Early Intervention for Neurodivergent Children

& The Indispensable Role of Parents
Authored by 
Suja Pisharody & Gopan TP

 

Part I

Abstract

 

Neurodivergent (ND) conditions like Autism, ADHD, Dyslexia, Dyspraxia, Dyscalculia, Pervasive Developmental Disorder (PDD), etc., are typically hidden disabilities. These disorders are suggestive of differently wired brains. Neurodivergence is not a medical condition, it is a term ascribed to a natural variation in brain function. The key to providing an enabling environment for ND children to flourish and grow by nurturing their strengths into productive individuals requires them to be equipped with the tools to manage/ cope with their various neurodivergent conditions. A well-designed Early Intervention Program (EIP) can provide ND children the required support while growing up during the phase when the phenomenon of neuroplasticity of brain is pronounced. EIP comprises various therapies provided by qualified therapists which help the ND children with their individual requirements while they deal with their different neurological wiring. For any programme which deals with the natural development of children, the role of parents is extremely crucial. In case of ND children undergoing EIP this become even more pronounced as there can be no better therapists for a child other than his/ her own parents.

 

Keywords

AAC     -           Augmentative and Alternative Communication

ADHD  -           Attention Deficit Hyperactive Disorder

ASD      -           Autism Spectrum Disorder

EI         -           Early Intervention

EIP       -           Early Intervention Program

ND       -           Neurodivergent

NT        -           Neurotypical

OT        -           Occupational Therapy

PDD     -           Pervasive Developmental Disorder

SI         -           Sensory Integration

SIT       -           Sensory Integration Therapy  

SLP       -           Speech & Language Pathologist

SLT       -           Speech & Language Therapy

 

Setting the Personal Context - Our Son Dhruv’s Journey​

1. We are parents to Dhruv, who is a 15-year-old Autistic boy. Our worldview on ND is shaped by our lived experience of bringing up Dhruv. He is our guiding light and torch bearer into the world of neurodivergence from the time we developed the awareness that he was ‘differently wired’.

2. Dhruv’s story exemplifies the core tenets of neuro-affirming early intervention. Diagnosed at age six, he began EI therapy only thereafter. Nine years later now, his transformation - from a child distressed by a drop of water on his shirt back then, to one who confidently rafted in the River Ganga for hours in wet clothing - illustrates how persistence, appropriate therapy, loving advocacy, all interwoven with a liberal dose of patience can lead to meaningful change. It is this perspective that we are attempting to present specifically thorough this paper and through all our other endeavours in general. We try to be mindful of these aspects while interacting with parents/ caregivers/ professionals (therapists) either in direct talks and communications or in support groups on social media channels.

3. Impact of Autism & Dyspraxia is what we experience in our daily lives through Dhruv. Therefore, based on our experience, it is important that child & adolescent psychiatrists/ (neuro) developmental pediatricians/ professionals/ therapists and last but not the least parents/ caregivers of autistic children understand the following aspects: -

       (a)   During the various evaluation tests like CARS or any other tests which define the 

              diagnosis through a representative score; the person/ child subjected to such 

              evaluations is not and SHOULD NOT BE defined by a ‘score’ or a ‘number’.

        (b)  The temptation to ‘fix’ / ‘fit’ the ND children into the otherwise ‘NT world’ should 

              be avoided.

        (c)  Do remember that the ND child is a human being who perceives and interacts

              with the world slightly differently compared to the majority NT population.

        (d) In case of Autism “Spectrum” Disorder, as indeed in the nomenclature, it is a                       “spectrum” which needs to be understood as: -

              (i) “Spectrum” refers to a continuous sequence or range of different but related 

                   elements, values, or properties. It is often used to describe phenomena that

                   vary gradually across a scale without distinct boundaries.

             (ii)  Viewing “spectrum” with the lens of Autism, it refers to a range of 

                   neurodevelopmental conditions characterised by differences in social

                   interaction, communication, and behaviour, recognising the wide variability

                   among individuals.

             (iii)  No matter which part of the autism spectrum an individual may be; it is

                    important to understand that ‘labelling’ into mild/ moderate/ severe or low

                    functioning/ high functioning is irrelevant because autism will remain an

                    integral part of the ND person’s life - however wishful the parent/ caregiver

                    may be. Autism is not a treatable medical condition but instead it is a disorder

                    and must be dealt with as such.

              (iv) Therefore, empowering the ND child/ person with the required coping

                    mechanisms is the most critical aspect to be worked upon right from the

                    commencement of an EIP.

              (v)  Parents/ caregivers must desist from following the ‘herd mentality’. One must

                    try to understand the child’s neurodivergence and work according to the

                    needs of the person. There is no one size fits all !  There is no easy way but to

                    understand your child’s ND condition so that the most appropriate

                    interventions can be provided.

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Introduction

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4. Neurodivergent (ND) conditions, encompassing a range of variations in brain function, are increasingly recognized not as deficits but as natural human differences (Kapp et al., 2013). Neurodivergence refers to the natural variation in human brain function and includes conditions such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Dyslexia, and Dyspraxia, among others (Armstrong, 2010). These are not deficits, but differences—an important shift in perception that reframes the discussion from medicalized "fixes" to supportive and empowering strategies. Unlike medical conditions requiring a cure, neurodivergence describes brains that are "wired differently," leading to unique ways of perceiving, learning, and interacting with the world (Walker, 2014). This perspective shifts the focus from "fixing" neurodivergent individuals to creating enabling environments and providing the necessary tools for them to flourish and leverage their inherent strengths.​​

 

5. The world at large is primarily composed of neurotypicals (NTs), individuals whose neurological development and functioning are considered typical. Consequently, neurodivergent individuals often navigate a world not inherently designed for their neurological makeup, necessitating specific strategies and coping mechanisms to thrive - a phenomenon often described as being "neurodivergent in a neurotypical world" (Botha, 2021). Just like neurotypical children, neurodivergent children require support to learn and navigate their early developmental years. The key distinction lies in the extra support a neurodivergent child needs, which is precisely where specialised therapies and early intervention programs become crucial. These therapies, delivered by qualified professionals, form the fundamental building blocks of an effective early intervention program, tailored to address individual requirements stemming from their distinct neurological wiring.​

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6. Early intervention is a comprehensive, holistic program of evidence-based therapies specifically designed for children experiencing developmental delays, autism, or other disabilities. Its primary goal is to support the child's development across various domains, particularly focusing on foundational skills that may not come as instinctively to neurodivergent children as they do to neurotypical children (Roberts & Prior, 2012). These foundational skills are critical building blocks for more complex activities and independent functioning. Early intervention is a collection of therapeutic practices provided during a child's critical developmental window, typically between birth and six years of age (Guralnick, 2011). The goal is to address developmental delays and support the acquisition of foundational life skills—particularly those not innately acquired by ND children.

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7. Beyond skill development, early intervention also emphasizes fostering communication and connection, equipping children with essential abilities to navigate a world that may not intuitively accommodate their differences. For example, therapies might focus on developing "sitting tolerance," a vital skill for school readiness, or facilitating peer interaction.

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8. The concept of early intervention is often underscored by the brain's remarkable neuroplasticity, which is particularly pronounced during the early developmental years, typically from ages two to six (Dawson et al., 2010). This period is considered optimal for interventions due to the brain's heightened capacity for learning and adaptation. Interventions initiated even slightly beyond this window, as in the case of our son Dhruv, still demonstrate significant benefits, emphasizing the principle that it is never too late to begin. This highlights that significant progress can be made regardless of the age of diagnosis, as the human brain continuously learns and adapts.

 

9. As parents of a child diagnosed with autism at age six, we embarked on our Early Intervention journey for our son, Dhruv, at 6 ½ years. While Early Intervention is undoubtedly beneficial, our experience, and the wisdom of experts like Dr. Preeja Balan, a renowned Speech and Language Pathologist (SLP), underscore that "the earliest you start interventions after a diagnosis, is Early Intervention."

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​10. A well-structured early intervention program is inherently personalized for each child. While some sessions, such as social skills groups, may involve multiple children, core therapies like occupational therapy or language/ speech therapy are typically conducted one-on-one to address individual needs more effectively.

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Components of Early Intervention

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11.  Typically, Early Intervention comprises: -

        (a) Occupational Therapy (OT). OT addresses a wide spectrum of skills, including sensory processing

             issues, fine motor skills, and gross motor skills. Sensory Integration Therapy (SIT), a specialised

             approach to tackle a child's sensory challenges, is often an integral part of occupational therapy (Ayres, 

             1979). OT also incorporates SIT to help children respond more effectively to their environments (Case-

             Smith & Arbesman, 2008). Fine motor skills involve small, precise muscle movements crucial for tasks

             like writing, tying shoelaces, or buttoning shirts. Gross motor skills, on the other hand, involve larger

             muscle movements necessary for activities such as catching a ball, skipping, swimming, or riding a bike.

             OT plays a vital role in improving these essential aspects of daily life.

         (b) Speech & Language Therapy (SLT). SLT focuses on building and enhancing a child's language and

              communication abilities, encompassing both expressive and receptive language skills (Paul & Norbury,

              2012). The emphasis is not solely on speech but on any form of functional communication; be it verbal,

              gestural, or assisted through Augmentative and Alternative Communication

              devices (AAC) (ASHA, 2020).

         (c) Social Skills Training. Group-based interventions prepare children for school settings and peer

              interaction, focusing on pragmatic language, turn-taking, and emotional regulation (White et al., 2007).

         (d) Behavioural and Developmental Approaches. Programs such as Developmental, Individual-differences,

              Relationship-based (DIR)/Floortime, Social Communication, Emotional Regulation and Transactional

              Support (SCERTS), or Naturalistic Developmental Behavioural Interventions (NDBIs) take a strengths-

              based and child-led approach, in contrast to rigid models that aim to "normalise" behaviour.

         (e) Group Sessions: These sessions are invaluable for developing school readiness, fostering interaction

               with peers, and building essential social skills in a structured group setting.

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To be continued in the next issue...

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