Causes of childhood delays and disabilities including psychosocial risk


We won’t dwell much on the health-related or in-born conditions that can cause disabilities (syndromes, in-born metabolic errors, birth trauma, injury, etc.). These are well known predictors of delays and disabilities. But for most kids we don’t know the cause. They may have a lesion on some part of their brain or some other cortical dysfunction. But even if we could do sophisticated imaging of how their brains work, that enormous expense won’t do anything to solve the problem (although we definitely want to make sure they are healthy, hear well, see well and don’t have any untreated but treatable condition).  So if we have ruled out health problems, here’s what we know: Only early intervention will help.
 
So the causes of most disabilities are unknown. But one cause that we can detect and address, is the adverse impact of psychosocial risk factors. What are these factors?
 
Risk factors: (4 or more of the following are generally needed before we should worry too much)include:parents’ with less than a high school education, being a single parent, being unemployed, parental mental health problems (of which depression is particularly common), housing/food instability, 3 or more children in the home, limited facility with English, limited literacy in any language, being among an ethnic minority, etc.

*Note that performance at the 16th percentile is fine for height, weight, and head circumference, but it is not OK when it comes to school performance. Even children whose skills are in the 25th percentile, struggle in school, instruction is over their heads, they are typically only one of a very few in a classroom who are behind, and... they often fail to make progress... leading to in-grade retention and dropping out of high school. We want to prevent that and the best way is early detection and intervention.

Probably the most important of risk factors (and also one with which we can readily intervene), is parenting style.
There are two worrisome types of parenting styles:
 
1) Neglectful, often visible in an infants’ failure to gain weight, in signs of child abuse and hygiene problems, and far more mildly, in parents who don’t come for visits with an extra diaper, food, or toys for their children, or who just don’t respond to their child’s efforts to communicate. These parents are often overwhelmed and often depressed. Mental health interventions and/or housing/food/child care assistance for such parents are usually needed. Parent training is essential; and, 
 
2) Authoritarian (also called punitive) parenting style. This is visible in parents who mostly yell “No” at their children but don’t engage their child in conversation, don’t talk with their child about the safe things he or she is touching or playing with; and don’t praise their child for good behavior. These parents often don’t know how to communicate with their child and they are unskilled as parents and… almost always overwhelmed and anxious. Parent training is much needed as is assistance helping them cope with life stressors.

 
Both types of problematic styles are characterized by limited back-and-forth communication between child and parent.  We know that for optimal language learning, children have to have lots and lots  and lots of conversations (including sound play). Having orders barked at them doesn’t do much. Watching TV doesn’t do much either. It has to be a conversation. Without that there will inevitably be a delay in learning language skills which, in turn, creates an enormous risk for delays in learning pre-academic skills which, in turn, leads to school failure).

Below is a graph from a recent study showing the dramatic impact of parenting skills on children's development. Even by 12 months of age we can see that parents who talk with their children, read aloud, and feel they can soothe their child when he or she is upset---have children perform in the average range on developmental measures (shown in the blue line). Parents who don't have such skills have children whose development falls further and further behind (red line).


All this means, that we can and should identify children (and parents who need guidance) way way way early. And screening alone won't work. Although screening is crucial, we also need to look for risk factors with particular attention to how parents are parenting and catch problems before they develop.

Other info on parenting styles:

Just FYI, there are two other parenting styles that are not associated with problematic outcomes. One is the Permissive style (where children “rule the roost”, interrupt adult conversations, climb all over your furniture and… sometimes make the rest of us crazy). But these parents are attentive and verbal with their children, as their children are with them.
 
The other, non-problematic parenting style is Authoritative (not to be confused with Authoritarian).  Authoritative parents pick on their child’s interests, point out new things, and engage in two-way communication. But they also lay down some clear rules for what is acceptable behavior and what is not.
 
On the next page we talk about protective factors—more on what helps a child do well even under adverse circumstances and…. what to look for in terms of risk and resilience.