When it comes to children who require additional support, it is important that their particular needs be identified as soon as possible in order to make suitable arrangements for them at home and at the concerned educational institutions for providing guidance, assistance and management.

In a developing country such as ours, state institutions are rarely proactive nor have the means to provide systematic care or house to house diagnostic services covering the specific support needs of children of the entire population. Even family physicians, psychologists, psychiatrists, neurologists or educationists will not be automatically attracted to provide help to our children, unless parents are first able to identify the needs in children. Parental involvement is of paramount importance therefore, especially for the early detection of the signs that can impair the healthy development of a child physically, emotionally and mentally.

While some of the contributing diseases in the case of children with disability, like autism, cerebral palsy, Down syndrome and other mentally challenging disorders become detectable in early infancy, disorders like attention deficit (ADD) and or attention deficit hyperactivity (ADHD) are at times difficult to diagnose with any clinical certainty and the conditions can easily be overlooked or neglected by doting or clueless parents throughout childhood and adolescence. As a result such disorders may well be carried into adulthood. It is important for parents to realize that they are in a unique position to have intimate knowledge of their child’s genetic background and are ideally placed to judge whether their children are at a higher risk of suffering from these disorders, especially when there is a known family history to support such prior apprehensions.

It is important that parents ensure a healthy home environment and social surrounding for the upbringing of their children. If the home or social environment for some reason is not nurturing, it would impede health development of children. It has often been observed that stress and trauma in a child’s life, like death of a parent or divorce of the parents can have an adverse impact on the development of the child, who may otherwise not have been at risk of suffering from ADD or ADHD. Similarly, any unrelated and untreated medical condition or inability to cope with difficult school work, depression, anxiety or insufficient rest and sleep could also create pseudo symptoms of a disorder. It is therefore important that the spoilt, bratty or bizarre behaviour of the child is discounted in the short term before coming to any absolute conclusion about the observed disabilities and disorders.

Thus parents have to be aware of the real, nagging and sustained symptoms of these disorders if they are expected to make an early but sound judgment call on any developmental malaise affecting their children. According to the American Academy of Child Adolescent Psychiatry (AACAP) and the National Institute of Mental Health (NIMH), the symptoms must be observed to have persisted continually for a standard period of time before any development disorder can be affirmed or confirmed for treatment.

It is understandable that the earliest chances of observing symptoms or traits of a disorder would be at home. According to the experts, the onset of disorders in classic cases of ADD and ADHD for example are said to appear much before the age of 7. By this age the child can be expected to be facing real handicaps in life as would be observable at home, in the classroom, the playground, community and all other social settings. This emphasizes the need for the parents to carefully and routinely observe the child’s behaviour and not ignore or laugh off frequent tantrums and the like just as cute willfulness and childish stubbornness of the adored child. Sustained vigilance would therefore, be the key for screening all suspect cases.

These are just guidelines that should prompt and spur the parents to devote more attention to any problem that may have the possibility to turn out to be a disorder. But the disorder can only be deduced and confirmed after the most careful and extensive observations. It is wisely recommended that a child psychiatrist, psychologist, development pediatrician, behavioural neurologist or a clinical social worker should also be consulted as early as possible. Thereafter, in a joint consultation that may ideally include the child’s teachers also, a comparative behavioural rating scale may be drawn up. This consensus scale could then be used to draw up a specific plan for administering behavioural therapy or medication as may be considered necessary for that particular child.

Parents of children, who are required to move due to transfers frequently such as in our military, civil or Foreign Service, should pay special attention to the developmental needs of their children. Frequent changes of residence, school, teachers and friends can put considerable strain on children and they may require additional support in order to deal with the changing environment.

Following are some suggestions which will facilitate in timely detection:

• Parents must visit their family physician routinely for medical checkups. Schools can also aid in organizing annual medical examinations of students that allow for screening of all students in school. This screening is vital for identifying any major or minor ailments and infirmities like the innocuous build up of wax in the ears, injury related or temporary deafness, shortsightedness, tonsillitis, trachoma and even malnourishment that if left untreated and can affect the student’s performance adversely.
  
• Keeping abreast of your child’s progress at school is important. Schools should also take parents into confidence vis-à-vis the child’s progress. Discussing any difficulties a child might be facing can aid in arriving at the right conclusions. For example a child may be performing poorly during an academic term due to a medical condition or due to the fact that s(he) is emotionally disturbed. Correct diagnosis will automatically lead to the right action.
  
• Parents must advocate that the school has provision for addressing need of all children. For example if it is not possible to employ a separate student counselor, at least a senior teacher may be deputed and if possible trained to provide counselling to the students in need of additional support. This will go a long way towards building an institutional framework that would help in timely referral of some children to behavioural therapists or any other health specialist depending on the needs of the referred students.

Recognizing a problem early is critical to any subsequent cure. Like a stitch in time saves nine, timely detection of warning signs will ensure good management of the disorder in the first instance and a possible cure when the management is sustained over a period of time. The role of the parent for being the child’s savior is therefore, undeniably pivotal.

About the Writer:
Mr. Sohail Ittehad Hussain is a former Ambassador of Pakistan and has been a career diplomat. He has served in Singapore, Brazil, Turkey, Libya, Niger and Zimbabwe as a resident diplomat and was actively associated with Malta, Suriname, Paraguay, Bolivia, Botswana, Burkina Faso, Liberia, Namibia, Togo and Zambia as well.