Last week, I paid a visit to Kennedy Krieger Institute (KKI) to find out more about developmental disorders. This institute has a number of medical and educational services aimed at improving the lives of persons with disorders of the spinal cord, brain and muscoskeletal system. It has a special unit dedicated to developmental disorders. I interviewed three members of this unit on various issues related to children with developmental disorders. In this summation paper, I report my findings from the interview.
My first stop during the interview was at Michael Cataldo’s office. Cataldo is the director of Behavioral Psychology at the institute. The first thing I noticed about Cataldo is that he is a very jovial man who loves what he does professionally. Thus, I knew right away that I was going to enjoy talking to him. However, due to his professional commitments, I acknowledged that we had to go straight into business of the day. My first question to Cataldo was about the state of developmental disorders in children at school and at home. In a pensive mood, Cataldo tells me that there are many children suffering from a myriad of developmental disorders throughout the world. For example, he tells me that about 1 in 70 children is autistic. While this statistic is a worry, Cataldo tells me that the percentage of children having such disorders has been increasing over the years. Indeed, my research showed that the current incidence rate for autism is a 30 percent increase from what was recorded 2012 (Falco, 2014).
Afterwards, I ask Cataldo about some of the challenges that these children experience while in school. He tells me that most of them, especially those with attention deficit and attention deficit hyperactivity disorders, have massive problems when it comes to concentrating in class. Consequently, it makes it very hard for them to learn like normal children. For such students, this can be very frustrating such that it may lower their self esteem. “I have always recommended that all parents having children with developmental disorders to take them to specialist schools so that their unique needs can be addressed”, he tells me.
For a person who has been in the medical field for decades, Cataldo finds it frustrating that knowledge of developmental disorders is limited. He says that even though behavioral and developmental disorders have become widespread worldwide, they are still understood very poorly by most people in the society. The lack of comprehension is compounded further by the stigma that frequently accompanies a diagnosis of a developmental disorder. Stigmatization has meant that many parents are scared of bearing children with developmental challenges. However, this should not be the case. “With proper understanding of these disorders, parents, physicians and the public can gain the expertise on how to manage children with developmental disorders and ensure that they lead normal lives just like other healthy children,” he concludes.
I was moved by Michael Cataldo’s words. Personally, I have never interacted with a child with developmental challenges. My knowledge about these disorders was also limited. As a result, I felt enlightened by Michael Cataldo. I thanked him for sparing his time to talk to me. He was also touched by my keenness to learn about the plight of challenged children. After saying our goodbyes, I went to interview Louis Hagopian who is the program director of the neurobehavioral unit. After introducing myself, I immediately got into the interview. My first question was “What experience have you had with children with developmental disorders?”This was his reply.
“I have talked to parents and observed children with these challenges, and also seen them at school. Their behavior can be extremely frustrating and tricky to deal with, and most parents are at a loss to find useful treatment. Some may find relief, albeit in the short term, with stimulant medication. In many children, this can lead to adverse side effects. Moreover, it does not offer a long-term solution. There is indication from a research study that children who had been treated with Ritalin have, in their pre-teenage years, greater risk of stunted growth as well as juvenile delinquency. As these children grow older, it can be problematic to find and maintain a job. Some of them resort to substance abuse as a way of self-medication”
Hagopian’s response was a demonstration of his extensive expertise in the field. After the interview, I researched on some of the things that he had told me. I found out that Ritalin is a drug that is a stimulant of the central nervous system, which affects chemicals in the nerves and brains that contribute to impulse control and hyperactivity. It is mostly used for children with hyperactivity and attention challenges (Breggin, 2009). Prior to my interview, I was aware of the importance of early intervention. Therefore, I asked Hagopian about ways through which parents can recognize symptoms of developmental disorders at the earliest opportunity.
Hagopian says that there are milestones in children development that parents can monitor to determine if they are growing normally. These milestones include sitting, standing, mimicking of movements, uttering of incomprehensible words, smiling and recognition of familiar faces. He says that when these milestones that are not achieved in time, a red flag might be raised. “If parents are concerned about their child’s growth, they should actively voice these worries to their pediatrician and not consider them as alarmist. It is particularly important that a standard screening tool be administered at any time when parents convey concerns about their child’s social, play and communicative behaviors,” he adds. According to the American Academy of Pediatrics, all children should be screened at the ages of 9, 18, 24 and 30 months (Collins-Bride & Saxe, 2013). Hagopian supports this assertion and encourages all parents to follow go for these screenings even if their children appear to be growing normally. “Once the screening shows that a child is experiencing growth delays, he/she should be taken to an early intervention (EI) program. In the event of a diagnosis, this child will be served with a developmental pediatrician, child psychologist, pediatric neurologist, special educator, speech/language pathologist, audiologist, and occupational therapist. This will give him/her the best chances of leading a better life.”
Presently, there are a number of medications aimed at treating disruptive symptoms of developmental disorders such as autism, cerebral palsy and ADHD. These include antipsychotic medications such as Risperidone (Risperdal), Clozapine (Clozaril), and Quetiapine (Seroquel), antidepressants (fluxetone and sertraline) and stimulants (methylphenidate). Apart from these medications, I was interested in behavioral therapies for developmental disorders. To obtain this information, I interviewed Nancy Grace who is a director at the pediatric developmental disabilities clinic at the Krieger Institute. She tells me that there a number of applied behavior analysis (ABA) interventions that can be used. However, the two common interventions are Pivotal Response Training and Verbal Behavior. The former aims at identifying essential skills that will influence a patient’s behavioral responses. In many cases, this involves family education to enable the child live comfortably in inclusive settings. Verbal Behavior incorporates strategies such as prompting and errorless teaching to guide challenged children on how to acquire basic verbal behaviors and some essential communication skills.
Grace tells me that the social skills of a challenged child can be improved through therapy. “For example, the TEACCH [which stands for Treatment and Education of Autistic and related Communication handicapped Children] can help a child to adapt to his/her physical environment. This approach uses visual cues and familiarity so that a child can develop a particular habit once he/she sees a signal.”Another intervention is called interpersonal synchrony, which targets imitation and social development skills. This essentially teaches children to become engaged with others.
I felt very enlightened once I was through with my interviews. I was grateful to the three experts for giving me an opportunity to share a platform and share their sentiments with me. I felt very motivated to know more about children with developmental disorders. Therefore, my plan in the near future is to visit a specialist school and interview teachers on how they manage these children.
Breggin, P. (2009). The Ritalin Fact Book: What Your Doctor Won’t Tell You About ADHD and Stimulant Drugs. Cambridge, MA: Da Capo Press.
Collins-Bride, G. M., & Saxe, J. A. M. (2013). Clinical guidelines for advanced practice nursing: An interdisciplinary approach. Burlington, MA: Jones & Bartlett Learning.
Falco, M. (2014, March 28). “Autism rates now 1 in 68 U.S. children: CDC.” CNN International. Retrieved 4 October 2014 from http://edition.cnn.com/2014/03/27/health/cdc-autism/