Separating growing pains from warning signs in kids

July 19, 2018

When your child trips on his shoes, does it signal a developmental disorder in the making?

Interfering with classmates’ work might now be viewed as an early sign of trouble.

More parents of young children are hearing surprising warnings these days from educators and doctors who say they are picking up on the subtler signs of developmental problems. It used to be red-flag disorders like autism and attention-deficit hyperactivity disorder that attracted attention in early childhood. But now specialists say they are being asked to evaluate kids for a more nuanced array of issues to correct them before they mushroom into bigger problems.

This includes behavior that can be commonplace in small children, like clumsiness, disorganized motor planning, poor self-dressing and weak communication skills. Dealing with stimuli—known as sensory processing—is especially problematic for young kids, who might find themselves overwhelmed by a loud playground or a sticky substance like Play-Doh. Knowing whether these responses are quirks or problems can be tricky. But while there’s no consensus on this relatively new set of theories, a growing group of specialists said it is worth getting the child checked, because these behavioral patterns can signal disorders that might make school and friendships tough for a child.

There is exceptional focus right now on young children’s development, in part because of the rapid rise in autism diagnoses, now at 1 in 88 U.S. children, according to the Centers for Disease Control and Prevention. Work with these kids has shown that catching a problem early is key to recharting its course, according to the CDC. And struggling kids will be in the limelight this spring, when psychiatrists publish the first update in 19 years to their diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5. It includes a number of changes for childhood disorders, including new diagnoses such as social communication disorder and global developmental delay, and broadened criteria for learning disorders.

All this is sending kids into the offices of occupational, speech and physical therapists, where treatments include building muscle strength and practicing handwriting. These are primary tools to help the growing cadre of kids diagnosed with developmental disabilities, up 17 percent between the late 1990s and the late 2000s, according to a 2011 report published in Pediatrics, the journal of the American Academy of Pediatrics. That same period witnessed a 25 percent jump in parents’ reporting a child with a developmental delay.

The catch is that many behaviors in kids can be considered normal as they grow. Some parents and doctors say children should be given more time to tell if a certain behavior is a quirk of personality or a disorder that needs treatment.

“At school, if a kid is a little clumsy or not talking like the others, all of a sudden they are referred to speech therapy or early intervention,” said Michel Cohen, a pediatrician who runs Tribeca Pediatrics in New York. “People are so quick to pull the trigger.”

One of the doctors in his practice recently saw a child who had been licking his shirt in preschool. The teacher had told the parents that the child should be evaluated by an occupational therapist for a suspected sensory problem. The pediatrician ultimately convinced the parents that the child was developing normally, Dr. Cohen said.

Though skeptics remain on the proper course of action, health professionals and educators are paying more thought to developmental delays, said Marshalyn Yeargin-Allsopp, chief of the developmental disabilities branch at the CDC and an author of the report in Pediatrics. Screenings at children’s well-baby visits more routinely include a thoughtful discussion of a child’s development, rather than just his or her growth, for instance, prompted in part by measures in the Affordable Care Act that require coverage of such consultations. “In certain communities, we are picking up on milder abnormal developmental milestones.”

One increasingly popular way to explain why some kids struggle in classrooms is called sensory processing disorder. A child who presses down too hard on crayons and breaks them or keeps running into other kids on the playground doesn’t understand where his body is in space, said Diana Henry, an occupational therapist in Flagstaff, AZ In these situations, the brain and body appear to be unable to process and interpret muscle and movement information from the senses correctly, she said.

Other kids with sensory problems might struggle with motor planning, which has to do with the sequence of steps required to put clothes on or eat lunch. These kids might also have what’s known as developmental coordination disorder, said Bryan King, director of psychiatry at Seattle Children’s Hospital and a member of the group working on updating the DSM’s developmental disorders section.

The DSM’s experts considered adding sensory processing disorder as a separate malady for the first time. Instead, they’ve included some sensory criteria as a possible manifestation of autism.

While research continues, many schools are approaching kids who might have problems earlier through a strategy known as “responsive intervention” rather than waiting for them to fail, said Dixon Deutsch, executive director of NYC Charter School Center’s Special Education Collaborative.

The School for Friends, a preschool in Washington, D.C., is one of many to have contracted with specialists to screen kids for developmental problems. “The schools have caught up with it, but some parents are reluctant,” said director Jim Clay. “They don’t want their kids labeled.”

Treatment can grow expensive quickly. Private occupational therapy can run to about $200 a session in a high-priced market like New York, and insurance often does not cover this cost. (Prices depend on location and whether the family is paying out of pocket for a private therapist or whether they’re getting services through early intervention or school.)

All the heightened awareness around these issues can pay off for kids, as it has for six-year-old Aden Weber of Flagstaff. His mother Jamie said she noticed her son was having problems in preschool, such as “freaking out” when his teachers put his hands in finger paint or when he’d lie down in the corner. She dismissed it as “just normal kid behavior,” electing to work with Aden more at home.

As kindergarten approached and academic expectations increased, so did Aden’s problems. He got in trouble in school for messing with other children’s work. When no other diagnosis fit, Ms. Weber turned to an occupational therapist, who thought Aden might be struggling with sensory processing.

Now, as part of a research project at his school, Aden’s teachers are learning techniques to help him organize himself. He wears headphones to tune out noise and chews gum when he takes tests, interventions that are making a difference for him.

“It’s way easier to blow past something like this and discount it as behavioral,” said Ms. Weber. “It scares me to think about how things would go if he had not been diagnosed.”