a·typ·i·cal

• –adjective not typical; not conforming to the

type; irregular; abnormal: atypical behavior;

(dictionary)

Typical Development: Child development refers to the biological and psychological changes that occur in human beings between birth and the end of adolescence, as the individual

progresses from dependency to increasing autonomy. (wikipedia)

Atypical Child Development

By Rowan Anderson

Typical Motor Development

3 months• Lift head when held at your shoulder • lift head and chest when lying on his stomach • turn head from side to side when lying on his stomach • follow a moving object or person with his eyes • often hold hands open or loosely fisted • grasp rattle when given to her • wiggle and kick with arms and legs

6 months• hold head steady when sitting with your help • reach for and grasp objects • play with his toes • help hold the bottle during feeding • explore by mouthing and banging objects • move toys from one hand to another • shake a rattle • pull up to a sitting position on her own if you grasp her

hands • sit with only a little support • sit in a high chair • roll over • bounce when held in a standing position

12 months• drink from a cup with help • feed herself finger food like raisins or bread crumbs • grasp small objects by using her thumb and index or

forefinger • use his first finger to poke or point • put small blocks in and take them out of a container • knock two blocks together • sit well without support • crawl on hands and knees • pull himself to stand or take steps holding onto

furniture • stand alone momentarily • walk with one hand held • cooperate with dressing by offering a foot or an arm

Information on this slide taken from:http://www.nncc.org/child.dev/mile1.html

Red Flags/Motor; fine and grossGross MotorIf a child is... • · Not rolling by 7 months of age • · Not pushing up on straight arms, lifting his head and shoulders, by

8 months of age • · Not sitting independently by 10 months of age • · Not crawling ("commando" crawling--moving across the floor on

his belly) by 10 months of age • · Not creeping (on all fours, what is typically called "crawling") by 12

months of age • · Not sitting upright in a child-sized chair by 12 months of age • · Not pulling to stand by 12 months of age • · Not standing alone by 14 months of age • · Not walking by 18 months of age • · Not jumping by 30 months of age • · Not independent on stairs (up and down) by 30 months of age

...an early intervention/developmental therapy referral may be appropriate.

•Here are some other gross motor "red flags":

• · "walking" their hands up their bodies to achieve a standing position

• · only walking on their toes, not the soles of their feet • · frequently falling/tripping, for no apparent reason • · still "toeing in" at two years of age • · unusual creeping patterns • · any known medical diagnosis can be considered a "red flag":

Down's syndrome, cerebral palsy, congenital heart condition etc.

Fine MotorIf a child is... • · Frequently in a fisted position with both hands after 6 months of

age • · Not bringing both hands to midline (center of body) by 10 months

of age • · Not banging objects together by 10 months of age • · Not clapping their hands by 12 months of age • · Not deliberately and immediately releasing objects by 12 months

of age • · Not able to tip and hold their bottle by themselves and keep it up,

without lying down, by 12 months of age • · Still using a fisted grasp to hold a crayon at 18 months of age • · Not using a mature pincer grasp (thumb and index finger, pad to

pad) by 18 months of age • · Not imitating a drawing of a vertical line by 24 months of age • · Not able to snip with scissors by 30 months

...an early childhood intervention/development therapy referral may be appropriate

Here are some other fine motor "red flags": • · Using only one hand to complete tasks • · Not being able to move/open one hand/arm • · Drooling during small tasks that require intense concentration • · Displaying uncoordinated or jerky movements when doing

activities • · Crayon strokes are either too heavy or too light to see • · Any know medical diagnosis can be considered a "red flag": Down's

Syndrome, cerebral palsy etc.From: http://www.sensory-processing-disorder.com/child-developmental-checklist.html

Atypical Motor Development

Autism

• Performs repetitive movements, such as rocking, spinning or hand-flapping

• Moves constantly• Clumsy• Fine motor difficulties: handwriting, buttoning a

shirt, holding a fork, typing shoelaces.• Sometimes late to sit up, stand, or walk• Toe walking• Unusual gait

Impact

“I think the fluidity of access to various places in my brain is dependent upon neurological movement between places. I'm no scientist, but have always been able to "see" this inside of me. Sometimes my speaking is hindered, other times my thinking, and sometimes my physical movement. The hardest is when thinking is not working smoothly.” Judy Endow (2010) author with autism

Typical Cognitive Development

Birth: Beginning to develop concepts e.g. becomes aware of physical sensations such as hunger. Explores using his senses. Make eye contact and cry to indicate need.

3 months: Takes increasing interest in his surroundings. Shows interest in playthings. Understand cause and effect, e.g. if you tie one end of a ribbon to his toe and the other to a mobile, he will learn to move the mobile.

6 months: Finds feet interesting. Understand objects and know what to expect of them. Understand 'up' and 'down' and make appropriate gestures, such as raising his arms to be picked.

9 months: Shows interest in picture books. Watches activities of others with interest.

12 months: Responds to simple instructions. Uses trial-and-error to learn about objects.

Red Flags Cognition/Problem Solving

If a child is... · Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby) · Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another) · Not able to imitate a model from memory by 27 months (ie, show me how you brush your teeth) · Not able to match two sets of objects by color by 31 months of age · Having difficulty problem solving during activities in comparison to his/her peers · Unaware of changes in his/her environment and routine

...an early intervention/developmental therapy referral may be appropriate

http://www.sensory-processing-disorder.com/child-developmental-checklist.html

Atypical Cognitive DevelopmentDown Syndrome

Working memory for children with Down syndrome

• They have a specific impairment in short-term memory for verbal information.

• This will make processing verbal information and, therefore, learning from listening, especially difficult for them.

• It will also impair vocabulary and sentence learning, so is probably a major cause of their speech and language difficulties.

• Their visuo-spatial short-term memory is better than verbal short-term memory.

• Their ability to learn from visual information is therefore a relative strength and can be used to support weaker verbal processing abilities

Information on this slide taken from: http://www.downsyndrome.org/information/motor/overview

ImpactMemory development for individuals with Down syndrome– An overview

Sue Buckley and Gillian Bird Working memory is the system in the brain that supports the daily

processing of visual and verbal information as individuals go about their lives. It has been described as ‘a mental workplace’, as it is not only essential for language processing, it also supports activities which involve holding and manipulating information such as reading a text with comprehension, planning and writing text or messages, doing mental arithmetic, and holding temporary information like a telephone number while dialing it. In addition to being a temporary storage and processing system essential to everyday functioning and to mental abilities, part of the working memory system which is specialized for holding verbal information - the phonological loop - is thought to be essential for learning a spoken language. The phonological loop holds the sound patterns for words. In order to learn a first language a child has to be able to store accurate representations of the sound patterns of words in order to link them to meaning and in order to be able to copy or produce the word when talking. If the phonological loop does not function well, speech and language will be delayed. There is evidence that there is a basic impairment in phonological loop functioning in children with Down syndrome. This is probably a major reason for their speech and language delays and difficulties and it also affects their ability to process spoken language and carry out cognitive tasks. Memory training studies indicate that it is possible to improve the short-term memory skills of children with Down syndrome. However, the biggest gains in short-term memory skills reported are linked to reading instruction and to being in a mainstream school. Reading activities may provide auditory training experiences which actually improve phonological coding (the accurate representation of the sound patterns of words) in the phonological loop. Memory training activities and support for weak auditory memory skills are discussed. However, a range of activities to improve speech sound and word discrimination are included, as they may improve basic phonological loop function and therefore result in the greatest gains for spoken language abilities and working memory.

• Buckley SJ, Bird G. Memory development for individuals with Down syndrome– An overview. Down Syndrome Issues and Information. 2001.

Autism Cognitive Development

Theory of Mind

• Difficulty in …– Predicting– Reading intentions– Understanding emotions– Explaining own behavior– Perspective or reference– Reading and reacting to others’ interests– Understanding social interactions

• ASD: The Invisible Disability

8

“You could teach a child with ASD the theory of relativity once and he’d get it. But you’d have to tell him the rules for lining up for recess 500 times.” Brenda Smith Myles

9

Language; receptive and expressive

Birth: Cries vigorously. Respond to high-pitched tones by moving his limbs.

3 months: Attentive to sounds made by your voice. Indicates needs with differentiated cries. Beginning to vocalise. Smile in response to speech.

6 months: Double syllable sounds such as 'mama' and 'dada'. Laughs in play. Screams with annoyance.

9 months: Babbles tunefully. Vocalises to attract attention. Enjoy communicating with sounds.

12 months: Babbles 2 or 3 words repeatedly. Responds to simple instructions. Understands several words. Uses jargon. http://www.child-development-guide.com/child-development-milestone.html

• babble, but it sometimes "sounds like" talking • say his first word • recognize family members' names • try to "talk" with you • respond to another's distress by showing distress or crying • show affection to familiar adults • show mild to severe anxiety at separation from parent • show apprehension about strangers • raise her arms when she wants to be picked up • understand simple commands

http://www.nncc.org/child.dev/mile1.html

Language Development Red Flags• Speech and Language Development, Which Includes• Articulation (pronouncing sounds)• Dysfluency (excessive stuttering—occasional stuttering may occur in the

early years and is normal)• Voice• Language (ability to use and understand words)• Red Flags• Articulation. Watch for the child

– Whose speech is difficult to understand, compared with peers– Who mispronounces sounds– Whose mouth seems abnormal (excessive under- or overbite;

swallowing difficulty; poorly lined-up teeth)– Who has difficulty putting words and sounds in proper sequence– Who cannot be encouraged to produce age-appropriate sound– Who has a history of ear infections or middle ear disorders

• Note: Most children develop the following sounds correctly by the ages shown (i.e., don’t worry about a 3-year-old who mispronounces t).

• 2 years—all vowel sounds• 3 years—p, b, m, w, h• 4 years—t, d, n, k, h, ng• 5 years—f, j, sh• 6 years—ch, v, r, l• 7 years—s, z, voiceless or voiced th• Dysfluency (stuttering). Note the child who, compared with others of the

same age, – Shows excessive amounts of these behaviors:

• repetitions of sounds, words (m-m-m; I-I-I-I-)• prolongations of sounds (mmmmmmmmmmmmmmm)• hesitations or long blocks during speech, usually

accompanied by tension or struggle behavior• putting in extra words (um, uh, well)

– Shows two or more of these behaviors while speaking: • hand clenching• eye blinking• swaying of body• pill rolling with fingers• no eye contact• body tension or struggle• breathing irregularity• tremors• pitch rise• frustration• avoidance of talking

– Is labeled a stutterer by parents– Is aware of her or his dysfluencies

• Voice. Note the child whose – Rate of speech is extremely fast or slow– Voice is breathy or hoarse– Voice is very loud or soft– Voice is very high or low– Voice sounds very nasa

• Language (ability to use and understand words). Note the child who – Does not appear to understand when others speak, though hearing is normal– Is unable to follow one- or two-step directions– Communicates by pointing, gesturing– Makes no attempt to communicate with words– Has small vocabulary for age– Uses parrotlike speech (imitates what others say)– Has difficulty putting words together in a sentence– Uses words inaccurately– Demonstrates difficulty with three or more of these skills:

• making a word plural• changing tenses of verb• using pronouns• using negatives• using possessives• naming common objects• telling function of common objects• using prepositions

• Note: Two-year-olds use mostly nouns, few verbs. Three-year-olds use nouns, verbs, some adverbs, adjectives, prepositions. Four-year-olds use all parts of speech.

Down Syndrome Language Development

Characteristics

• Summary of the speech and language profile of individuals with Down syndrome

• Speech and language skills are specifically delayed relative to non-verbal abilities

• Non-verbal communication is a strength in infancy and beyond

• Use of gestures to communicate is a strength• Vocabulary is understood slowly but steadily and becomes

a strength • Spoken production of words lags behind comprehension• Early grammar is learned slowly and is paced by vocabulary

size• More complex grammar is specifically delayed relative to

vocabulary • Spoken production of grammar lags behind comprehension

of grammar • Difficulty with speech production – first words delayed,

strings of words difficult• Articulation and phonology are a challenge, therefore

speech intelligibility is a weakness• Teenagers and adults often still communicate with short,

telegraphic sentences

Impact Children with Down syndrome usually experience considerable delay and

difficulties with learning to talk. • Most children and adults with Down syndrome understand more language than

their expressive language skills suggest and therefore their understanding is often underestimated. Their social interactive skills and non-verbal communication skills are a strength but speech sound production (articulation and phonology) is a specific weakness. Vocabulary learning, while delayed, is also a strength but grammar learning is a weakness, so that the children tend to talk using keywords rather than complete sentences.

• Children with Down syndrome show the same progression from one word to two word combinations, once they can say between 50-100 words, as other children, and they show the same progression to early grammar in their speech when they have a spoken vocabulary of 300-400 words. Unfortunately the usual delay in reaching a productive vocabulary of 300-400 words (at 5 to 6 years, instead of at 2 to 3 years) may compromise the ability to master fully sophisticated grammar and phonology in later speech.

• Some of the reasons for the speech and language difficulties• Learning difficulties - need more examples to learn• Anatomical differences - affect speech skills• Learning language from listening is affected by:

– hearing loss– auditory discrimination– verbal short-term memory

• Speech motor difficulties: – delay vocabulary and grammar development– affect the way a child is talked to and included in conversations

• Joint attention difficulties and slow development of speech will both reduce language learning opportunities

• All these difficulties can be targeted with appropriate and effective intervention strategies

• Progress in comprehension and production of vocabulary is probably compromised by hearing difficulties. It is certainly compromised by the children's specific difficulty with speech sound production. Progress in sentence production and in later grammar learning is probably compromised by a weakness in the auditory or phonological short-term memory system.

Autism Language Development• Difficulties with nonverbal communication• – inappropriate facial expressions• – unusual use of gestures• – lack of eye contact• – strange body postures• – lack of mutual or shared focus of attention• Delay in or lack of expressive language skills• Significant differences in oral language, for those who do develop

language• – odd pitch or intonation• – faster or slower rate of speech than normal• – unusual rhythm or stress• – monotone or lilting voice quality• A tendency to use language to have needs met, rather than for social

purposes• Repetitive and idiosyncratic speech patterns• “The student may be using echolaic utterances to rehearse what is heard

in order to process the information, or as a strategy for self-regulation.” Prizant and Duchan, 1981

• Echolalic speech, immediate or delayed literal repetition of the speech of others

• – appears to be non meaningful, but may indicate an attempt to communicate

• – indicates the ability to produce speech and imitate• – may serve a communication or cognitive purpose for the student• Restricted vocabulary• – dominated by nouns• – often confined to requests or rejections to regulate one’s physical

environment• – limited in social functions• Tendency to perseverate on a topic• —that is, to continuallydiscuss one topic and have difficulty changing

topics

• Difficulty with the pragmatics of conversation• – problems initiating communication• – difficulty using unwritten rules• – inability to maintain conversation on a topic• – inappropriate interrupting• – inflexibility in style of conversation, stereotypic style of

speaking

Impact People with autism spectrum disorders often have difficulty

comprehending verbal information, following long verbal instructions and remembering a sequence of instructions. The comprehension of language may be context-specific. The extent of difficulty varies among individuals, but even those who have normal intelligence, usually referred to as high-functioning, may have difficulty comprehending verbal information.

• Source: Teaching Students with Autism Spectrum Disorder

Typical Adaptive Skills Feeding

• 8 months Gums solid foodsFeeds self crackersHolds own bottleDrinks from cup held by adult

• 12 monthsPicks up small pieces of cereal to eatHolds cup and drinks with some spills

• 24 - 30 months Drinks from a small cup, holding it with one handBites well through food Brings spoon to mouth with the palm facing up Can eat a meal using a spoon with minimal spilling

• 30 - 36 monthsPours from a small cupBegins to use a fork to spear foodCan spread with a dull butter knife

• 3 - 4 yearsPokes food with a forkBegins using fork more than spoonHolds spoon in fingers with palm upLearns to cut soft foods with the edge of forkLearns how to prepare a bowl of dry cereal with milkUses napkinServes self at table with little spilling

Information on slide by Penn State University ,Better Care Kid Program

Dressing• 15 - 24 months

Learns to take off hat, socks, and shoes without lacesLearns to unzip large zippers

• 24 - 30 monthsCan pull pants down with assistanceIs beginning to unbutton large buttonsAnticipates the need to use the toiletCan put shoes on with helpStill needs help getting pullover shirts over head and pants up over bottom

• 30 - 36 monthsPuts on items such as shoes, socks, pants, shirts, and jacketsPulls pants upUndresses and dresses with adult helpStill needs help with tying

• 3 - 4 yearsUses toilet with adult help Has daytime toilet controlLearns to undo fasteners, such as snaps and lacesDistinguishes between the front and back of clothesZips front-opening clothesStill needs adult help with dressingButtons large buttonsPuts on socks, may need help with heel placementZips and unzips jackets but needs help with startingPuts shoes on, may have trouble telling which feet

• 4 yearsPuts on socks with heel placementPuts on shoes with some adult helpBuckles shoes and belts

• 5 yearsPut shirts on correctlyPuts belt in loopsUnties a tie on an apronSome can put shoes on correct feet and tie laces

If a child is... · Having difficulty biting or chewing food during mealtime · Needing a prolonged period of time to chew and/or swallow · Coughing/choking during or after eating on a regular basis · Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds) · Having significant difficulty transitioning between different food stages · Not feeding him/herself finger foods by 14 months of age · Not attempting to use a spoon by 15 months of age · Not picking up and drinking from a regular open cup by 15 months of age · Not able to pull off hat, socks or mittens on request by 15 months of age · Not attempting to wash own hands or face by 19 months · Not assisting with dressing tasks (excluding clothes fasteners) by 22 months · Not able to deliberately undo large buttons, snaps and shoelaces by 34 months

...an early intervention/developmental therapy and referral may be appropriate.

http://www.sensory-processing-disorder.com/child-developmental-checklist.html

Red Flags/Adaptive Skills

If a child is... · Very busy, always on the go, and has a very short attention to task · Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap) · A picky eater · Not aware of when they get hurt (no crying, startle, or reaction to injury) · Afraid of swinging/movement activities; does not like to be picked up or be upside down · Showing difficulty learning new activities (motor planning) · Having a hard time calming themselves down appropriately · Appearing to be constantly moving around, even while sitting · Showing poor or no eye contact · Frequently jumping and/or purposely falling to the floor/crashing into things · Seeking opportunities to fall without regard to his/her safety or that of others · Constantly touching everything they see, including other children · Hypotonic (floppy body, like a wet noodle) · Having a difficult time with transitions between activity or location · Overly upset with change in routine · Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc. · Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.

...an early childhood intervention/developmental therapy referral may be appropriate.

NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.

Possible visual problems may exist if the child... · Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes · Does not reach for an object close by

Possible hearing problems may exist if the child... · Does not respond to sounds or to the voices of familiar people · Does not attend to bells or other sound-producing objects · Does not respond appropriately to different levels of sound · Does not babblehttp://www.sensory-processing-disorder.com/child-developmental-checklist.html

Red Flags/Sensory

An Amazing and Extensive Sensory Processing Disorder Checklist:

http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

A children’s book

Creating Sensory Diets for children with Autism, Downs Syndrome and other sensory sensitive disorders.

What is a sensory diet?Just as your child needs food throughout the course of the day, his need for sensory input must

also be met. A “sensory diet” (coined by OT Patricia Wilbarger) is a carefully designed, Personalized activity plan that provides the sensory input a person needs to stay focused and organized throughout the day. Just as you may jiggle your knee or chew gum to stay awake or soak in a hot tub to unwind, children need to engage in stabilizing, focusing activities too. Infants, young children, teens, and adults with mild to severe sensory issues can all benefit from a personalized sensory diet.Each child has a unique set of sensory needs. Generally, a child whose nervous system is on “high trigger/too wired” needs more calming input, while the child who is more “sluggish/too tired” needs more arousing input.

www.sensorysmarts.com

For examples of sensory diets, go to:http://sensorysmarts.com/sensory_diet-activities.html

Social Emotional DevelopmentBy the end of 3 months

Begins to develop a social smileEnjoys playing with other people and may cry when playing stopsBecomes more expressive and communicates more with face and bodyImitates some movements and facial expressions

By the end of 7 months Enjoys social play

Interested in mirror imagesResponds to other people’s expressions of emotion and appears joyful often

By the end of 12 months:Shy or anxious with strangersCries when mother or father leavesEnjoys imitating people in his playShows specific preferences for certain people and toysTests parental responses to his actions during feedingsTests parental responses to his behaviorMay be fearful in some situationsPrefers mother and/or regular caregiver over all othersRepeats sounds or gestures for attentionFinger-feeds himselfExtends arm or leg to help when being dressed

YouTube - Hahaha.url

A happy baby, you tube!

Red Flags SoSocial/Emotional/Play Skills

If a child is... · Not smiling by 4 months · Not making eye contact during activities and interacting with peers and/or adults · Not performing for social attention by 12 months · Not imitating actions and movements by the age of 24 months · Not engaging in pretend play by the age of 24 months · Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers) · Fixating on objects that spin or turn (i.e. See 'n Say, toy cars, etc.); also children who are trying to spin things that are not normally spun · Having significant difficulty attending to tasks · Getting overly upset with change or transitions from activity to activity

...an early intervention program referral may be appropriate

http://www.sensory-processing-disorder.com/child-developmental-checklist.html

The specific developmental profile associated with Down syndrome“Children with Down syndrome are all individuals and vary in their rates of progress - however, they tend to have a specific profile of strengths and weaknesses: Social development and social learning are strengths, right from infancy - the children enjoy and learn from social interaction with adults and peersMotor development is usually delayed and may hold back progress in self-help skills, handling toys in play and in writing, though the use of gesture to communicate is a strengthSpeech and language development is usually the children's area of most significant delay - it is more delayed than non-verbal abilities. Most children understand more than they can say and signing is an important bridge to speaking. Speech intelligibility is usually a difficulty. A high incidence of hearing difficulties is contributing to speech and language delay.Working memory development is specifically delayed relative to non-verbal abilities, particularly the verbal short-term memory component - so that learning from listening is difficult for the children. Working memory also supports thinking, problem solving and reasoning. Visual and spatial processing and memory are relative strengths - so that the children learn effectively from visual information - they can be thought of as visual learners.Social behaviour- the children have strengths in social skills and in developing age-appropriate social behaviour, if this is encouraged and expected. However, their good social understanding and empathy leads them to pick up on non-verbal emotional cues, such as those for anxiety or disapproval, very quickly. They are therefore sensitive to failure and may use behavioural strategies to avoid difficult situations.” http://www.down-syndrome.org

Autism Social Skills Group

• Social deficits observed in children with autism may include:

• Difficulties understanding the facial expressions of others

• Difficulties with or complete lack of initiating social interactions with others

• Lack of responding to social initiations made by others (Hauck, Fein, Waterhouse, & Feinstein, 1995)

• Lack of responding to the emotions of others (Sigman, Kasari, Kwon, & Yirmiya, 1992).

• Deficits in showing (directing attention) (Stone, Coonrod, & Ousley, 2000)

• Lack of interest in other children• Absence of or limited use of gestures such as

pointing to share enjoyment with others• Absence of or limited imitiation skills• Lack of friendship seeking behavior

The Center for Autism Spectrum Disorders at Binghamton University

A Gift

March 01, 2010 Temple Grandin sees her autism as a gift,

not a disability. The professor at Colorado State University,

who has become a prominent animal rights activist, spoke at the recent TED Conference in California about how people's brains work in different ways -- and how that's something that should be appreciated, not stigmatized.

Grandin, for instance, thinks in pictures, "like Google for images," she said.

She also grabs hold of details, a brain function she feels could help politicians.

"I get satisfaction out of seeing stuff that makes real change in the real world," she said. "We need a lot more of that and a lot less abstract stuff."

          States of Grief for Parents of Children with Special Needs By Kristin Reinsberg, MS, LMFT April 23, 2010                                           Daily tasks, demands and challenges continually test a parent’s patience, problem solving skills, and flexibility. Time to recharge, and relax is often in short supply as the responsibilities of parenthood pull for more of our energy. Stress can impact our health and can greatly affect our relationships with partners, friends, and most importantly, our children. If you are a parent of a child with disabilities, stress can be a uniquely pervasive and isolating experience. Grief& Loss: Internal Contributors to Stress As parents, we develop hopes and dreams about who our baby will be in the world and how we will be as parents. This process of creating an internal life for our baby and ourselves is a natural part of what all parents go through. We do not expect that our baby will be born with, or develop, a disability or special need; when that happens, much of what we imagined and planned is forever changed.For parents of children with special needs, feelings of stress are often compounded by a profound sense of grief that results from this loss of one’s initial hopes, dreams and expectations. These feelings can be similar to those experienced when we encounter any other significant loss, such as a death or divorce. Recent research has indicated that parents of children with special needs may even experience feelings and symptoms of traumatic stress, particularly at the time of their child’s diagnosis. These feelings of grief and loss are often experienced but rarely spoken about or shared. Parents may be worried that expressing their feelings of anger, depression or fear may not be welcomed or tolerated by those around them. They may even feel pressure from family and friends to be “strong” or to remain positive, leaving those feelings of grief without a place for expression. It is important for families to understand and talk about these feelings, and to know that what they are feeling is natural.

States of Grief We typically think of grief as having distinct “states” (Moses, 1987). For parents of children with special needs, grief rarely happens in a predictable or linear fashion. Oftentimes, the sense of loss is on-going and it is very common for parents to re-experience various feelings of grief at many points throughout their child’s development. A parent who may have adjusted expectations for their child’s needs at home may find themselves again experiencing feelings of denial, fear or depression when presented with new challenges their child is facing at school. While these feelings are often difficult to sit with and even harder to talk about, it is important to remember that all of the feeling states associated with grief serve a purpose and help us to cope, manage and mobilize. The feeling states of grief that we all experience following loss are:                             •Denial •Anxiety • Fear • Guilt • Depression • Anger (Continued in next slide)

. Every parent is different, and grief is a uniquely individual process. There is no “right” or “wrong” way to experience grief; however, parents need to have the space to fully experience and express all of these important feelings. Letting go of the hopes and dreams that we originally had, and which no longer serve us, is an exceptionally complicated and complex process. Doing so can help us connect more fully with what is right in front of us, and can enable us to develop and create new hopes, expectations and dreams for ourselves and our family. Outside Stressors Also Impact FamiliesParents also experience stress due to the challenging external realities of raising a child with special needs. Parents often find themselves juggling the daily needs of their family with medical and therapy appointments, teacher meetings and advocating for services Siblings may experience stress; feeling overlooked or overly relied upon. Financial pressures may develop when parents are unable or choose not to work in order to care for their child, or when families need to pay for services that are not covered by insurance or other agencies. For many parents, support is limited. Agencies that once provided services have been impacted by state and local budget cuts. Supportive services for families, such as respite care, are being greatly reduced or eliminated. Parents may experience long waitlists or delays in getting the necessary and needed services for their children and for themselves.Support for Parents of Children with Special Needs• Take time for yourself. Carving out time to relax, read, talk to friends, or do whatever else that helps you to nourish yourself cannot be overstated. We

cannot care for others unless we also find ways to take care of ourselves. Taking time to rejuvenate and relax will help you respond to daily stressors and be more available to your children and partner

• Express and share your feelings of grief. Finding a way to share your story with trusted friends, family or professionals will help with feelings of isolation and hopelessness. It will help clear the way for new strengths and gains to be discovered. Additionally, it will help those around you to know and understand your experience so that they may be able to offer support in more effective ways.

• Seek out Parent and Peer Support Groups. Knowing that others “have been there” can be a very comforting. Many early intervention programs offer groups; they can be specific to parents who have children with particular disabilities, or be more general support groups offering parents a chance to share and to have an hour or so to just sit and relax. For parents in remote areas or for those who have difficulty leaving their home for extended periods of time, the internet offers many “virtual” peer/support groups.

• Seek out intervention programs or individuals who take a family- or relationship-based approach to serving your child. Working with agencies or individuals who focus on the parent-child relationship, and on how to utilize this relationship to help promote the growth and development of your child, can help you feel included, supported, and confident. Interventionists who employ a relationship-based approach to providing services for your child can help promote your feelings of connection and competence with your child and can reduce stress by providing another forum in which you can discuss your experiences, concerns and feelings.

In my article on stress and mindfulness, I have explored a variety of ways to understand and manage stress that will be useful to all parents, and I encourage you to look at those ideas http://www.abilitypath.org/love-laugh--live/stress-relationships/coping/articles/stress-management-tips.htmlNote: Our website, www.abilitypath.org, offers parents the opportunity to connect, chat, share information and gather information about a variety of topics related to special needs and parenting.Links & ResourcesMoses, Ken (1987). The Impact of Childhood Disability: The Parent’s Struggle. WAYS Magazine, Spring. Evanston, IL.Foley, G. & Hochman, J., Eds. (2006). Mental Health in Early Intervention: Achieving Unity in Principles and Practice. Baltimore: Brooks Publishing.