My pediatrician wants my toddler to be in therapy!

The American Academy of Pediatrics recommended a few years ago that all young children, including infants, be screened for possible delays in their social and emotional development. Traditionally pediatricians have been concerned primarily with the physical development of children. However, as we became more aware of the importance of kid’s social functioning for later development, pediatricians began to pay closer attention to children’s behaviors and emotional functioning. In fact, many pediatricians are now conducting screenings of all children to “flag” kids who appear to have behavior problems or have delays in their social or emotional functioning. When the evaluation suggests that a kid is “at-risk” due to the presence of some of these concerns, pediatricians usually recommend that the child receive intervention, such a seeing a child therapist who provides services for young children. In some cases the therapist works directly at the pediatrician’s office but in many cases the child is referred to someone in the community.

What is a parent to do?

When presented with this recommendation, many parents agree and seek intervention for their kids, while many others decline the recommendation, either because they believe it is not necessary or that the intervention would not do anything.

However, the evidence that these interventions work in improving social and emotional functioning continues to increase.

For example, this month the journal of the American Academy of Pediatrics published a study that examined 3,169 children (ages 6 months to 3 years) who were screened at a pediatricians office. Of these kids, about 711 or 22% were considered “at-risk” in that they showed signs of significant delays in their social or emotional functioning or had behavior problems, as reported by their parents in a screening questionnaires. Slightly more boys (25%) than girls (19%) were considered at-risk. These children were then offered the option to participate in an early intervention program that included either more monitoring, some intervention at the pediatricians office, or a referral to outside services in more severe cases.

285 parents declined the offer to participate in the intervention and 426 parents accepted the intervention. The authors then examined a group of kids who received a re-screening during a follow up visit (after the intervention). Specifically 170 children had this second evaluation. Of these, 67 (40%) came from the group who had declined the recommendation for intervention while the rest came from the group that accepted the intervention. This allowed the researchers to compare the kids who had the interventions with those who declined the intervention.

Did the intervention work?

About 56% of the kids who received the intervention showed a significant improvement in their social and emotional functioning. However, declining the intervention was associated with a 75% reduction in the probability that the child would show significant improvement during the second evaluation. The only exception was for kids with autism-style developmental delays who were referred to outside specialists and who unfortunately did not show improvement during the second evaluation.

Does this mean that the intervention worked? Most likely. The results clearly showed that the kids of parents who accepted the intervention were more likely to improve than the kids of parents who declined the intervention, which suggests that the intervention was effective for many of these kids. However, there are other possible explanations. For example, it is possible that families who accepted the intervention were more concerned about their kids and thus more likely to make other efforts to address these delays, such as making changes at home, seeking resources, etc, which may have resulted in the improvements. In this case, maybe it was not be the intervention, but the actions of the parents who agreed to the intervention, that resulted in improvements.

So should you accept the pediatrician’s recommendation for intervention? I would say YES. The evidence for the effectiveness of these early interventions is growing and I am yet to see evidence for any possible negative consequences that may come from receiving these early interventions.

Cheers, Nestor.

The reference:
Briggs, R., Stettler, E., Silver, E., Schrag, R., Nayak, M., Chinitz, S., & Racine, A. (2012). Social-Emotional Screening for Infants and Toddlers in Primary Care PEDIATRICS, 129 (2) DOI: 10.1542/peds.2010-2211