How to gently suggest to a parent that their child may need an evaluation??

[just_lily]

I have a home daycare, and I have a 27mo girl who has been in my care since last September. There are a number of small issues that add up to a larger issue that I really believe need to be checked out.

I think she has some kind of a speech/language delay. She will sing songs and ABCs but almost never has any spontaneous, communicative language. Mostly she will grunt, or scream. I have never heard her put two words together that isn't just a repeat of what I have said, or a song.

There are some other issues, like not always responding to her name (maybe 25% of the time she will), not really playing with the other kids, and she has a bit of an awkward way of walking and can be quite clumsy. She also has an awkward way of doing fine motor activities... how she holds a fork or a crayon, and how she picks up things like cheerios just doesn't look the same as other kids.

My DD is three months younger, so although I try not to compare them, the gap between them has been widening over the last six months. I think DD may be a bit on the precocious side, but the fact that the difference is getting greater concerns me.

Anyway, I think I need to bring this up with her parents, but I have no idea how to do it. I want to be gentle, and respectful, and not be out of place. I'm definitely not an expert, but I do have their child for 45 hours a week and I have a gut feeling that something is a little off.

I have been hoping that they would pick up on it themselves and seek an eval on their own, but it is just not happening. They had a doctor appointment a couple of months ago for another issue (constipation) and I hoped that they would have done a developmental screen at the same time but it didn't happen. She hasn't been for any other check ups since she has been in my care (and I have her 9 hours a day every day, so I would definitely know if she had appointments) so nothing is being picked up at a WBV or anything.

So, please help me BTDT Mamas. What do I say, and how do I say it in order to not offend anyone, but still make sure this child gets any help she may need?

[SpottedFoxx]

I really wish I had a caregiver like you when DS was that age. His teachers were shocked when we took him in for a speech evaluation (he's a boy, boys always talk later, etc.).

What kind of relationship do you have with this parent? Have they been receptive when you've brought smaller issues (toilet, behavior, etc) to their attention? If so, I'd maybe set aside a time to have a cup of tea with them and have a chat with the parents about your concerns.

[just_lily]

We have a friendly relationship, but they seem to brush a lot of things off. I have mentioned that she doesn't always respond to her name, and mom was like "oh yeah, that's just ----". So I think (fear) that I am going to have to be more direct.

What is a bit puzzling to me is that her mom is actually an OT, although she works mainly with seniors. Even still, I am surprised that she hasn't picked up on the motor skills issues.

But this child is an only child, so I don't know how much exposure the parents have to other kids in order to have a baseline of typical development.

[VroomieMama]

Just be as truthful as you can be and how they will respond is their problems not yours. Hope they will respond with respect.

Good Luck

[SpottedFoxx]

Originally Posted by just_lily

We have a friendly relationship, but they seem to brush a lot of things off. I have mentioned that she doesn't always respond to her name, and mom was like "oh yeah, that's just ----". So I think (fear) that I am going to have to be more direct.

What is a bit puzzling to me is that her mom is actually an OT, although she works mainly with seniors. Even still, I am surprised that she hasn't picked up on the motor skills issues.

But this child is an only child, so I don't know how much exposure the parents have to other kids in order to have a baseline of typical development.

Oh my friend, professionals are the WORST when it comes to their own children! You need to be kind but firm. Remember, you are not a specialist so please don't diagnose. Absolutely point out all the warning signs and maybe gently remind her that the earlier she gets intervention, the easier her daughter will have it in the long run.

Good luck. You are a good soul.

[SilverFish]

as a teacher, i've had to make suggestions like this in the past (or worked with other teachers who've had to make them). since we are in a specific environment with clear boundaries, there are certain things we can say or not say, so your job is actually a little easier. do you ever have scheduled meetings with your parents to discuss issues, or is it always an on the fly kind of situation? is there a time that you know would be best for you to have a longish chat? i would definitely make a scheduled time to chat, but arrange it to be as close as possible to when you suggest it so there isn't a lot of time in between to worry about it.

before you do that, i'd spend a little time specifically documenting the situations that have you worried. like a PP mentioned, professionals are the worst when it comes to their own kids, but a list clearly documenting the issues is helpful for them to turn their professional brains on and see the problem. be even more specific that you were in your post. don't compare her to other kids, and keep the list to just the most worrying things. i've made the mistake of talking to parents before about vague worries without taking the time to think of specific instances where the behavior is occuring, and it never works. a timeline is also helpful. in your case, all you need to do after presenting your concerns is just suggest that she be evaluated.

i know it's kind of nerve-wracking, but you are with her for such a large part of the day... if you don't say something, it's possible this will never be resolved until she goes to school.

one thing i wanted to mention is the suggestion in your post that there is something offensive about suggesting a child might have a delay. i know you probably don't mean it like that, but it is a problematic mindset. this child may have delays or may not, but there's no need for "gently" suggesting anything. the more matter of factly you present your concerns, the better. it's true, many parents have fears and denial about their child having special needs, but it's frustrating when other people tip-toe around the issue as though they were afraid of offending parents by suggesting it.

[kme]

I think it is wonderful that you have picked up on this stuff. My son was my 3rd child so I knew something was "off". Had he been my 1st, I don't think I would have known as readily. It is easy to blow things off when they are little; however, EI is just so important!!

Unfortunately, I don't think there is much you can do other than to set aside a time to talk to the parents about what you are seeing. You could just put it as "i'm seeing some things with XXX that are concerning..." and then give solid examples. No comparing to other kids, no judgments, no guessing on diagnosis, just a simple review of the facts. Then it is up to them to decide what to do about it.

[christinelin]

Other folks have said good stuff, but I thought I'd chime in. I am a preschool/parent ed teacher and mother of an ASD kiddo. What I think works best is very specific spelling out of what is typical at a given age and what you are seeing in their child. One of my colleagues even saved some examples of art projects from the child in question and his peers to show the parents the differences (in this case most kids pasted wheels on the train car and he lined up a collection of wheels in a row). You could even videotape the differences in motor skills. This stuff i hard to do, but so important. Good luck!

[Emmeline II]

I think that something on paper would help; even if they brush you off at the time they'd have something to look at later. And I'd include whatever resources may help, like a contact number for the school district office that does evaluations. Since she is not a child OT it may not be obvious to her where to go next.

I remember when ds' K teacher brought up his sensitivity to sounds (the first fire drill brought out some distinctive behavior) there was a little sense of panic that we were not the only one who noticed it.

[just_lily]

Unggh.....

So I tried to talk to mom at pick up time tonight and it did not go well. I said that the child had a number of screaming meltdown incidents today (true) and that I thought maybe she was having a problem communicating, and asked if they had thought about looking into having a speech evaluation done. She said "Oh no, her speech is coming, just slowly. I'm not worried!" I said that I myself was stumped because she will sing songs and count to ten (just "1 2 3 4 5 6 7 8 9 10", not really counting anything) but won't say things like "more juice".

And then another one of my parents showed up. Normally the child in question is picked up a half an hour before any of the other kids so I thought we would have more of a chance to chat but the other parent showed up early, and mom was like "Ok, see you tomorrow, BYE!" a little faux-cheery.

So definitely not how I wanted things to happen. But hopefully she went home tonight and talked to her husband... or maybe I put a little seed in her brain. I don't think so, but maybe.

I have never had any kind of sit down meetings or anything like that. I usually just talk to my parents at the doorway, mainly at the end of the day because everyone is less rushed. But I have never had anything like this to discuss with a parent either. My gut feeling is that the parents would be suspicious of a meeting, and likely to blow me off.

SilverFish, I definitely agree with you, and wish that most people wouldn't be offended about their children having a delay. But I definitely think some are, and I don't want to come accross that I am telling them that there is something 'wrong' with their child. And the reality is that it is not like I am employed as a teacher or in a daycare - I am afraid that if I don't handle this well they may feel like I just don't like their kid, or that I am labelling them, and they end up taking her out of my daycare because of it.... and taking 20% of my monthly income with them.

(And I don't want to come accross that money is my motivation here - I really want to see this kid get help, and think they need a full evaluation. But the fact that they pay me directly definitely influences how I bring this up with them.)

I think the idea of having examples of what is typical is a great suggestion. Does anyone have a link to a very detailed developmental milestone listing or questionnaire? Everything I can find online is very basic.

[APToddlerMama]

I think it is good you were able to talk to them, but I would just let it go for several more months. Parents have to be *willing* to see what is going on and if she is an OT, she knows something is going on deep down. Early intervention is always best, but if the parents aren't ready, you can't push them. If she is still really lagging behind in three or four months, I would try to gently bring it up again.

[MamatoA]

Originally Posted by just_lily

I think the idea of having examples of what is typical is a great suggestion. Does anyone have a link to a very detailed developmental milestone listing or questionnaire? Everything I can find online is very basic.

Maybe these would help? They are in plain-language but are detailed as to what to what 'normal' development looks like. http://www.zerotothree.org/about-us/...-handouts.html

[VroomieMama]

I'm not sure if its ethical or good idea but I was thinking that perhaps you could video tape all kids but not targeting her child and maybe she'll see what you're talking about?

[NewDirections]

If you bring it up again soon they'll probably change daycares. They're simply not ready to hear it.

[BookGoddess]

I've been on the other side of the issue on this so I can related to the mom's reaction. My SIL told my mother that the child SIL was babysitting at the time could say all these things compared to DD. My mom told me this, and I sent SIL a lengthy email about not comparing kids and how each child progresses at different rates. I was so not ready to hear about delays. I really wasn't. I needed to get to a point emotionally where I was ready to hear it. But a seed was planted in my head after SIL's comments, and eventually (months later) I did call EI for an evaluation. At the time DD had speech abilities ahead of the child you're describing and she was also younger than the child you're describing. I think you've planted the seed. Now you just have to give it time to germinate....

[just_lily]

Originally Posted by MamatoA

Maybe these would help? They are in plain-language but are detailed as to what to what 'normal' development looks like. http://www.zerotothree.org/about-us/...-handouts.html

Those are pretty good. I was getting frustrated because a lot of what I found was for Ages 2 to 3 all lumped in which isn't all that helpful. What a young 2 can do compared to a nearly 3 is quite different. I think I may print them out and post them on a bulletin board near my doorway so parents can check it out if they are interested.

Originally Posted by VroomieMama

I'm not sure if its ethical or good idea but I was thinking that perhaps you could video tape all kids but not targeting her child and maybe she'll see what you're talking about?

I have thought about this. All of my parents sign photo release forms as part of my registration forms, so taking video of all the kids and showing it to a parent is well within what permissions I have been given. But I am afraid it would be too confrontational after our conversation last night. Maybe I will record the next time we do something out of the ordinary and fun and give a copy to all the parents.

Originally Posted by NewDirections

If you bring it up again soon they'll probably change daycares. They're simply not ready to hear it.

Originally Posted by BookGoddess

I think you've planted the seed. Now you just have to give it time to germinate....

NewDirections, I agree, and BookGoddess I hope you are right.

This morning neither of us brought it up, but as mom was leaving I prompted the girl to say "Bye Mommy!" and she said "bye" without looking at her and while walking away. My DD stood there and said to the mom "Bye Mommy. Have good day. Bye soon!" [her version of 'see you soon']. So again, not comparing kids, but I am hoping that perhaps the more she hears my DD speak that maybe the seed will grow a little.

[kme]

Denial is a strong thing and so is hope. It sounds like that's where this mother is right now and that's really OK - it can take a while for it to "sink in" that something is wrong. You planted the seed, and she probably does realize there is a problem. I would probably let it go. It can be VERY hard to hear and accept that something is wrong with your child.

[ericswifey27]

Originally Posted by SpottedFoxx

Oh my friend, professionals are the WORST when it comes to their own children! You need to be kind but firm. Remember, you are not a specialist so please don't diagnose. Absolutely point out all the warning signs and maybe gently remind her that the earlier she gets intervention, the easier her daughter will have it in the long run.

Good luck. You are a good soul.

ahem. I'll admit I've found that to be true, among colleagues, and speaking for myself. I work in special education and work closely with many kids with autism, and I definitely had my blinders on for quite a while concerning my son. I knew he was different, and more challenging, but I didn't put two and two together. Also, there are many things my son could do that most of my students did not... so I reassured myself everything was ok, I was just being paranoid. I did have many concerns, but everyone brushed them off... until after the diagnosis, then they all came out of the woodworks to share their "concerns"! It would have been so helpful to hear it spelled out that other people also had concerns about my child, and that I could take him to x, y, or z for an evaluation, and that yes, it really needed to be done.

My son has motor skills delays too and there is an AWESOME book I just checked out of the library that has all of the developmental milestones listed by age all in one place...

It is called Understanding Motor Skills in Children with Dyspraxia, ADHD, Autism, and Other Learning Disabilities: A Guide to Improving Coordination (JKP Essentials Series) by Lisa Kurtz

http://www.amazon.com/Understanding-...pr_product_top#_
There are VERY DETAILED LISTS in there showing chronological age, and what a child should be doing by that stage (holding a fork, buttoning, hopping, riding a bike etc.)

Check the Amazon link and click the "Look Inside" feature... page 18 shows an example of chronological developmental milestones.

As an OT I am sure she is *familiar* with this, but remember she may have never sat down and "evaluated" her own child... and what she learned in school about children's development may be very different from the work she does day in and day out with older folks. Let me tell you, it is shocking to see it all laid out like that...and much harder to deny.

[ericswifey27]

Originally Posted by NewDirections

If you bring it up again soon they'll probably change daycares. They're simply not ready to hear it.

Maybe she could be more indirect about it... start sending home a newsletter to ALL parents about healthy eating habits, or help with sleep time or tantrums, or whatever (maybe ask the parents for input on what they'd like to see)... and just happen to highlight "motor skills" then "communication skills" the next issue with VERY detailed lists by chronological age, like from the book I mentioned earlier. Maybe if she doesn't see it husband will...

I think the video is also an AWESOME idea. If she is not seeing her child alongside other peers, such as in a playgroup setting, it may not be as obvious what her child is struggling with. He is a first child- in my case as my younger one grew older I noticed things he could do that my oldest could STILL not do. If she doesn't have a younger child or nieces and nephews that play together with him, that would make it harder too. (Maybe ask for the parent's permission to film a special outing or playdate with their kids to burn onto dvd and share??)

[Kristine233]

I know you are concerned, but I'd leave it. Unless you have a background in Early Education or promote yourself as a learning center, I wouldn't say anything. I can not tell you how many freaked out parents I've seen over the years because a home daycare provider planted a seed that something was wrong with their child. With no training or background in this I think its not something that should be brought up. If you were good friends or something it would be different. Understand that it may be something they have talked about themselves or has been brought up by the family Dr and they are handling things privately or on their own or doing a "wait and see". 27 months really isn't at the age yet where its major. A speech delay usually isn't considered more serious until past the age of 3.

I'll add in that I was a preschool teacher for 10 years and have 1 ASD child and 2 of my children had speech issues/delays. My DD2 has major speech issues. I've had to bring up speech and other issues to parents before, but I have had training in child development. Even then I have to be VERY careful not to imply anything or make a diagnosis, even if I'm %99 sure I know whats going on. Its because of these very issues that centers and home learning centers often do "evaluations" 2 times a year. I used to have a basic form I did with all the children I worked with (when in a center and when I did home based) that covered all the basics for typical development. Since it was something I did with all the children the parent didn't feel like I was singling their child out. It also clearly showed where their child was at with different tasks and abilities. NEVER compared children, ever. I never even said "should be doing xyz" because children develop differently, that wasn't my job no matter how much I cared about the child. What they do with that information is up to them. Some just hang onto it and some use it as a spring board to seek more information. If a parent point blank asked me what I thought I would say it wouldn't hurt to get an evaluation from someone trained in child development and would give them local contacts.

It is hard not to get too involved, even when you spend all your time with a child and love them to death. Its one of the harder parts of the job.