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The earlier, the better
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There are four major milestones in the development of a child's faculties. If, for any reason, they do not occur on time, the child is at risk of lifelong disability. Early detection and intervention can go a long way in correcting the situation. Infact, there is hope in it for the child and the hapless parents. DR. HARIMOHAN dwells on this informative aspect in mental health.
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THE HAPPINESS that a newborn brings to a family is at times devastated when the child is not normal. The future of such children was bleak in the past, but times have changed and today the revolutionary concept of early detection and intervention of disabilities holds a ray of hope in giving them a better quality of life.
Developmental delay includes a wide spectrum of conditions, which, on one end, involves at risk (of developing future disabilities) babies who could become normal with proper and timely intervention, to children with severe mental, physical and sensory disabilities (deaf and dumb, blind, mentally handicapped, cerebral palsy, etc). The big question is, why does all this happen?
Causes vary from hereditary, and genetic conditions, to infections and abuse of pregnant women in the form of harmful drugs, radiation and at times to severe stress and complications during delivery that deprive the child of vital oxygen or nourishment, and later after birth, by head injuries, malnutrition and infections.
Tests like karyotyping, amniotic testing can, to a certain extent, predict genetic malformations, and genetic counselling for `at risk couples' helps in prevention, but in a country like India, with rampant poverty and lack of sophisticated equipment, such tests are a luxury and for a chosen few.
Modern medical advancement saves many a child born premature and with multiple problems, but has this contributed to an increase in children with developmental disabilities? The present concept is to start rehabilitation at the earliest for maximum benefits for `at risk' infants.
Early intervention provides educational, therapeutic, preventive, and supportive services for children with developmental delays and guidance for their parents. "The early period where the brain is receptive to a positive change is called as the critical period", says Dr. Premila, who has done a post graduate diploma in Early Intervention.
She also runs the Shilpa Special School in Cochin (Email ID - shyammenon@eth.net), started in memory of her daughter, 6 years ago.
She adds that 75 per cent of brain growth takes place in the last three months before delivery and first two years of life, when there is intense activity in the brain. This is the period where interconnection of neurons takes place, which is facilitated by stimulation of the cells by experiences from outside.
It is called plasticity of the brain ie. the brain can be moulded by external experiences. Millions of neurons, when not stimulated by experiences, wither off and most of us are leading our lives as intelligent beings with a mere fraction of the cells we would have had.
Early intervention for children with developmental disabilities is based on this fact that stimulatory experiences at an early age will help the child have a better functioning cells which could compensate for the damaged ones. In children with cerebral palsy, abnormal and exaggerated muscular activity could result in permanent disabilities. If proper intervention is given during this period, it can be corrected before permanent deformities result.
Nature is what brings a child to the world and nurture is what affects him after birth. Professor M.K.C. Nair, Professor of Paediatrics and Director ,Child Development Centre, Thiruvanathpuram Medical College, who has been doing pioneering work in this field for many years and is an authority in the field, emphasises the importance of timely detection and intervention.
Any delay in the four important milestones of normal development like, 1. Smiling (by 2 months), 2.Neck holding (by 4 months), and 3. Sitting independently (by 8 months) and 4.Standing alone (by 1 yr) should ring a bell and the child must be assessed by an expert.
`At risk' babies are given intervention by visual (colour, light), auditory (musical toys, cooing, talking mothers, and recorded voice), tactile (cuddling, massaging, and rubbing) and vestibulo- kinetic stimulation (sense of balance, like putting on a balance board, waterbed etc.) methods. Prof Nair stresses on the need to develop a preventive strategy through adolescent and prenatal care. Dr. Abraham Paul, paediatrician, Cochin Hospital agrees, and says that even learning disability (a condition of backwardness in school going children), which is usually detected after the age of 4, can be improved by early intervention.
With the increase in detection of developmental disabilities the need for early intervention units in every district is an urgent necessity. At present, parents of a child with delayed development run from pillar to post for guidance and help. Quacks exploit their helplessness and promise wonder cures, which leads to waste of money and time, until it is too late. Intervention by correction of visual, auditory and motor (muscular activity) senses prevents further deterioration and helps the child to respond better to external stimuli, which in turn, enhances their faculties.
"Devika used to just lie down and could not crawl at 9 months. After two months of physiotherapy she can now walk independently. Her vision has been corrected by spectacles and she is a happier child now with better social acceptance", says Darshana Murugan, whose daughter never cried at birth and had delayed development.
She is happy about her child's progress since last year and a half. Kartika, a one and a half year old with slow progress, showed great improvement after timely intervention. Lishma, Sando, Joel, Ajay, and other children of the early intervention unit of Shilpa special school have benefited much.
C.J.Kavi, who is a physiotherapist in Faith India, Puthencruz, emphasises the need to spread the word on early detection and intervention among society at large. Whatever be the faculties, an infant is born with the concept of early detection and intervention can go a long way in helping the mentally challenged.
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