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

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#1 of 30 Old 07-15-2010, 04:00 PM - Thread Starter
 
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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?

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#2 of 30 Old 07-15-2010, 05:19 PM
 
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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.

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#3 of 30 Old 07-15-2010, 05:26 PM - Thread Starter
 
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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.

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#4 of 30 Old 07-15-2010, 05:34 PM
 
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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

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#5 of 30 Old 07-15-2010, 06:12 PM
 
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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.

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#6 of 30 Old 07-15-2010, 06:42 PM
 
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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.
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#7 of 30 Old 07-15-2010, 07:11 PM
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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.
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#8 of 30 Old 07-15-2010, 08:27 PM
 
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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!
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#9 of 30 Old 07-16-2010, 12:27 AM
 
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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.

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#10 of 30 Old 07-16-2010, 01:05 AM - Thread Starter
 
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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.

Wife to DH (06/10) and Mummy to DD (07/08).

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#11 of 30 Old 07-16-2010, 01:15 AM
 
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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.
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#12 of 30 Old 07-16-2010, 03:30 AM
 
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Originally Posted by just_lily View Post
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
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#13 of 30 Old 07-16-2010, 03:46 AM
 
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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?

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#14 of 30 Old 07-16-2010, 04:09 AM
 
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If you bring it up again soon they'll probably change daycares. They're simply not ready to hear it.

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#15 of 30 Old 07-16-2010, 05:24 AM
 
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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....

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#16 of 30 Old 07-16-2010, 12:09 PM - Thread Starter
 
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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.

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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.

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

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#17 of 30 Old 07-16-2010, 04:01 PM
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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.
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#18 of 30 Old 07-17-2010, 03:25 AM
 
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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.

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#19 of 30 Old 07-17-2010, 03:34 AM
 
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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??)

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#20 of 30 Old 07-17-2010, 07:04 PM
 
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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.

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#21 of 30 Old 07-17-2010, 08:21 PM
 
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I'd let it go. You planted the seed. Time for her to come to her own conclusions/be ready to accept this is ok. The negative here is the child will likely be almost out of out of early intervention before mom comes to the conclusion the child needs help. But I think it's more harmful to push before a parent is ready. I threw up after she left when someone first mentioned autism to me. She completely backed off and never said a word again but the seed was planted. It took me six months to follow up on that plant in my own mind.

It's hard to hear this stuff and for many of us it's a process to accept that something is not right. That's ok.

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#22 of 30 Old 07-17-2010, 08:31 PM
 
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If you could give her the number to the early intervention office say something like 'I read an article and this is what I found....' or something like that.

Parents don't like to hear that something is 'wrong' with their child. They don't like to think they missed anything. My now 8 year old was dx'd w/autism at 2 1/2. My now 6 year old is just now getting eval'd for autism as well. I'm pretty sure he will be dx'd with it also.

I got him into preschool in the school district b/c of speech and social delays and quickly found many sensory and OT issues. I felt like an idiot for missing so many of the symptoms in ds2, especially b/c ds1 had been dx'd, but they are SO different in the way they present symptoms, you know? Ds1 had and still has very, very little speech. Ds2 had speech, but was delayed. Now, he can speak in complete sentences, carry on conversations, but his intonation is strange.

You don't want to compare children, but there comes a point where the differences are more apparent. If she doesn't want to get an eval, she won't. But, it's a hard pill to swallow and some feel if they don't get eval'd, there is nothing wrong. Maybe pose it to her as the option to rule anything out??

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#23 of 30 Old 07-19-2010, 11:07 AM
 
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Does your state allow childcare providers to make referrals to early intervention? In my state, they can.

I would talk to the mom one more time, and tell her your concerns, and that you want to call early intervention to do a screening. I would approach it from a "we should just have it checked out to make sure it's all okay" stance. If Mom agrees to the screening, call and make the referral.

Taking an approach that it's just a screening and setting Mom up might make it less threatening because you're not saying something is definitely wrong and you're not asking her to figure out what to do. She might be feeling sort of over-whelmed.
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#24 of 30 Old 07-19-2010, 02:27 PM
 
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Does your state allow childcare providers to make referrals to early intervention? In my state, they can.

I would talk to the mom one more time, and tell her your concerns, and that you want to call early intervention to do a screening. I would approach it from a "we should just have it checked out to make sure it's all okay" stance. If Mom agrees to the screening, call and make the referral.

Taking an approach that it's just a screening and setting Mom up might make it less threatening because you're not saying something is definitely wrong and you're not asking her to figure out what to do. She might be feeling sort of over-whelmed.
Or alternatively if that's not the case on her state perhaps just find out when general preschool screenings are in the area and have the information available. It could be information available to all parents and be less threatening.

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#25 of 30 Old 07-19-2010, 05:04 PM
 
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Does your state allow childcare providers to make referrals to early intervention? In my state, they can.

I would talk to the mom one more time, and tell her your concerns, and that you want to call early intervention to do a screening. I would approach it from a "we should just have it checked out to make sure it's all okay" stance. If Mom agrees to the screening, call and make the referral.

Taking an approach that it's just a screening and setting Mom up might make it less threatening because you're not saying something is definitely wrong and you're not asking her to figure out what to do. She might be feeling sort of over-whelmed.
It might go over well or it could go badly as in "who are you to do this? This is my decision, my child. Stay out of our business." If this mom isn't ready to do a screening yet then saying you (the OP) want to call EI to do the screening could alienate her. I know it would have alienated me. Don't misunderstand me. I think EI is needed for this child, but it should be parents who make that decision. It should be the parents who make the call.

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#26 of 30 Old 07-19-2010, 05:51 PM - Thread Starter
 
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I am in Canada, so we don't have "Early Intervention" per se. Nor are there scheduled pre-school screenings. I'm not even sure if there are screenings in elementary school anymore as I don't yet have a school-aged child, and we don't have school nurses or anything like that.

I do run a licensed home daycare, and I am pretty certain that if I were to phone our community support office they would be able to schedule an evaluator to come to my home - but of course the parent would need to give consent for this to happen. One of the other providers in my agency went through this process with one of her kiddos, and the child was diagnosed with ODD.

I want to make it clear that I am NOT trying to diagnose this kid myself. But it is pretty clear that she is definitely a quirky kid, and something is going on. Whether she just needs some behavoural support, or if there it is something else is not my place to decide, nor am I attempting to do so. I do have some training in typical child development as I am a licensed provider, but I am in no way qualified to diagnose. I am exposed to a large number of toddlers and preschoolers in my own home, other kids in my agency (we have a play group once a week), my friends' kids, and from volunteering in our church nursery and preschool room. And this child stands out.

I do feel a lot of responsibility about this. I have this child from 7:30 to 4:30 five days a week. If it turns out that there is an issue and things could be improved by early therapy or treatment.... but I am the only one who notices an issue, and I never say anything.... I would feel quite bad about that. I would feel like I failed the child because I never spoke up on their behalf.

So I did bring it up, and I feel like I have fulfilled my immediate responsibility. The parents will need to take it from here. If, in a few months, things don't improve and the parents still haven't taken any initiative I will bring it up again. But I don't want to alienate the parents in the process and have them switch daycares.

A pp suggested that perhaps this is being followed by the child's doctor. I am confident that this is not the case. I have her all day, every day (even when her parents have days off, they still bring her to me). I would know if they were taking her to appointments, and they are just not.

Wife to DH (06/10) and Mummy to DD (07/08).

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#27 of 30 Old 07-20-2010, 12:27 AM
 
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Ooh, I just have to weigh in and say that I would be *horrified* to have my child videotaped alongside other children for the purpose of showing me something was wrong... Please don't do this to these parents! It sounds like you are on the right track right where you are...planting the seed and leaving it be for now.
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#28 of 30 Old 07-20-2010, 05:25 AM
 
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I am still sad about the way my son's preschool teacher suggested I get an eval done for my son. It was one morning at drop off, and she was watching my son walk into the classroom and she turned to me and said "I think your son might be autistic." I was so shocked. I had never considered anything of that nature at all, just a little slower to meet milestones, compared to his peers.
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#29 of 30 Old 07-20-2010, 10:06 AM
 
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It might go over well or it could go badly as in "who are you to do this? This is my decision, my child. Stay out of our business." If this mom isn't ready to do a screening yet then saying you (the OP) want to call EI to do the screening could alienate her. I know it would have alienated me. Don't misunderstand me. I think EI is needed for this child, but it should be parents who make that decision. It should be the parents who make the call.
I totally agree with this. That's why my post said "If Mom agrees to the screening, call..."
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#30 of 30 Old 07-20-2010, 10:20 AM
 
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I say this gently, but unless there is something you are failing to convey over the interwebz, nothing that you have described sounds outside the realm of normal to me. Children develop at vastly different rates. I have had children in my care who didn't walk and talk with any proficiency until they were almost 4 and by the time they were 5 you could not distinguish them from their peers. You also have no real way of knowing whether or not the parents have taken any "initiative".

I believe that your concern is valid and I think you have the very best of intentions, but beyond mentioning your concerns to them, I'd leave it be.

Mama to Thing 1 and Thing 2.
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