Eye on Education

The sooner the better: Diagnosing, assessing special needs early improves a child’s odds for later success

Across the central San Joaquin Valley, almost 2,600 children ages 4 and younger with a wide range of disabilities receive services and instruction through special education programs run by counties or school districts to prepare them to enter kindergarten.

Such early and specialized intervention is increasingly recognized as crucial for very young children with developmental, emotional, behavioral or physical disabilities to potentially reduce the need for more intensive services later in their lives. But there are likely thousands more infants and toddlers in the Valley who are missing out on such services.

The reasons are myriad.

Travel distance becomes an obstacle for lower-income families in isolated Valley farming towns. Some parents don’t know how to recognize telltale indicators of developmental delays in their infant or toddler, or don’t realize that services are available to help them. Others may be in denial that their child has a problem and resist reaching out for help. And there is often a lack of capacity in preschool programs for children with special needs.

The California Department of Education reports that children 4 and younger are enrolled in special education programs in the Valley and statewide because of about a dozen diagnoses. While special ed programs include youths and young adults up to age 22, the most common issue among the very youngest children in the Valley are speech or language impairments — kids who get a late start in talking or who have a speech impediment or some other problem with verbal communication.

Youngsters also are diagnosed with autism, hearing problems, visual impairment, intellectual disabilities, emotional disturbance, orthopedic impairments (from birth defects, disease or accidents), learning disabilities, health conditions that hamper learning, and traumatic brain injury.

Some conditions are obvious from birth; others might not become clear for months without the eyes and ears of an attentive parent, a child-care provider or a pediatrician. And more subtle concerns are easier to ignore or overlook in a parent’s hope for the best, said Christine Borges, autism program manager for the Fresno County Office of Education’s special education division.

“Parents want to give their child the benefit of the doubt; they want to hope that they’ll catch up,” Borges said. If they sense something might be an issue, “some parents think, ‘maybe I’m wrong and by the time they enroll in kindergarten they’ll be fine.’”

An early start

Whatever the condition, experts concur that the earlier a child can be assessed and care provided, the better the odds the child will improve as they grow older.

“There has been a lot of research showing that if we help children in those early years, it can help prevent secondary problems,” said Barbara O’Neill, an early childhood and special education professor and director of Fresno State’s Joyce M. Huggins Early Childhood Center. “A lot of children with language delays also have difficulty with social interaction. If you have my toy, and I don’t have a way to say, ‘Hey, you took my toy,’ I’m more likely to just grab it.…Sometimes that comes out in a physical form, either externalizing and being aggressive toward someone else or internalizing and withdrawing.”

Tammy Frates, Fresno County’s program manager for infant and preschool special education programs, said the results can be dramatic for some children, particularly those with social and emotional disturbances. “Between birth and 3 years old, the brain is so pliable, we can change and improve those neural pathways and improve their outcomes,” Frates said. “It’s a huge difference (to intervene) from birth to 3 than waiting until they’re 10 and trying to work on the social-emotional issues or language development.”

Borges said early assistance helps children and their families learn how to deal with special-needs challenges. “Research in autism is very clear that the more intense your early intervention is, the better the future outcomes are,” she said. “It doesn’t make your autism go away, but it means your life outcomes, your adaptive behavior (and) your ability to take care of yourself all have the best chance with that early intervention.”

Similarly, speech and language exercises, occupational therapy and other exercises all can help youngsters catch up on developmental milestones.

Frates’ team of educators and specialists spread out across Fresno County to serve about 75 infants and toddlers under age 3 in their homes with their families. Children from ages 3 to 5 with diagnosed disabilities can receive services at several county-run preschools. Borges said her autism preschool program serves about 24. The county also has special preschool classes for children who are deaf or hard of hearing and for youngsters with moderate to severe intellectual disabilities.

Frates and Borges said the goal is to help children with special needs prepare to join their peers in a typical classroom — what educators call the “least restrictive environment” — for some or all of the school day by the time they’re ready for kindergarten.

Inclusion and socialization

Many children likely will require at least some special education services as they make their way from kindergarten through grade school and beyond. But a small proportion of children eventually reach a point where they no longer require the extra assistance. “We call it ‘accommodating to their disability,’” Frates said. “They still have their disability, but they no longer need special education; they know how to accommodate it.”

That’s just one reason why educators prefer to place children with special needs with their “typically developing” peers in preschool classes when possible.

“It’s just really crucial to many children for their success,” said O’Neill, the Fresno State professor. “It’s maybe not the right setting for every child, but we certainly have a lot of research showing the benefits of including children.… For children with special needs, especially if they have a language delay, it’s really important to hear their peers modeling the language.”

The Huggins Early Childhood Center at Fresno State has 12 of its preschool slots reserved for children referred from the Fresno Unified School District with special needs ranging from autism to Down syndrome to developmental or intellectual disabilities. They spend their mornings with the other children, helped by a full-time special education teacher and a part-time special ed assistant.

“For language development, for socialization and learning the rules and routines of the classroom, and even cognitively and intellectually, having these children in the classroom to hear the questions their peers are asking and starting to have conversations can really help bring those children along, to kind of stretch what they can do,” O’Neill said. “If children are thriving in their environment and interacting with their peers, memorizing the names of shapes and colors…ends up being easy compared to navigating the classroom.”

It’s a similar practice at Exceptional Parents Unlimited, now known as EPU, a nonprofit agency established in 1976 as a support group for mothers of children born with Down syndrome that now operates an east-central Fresno campus with an assessment center, library, therapy rooms and classrooms for more than 3,000 children and families with all manner of special needs.

On a recent visit, children with special needs mingled with typically developing children for playtime in one of EPU’s toddler rooms. When families bring a disabled child for therapy or classes, the playrooms offer activities for the siblings, too. “If a family has to hire a baby-sitter, that’s a deterrent to them coming here for services,” development director Kathleen Price said.

“They just all come together here,” added executive director Ellen Knapp. When play sessions start, children sit in a circle with their parents, “and they sing a song or read a book together” before the parents go to their own special support groups or classes. For the rest of the session, the special needs and other children are in the classroom together — an important socialization time for both sets of children.

The adult support groups and classes help parents learn to understand how they can provide the best care for their special needs child.

“We know we can treat the child, but if we don’t strengthen the family, the child doesn’t stand a chance,” Price said. “We see things like substance abuse, domestic violence, poverty, food instability, housing instability, all kinds of issues.”

Obstacles to overcome

Early-childhood special education programs are free to families from the county offices of education, EPU and other resources. But experts believe there are thousands of infants and toddlers in the Valley whose families don’t realize that their children are lagging in development or who don’t understand that help is available.

“We have a large Hispanic farm labor community in Fresno County that has no access to support or services,” EPU’s Price said. EPU tries to overcome that by sending its fleet of 11 vans out across the county to bring families into the Fresno center every day; on Fridays, the vans visit farming towns on the west side of the county to take families to Firebaugh, where therapy and counseling services are provided in Spanish. Frates’ Fresno County program for infants and toddlers takes its services out to the homes of families across the county, thus removing a potential transportation obstacle for isolated, low-income families.

And while both Fresno County and EPU receive referrals from Valley Children’s Hospital, pediatricians and other medical offices, many parents lack knowledge about what their children should be achieving as they move from infancy to toddler to preschool. “Some families just don’t know what to expect in terms of typical development,” said O’Neill. “If they don’t have access to health care or contact with a pediatrician, they might miss those really early check-ins that a pediatrician might notice.”

A lack of program capacity is another concern, particularly after a child with special needs turns 3 and is eligible for preschool. “For preschool, there is absolutely a lack of resources,” said Borges, the Fresno County autism program manager. “Preschool is not mandated by the state, so school districts have the option to provide it or not.”

There are Head Start preschool programs, but they are only open to lower-income families even if a child has a disability. “So the only programs then available for a middle- to higher-income student with a disability are special ed programs or private preschools,” Borges said. Many private preschools also have a requirement that children be potty-trained, which can be a challenge for children with developmental disabilities.

Fresno County’s preschool autism program offers an example about capacity issues. “I have three classes, and at some point you can’t accept more students with autism into a class in order to run a program where students can see growth,” Borges said.

In other instances, families can be daunted by the complexity of the special-education apparatus, “especially if they are struggling financially or in poverty and trying to navigate the system,” O’Neill said. “They don’t understand that there are free government-provided services, and even if they do, it can be overwhelming to navigate, to make the call and get their child there.…It’s a clunky system, and it’s not exactly user-friendly.”

Early-childhood special education

The number of children ages 4 and younger in the central San Joaquin Valley enrolled in special education programs through either county offices of education or local school districts:

County

Children 0-4

Fresno

1,430

Kings

139

Madera

303

Tulare

716

Source: California Department of Education, December 2014

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