Child Development:  Issues and assessment

Cultural context

In Canada, children with disabilities are included in most aspects of life and have opportunities to be active members of society. This is not the case in all other countries. Newcomers may come from societies where knowledge and attitudes toward children with disabilities is very different from the experience of the Canadian-born population.

Newcomers may:

• be unaware of typical child development patterns and milestones.
• not know about resources and systems to help children with developmental problems.
• not know that governments and schools provide supports and accommodations for people with disabilities.

Keep in mind that some families may be reluctant to identify concerns for fear of affecting their success in applying for permanent residency status in Canada. Conversely, families often put great hopes in Canada’s health system’s ability to solve developmental difficulties that may not be curable, such as those associated with chromosomal anomalies, for example.

Children who enter school ready to learn adjust better to formalized schooling and are more successful over time. The Early Development Instrument (EDI) identifies populations more or less at risk at the time of school entry. Second language learners — children not proficient in the language of educational instruction (e.g. English or French) — may be equal in their physical readiness to learn, but behind in their language, general knowledge, communication and cognitive development.¹

If a child has an additional developmental problem, it is important to link the child to programs that improve school readiness, such as structured preschool programs, as well as other developmental services and parenting supports. 

Identifying and managing developmental disabilities

When children arrive in Canada

At the initial assessment: Information about a child’s current development, the family’s migration history, as well as any earlier educational experiences, can help to identify whether a child should be linked to support services. Some children may have had more intensive services than are available in Canada’s publicly funded system. Children may have been prescribed medication that is not available or not used in the same manner in Canada. An Internet search can identify the ingredients in uncommon medications.

Using structured approaches such as the Rourke Baby Record, Healthy ABCs/ABCdaire, or the Ages and Stages Questionnaires (ASQ) can help identify developmental issues in preschool children up to age 5. The ASQ is available in English, Spanish, Somali and Hmong, and the second edition is available in French.  Information is available on the Ages and Stages Questionnaires in other languages.

In older children, information about medical history, previous developmental/psychological assessments, and educational experiences can help reveal whether children had identified difficulties before coming to Canada.  Interpreter support can be very helpful in obtaining accurate information and in allowing families to participate fully in the medical visit.

Developmental assessment

Health care professionals in Canada use ongoing surveillance processes to identify children at risk for a developmental problem in order to link them to additional community resources.  

In Ontario, for example, there is emphasis on the 18-month well-baby visit to identify children believed to be at risk for a developmental problem, using the Nipissing District Developmental Screen. Active developmental surveillance is necessary to identify children who are delayed and may require intervention.

The Rourke Baby Record or ABCdaire can provide a structure for assessment, but it is critical to link identified children to supports upon identifying a concern. Because the newcomer family may have difficulty in navigating for services and referrals, they may benefit from follow-up contact by the health care professional.

Assessing a school-aged child or adolescent new to Canada can be challenging because tools are typically available only in English or French. Tools that assess non-verbal skills may be useful. Resources are available from the Canadian Paediatric Society.   

Immigrant and refugee parents may face challenges that make it difficult to act on the health care provider’s advice, such as lack of support systems, grief at what they have sacrificed, traumatic migration history, difficulty coping with their child’s disability, or mental health complexity. They may be underemployed or working extended hours to provide a basic family income. In addition, many of the information resources for parents may only be available in English or French. These are additional risk factors that can aggravate the child’s condition, and impact their ability to access care.

When a developmental issue is identified, it is important to communicate and interpret it with the family in their unique psychosocial and  cultural context. In different cultural perspectives, it may not be seen as a priority for children to reach certain milestones — such as self-feeding or dressing — at a particular age. Sharing with parents that children are expected to have specific basic skills at school entry can give a rationale for actively teaching these daily living activities. Also, it is important to emphasize the importance and time-sensitive impact of rich early learning experiences for long-term developmental outcomes. Information for parents on developmental milestones is available from the Canadian Paediatric Society.

Most communities have services and programs for children and youth with disabilities. The family may additionally be eligible for government benefits. Some families may not be aware of services provided at no cost. Once a developmental condition is identified, it is helpful to outline services and funding in the Canadian system available to support the child’s development, and in linking to local services, while emphasizing the benefits relating to participation. Families may find it helpful to connect with an advocacy or support group that is focused on the needs of their cultural, linguistic or ethnic community.

What health professionals can do

1. During the initial assessment, use active questioning based on existing tools to detect developmental problems, using an interpreter if possible, and a culturally-competent approach.
2. Actively observe for developmental problems in young children using the resources available in your province or territory, such as the 18-month well-baby visit in Ontario.
3. When taking a medical history of children born outside Canada, consider infectious and non-infectious diseases that are uncommon in Canada but which may have developmental sequelae, such as cerebral malaria, vitamin B12 deficiency or lead toxicity.
4. Link the child’s family to available preschool and/or intervention and support services. 
5. A letter from a health professional outlining the child’s needs and diagnoses can be helpful for parents negotiating therapeutic service and the school system.

Selected resources

• Best Start Resource Centre. Growing Up in a New Land:  Strategies for Working with Newcomer Families. A manual for service providers working with newcomer families, particularly in public health, with emphasis on child development.  Growing Up in a New Land:  A Guide for Newcomer Parents.  A booklet for newcomer parents with children 0-6.
• Washbrook E, Waldfogel J, Bradbury B, et al. The development of young children of immigrants in Australia, Canada, the United Kingdom, and the United States. Child Dev 2012;83(5):1591-607.
• Ages and stages questionnaires (ASQ), 3rd edn. Baltimore, MD: Brookes Publishing Co.
• Janus M, Hughes D, Duku E. Patterns of school readiness among selected subgroups of Canadian children: Children with special needs and children with diverse language backgrounds. Hamilton, Ont.: Offord Centre for Child Studies, McMaster University, 2010.
• Nipissing district developmental screen (NDDS) is a developmental screening tool for infants and children up to 6 years of age, to be completed by a parent or health/child care professional.
• Rourke L, Leduc D, Rourke J. Rourke baby record: Evidence-based infant/child health maintenance guide, 2011.
• Survey of Wellbeing of Young Children (SWYC) is a freely-available, comprehensive screening instrument for children under 5 years of age.

Parent handouts from the Canadian Paediatric Society’s Caring for Kids:

• Your child’s development: What to expect
• Child care: Making the best choice for your family
• Playtime with your baby: Learning and growing in the first year
• Your baby’s brain: How parents can support healthy development

References

1. Janus M, Hughes D, Duku E. Patterns of school readiness among selected subgroups of Canadian children: Children with special needs and children with diverse language backgrounds. Hamilton, Ont.: Offord Centre for Child Studies, McMaster University, 2010.