How it Works: For the Parent Who Suspects a Developmental Delay
Many kids struggle with developmental problems at some point in their childhoods, and getting care for them can be costly and confusing.
If your child isn’t babbling or sitting at nine months, for instance, struggles with stairs or speaks unclearly at age three, you might be worried about a developmental delay. Help is available to enable your child to catch up, but parents will need to navigate a complicated zone where health care rubs up against education—and kids sometimes fall through the cracks.
“The intersection of what’s being provided by schools and the health-care system is a huge issue for families because the two systems aren’t well integrated,” says Georgina Peacock, medical officer and developmental pediatrician at the Centers for Disease Control and Prevention. “Parents are having to knit together services to have their kids be successful.”
Developmental milestones, developed by the American Academy of Pediatrics, look at how your child is measuring up against social, emotional, cognitive, physical and language standards. These can alert parents early on to the potential of a child developing conditions such as autism, attention-deficit hyperactivity disorder, sensory processing disorder or learning disabilities.
If your child isn’t on track, the treatments can include speech, occupational or physical therapy or visits to a child psychologist—which can be expensive and difficult to get your health insurer to cover.
The good news is that awareness that resources exist is growing while the stigma of seeking therapy is decreasing, say therapists, driving more use of such services. And the health-care overhaul could bring some relief as early as next year, when many insurance companies will be asked to provide a certain level of essential benefits, including what are known as habilitative services. Those are services to help someone acquire a skill they never had, such as help for a child who cannot fasten buttons.
If your child needs extra help, the first thing you should know is that much of it can be obtained free or at a discount through public programs. The CDC’s website (cdc.gov/ncbddd/actearly/concerned.html) is a good place to start.
It’s important for parents to speak to their child’s doctor as soon as they suspect that there is a problem, says Dr. Peacock.
In general, states offer early intervention for kids under the age of three, and special education for older children through the public education system. Programs vary and you will need to check on what your area offers. Some are free while others bill parents on a sliding fee scale. The site of the National Dissemination Center for Children With Disabilities (nichcy.org) has a wealth of information.
In some states, it’s easy to qualify for services, while in other states the criteria are restrictive, according to the American Speech-Language-Hearing Association. Another problem is “there are simply not enough providers to go around,” says Cindy Oser, senior policy strategist at Zero to Three, a nonprofit focused on young children.
That’s one of the many reasons why a family might turn to a private therapist, where sessions can range up to $200 a pop and treatment can continue for years, say therapists. A family might also feel that the child will make faster progress in a private setting, or avoid a perceived stigma of entering the special-education system.
Health insurers don’t always pick up the tab, however.
Before you start down the private route, make sure you know what your plan will and won’t cover. Some health-insurance plans may not cover such services or may limit treatments to a certain number of visits per year, after which point they want to determine whether progress has been made.
In other cases, insurers cover speech or occupational therapy, but an employer has elected to not include such services as part of its insurance benefits.