'Disability’ refers to an intellectual, psychiatric, cognitive, neurological, sensory or physical condition or impairment that has a substantial impact on a child’s ability to learn, communicate, move, participate in social situations or care for themselves. In children aged 0-6, the term ‘developmental delay’ is used to describe when a child is slower to develop skills in these areas.
Developmental delay does not necessarily mean a child will go on to receive a formal disability diagnosis. With the right interventions, a child experiencing developmental delay may receive all the support they need to ‘catch up’ to their peers.
Identifying when a child has a disability can sometimes be difficult, as signs and symptoms of some types of disability can easily be confused with signs and symptoms of neglect, or a child’s response to trauma. (Refer to Child traumatic stress and disability).
It’s important to have an understanding of children’s developmental milestones and what might be a cause for concern. Using simple resources with parents and caregivers to identify childhood development and areas of need can help children receive early intervention and support for any possible disability.
The resource Red flags early identification guide for children aged birth to five years developed by the Child Development Program in conjunction with Brisbane North Primary Health Network (2016) can be used to have conversations with parents and caregivers about their child to identify any areas of concern so early intervention can occur.
The Queensland Government (2014) has numerous resources on child growth and development including expected developmental milestones for different age groups ranging from newborn babies to children age five years.
To ensure that a child with disability can access the disability supports they are entitled to, it is important to challenge assumptions and beliefs in relation to the presentation of the child. Ask yourself:
- Could these behaviours be signs of a disability? Could the child be using them as a way to communicate an unmet need?
- Could trauma symptoms or coping strategies be masking this child’s disability?
- Has a health professional thoroughly assessed this child and identified any possible developmental delays? (Refer to procedure 5 Develop a child health passport.)
- Could this child benefit from further assessments to identify any potential impairments or disability?
Whenever signs or symptoms of possible disability or developmental delay are present or emerge, investigate and respond to this in a timely way. Access to early intervention support can be the key to a child achieving their optimal development and wellbeing, and can dramatically improve their social, emotional, behavioural or mental health outcomes later in life. If there is uncertainty about whether certain behaviours, signs or symptoms displayed by children you work with may be a possible developmental delay or disability, talk to your Senior Team Leader, Senior Practitioner or Specialist Services Clinician for further advice.
Traumatic stress and disability
Many children you work with have experienced stress and trauma due to abuse, neglect, and other adverse life experiences. Not every child who experiences abuse or neglect will experience a traumatic stress reaction, but many will. When a child has traumatic stress, they may exhibit signs such as:
- An inability to concentrate
- Behavioural regression (for example, wetting themselves when previously toilet trained)
- Separation issues, appearing fearful and anxious
- Somatic complaints (complaining of a stomach ache with no medical explanation)
- Impulse control issues
(Wraith (nd); Royal College of Psychiatrists, 2019).
Working with a child who may have experienced trauma and is exhibiting signs of traumatic stress is complex, as many of the signs and symptoms of traumatic stress can overlap with different disabilities.
Consider the following scenario:
You have received concerns about a five year old boy named Sam. The concerns indicate that Sam was in the kitchen when his father came home intoxicated and held a carving knife to his mother’s throat, then cut her on the arm with the knife. The police arrested Sam’s father, and Sam went to the hospital with his mother via ambulance for her injuries to be treated. Feedback from both Sam’s parents and school indicates he has an inability to concentrate in the classroom and finds learning difficult. He appears disorganised and doesn’t seem to listen to what others are saying to him. He is constantly fidgeting, has great difficulty sleeping, and sometimes has nightmares. When you try to talk to him about simple things like his age and interests, he is reluctant to talk and make eye contact with you, and moves away from you soon after you sit down together.
- Does this sound like Sam is having a traumatic stress response to the domestic and family violence he has experienced?
- Does it sound like Sam has ADHD?
- Perhaps Sam has undiagnosed ADHD and his symptoms have worsened since his father’s violent behaviour towards his mother?
- What would the outcomes for Sam be if you only pursued therapeutic intervention for Sam in response to his traumatic stress due to the domestic violence?
- What would the outcomes be for Sam be if you only pursued an ADHD diagnosis?
Examples such as these highlight the importance of ensuring a rigorous and balanced assessment of Sam’s needs to ensure his disability and therapeutic needs are being recognised and responded to. The following diagram provides an overview of the signs and symptoms of trauma, ADHD, as well as the overlap between the two. For more information on ADHD, refer to Attention Deficit Hyperactivity Disorder.
Develop an understanding of the child and their disability
The International Classification of Functioning Framework can help understand how a child’s disability affects their functioning in everyday activities.
A clear understanding of a child’s disability and the impact it has on their functioning is critical to complete your core business. This knowledge assists practitioners to effectively meet the needs of children and families, supporting them to:
- Plan more effectively for Investigation and Assessments and consider what resources or people are needed present to interview the child in a meaningful way.
- Complete comprehensive child strengths and needs assessment, including the ways a child’s disability influences domains beyond ‘Child Development and Intellectual Ability’.
- Develop clear worry statements, goals and actions for parents who need to change their behaviour to better respond to their child’s need for safety, belonging and wellbeing.
- Organise effective, person centred Family Group Meetings or case plan review meetings to ensure the child is heard and their needs are met.
- Complete meaningful placement agreements that ensure all appropriate supports are documented and implemented for children and their carers at the commencement of a child’s placement. This includes providing high support needs and complex support needs allowances.
- Ensure the child's NDIS plan is appropriate to meet their disability support needs. (Refer to Procedure 5 Respond to a child's disability needs.)
Everyone’s disability affects them in a different way. Never assume to know how a person’s disability affects them without asking them and understanding first.
The following short video shows what it feels like to walk down the street for a neurotypical person, then for someone who has autism.
- What did you learn about Autism from watching the video?
- If you were the CSO for a child whose autism experience was similar to the person in the video, what do you think you would need to consider to effectively engage with them and have meaningful home visits?
Developing an understanding of life for the child’s parent
Parenting or caring for a child with disability will have its own joys and challenges. In order to support a child who has a disability, understanding the experiences of the child’s parents and caregivers can help you meet the needs of the child and improve family functioning.
A study of over 1000 people caring for someone due to disability or old age from the Australian Institute of Family Studies revealed that in comparison to the general population, the caregivers:
- Experienced higher rates of mental health problems
- Had poorer physical health
- Suffered from greater financial hardship (Edwards et al., 2008).
To help understand life for a parent of a child with disability, complete a Circles of Safety and Support Tool to support them to identify safe people and potential connections who can be part of their network in assisting the parent and their child to be safe and supported.
The Raising Children Australia website can help you understand what some parents may experience when parenting a child with additional needs.
Children with disability are at increased risk
Children who have a disability are at increased risk of abuse and neglect. This risk can increase or decrease depending on the type and severity of a child’s disability, and the presence and absence of a range of risk and protective factors. For information on risk assessment with children with disability, refer to the Risk assessment section of the Disability practice kit.
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