Delay in thinking or understanding in children: When to intervene and how therapy helps

Nine-year-old Akshay often found it difficult to keep up with peers when it came to understanding lessons at school. It was only much later that his parents recognized the need to get him assessed. To their utter shock, Akshay was diagnosed with a cognitive delay. 

Why didn't Akshay's parents realize there was a problem? How did they miss out on 'obvious' signs? What if they had intervened early?

What is cognitive development?

Cognitive development is about how a child's brain develops thinking skills such as attention, concentration, memory, perception and logic. For instance, logic in a little child is his understanding of cause and effect, "If I pull, the toy comes closer to me".

Cognitive delay

When a child is diagnosed with cognitive delay, it means he lags in that area of development as compared to his peers. A child with a cognitive delay may probably not have problems with his five senses, however, the way he understands information received by his senses is different from that of a normally developing peer.

For example, a child with cognitive delay may have the ability to hear, but she may not be able to listen, pay attention or understand when you call her or talk to her. She may even get agitated by what may seem to you as a normal conversation. The perception to her, in this case, may either be too low, too high (she cannot take the decibel level) or irrelevant (you may be speaking, but it may feel like just 'noise' to her, or she is unable to decode language).

A cognitive delay can impact development in areas such as:

The causes of cognitive delay may include:

Cognitive delay can also be a symptom of underlying developmental disorders such as:

Play can help your child develop thinking skills

'Play' plays a big role in ensuring your child's healthy development. After all, young children understand their world better through play. It also helps you and your child bond. Here are some tips:

• Set aside playtime every day so there is no other distraction for you or your child.
• Encourage your child by focusing on his strengths to help him build confidence.
• Ask your child's therapist about the assistive play that can help. He may suggest activities like drawing, using crayons, textures, visual cards or other sensory games.
• Apart from assistive play, allow your child to simply engage in activities she enjoys. Let her take the lead. Don't be rigid. And remember, don't expect instant results.
• When your child is playing and you need her to eat or do something else, give her the time to unwind from that activity and redirect. For instance, tell her: 'Dinner time is five minutes from now'. This will give her the time to prepare. Do not rush her. It will disturb her attention.

Be mindful of what stimulation you can provide for your child. Let it not go against his will or preference. Discuss this with your therapist.

Who can help your child work through the delay?

As a parent, when you have a concern, trust your gut and act at once. Speak to your pediatrician who will guide you to the appropriate therapist. In the case of Cognitive Developmental Delay (CDD), you will be referred to an Occupational Therapist (OT).

An OT will help your child develop skills required for everyday activities and interactions with people and the environment. The OT might take support from a team of experts including a psychologist, a special educator and a pediatrician for accurate evaluation and for charting out an effective intervention plan.

How to spot a delay

Take note if your child is repeatedly delayed in reaching multiple developmental milestones. Some key symptoms to look out for are:

• If your child doesn't watch moving objects, smile at people or bring things to the mouth by four months of age
• If she doesn't know familiar faces, play with others or show affection, at age six months
• If he still doesn't recognize familiar people, respond to his name or babble, at age 12 months
• If she does not follow instructions, imitate actions or know the use of common objects at home, by two years of age
• If he is losing the skills he once had, or if his skills are not improving with age (stuttering speech, repeating words, uncoordinated movement, etc.)

Other specific signs to look out for in children aged three years and above:

• Has difficulty in decoding language
• Has difficulty in understanding instructions
• Does not remember things easily
• Does not apply learning to new situations - cause and effect
• Has difficulty in using actions to communicate
• Is unable to see details in pictures

What to expect during your visit to an OT

• The preliminary evaluation process involves taking a detailed history of the child: family history, birth history and detailed medical history.
• This is followed by an interaction with the child.
• The OT will also speak to the parents to understand the issues and challenges the child faces.
• The OT will then make an initial evaluation and let the parents know about the child's condition and how treatment or therapy can help. The therapist will also speak about the intervention plan that can help the child.

History-taking may be a tedious process but be assured that it helps in arriving at an accurate evaluation.

What to expect in therapy

Here's how the therapist will plan the therapy:

Step 1 - Starts with improving the child's sensory response to external stimuli.

Step 2 - Uses everyday activities to teach the child basic life skills, hand-eye coordination, etc.

Step 3 - Works with the child on specific issues the child may have (social skills, movement, speech, etc.)

The brain is neuroplastic and therefore, it continuously evolves with the experiences a person has. So, a caring, understanding and encouraging environment (both at home and school), and the right therapy can have an immense impact on your child's progress.

Supporting therapy at home

It is important to understand from your child's therapist how you can support your child at home. Your therapist may suggest that you:

• Pay attention to your child's gestures and understand his needs and cues based on guidelines given by the OT
• Involve your child in peer-group interactions
• Avoid the use of gadgets as it tends to distract your child's attention as opposed to building her capability to concentrate and pay attention
• Involve your child in alternate activities to engage - playing, speaking, reading or storytelling which will help improve his skills
• Provide a nutritious diet. Avoid high-energy food that contain saturated fat and sugar as it may heighten your child's activity for a short duration making her jump from one activity to another, as she struggles to focus

Your child's cognitive delay can be effectively treated with timely intervention and a supportive home environment. Remember, it's very important to act early. Always keep track of your child's developmental milestones and talk to your doctor about them during your routine visits.