## Introduction

### How Your Garden Grows

I live and work in Syracuse, a medium-size city in Upstate New York best known for its basketball team (the Orange) and its dubious distinction as the snowiest city in the continental United States. We do have long, cold, snowy winters in our part of the world, so the first signs of spring are met with great enthusiasm. As the snow melts in my backyard, indistinct shapes of objects long submerged and half forgotten gradually reveal themselves. Among these are the raised garden beds I built several summers ago. Their reappearance every spring reawakens a primal yearning in me to plant and grow things. I do this every spring without fail, despite my less than distinguished career as a gardener. Every year I put in tomatoes, cucumbers, zucchini, spinach, and lettuce, and every year I try something new. And every year, something grows well: I may get a bonanza of delicious grape tomatoes, or a bumper crop of zucchini that I have trouble harvesting before they grow into green behemoths, or baskets brimming with crisp, sweet cucumbers. And every year something I have planted with great expectation and optimism will turn out to be a complete bust. One year I bought a beautiful overpriced tomato plant that promised immense, dark red tomatoes of exceeding quality, excellent for slicing, the prime ingredient in the perfect summer sandwich. The plant grew with leafy vigor but produced only a few scrawny-looking, tasteless tomatoes. Another year all of my zucchini plants wilted. I have long since given up on peppers, which refuse to grow for me. This year the cucumbers look surprisingly lackluster, though I have not given up on them yet.

Despite my best efforts to amend the soil properly, choose plants carefully, and water and weed diligently, I must admit to a complete inability to predict the outcome of my efforts from one year to the next. Raising a child is very much like gardening in its inherent unpredictability. First-time parents are often surprised by the striking individuality of their newest family member and how different their infant is from what they expected. Parents with several children are likewise surprised by how different their offspring are from one another—they often wonder how these siblings could possibly have the same parents! My oldest daughter, who has grown into a smart, talented, beautiful, vivacious teenager, was a colicky, high-maintenance infant who had to be held constantly, slept poorly, and demanded constant attention. My son, by contrast, was a docile, low-maintenance infant who has grown into an exceptionally creative, slightly disorganized, but always kind-hearted and thoughtful preteen. My wife and I like to think that our parenting skills have something to do with how great our kids are turning out, but I have a sneaking suspicion that we just got lucky. Like the gardener who diligently attends to his crop, parents have an expectation that if they clothe, feed, and nurture their children well they will grow and develop in predictable ways with predictable and positive results. But things do not always turn out as expected. This is especially true if you discover that your child is developing in unexpected ways. Perhaps your child has been slow to acquire expected skills. You may have an 18-month-old who is not walking yet or a 24-month-old who has not started talking. Perhaps your preschooler is struggling to learn his colors and shapes or is having trouble with toilet training. Or perhaps your first grader is having unexpected difficulties learning to read. These are examples of delayed development. Mild delays may simply represent expected variations in development that naturally occur among children, but more significant delays may indicate a persistent difference in ability that has long-term functional implications.

Development can also go unexpectedly off track. Rather than experiencing a delay in acquiring an expected skill, your child may exhibit skills or behaviors that are qualitatively different from those of other children. For example, your child may randomly repeat bits of a favorite television show or movie, imitating precisely the words and intonation of the original, or he may be inclined to label objects compulsively but show little inclination to use words to communicate with others. Or your child may walk on her toes, or be unusually sensitive to noises, or exhibit unusual body movements, or have difficulty making eye contact. These are all examples of off-track or divergent development (divergent here referring to a tendency to diverge or deviate from an expected developmental path). Your child may exhibit delays or divergence in multiple areas of development, including speech and language skills, motor skills (skills required for physical coordination), play skills, social skills, and skills that are required for daily living activities (e.g., eating, dressing, toileting). This pattern is called global developmental delay. Or your child may have an uneven pattern of skills, showing significantly delayed or divergent skills in some areas and being more usual or typical for her age in others. This is called dissociated development.

When a child shows persistent difficulties in one or several areas of development that clearly affect his or her ability to function in real-life situations, that child is said to have a developmental disability. Some developmental disabilities are common and relatively mild, such as language disorders, coordination problems, learning disabilities, and disorders of attention and impulse control. Other developmental disabilities are less common and more severe, including global learning problems, disorders associated with a lack of communication and social interaction skills, and disorders of movement and muscle control associated with abnormal reflexes and very tight or very loose muscles.

Knowing when your child has a developmental disability can be difficult. When your child first shows signs of developing in unexpected ways, it may take time to determine whether the problem is temporary or persistent and when consultation with a developmental specialist is warranted. The most important thing you can do to help your child when you suspect that there is a problem is to trust your instincts. Many parents, especially first-time parents, lack confidence in their ability to recognize developmental problems, but research has demonstrated time and again that parents are extraordinarily sensitive to their child’s development and are almost always right when they suspect that there is a problem.

My goal in writing this book is to help with the next step: Once you have recognized that you have concerns about your child’s development, you can use this book to learn more about the problem, fill in the gaps, and form a fuller picture about possible diagnoses and helpful interventions.

Section I is devoted to common areas of concern: speech, language, and communication skills; motor skills and coordination; activities of daily living; social skills; behavior; and learning skills. Specific developmental disabilities are considered within the context of these broader discussions: developmental language disorder (Chapter 1), developmental coordination disorder (Chapter 2), cerebral palsy (Chapters 2 and 9), social cognitive disability (Chapter 4), autism spectrum disorders (Chapter 4), attention-deficit/hyperactivity disorder (ADHD; Chapter 5), learning disability (Chapter 6), and intellectual disability (previously called mental retardation; Chapter 6). Although particular developmental disabilities are highlighted in certain chapters, the elements of a diagnosis that relate to the main subject of another chapter are discussed in that chapter as well. For example, although ADHD is highlighted in Chapter 5, the coordination difficulties, writing problems, social difficulties, and learning problems associated with ADHD are discussed in Chapters 2, 4, and 6.

Ways to find and provide help for your child are discussed in each chapter, with a focus on interventions that relate specifically to the subject of that chapter. Chapter 7 (“When Your Child Needs Extra Help”) offers a general discussion of interventions relevant to all areas of concern and all diagnoses, with a particular emphasis on early intervention and special education.

Section II takes up topics of general concern for children with various developmental disabilities. Hearing, vision, and sensory processing disorders are considered in Chapter 8. Special health care concerns relevant to all children with developmental disabilities are discussed in Chapter 9; particular attention is given to the unique health care concerns of children with Down syndrome, spina bifida, and cerebral palsy. Medication interventions for children with developmental disabilities are considered in Chapter 10, and the causes of developmental disabilities are discussed in Chapter 11.

It is my hope that as you read this book you will find information, insights, and suggestions relevant to the concerns you have about your child. I would be very glad to know that my book helped you to clear out some of the weeds of confusion from your garden, for it is my goal—as I know it is yours—to help your child grow and prosper and enjoy his or her time in the sun.

### A word on some special elements used in this book: 
In addition to traditional illustrations and tables, I have made use of the following special devices to highlight or elaborate on elements of the main text:

Every garden starts with seeds and the right sorts seeds of seeds make for the best and most productive gardens. In this book, “Seeds” represent those pivotal concepts, important distinctions, and key recommendations for intervention that are developed and elaborated in the main text.

#### Jargon Buster

Understanding your child’s developmental problems necessarily involves grappling with a lot of professional jargon. I have made every attempt to stick to plain English wherever I can in this book, but it is impossible to completely avoid technical terminology. Jargon Busters are used to highlight and explain the definitions of key technical terms commonly used by professionals who work with children with disabilities. FYIs (For Your Information) are extra tidbits of information related to the main topic of discussion that offer additional detail, highlight related ideas and information, or explore a tangent that is (hopefully!) interesting and perhaps even entertaining.