often it is even the regular ed children who present with real issues that their parents are completewly oblivious too. It breaks my heart to tell the parents about my concerns, but obviously that is my job. I am not referring to more minor issues like language or fine motor delays. I mostly mean children who appear to be on the autistic spectrum.

My job is to gently mention this to parents and encourage them to have their child evaluated.

My question for you is, what do you think is the best way to approach this with parents? How would you have liked to have been approached about this? I'm concerned about the subtle things that may be hurtful that maybe I don't realize. So I guess I'm asking about both "do's" and "don'ts".

Thanks so much for your input.

[pinkmomagain]

When my middle daughter entered nursery school at 3yo, the classroom teacher had to approach me and tell me that it appeared she had delays and she should be evaluated. While it hit me very hard, I don't know that any parent is completely oblivious...there is that little voice inside that feels like there might be something off....

First, I would never ever offer a dx or a possibility of a dx. At that age, many responsible professionals would hesitate to dx that early. At 3 and 4, my dd easily appeared to be on the spectrum (stimming, no eye contact, awkward socially, fine and gross motor delays....), however many years later she was dx'd with ADHD & Anxiety.

Secondly, I would allow the parent to observe their child with peers. Oftentimes, it is difficult for a parent to recognize there is something off if they haven't had the chance to compare their own child with other his/her age. My daughter clearly stood out from her peers when I observed.

Lastly, I would have on hand, resources for the parent. Please don't just send the parent off into the wilderness to deal with the news. I'm talking about book recommendations, evaluation facilities, state/county/school district info..while of course encouraging them to discuss with their pediatrician. Also, if there are fellow parents you know of who have indicated a willingness to talk with other parents of kids with delays, that would be great.

That's all I've got. I'm sure there are other mamas on here with terrific ideas for you.

[egoldber]

I agree with all of pinkmom's post.

Older DD's 4 year old preschool teacher told us she thought that older DD would benefit from an evaluation. It is a Jewish preschool with a JSSA social worker on staff and she did an observation and evaluation. My own personal issues with this is that it led us down a path of OT for a long time that in retrospect I don't think was very helpful, was quite expensive and prevented us from getting a real evaluation. But I guess part of it is just the process. At such a young age, you're really treating symptoms because it can so hard to tease out one issue from another. My DD also has a lot of behaviors which can appear ASD spectrum-y, but does not have an ASD diagnosis. I also did not much like her 4 year old preschool teacher or her OT group which no doubt colors my perception.

Also, sometimes parents are oblivious because it is perhaps their first child and they don't have a lot of experience in general with children. But many times parents do have an idea. It may just be a nagging feeling or they may have had assessments and decided not to share them at this point, or they may have talked to their ped and be taking a wait and see approach, etc.

[crl]

I agree with the previous posters.

That said, I was always the one pushing for evaluations because I knew something was off, even though my mom friends and my husband didn't think so. And my ped's advice was to wait (although when I said I wasn't comfortable waiting he tried to help me get evals right away). So I do come from a different perspective.

One thing I always appreciate is when teachers, therapists, evaluators, etc find something positive to say about my kid. It has to be the truth, of course. But it makes me feel like the person is seeing my whole child, not just a label or a problem. I also strongly agree with the suggestion to give parents some resources, books, other parents' contact information, information about how the school's process works, etc. And give it in writing. It can be very hard to absorb that kind of news and really hard to focus on anything else in the moment. Also, if appropriate, offer your contact information for a follow up conversation. And I strongly agree not to offer any potential dx, just a description of the concerning behaviors, lack of skills, etc.

Thank you for asking!
Catherine

[niccig]

A friend was a preschool teacher and is now doing her Masters in Special Ed. She told me that she's found some parents need to hear it from 3 professionals before they can start to process the information. She said she's been the first person and the parents have gotten upset, and at other times she's been the 3rd person and they're more accepting of the information. Sometims families leave a preschool and it's not unitl they're on the 3rd or 4th school do they listen, or in case of a mutual friend, the preschool told the parents that the parent or someone needed to be at school with the child to help in the classroom otherwise the school could not keep the child enrolled. It was the 2nd preschool to say this, and then the child got evaluated. He's older now, and just got an Autism diagnosis.

I suppose I'm saying that some parents will not want to hear this - and all you can do is present the information as carefully as you have been.

[VClute]

First, I am so pleased that you're asking how to deliver this information. Thank you for being sensitive to another parent's feelings.

I agree with previous posters - Don't offer a diagnosis, have resources available, include positive observations. It may be obvious, but I would also not mention this kind of thing at drop-off or pick-up. I would schedule a conference with the parent (call it something simple like a mid-term progress conference) and give them the information there. Have concrete examples of your concerns, examples of work the child has done, or specific instances that have raised your antennae. If there's a handout that outlines expected behavior/accomplishments for that child's age, have that ready, too. Don't let the parent lead you into, "Well, what do YOU think it is?" It's tempting, but really - Let an MD diagnose. If you say something that is later not validated, they'll mistrust your expertise, and you may start to doubt yourself!

Again, thanks so much for posing this question. What a thoughtful thing to do.

[happymom]

Wow, such great insight from all of you. Thank you.

I agree that many times parents have a nagging feeling that something may be wrong. But, as Egoldber mentioned, I have also seen some parents who really have no exposure to other children and just don't realize that its abnormal. For example, and this is a small incident- I mentioned to one of my new parents that her child (just turned 3) seems to have a lot of trouble feeding himself properly- when he eats cereal and milk, the cereal is all over his lap, the floor, and the table. All over. She responded that she thought all 3 year olds eat that way. This is where pinkmom's idea about allowing her to observe would be helpful. She would see the other children spill a little, but nothing like her son. I guess I worry about parents feeling even worse when they see their child is functioning so differently from peers. But of course I understand the benefit of it as well.

I would never actually mention a diagnosis, btw. I'm not qualified to do so and this is why I always refer them for an evaluation. But you are right, VClute, many parents do push and ask...what do you think it may be??? And some parents just realize on their own that the behaviors I am mentioning are symptoms of ASD or something else. And Pinkmom, I have seen children who sound like your daughter- ASD behaviors that are actually manifestations of anxiety or ADHD. It can be hard to distinguish at such an early age!

Crl, thanks for mentioning the idea of saying an honest, positive thing about the child as well. I have always done this, and wondered it it just seems trite- but I will continue to do it!

Good point about scheduling a real conference to discuss these issues, VClute.

And Niccig, I have seen exactly that so many times- parents who just cant hear what I am telling them (I am often the first person to say anything) and I KNOW they will hear it again next year and the next, and eventually get the help they need. It just saddens me that these kids arent getting the help NOW, when so much can be accomplished.

Thank you all again for all your input.

[sidmand]

I think it's great that you're asking and I agree with everything that's been said above as well.

I also think you're just in an extremely tough position where you're kind of damned if you do/damned if you don't.

Some parents will NEVER want to hear that something is "wrong" with their child and will get angry and defensive no matter what.

I think most parents realize that there is probably something different but may or may not be ready to hear it.

And I think there are some parents that are ready and willing to hear anything as long as it's brought up sensitively.

But there is no way to know who you are talking to or where they are in their own process.

But I think it's wonderful that you'd ask!

[elliput]

Secondly, I would allow the parent to observe their child with peers. Oftentimes, it is difficult for a parent to recognize there is something off if they haven't had the chance to compare their own child with other his/her age. My daughter clearly stood out from her peers when I observed.

It was when I took my DD to things where lots of other children her age were and watched her daycare Christmas program, that it really stuck me how different my child was from the norm.

I really don't have anything else to add.

[nov04]

One thing I always appreciate is when teachers, therapists, evaluators, etc find something positive to say about my kid. It has to be the truth, of course. But it makes me feel like the person is seeing my whole child, not just a label or a problem. I also strongly agree with the suggestion to give parents some resources, books, other parents' contact information, information about how the school's process works, etc. And give it in writing. It can be very hard to absorb that kind of news and really hard to focus on anything else in the moment. Also, if appropriate, offer your contact information for a follow up conversation. And I strongly agree not to offer any potential dx, just a description of the concerning behaviors, lack of skills, etc.

ITA and I'm another SN parent thanking you for asking.

We received our best diagnostic information from our ped., a developmental pediatrician (attached for local agency), hospital neurologist and school-recommended psychologist.

We knew that dd2 didn't have autism although she presents with some autistic traits but we chose a psychologist with experience with brain injuries who could evaluate her specific strengths and weaknesses and a recommendation for her path in school: mainstream vs. special ed.

I know I've always connected best with professionals that can see dd2's needs as part of her as a whole person. Yes, she has those needs, but she's an incredibly social, loving, inventive, creative, beautiful person overall.

thanks again.