A child in my class has cerebral palsy. Now that we're several months into the school year, I'm noticing delays in areas other than motor skills. Her language skills are not well developed and she seems particularly sensitive to loud sounds and to touch. What is the best approach to take in dealing with these different challenges?

The first step for teachers seeking to help children with multiple challenges is to do their own assessment of the children's strengths and weaknesses. A good place to begin is by doing careful observations of what we call the children's functional-developmental capacities in certain broad areas. These areas include the ability to:

  • attend
  • relate to others
  • show their intentions through gesturing
  • problem-solve (first without, then with, words)
  • develop and express creative ideas
  • become a logical thinker

The teacher should look at how far up this ladder the child has progressed. She should then look at how well the child's processing skills are developing, particularly in the areas of:

  • auditory processing of language
  • visual-spatial processing and thinking
  • the ability to plan and sequence actions
  • the ability to modulate sensations (not being over- or under-reactive to touch, sound, movement, or smell)

Finally, the teacher should look at the way the child currently interacts with the adults in her environment, including teachers and parents, in order to assess her abilities in relating to others, interacting purposefully, and communicating and using her ideas.

Fine Tune Your Investigation

Here is why this investigative process is so important. Let's say a child has been diagnosed with a cognitive challenge, and at the same time he has severe motor and language problems. As the teacher works on the profile, she might discover that the child is a very good logical thinker and that his supposed cognitive delays are a result of his language problem. In fact, this may be a child who has a fundamental language problem that only looks like a cognitive delay. The teacher might see the child make complex designs with blocks, and she might even discover this child is doing a lot of creative problem solving such as using a stick to help get a toy from a high shelf. Even though he has severe language problems, he actually has some cognitive strengths that have been missed. So by doing a more fine-graded and fine-tuned analysis, we can understand better what the child's strengths and weaknesses are, and we may even revise our picture of how we consider the child challenged.

Plan a Program

It's important to note that children with multiple challenges require a program of education and intervention that's based on their individual profiles rather than on labels. And the intervention program has to work in an integrated way on all of the areas in which they are challenged.

In this kind of program, it will not be enough to simply teach the child to label pictures and acquire more words. Nor will it be enough to help the child develop her motor skills by using a pegboard or copying designs or stacking blocks. These activities, in an isolated way, have limited value to the child. What has much greater value is to take an integrated approach, where the child is practicing all six capacities mentioned at the beginning of this article.

Always have a plan that mobilizes all six levels of the functional-developmental capacities up to the highest level a child is capable of. So, when we engage the child who has multiple delays in activities, we should try to:

  • get the child's attention in a calm, regulated way.
  • heighten the child's engagement with the caregiver so the child is relating to a person, not just doing something with an object.
  • encourage the child to purposefully interact with that person.
  • motivate the child to be interactive in what we call a "continuous flow" with that person.
  • encourage the child to use her words and also to build bridges between her words, all at the same time.

Encourage Partnerships

Children with multiple delays often have difficulty mastering social skills because their limited language and motor problems interfere. We must remember that children with multiple challenges need extra practice in socializing so that they exercise with other children the same cognitive and language skills that they're practicing with adults. To do this, the best thing is to have a child with special needs work with a partner who doesn't have special needs. We get it cooking when we challenge a child with special needs to use all of his functional-developmental capacities through enjoyable interactions with another child, including an exchange of toys, drawing and painting with one another, or climbing together.

Involve Parents

Parents of children with multiple challenges should see their role as similar to the one we have just described for educators. They should do what we call "floor time" at home. So for a child who's not engaged, it might mean getting down on the floor with the child, taking a little truck that he's been looking at or just pushing back and forth and putting the truck on our head so the child takes it from our head and smiles and giggles at us.

At school and at home, keep three things in mind:

1) There is enormous value in the kind of spontaneous interactions we call floor time.

2) As a way of teaching new skills, we need to set up problems for the child to solve. This is different from the rote-memory approach, in which a child might be shown a picture and asked to memorize the pictured word (chair, apple, banana). In the problem-solving approach, we ask the child to use that word in order to get something he wants.

3) Involve children in some looking/doing games, ordinarily involving throwing, catching, kicking, or hitting. (If the child is in a wheelchair, we may ask him to begin following an object with his eyes.)

If we do these things, we will be giving children a good mental workout, helping them exercise skills related to all the ways in which they are challenged at once.