As a caregiver you may be the first person outside the family to closely interact and observe a child, so you may be the one to suspect that there is a developmental delay or undiagnosed special need. Often parents and family members sense there may be a problem. The reality is so painful that nagging worries may be buried beneath thought of, "He’ll outgrow it," or "She’s just a little slower developing in that area," or "But look at how advanced he is in..." Delivering the news that you see a potential problem may be a devastating blow or a welcome relief. How that news is conveyed is vital to the parents accepting and acting on that information. Here are some helpful tips:

1. DO NOT DIAGNOSE. While you may have a wide knowledge of child development and even suspect accurately what the problem may be, it is premature and not the caregiver’s role to put a name to a possible problem. Many caregivers have demonstrated their knowledge but broken trust with a family by giving a premature diagnosis of a problem.

2. DOCUMENT SPECIFIC BEHAVIORS. Accurate anecdotal recordings are written, detailed descriptions of behavior, giving the setting, what precipitated the behavior, exactly what you saw and heard, and the results. These dated, objective accounts (more than one) give the parents and the referral agent the raw data from which to draw their own conclusions. This should be like: "David went to the sandbox and began to scrape sand from in front of K. K said, "David, that’s my sand." D did not respond and went on scraping. Louder K said, "D, that’s my sand!" D still did not respond. K reached out with his shovel and scraped the sand back to his area. D looked up at K with a surprised look on his face."(2/20/97)
   rather than: "David doesn’t pay attention when other children speak to him."

3. SPEAK TO THE PARENT PRIVATELY. At the door with other parents around is no place to discuss a concern about a child-ever-but especially a concern that there may be a special need that has not been diagnosed. Ask the parent to come into a private area, outside the presence of others, including the child. Have the documentation showing several instances to demonstrate the basis for your concern. Avoid using technical terminology or acting in the role of the "expert." Remember, the real expert on the child is the parent (Nilsen, 1997)

   Relate what strategies you have been using with the child and the results or lack of progress that has raised this concern but be careful not to compare to other children and not to use terms like "immature," "hyperactive," and "never/can’t." Be prepared for predictable stages: denial, projection of blame, fear, guilt, mourning or grief, withdraw, rejection and finally acceptance (Berger, 1995.)

4. SHOW CONCERN AND HELPFULNESS. Express your concern and ask if what you have seen and heard is typical of the child’s behavior in other settings. Ask how the parent reacts to it at home and if the parent has any advice as to how you should handle it. Be willing to try parents’ suggestions, if they seem reasonable or if you sense the parents need more time to think about what you have told them. If they seem to accept your concern, offer the names and phone numbers of some referral agents that are general in nature where the parent may discuss these concerns and possibly have the child evaluated. You may begin with the child’s pediatrician or medical facility. Offer to speak with the referral agent only with the parents’ written permission. [Have a "Release of Information" form (below) ready; if it looks like this may be recommended.]

   RELEASE OF INFORMATION FORM
   I give permission to ______________________(teacher) at ________________________(care facility) to release information concerning ___________________(my child) to ____________________________(referral agent). Signed __________________________Date_____________

5. PLAN FOR A FOLLOW UP. The parents may need some time to think about what you have told them so set up a time to talk again soon, either by telephone or in person, so that further questions and next steps can be discussed. Avoid rushing into solutions unless this is a critical situation. If a formal diagnosis is made, ask for a conference with the parents and the specialist so that you can understand and incorporate strategies with the child to meet the child’s need.

Working with the family and a child with special needs can be an intensely rewarding experience, seeing the successful results of specific interventions. There can be a feeling of satisfaction in assisting the child and the family to adjust and cope with changing expectations and possibly, hopes and dreams for the child. Empathy for the feelings of the family and collaboration with the child, the family, the child care setting and the specialist can make it successful for all.

REFERENCES

Berger, E (1995). Parents as partners in education: Families and schools working together. Englewood cliffs, NY: Merrill.
Nilsen, B (1997). Week by week: Plans for observing and recording young children. Albany, NY: Delmar Publishers, Inc.

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