It is easier to make a diagnosis the first time you see a patient and it gets harder the better you know a patient. – Irving Yalom
Post #3 in category. We suggest reading posts in numerical order.
Too often, people think of children with developmental disabilities as “different,” as somehow belonging to a separate category of childhood. This outlook is reinforced by the medical model, the pathology model of diagnostic codes, deficits, differences, impairments and disorders.
When we interact with a child without rushing to measure or to judge, we discover that children with neurodevelopmental differences have far more in common with their typically developing peers than is generally realized. Do we see children for what they cannot do? Or do we appreciate what they can do? Do we recognize the commonalities they share with all other children? Can we identify their hidden potential?
In the development rather than the disease approach, we can see the important signs of their need for connection, for exploration, mastery, and need for comfort that we recognize in all young children. What differs is the clarity with which they can be expressed and the pathways through which they emerge. When expressive language is limited, when motor planning or sensory processing are disrupted, the outward signs may be muffled or confusing. But the basic human needs and intentions remain.
A pre-verbal toddler may not have the words to say, “I’m overwhelmed” or “I need help,” but will communicate through body tension, vocal tone, avoidance or clinginess; and so will some non-speaking eight-year-olds with developmental delays. Their expressive strategies are developmentally appropriate for their current skills and understandings, for their neurological and communicative stage of development. Because their age does not match their behavior, adults often misread the child as being oppositional, or indifferent, or knowing far less than they actually do.
One of the most persistent misunderstandings is the tendency to interpret developmental difference as emotional or intellectual deficit. A typically developing younger child and an older but delayed child may both cry when frustrated, both seek or avoid eye contact, both understand far more than they can express. But only the younger, typically developing child’s behavior is seen as natural. The older child with developmental delays is too often judged and devalued.
A child who is not yet able to speak can detect tension between adults, pick up subtle social cues in tone of voice, and communicate choice or objection without words. I very much agree with the sentiment I saw on a T-shirt, which read, “Just because I can not speak does not mean I have nothing to say.”
In the medical model, children are defined by what is missing. In the developmental model, we focus on what is emerging. An early injury or difference, neurological, metabolic, genetic can affect the timing and sequencing of all related developmental domains. Disruptions ripple outward, causing some changes and delays in functioning and the pace of skill acquisition.
But the child with special needs is still a changing, growing human being. Every child is more like every other child than they are different. Each of us can learn and can grow when the conditions are right. Unfortunately, people tend to focus more on differences than on similarities.
There are many similarities between an eleven-year-old with developmental delays and a typically developing younger child, and also has some idiosyncratic differences. We must learn to “read” communication in broader terms, not just as words, but as gestures, glances, vocalizations and patterns of movement. We must think of the feelings, thinking and actions of the child with developmental delays as delayed steps toward higher development.
The neuroscientist Antonio Damasio wrote, “We are not thinking machines that feel; we are feeling machines that think.” I would substitute the word “beings” instead of “machines,” but I accept his major premise. Their emotions and intentions are present even when they are not easily identified or understood. When we recognize the feelings and humanity in children with developmental delays and learn how to connect and to communicate with them, we begin to see how deeply we have misunderstood them.
It is the adult’s responsibility to re-tune ourselves, to slow down, to appreciate with insight and humility what is common between us all, rather than what is different. To recognize the shared human condition beneath the diagnostic label. To recognize the higher potential of each developing mind, unique in some ways, delayed in some areas, but not alien.
Copyright © 2025 Shlomo Chaim
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