Ten Ways to Promote Mental Health in Infants and Toddlers with Developmental Disabilities
By: the Mental Health & Developmental Disabilities Center
Raising a developmentally different child is a challenge for most parents. The challenge begins when the parent first learns that their child is not "normal." At some point during their pregnancy, most soon-to-be parents worry about whether or not their child will be healthy, but for the most part, parents count on thinking that everything will be okay. For those parents who find out at or before the child’s birth that something has gone amiss, there is a natural period of mourning and sadness that occurs in them and their family members. The fact that family members (i.e., grandparents, siblings, uncles, aunts), and even close friends are affected too, is very important because these are the people who are part of the parents’ usual support system. Most people have a difficult time responding to the grieving parents because they, too, are dealing with their own pain and loss both for themselves and for the new parents.
Some parents have what appears to be a "typical" child at birth and even for several months thereafter. Then suddenly, problems begin to occur—the child doesn’t respond to situations in a typical manner; the child has developed unusual mannerisms; the child has lost previously acquired language—these are some of the losses of functioning that commonly occur in autism. Finally, there are those sad and unfortunate cases of accidental injury or allergic reactions that result in tragic permanent disability due to the insult on the child’s brain.
1. Take care of your own emotional health first.
For all parents, there are some similar issues that may likely interfere in their ability to promote mental health in their infants and toddlers if these issues are not examined and resolved. Some of these issues include loss and mourning of the typical child they fantasized about and all the concomitant fantasies such as, "I wanted my daughter to be a ballerina," or "I hoped my son would have a chance at the major leagues." Then there are those other expectations we all have for our children, including college, marriage, and procreation. Suddenly parents are faced with the possibility that their child may be dependent on them for quite some time, if not for their entire life. What happens when the parents are no longer able to care for the child? In a flash, parents are flooded with having to learn about a disability they had never or only vaguely heard of, dealing with professionals, teachers, doctors, and other individuals who, although they are nice and knowledgeable, most parents would rather not have to deal with them in the first place! All of this occurs while parents are grieving, and it is sometimes very tempting to throw oneself into this knowledge acquisition phase and ignore one’s most important feelings—the loss of the typical child one dreamed about.
Parents whose child becomes disabled some time after a period of "normalcy" have yet another emotional burden to deal with—betrayal. For months they thought they had a "normal" child and suddenly, their whole world gets thrown into confusion.
It is so important for parents of developmentally different children to deal with their own emotional reaction to their child’s challenges if they are to be effective promoters of mental health in the child’s development. Learning about your child’s developmental challenges can affect you individually and your marriage. So, if you want your child to get the best of you, seek professional help as soon as you are able to, so that you can get the best of you back to give to your child.
2. Observe! Take the time to learn about your child’s emotional response sets to a variety of situations, including his/her reactions to you.
The next challenge that faces most parents of developmentally challenged children has to do with the child’s emotional reaction to the parent. Research has proven that as a species, we are innately programmed to respond to vulnerable creatures (i.e., young children and young animals) because they are programmed to elicit a response in us. Developmentally challenged infants and toddlers do not necessarily provide us with the responses that trigger our innate impulse to care for them. Some of them initially don’t respond much at all (i.e., the flacid, passive baby), others have responses that we don’t understand (i.e., the colicky, rejecting baby), and others respond differently every time the parent approaches them. These unexpected response styles create a state of confusion and a sense of inadequacy in many parents.
The best way to learn about your child is to observe the child. Obviously, all parents do this instinctually. But, as a parents of a developmentally challenged child, it is important to remind yourself on a regular basis that, although your child is not responding in the way you thought she would, she still is responding. You have to take on the role of detective to get clues and solutions to the problems that parents of typical children don’t usually have to deal with.
Find out what gives your child pleasure, learn to adapt yourself to your child’s changing moods, learn what turns your child off, and most of all, remind yourself everyday that your child’s emotional responses do not necessarily mean that you are a failure.
3. Follow your child’s lead! Participate with your child in those activities that bring him pleasure—even if it feels strange to you.
Joining your child in his world requires one essential parenting skill—imitate and follow—don’t make demands, don’t ask him to perform (i.e., "What color is this?" or "What does a cow say?"), and don’t direct the play. Sounds simple, doesn’t it? Well, it’s not! As parents we all want to feel proud of what our children know and we get great pleasure in asking them to show off, especially in front of other people so that they can see what great parents we are. However, most children don’t like to be drilled (nor do adults, for that matter), and when too much of this occurs, the child simply withdraws. Truly joining in your child’s world gives him the feeling that you treasure what comes from inside of him, not only what you draw out of him. It says to him, "I’m so delighted in you that I’m going to sit here with you and watch what you do, do it alongside you, and wonder with you why this is so fascinating to you." Granted, as parents we will always be tickled by our child’s responses to our questions, but too much of this can backfire on you. Instead, join in, talk about what you and the child are doing (i.e., "Boy, these rays of sunlight on the floor are really interesting…" or "You really like the sound of that block banging on the table…"). Finally, don’t be afraid to add to the play with your own creations in the hope that your child will someday become interested in you, too. If your child has limited awareness of others, you can gently create situations in the play to get your child to notice you. For example, if he is building with blocks, you might "accidentally" knock them over then help build them up again.
4. Feelings Talk! Put words to your child’s feelings.
Whenever possible, label your child’s feelings for him. Children who are able to identify their internal experiences have a better sense of who they are. Many children with special needs have a difficult time identifying abstract concepts, and feelings are abstract. Therefore, as a young child learning about the world and about himself, one important area of learning has to do with emotions. When you set limits and your child exhibits anger (i.e., throwing things, tantrumming, etc.), one of the first things you can do is label the emotion—"You’re so mad that you have to stop playing now." You may, of course, need to make other interventions, but don’t forget to label that feeling—even for young infants!
5. Positively Praise! Praise your child’s appropriate behavior.
As a parent it is easy to fall into the criticism trap, especially when we are overwhelmed and faced with difficult behaviors. However, it is important to remember basic behavioral principles—whatever you pay attention to, and attention can be either positive or negative, will increase. Therefore, if you are criticizing and not praising, the behavior you criticize will increase.
However, if you praise, praise, praise the positive, you’ll get more of it. Sometimes it’s helpful to put yourself on a behavioral program—challenge yourself to praise your child every 2-3 minutes. Statements such as, "I like the way you’re playing with your toys," or "I like the voice you used to ask for a cookie," will go a long way against banging, throwing, and whining. Praising your infant especially, but not exclusively, has a great deal to do with providing her with a "gleaming" mirror of herself—that gleam in your eyes when you look at her, the gentleness of your voice when you talk to her or imitate her cooing noises, the appropriateness of your touch (some like it softly, some like a more solid stroke—figure out which yours likes best). Let your child know that she is loveable and worthwhile at least 100 times/day!
6. Capitalize on Special-ness! Find out what is special and unique about your child and capitalize on it.
Your child may have special needs and he may be different from other children, but he is also special in his own ways, and it’s your job to figure out how. Once you have, capitalize on opportunities to let him experience his special-ness. For example, if he loves numbers, engage in activities where he can be the "smart" one and find the numbers needed. Whenever your child proudly brings you a "gem"—a lump of play dough; a scribble on a paper, etc.—act as if it is the most precious thing you’ve ever received. You may feel disappointment because you wish this product were more representative or age-appropriate. The most difficult thing you may have to learn to do is to keep a check on your expectations and learn when to push for more and when to put your child’s self-esteem before your own expectations.
7. Read emotional signals! Respond to your child’s dependency needs and assertiveness by knowing when your child needs your warmth and when your child needs you to let him grow.
Emotional signals can be tricky. At times your child may need to be dependant on you—he may need a hug or want to be close. At other times your child may be struggling but needs you to be able to tolerate her struggle in order for her to grow. There is a fine line between hovering/overprotection and under-protection. At the wrong time, either response will feel like a lack of empathy to your child, and he will feel misunderstood. In order to achieve competence in this area, parents may have to examine their own reactions to dependency and autonomy both to their child and to other people in their environment. Parents of special needs children also carry around a great deal of guilt, which sometimes gets in the way of responding in a developmentally appropriate manner. Have an open mind about yourself, get lots of reality checks by asking others to provide you with feedback, and be willing to bear a little of your child’s suffering along with her so that she can grow.
8. Adjust your levels! Keep your interactions at the child’s physical and developmental level.
Whenever you talk to your child, give directions, set limits, etc., do it at your child’s physical level. This means you have to squat down to make sure your child can see your face when you talk to her. Make sure you have eye contact before talking to your child—use the words, "look at me" to cue your child every time, if you have to. Talk to your child at her developmental level. For infants use simple one to two word phrases. Use visual cues whenever possible, but know when your child doesn’t need them. For example, if you give directions and always point, you’ll never know if your child truly understands your language or is relying on your visual cues to assist in comprehension. Gradually "fade" out the visuals when it’s appropriate. It may be helpful to work with your child’s teachers on this. Many children with special needs have problems with sequencing and/or processing auditory and/or verbal information. It is important to learn about your child’s idiosyncratic ways of learning and to respect those when interacting with her. If you approach your child in a manner that is too difficult for her, she will continually feel as if she is disappointing you and she won’t feel as if the world understands how she operates.
9. Wait! Don’t repeat your instructions over and over.
In addition to sequencing and processing difficulties, many children with special needs have delays in their response time. What this means is that you’ll have to learn to wait for your child’s response. Most parents—even parents of typical children—tend to repeat themselves, as if giving an instruction several times will get the child to do it quicker! For most children (and adults), this feels like nagging, and they tend to tune out. Furthermore, when you deliver the same instruction repeatedly, the child once again may feel as if they disappoint you (as you get angrier and angrier), and their self-esteem will be diminished. On top of this, if your child has a processing delay in response time, as they are processing the instruction you gave the first time, their process gets interrupted by the second and third times you deliver the same instruction, and they get confused and shut down. With special needs children it is important to deliver an instruction and wait—as much as 30 seconds (which can feel like a lifetime!)—before delivering the same instruction. More often than not, you’ll find that your child will respond appropriately if you give him the time he needs to process what you’ve said. Then, of course, you’ll praise him, tell him how great he is, and he’ll feel like the king of the world!
10. Ask for help! How to know when to seek professional help.
As you move into the world of special needs with your child, you will find that you are surrounded by professionals and specialists. Use them as much as you can to ask questions, clarify confusions, and get advice. Prior to visiting with a doctor, teacher, etc., make a list of all of your questions so that you’re sure not to forget anything. Finally, know when to get professional help with your child’s emotional needs by keeping your eyes open to some of the following symptoms/behaviors: sudden, inexplicable changes in mood; newly observed regressive behavior (clinginess, bedwetting, separation/school anxiety); excessive tantrumming; changes in sleeping or eating patterns; a general lack of motivation or enthusiasm about anything; or any other symptoms/behaviors that don’t "sit well" with you. You know your child better than anyone else who works with your child, and you probably have good instincts about your child. Follow them, and don’t be afraid to ask for help.
This module was contributed by Dr. Sarita Freedman. Dr. Freedman is a Licensed Psychologist in private practice in Woodland Hills, CA. She is a former special education teacher with over 15 years of experience working with children, adults, and families—both educationally and psychologically. Dr. Freedman is also the Director of Special Needs Programs at the Center for Infant Parent Development, Woodland Hills, CA. She can be reached at (818) 999-9330.
Copyright, Mental Health & Developmental Disabilities Center