December 6, 2023


education gives you strength

Early intervention: Spotting problems in your adopted child’s development

Reprinted from:

Maybe I was paranoid. Everyone seemed to think so. But my son was almost 2 years old and showing no signs of talking. Boys always talk late, people said. Albert Einstein didn’t talk until he was 3, they said. But I knew plenty of 2-year-old boys who were at least trying to speak. And I knew that my son’s blood lead levels had at one time been elevated. To say I was worried is an understatement.

When I confessed my fears to a friend, she had a simple response: “Have you tried Early Intervention?” Of course I hadn’t. I had never heard of Early Intervention.

The Early Intervention program

Discovering the Early Intervention program can feel like stumbling upon a pot of gold on the steps of City Hall. You’re going to evaluate and diagnose my child? You’re going to assign committed, talented therapists and educators to his case? And these services are going to help my child reach his potential? And it’s all for free or, at worst, for a pittance?

Hard to believe, but it’s true. Early Intervention (EI) provides special services to children from birth through age 3. It arose from the Individuals with Disabilities Education Act (Public Law 99-457), passed in Congress in 1986, which mandated that children with developmental delays were entitled to a wide range of rehabilitative services. These include speech therapy, occupational therapy, and family counseling. Services may be rendered in a freestanding agency or in the child’s home, for up to 40 hours a week, according to the needs of the child.

It is quite common for young children, whether they come to their families by birth (as my son did) or through adoption, to experience some delays in their early development. “About 75 percent of the kids I see are delayed when they come,” says Dr. Jane Aronson, a pediatrician at International Pediatric Health Services in Manhattan. Aronson specializes in adoption issues, often fielding calls from nervous new parents in hotel rooms overseas. “About 25 percent look pretty normal. A lack of experience and a lack of stimulation have led to teeny delays that disappear in a matter of months. The other 75 percent take more than a few months.”

To speed the progress, and to prevent further issues from cropping up, Aronson heartily recommends Early Intervention (or at least the evaluation) for virtually all adopted children.

Getting in

To become eligible for the program, children first need to be referred, then evaluated. In some states the referral must come from a pediatrician. In others, it can come from a social worker or even the parents themselves. If the child is diagnosed with two areas with a 25 percent delay, or one area with a 33 percent delay, he or she will be admitted to the state’s EI program and assigned therapists. 

EI therapists caution against relying solely on a pediatrician’s advice – or the well-meaning opinions of friends and family. “We heard, ‘Oh, you’re overreacting,'” remembers Susan Tombrello of Littleton, Colorado. But her son, Sasha, who came from Russia at the age of 6 months with a developmental age of 10 weeks, was not progressing. The Tombrello’s HMO advised them to wait until Sasha was older, when he could get help through the schools.

“That’s wrong,” says Aronson of this kind of advice. “My saddest cases are kids who were not seen in EI and waited until they were 3 and could get Special Ed in the schools.”

Sasha was 4 before the Tombrellos found a neurologist who was able to guide them to the help they needed. Now 5 1/2, Sasha is in therapy, with an excellent statistical prognosis. Without sounding regretful, Tombrello says, “I wish it had been easier for us. We came to the right answers, but it was very circuitous.”

Educating parents, too

One of the benefits of early intervention is the education that parents receive from regular encounters with therapists. “Our therapists not only taught our daughter,” says Kara Post, “but they also showed us how we could help her. I learned a lot by watching them.” One therapist gave the family homework assignments. “They were fun things, like making edible play dough that she could put her hands in and have that tactile experience. I wouldn’t have known that.”

Yet some parents hesitate to seek help. “At the beginning it was so hard,” remembers Rosemarie Crowder, a Brooklyn mother of four, who has seen three of her children through EI. “I was embarrassed about it. How could I explain this to my family?” Finally, Rosemarie consulted with an EI counselor. “She guided me through the anger,” she says.

Some parents worry that the child’s diagnosis will go onto his or her permanent record, a fear that Susan Campbell, Director of Significant Steps, a service-provider in Brooklyn, New York, waves aside. In most states, after a child turns 3, the intervention record is not passed along, unless the child continues with services through the Board of Education. In that case, the child’s record would indicate services had been provided – but the parent is able at any time to erase that information. “It doesn’t have to stay on your record,” says Campbell. “It’s up to the parent to have it taken off.”

Thankful families

After age 3, children who still need services will switch to programs provided through their state’s Board of Education. In many cases, children are phased out of the program as the delay is overcome. Rosemarie Crowder says of her son Peter, “Now he’s 5 1/2. As of July 18, his diagnosis of PDD (Pervasive Developmental Disorder) was removed. I know in my heart, had it not been for Early Intervention, he would still be locked in his own world.”

“EI is a great program. It is proven,” says Susan Campbell. “It gives children the boost they need.” Ultimately, she says, it saves money to treat children earlier rather than later. 

And yet EI is in danger of being chipped away. In many states, it has become a fee-for-services program with a sliding payment scale. Campbell encourages parents who’ve had good experiences with EI to contact their representatives and let them know how important EI is.

I’d be happy to offer such a testimonial. My son was evaluated by three therapists and admitted to EI with a significant speech delay. Over the course of a long, hot summer, a young speech therapist named Nicole came three mornings a week to our apartment. As far as my son was concerned, she was a fantastic playmate with a big bag of toys. At first, progress was slow. “Do you really think this is going to work?” I asked Nicole on one particularly frustrating day. She laughed and assured me of a good outcome.

She was right. By the end of the summer, an explosion had occurred. Full sentences, colors, commands, feelings. My son was back on track. I joined the legions of families grateful to have stumbled upon a pot of gold – my child’s potential.

Early Intervention 411

What is Early Intervention?
Under the Federal 1986 Individuals with Disabilities Education Act, children from birth to age 3 diagnosed with a developmental delay are entitled to receive rehabilitative services free or on a sliding fee scale. After age 3, if the child is still needs services, he or she comes under the auspices of the local Board of Education.

What are some of the services provided by EI?

  • Speech Therapy: Develops skills that affect the child’s ability to make sounds and form words. These may include swallowing and breathing techniques.
  • Occupational Therapy: For fine motor skills, such as holding small objects.
  • Physical Therapy: For gross motor skills, such as standing and sitting.
  • Also available: family therapy, special education, parent support groups, developmental groups, siblings services, and sometimes transportation assistance.

How do you contact the EI program?
In some states a child’s pediatrician must make the referral; other states have a hotline, by which parents themselves can make the referral.

What are some common signs that lead parents to EI?
Doctor Jane Aronson has treated many adopted children in her pediatric practice. Here are some of the indicators that lead her to recommend an EI evaluation:

  • A child seems to understand what others are saying, but doesn’t express himself.
  • Delayed crawling or walking – even if it seems to result from institutionalization. You don’t need to wait for a child to “catch up” – that’s what EI is for.
  • A child very suddenly stops or regresses, after previously progressing normally. (Plateaus are normal, but a radical halt or regression is worth looking into.)
  • Any sudden change in the habits of daily life: e.g., a child becoming less playful, or loss of appetite.
  • If a parent suspects a child isn’t developing normally. You are the expert when it comes to your child!

What to expect
Children develop at different rates. Don’t panic if your child isn’t reaching every milestone. But if you think there is a delay, schedule an evaluation. Here are the New York State Early Intervention guidelines for normal early development:

At 6 months

  • Follow moving objects with their eyes
  • Turn toward source of normal sound
  • Reach for objects and pick them up
  • Switch toys from one hand to the other
  • Play with their toys
  • Help hold the bottle during feeding
  • Recognize familiar faces
  • Babble

At 12 months

  • Sit without support
  • Pull to a standing position
  • Crawl
  • Drink from a cup
  • Play peek-a-boo and patty cake
  • Wave bye-bye
  • Hold out arms/legs while being dressed
  • Put objects in a container
  • Know five or six words
  • Stack two blocks

At 2 years

  • Use two- to three-word sentences
  • Say names of toys
  • Recognize pictures
  • Carry something while walking
  • Feed self with a spoon
  • Play independently
  • Turn two or three pages at a time
  • Like to imitate parents
  • Identify hair, eyes, ears and nose by pointing
  • Stack four blocks
  • Show affection

At 3 years

  • Walk up steps (alternating feet)
  • Ride a tricycle
  • Put on their shoes
  • Open door
  • Turn one page at a time
  • Play with other children for a few minutes
  • Repeat common rhymes
  • Use three- to five-word sentences
  • Name a color correctly
  • Are toilet trained

Find out more:

Pre-adoption medical assessment

How my son learned to play

Downloadable worksheets to help you budget for and navigate the adoption process

Larissa Phillips is an associate editor at New York Family, in which a version of this article originally appeared.

Copyright © 2014 Adoptive Families

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