Martin O’Connor’s decision to write his book, called Early Childhood Intervention – Time for a New Conversation was inspired by an article he read in The Irish Times on November 10, 2024.
It was written by Laura Kennedy, the aunt of a little boy with a developmental disability. Two particular paragraphs “jumped off the page” for the Ballinasloe man and chartered psychologist who has spent his career working in child and adult disability services.
“It was a beautifully written article and it was the catalyst for me to finally make the decision to write this book,” he says. “It had been on my mind for a year or two.
“In one of the paragraphs, she described the frustration experienced by the child’s parents at waiting almost two years for a diagnosis. Many parents can identify with this, it can be a stressful time, particularly if it’s your first child. You’re catapulted into an unknown space – you have no prior parenting experience, only how you were parented yourself.
“But then, in the next paragraph she describes the little boy as being on the kitchen floor, not crawling in the normal way. But if he saw a toy at the far end of the floor, he was able to get to it in his own way.”
This passage represented a light bulb moment for Mr O’Connor. It highlighted the little boy’s determination and innovation and, most of all, his problem-solving approach.
“I thought, that’s child development in action, on the kitchen floor. The insight I had was, well, the little boy wasn’t waiting for a diagnosis, development doesn’t wait for one. A young child is figuring out ways in which he can get from one place to another. He is not doing this in the so-called ‘normal’ way, crawling or walking.
“But, how much does it matter that he is not doing it like everyone else? While parents are waiting for a diagnosis, a child’s development is already taking place. It is this development that needs to be supported and progressed from the child’s earliest days. We frequently use the phrase ‘developmental disabilities’. Traditionally, and perhaps understandably, we have focused primarily on the word ‘disability’ which becomes equated with an assumption of there being ‘something wrong with the child’. However, we have largely given much less attention to the word development and implications for early intervention and supporting families.”
Family-centred
It is important to remember that children under eight years with developmental disabilities do not experience their developmental needs and learning in the context of ‘therapy’ sessions with healthcare professionals, he says.
“Their development and learning happens in the context of everyday daily life with family, pre-school, and so on, with the people they spend most time with. This is the rationale for what is called a family-centred approach to early childhood intervention.
“In addition, the emphasis on ‘therapies’ for a child continually refocuses parents on their child’s impairments and limitations, as well as implying that their efforts are never enough, because their child still needs more therapy.”
The psychologist outlines that a family-centred approach centres on three main premises, that parents/caregivers are experts on their children’s needs and abilities, all families are unique in their identity, culture, beliefs, and values, and that the family is the most important influence on young children’s development and functioning.
He says children’s development urgently needs to be supported from their earliest days by healthcare professionals working in partnership with parents. This should be a sharing of responsibility, not a shifting of it, to parents only, which has resulted from a misunderstanding of the rationale for, and the purpose of, a family-centred approach, he believes.
“Child development is already happening when parents meet healthcare professionals for the first time. And because the child’s development is already occurring in their family environment and context, when parents and healthcare professionals meet for the first time, the child’s situation is already family-centred.”
That first meeting between the parent and the health care professional is highly significant, he says, in terms of what happens and what each brings to the table.
“When you meet with the parent of the child for the first time, keep in mind that they have probably spoken to GPs, medical professionals, paediatricians. What have they said to the parent that will influence their expectations? That first meeting is all about the parents and the families’ world, not you. It can look like the parent is meeting an expert in the field but what is the parent an expert on? They are experts on their child’s development but they may not realise it. What do they already know – the hopes and dreams they have for their child?
“Important questions for service providers are how is the child functioning in daily life and how are they participating in family routines. Are they looking after themselves, are they dressing themselves? See them as children first.”
Significant barrier
He says our preoccupation with diagnosis has been, and continues to be, a significant barrier to talking to parents and families as early as possible about their child’s development.
“The area that is unintentionally overlooked by practically everybody is while parents wait for a diagnosis, how can we reframe or reshape ourselves so that we can support them? What is it that we really want for young children with developmental disabilities so that a fulfilling life is within reach of the parents and the child? We don’t have a statement of purpose that has the potential to unify stakeholders so that everybody is singing from the same hymn sheet. Currently, everybody is singing from different hymn sheets; that’s not a good recipe for constructive, helpful, communication.”
Mr O’Connor says an excellent example of a potentially unifying, compelling, and authentic purpose statement would be that we all want children to be the best they can be, to function well, be engaged, and meaningfully participate in their family, pre-school, school, and community to the greatest extent possible and in whatever way they can.
He believes services, by and large, are not aligned to that vision. “Sadly, despite policymakers and service providers expressing a commitment to a family-centred approach to service delivery, the unachievable ‘fix’ continues to influence societal, political, and media thinking about childhood disability and early intervention. The ‘fix’ mentality, allied with therapies and treatments, or trying to make things ‘normal’, is at odds with the infinitely more realistic and achievable goal of improving child functioning in everyday environments and child and family quality of life.”
The Ballinasloe man, who now lives in Ballina, Co Tipperary, says he wrote the book to highlight the importance of child development from the first day of the child’s life and to present a compelling case for the need for a new conversation about early childhood intervention.
There is a need for early support for families, he believes. “They need high quality, evidence and relationship based, developmentally appropriate, family-centred practices that support both children and their families.”
Families of young children with developmental disabilities have the same needs as other families; for social support and acceptance, participation in community activities, and housing and financial security, he says. They also need additional support to meet their children’s basic care needs, to build on existing skills, and gain new ones to strengthen their children’s development and learning skills.
“Early investment in families will pay significant dividends long-term. It is not only the right thing to do for children and families, ethically and professionally, but also makes long-term economic sense.”
• Early Childhood Intervention – Time for a New Conversation by Martin O’Connor costs €18.99 and is available from Charlie Byrne’s Bookshop, Eason’s, and Amazon.ie
