I have been really excited to highlight this topic over the last few weeks of shifting the focus from a person's condition or diagnosis to their development. This is a pertinent issue as we embark on the launch of our first private clinic in Brisbane! We will be available for Paediatric mat and reformer Pilates, NDIS sessions right through to women's health and sports performance. We are also working alongside over 30 early learning and kindergarten centres across Queensland this year through both our private program and the Kindy Uplift Pilot program that is being rolled out across Queensland. So this topic is extremely relevant to what we are doing at the moment.
February 5th was Physical Disability Awareness day drawing attention to one of the most common systems that impact children and can have such a large impact on a child's development holistically. Often I get asked if my courses and programs are suitable for children in the disability sector. I get asked why we don't have a Cerebral Palsy or Autism specific program or course. My answer is fairly simple, I like to focus on areas of development or symptoms rather than conditions and I do this for several reasons. All conditions affect our various systems on a spectrum. This is evident in both typically developing children as well as children with diagnosed developmental conditions. Each system will develop at different rates and times. It's important that we assist children holistically and avoid making assumptions on their abilities based on conditions.
Clinical Psychologist Kathryn Smith of Brisbane-based practice, Psychology Consultants concurs saying; “focusing on the behaviour or problems assists in tailoring an individual approach rather than simply making assumptions based on a diagnostic category.”
“Many diagnostic categories are broad and in reality each person presents with a unique set of symptoms, displaying them in different ways.”
“To assist clinicians and caregivers we can target those specific problems or areas that require development and separate them from the child as a person.”
Kathryn continues to say that unnecessary labelling can be problematic as assumptions about the child or person are made without understanding their unique set of symptoms and capabilities. The knock-on effect is lowered self-worth and confidence issues.
As clinicians, we respect and understand the interplay of all key areas of development. This is why development is the underpinning value and focus of Kids Heart Pilates programs. By taking this approach we have an opportunity to promote childhood development holistically.
Conditions impact children differently as will differing interventions, strategies and techniques. While most Allied Health professionals willingly work with children with prior funding approval such as NDIS funding, there are so many children in our early learning sector that remain undiagnosed, that are the ones who struggle and could benefit greatly from exercise interventions and the opportunity to highlight areas of difficulty to fast track diagnosis. At Kids Heart Pilates we work in early learning centres as well as with children privately but our work in early learning environments helps identify children who may not have otherwise been diagnosed. Sometimes in our sessions, we are able to pick up mild symptoms that with early intervention can be quickly resolved. The structure and flexibility of our program promote inclusivity, providing a paediatric clinical service that allows for greater reach and impact than might otherwise be offered. Currently, there is a huge support in the early childhood sector for this very reason. We have been working within the Uplift Pilot Program in Queensland and there is also The Healthy Schools Program, whereby schools in Western Australia are getting funding for programs that promote the health of students through activities to help children develop across the board. These initiatives are addressing exactly what I am focussing on today, leaving no one behind and getting interventions and training for children and educators that work in various situations and environments. It is not surprising that there is government funding for this when we consider just how many children are struggling with their development.
I was talking to John Cairney, Child Development Expert and the head of Health and Nutritional sciences at UQ, recently and he agreed that the impact of interventions will be greater with people that have more severe symptoms as there is a larger scale of improvement opportunity. So when we consider the impact opportunity we know that when we see the benefits in typically developing children from interventions, we can expect to see even greater gains made by those children with developmental difficulties or disabilities.
And finally, the opportunity cost is significant when we focus too acutely. When we establish an intervention from the perspective of increasing health and well-being as a whole rather than the condition implications we can see how this translates to so many activities which have been identified in the literature by Rosenbaum et al, which I will explore today.
How children develop uniquely
Research and science suggest that most of our brain cells are formed before birth, however, connections between these cells are made during infancy and early childhood (4). The connections are how information is processed and action or reaction is determined and executed. Learning is the process whereby with every new experience new neural pathways are strengthened and change in our behaviour is a result. With repetition, the number of nerve impulses traveling these pathways increases and strengthens. This process is the hardwiring of the brain and contributes to plasticity of the brain which is the adaptability to change and develop (4). Brain plasticity is heightened in the early years (particularly up until the age of 12 years) which further demonstrates the importance that early intervention and experiences are vital to healthy brain development (5).
There is a new train of thought supported by research indicating there are optimal times of development rather than critical times. This indicates that milestone guides should be used very much as guides only. These milestone guides, when used effectively, can be extremely helpful for parents to understand how their child is progressing or coping in an education environment, they will allow for crucial early intervention which is widely supported by research if any developmental delay is present. However, keep in mind that each child develops in their own unique timing. It is important to note that when there is an area of difficulty it becomes an issue when health, both mental and physical and/or learning and development are impacted. It is at this point that further investigation and intervention is the way to go! Listen to my instagram live where I talked about this in 2022.
A child’s development cannot be accelerated, they will develop in their own time further supporting why it is crucial to know where they are individually and create a supportive environment that will aid development rather than try and push kids beyond their capabilities at a given time. Each child develops uniquely and learns and experiences at different rates which can be supported rather than accelerated. They may be exploring one area of development more intensely and then follow on to another, ideally balancing it out in time which is extremely important to understand, so the child continues to develop rather than overcompensate on one area of development (6) (7). Therefore, it is important not to rush or force a child’s learning and development but rather to provide support and gently encourage the child to complement their current capabilities and interests. Rushing or pushing may have psychological impacts resulting in the child having adverse feelings to activities and later avoiding it, having more dire repercussions to their development and health. Research now supports that if there is a delay in development the plasticity of the brain will allow time for the child to ‘catch up’ (4).
It is crucial to note that during these stages of increased development or in the instance of developmental difficulty, it may also be a time of increased vulnerability for the child as they enter new experiences completely foreign and difficult for them. It is often during these years that they are learning that they are separate from their parents and finding their own individuality and place in society. It is important that the child has appropriate support, encouragement, and assistance through these stages of growth, development, and vulnerability.
Disability defined
The Australian Bureau of Statistics and Survey of Disability, Aging and Carers (SDAC) defines a person as having a disability if they report having a limitation, restriction or impairment, which has lasted, or is likely to last, for at least 6 months and restricts everyday activities (3).
Many paediatric conditions are complex and have a neurological basis impacting and generating symptoms in multiple systems. Examples of these include musculoskeletal conditions, cognitive, behavioural and communication disorders. For example, conditions like Cerebral Palsy and Autism appear to be specifically defined conditions however have ‘in reality they describe a rather heterogeneous group of conditions that can impact on the development of children's function for a variety of biological reasons, with a very wide range of effects’ (1).
It is estimated that around 7.4% (or 329,000) of Australian children aged 0–14 had some level of disability. The proportion was slightly higher among boys than girls (9.4% compared with 5.4%)(3)
The most common disability types among children were Intellectual and sensory and speech followed by psychosocial and then physical (Figure 1).
Of children aged 5–14, 219,000 (7.6%) had schooling restrictions. This includes children who have core activity limitations and schooling restrictions
The notion of Health as well as disability
A holistic and dynamic approach to interventions and disability will provide children with inclusivity and the opportunity to benefit across multiple systems and functions. This was explored with the International Classification of Functioning, Health and Disability 2001 (ICF) explored by Rosenbaug and Gorter (2011).
Rosenbaug suggests when using a dynamic intervention the impact is seen to impact more holistically in relation to their development. Dynamic approaches ‘create an opportunity to consider all health issues within a broader context’. It highlights the aspect of function that is influenced by a myriad of factors (1). This is exactly what we explore in our courses and how all key areas of development are influenced by one another. When we provide opportunities for physical development we are engaging the cognitive system and vice versa for example. When we focus on development and symptoms rather than conditions it means that we can move away from pigeonholing a condition and series of symptoms and we can work with where the individual child is at and look at function and health as a whole picture.
When we focus on conditions we can prevent an opportunity to bolster global development by perhaps not using an intervention if they are considered to be outside the normal ranges of performance or capacity. Capacity being the potential ability and performance being the actual ability. Pilates for a paediatric population is so relevant here, I often get asked how a child can do Pilates with the correct technique and will explain that technique is not the focus in paediatric pilates. The focus is them being engaged, having a go and experiencing the intervention in their own way not how we determine is the ‘normal’ way(1). Getting children to try and do it their way will build intrinsic motivation and build healthy habits and compliance and then we have the opportunity to build and refine their skills, participation is key.
In my course, I explore all key areas of development. Physical development bolsters social-emotional development through but not limited to boosting self-efficacy and confidence. We can revisit the inclusivity theme here, showcasing how by providing programs for the greater community we provide everyone the opportunity to reap the benefits of clinical intervention, regardless of their capacity, technique or performance. Gibson and her colleagues highlighted the importance in their study to encourage the development and practice of function without regard to how ‘nicely’ it is achieved. They found that children are affected by normative ideas about movement which can contribute to parental feelings of angst and doubt, and negative self-identities for children further identifying the importance to include children of all levels and abilities (2). They suggest that rehabilitation programmes need to consider how they may unintentionally reinforce potentially harmful beliefs (2).
It is also important to recognize that children with disabilities can often be ‘deprived’ of experience. It can be extremely difficult for children and adults in the disability sector to participate in physical activity frequently. So much of their time is spent in therapy and if we can provide them an opportunity to participate in a program with a priority on their health and enjoyment holistically rather than their disability or condition with the same benefits we can help them feel included, valued and seen (1).
We have a responsibility to focus on children of all abilities as individuals. We know that no two children will develop exactly the same regardless of whether they are typically developing or not. We have an opportunity to provide holistic intervention and create meaningful participation and when we do this we are in a position to promote intrinsic motivation which will improve their scope and frequency of involvement which will then have a much greater impact on their health overall. Just as children develop uniquely paediatric and neurological conditions impact both typically and disabled children on a scale or spectrum. Therefore when we focus on where they are individually and remove focus on technique then we will provide an environment where they are much more likely to thrive.
References
Rosenbaum, P., & Gorter, J.W. (2011). The ‘F-words’ in childhood disability: I swear this is how we should think!. Child: care, health and development, 38(4), 457-463. https://doi.org/10.1111/j.1365-2214.2011.01338.x
Gibson, B. E., Teachman, G., Wright, V., Fehlings, D., Young, N. L., & McKeever, P. (2012). Children's and parents' beliefs regarding the value of walking: rehabilitation implications for children with cerebral palsy. Child: care, health and development, 38(1), 61-69.
ABS 2019b. Sources of data for Aboriginal and Torres Strait Islander peoples with disability, 2012–2016. ABS cat. no. 4431.0.55.004. Canberra: ABS.
Meggitt. (2012). ‘Understanding Child Development’, London, Hodder Education
Pica, R. (2011, October 1st) How to Make the Case for Movement in Education, BAM Radio (Audio Podcast)
E, Mackie, (26.11.19) Personal Communication.
Carly Betts, (28/22/19) Interview