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Screening for developmental disorders

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Minister Lionel Carmant wants to reassure parents who are waiting for services for their child suffering from developmental delay.

  • Véronique Prince (View profile)Véronique Prince

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The Agir Tôt program, which aims to detect developmental delays in young children, has made it possible to screen for learning disabilities in at least 30,000 children since its launch in 2019. Many families, however, have the impression of finding themselves in a bottleneck, waiting several months before being able to consult a specialist who will take care of their child's follow-up.

What I would like to tell families is that the intervention is done in stages, says the minister responsible for Social Services, Lionel Carmant. In our heads, we are a little fixed at the point where we say to ourselves “until I have seen the speech therapist, I have not received intervention”, but that is a third step!

Minister Carmant, previously a pediatric neurologist at CHU Sainte-Justine, wants to reassure waiting parents: Stimulation with parents, then group meetings, is part of the process. It's a very, very important message.

He thus wants to respond to the figures revealed in September by the Toddler Observatory, according to which 21 % of children with a delay do not receive follow-up within the prescribed time frame.

As part of the Act Early program, a nurse takes advantage of the 18-month vaccination appointment to carry out checks. If a possible delay in the child's development is detected, the parents are first advised on ways to stimulate them. Then, a group meeting, with other children and a specialized educator, is offered to them. The consultation with a specialist often occurs at the end of these first two stages.

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The specialist educator is available more quickly than the speech therapist. Parents must understand that this is already a first intervention, adds the minister.

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The minister responsible for Social Services, Lionel Carmant, wants to be reassuring. (File photo)

We went to meet the stakeholders involved in this program at the CIUSSS de la Montérégie-Est. With the team of nurses she supervises, Julie Desmarais notices a significant increase in screenings. One of the consequences, according to her, of the success of the Agir Tôt program. Nurses use a tool called the alphabet book to assess a child's motor and language development.

Yes, there are false positives, children who may have something, but ultimately, there is nothing. So much the better! At least we didn't take any chances! That doesn't mean that all the children we screen will need services, she says.

Still, it's worrying the parents, in a hurry to obtain medical follow-up, which Martine Piotte must then manage. We could not have predicted that there would be such a large volume. This is a shared concern. I have this concern every day!, admits Ms. Piotte, program manager of Youth Access in Montérégie-Est.

We tend to think of traditional services. Language needs means: I sit down with a speech therapist for individual monitoring. We are trying to see how we can intervene more quickly, for example with groups. The child is evaluated dynamically, through the participation of the group, and the parent is equipped.

A quote from Martine Piotte, program manager of Accès jeunesse in Montérégie-Est

In Montérégie-Est, as elsewhere in Quebec, language disorders seem to be predominant. I must say that I am surprised by the figures: 85% of Agir Tôt screenings are due to language delays, recognizes Minister Carmant. I knew it was the number one developmental delay problem among our young people, but so much?

This can be explained in particular by wearing a mask during the pandemic. Many pediatricians had also questioned the government on the need for young children to see facial expressions. In addition, workers in Montérégie-Est notice language delays in the children of asylum seekers who have had a difficult journey to flee their country.

During our visit, we met Bryan, now five years old, and his mother, Annie Paquette. After heart surgery at two and a half years old, he practically stopped speaking. Ms. Paquette had to make multiple appointments to try to resolve her developmental language disorder.

The time to enter Act Early is a little long, yes. It’s the healthcare system! But once you get into gear, there you go! It changed the way I was a mother. I understand my child better and I have more tools, she says.

Ms. Paquette tries to reassure parents who are going through the same situation as her. With Agir Tôt, contact is constant. Nadeige [Bryan’s caseworker] gave me her phone number, came to my house, and we talk all the time. She has just had an appointment with a speech therapist for the rest of the follow-up.

Creating more positions to meet the demand for the Agir Tôt program is proving to be a dilemma for Minister Carmant, who must ensure not to undercut other key sectors.

You have to be careful, especially with specialist educators, who often come from youth protection, for example. I can't open too many educator positions at once. The first year of the program, many left youth protection. It was something I should have done differently, but it was a new program and we had to move forward.

A quote from Lionel Carmant, Minister responsible for Social Services

Lionel Carmant also wants to open new audiologist positions over the next year, since hearing problems can explain certain language delays. He also asks pediatricians to go more into the field, by integrating CLSC community teams, to see children more quickly.

Historically, children had to be placed on waiting lists to consult a pediatrician in four specialized centers, namely the Montreal Children's Hospital, the CHU Sainte-Justine, the CHUS de Sherbrooke or the CHUL in Quebec. Pediatricians carried out follow-up following a request for consultation from a family doctor or the hospital pediatric clinic.

When I left Sainte-Justine, the waiting list was much more than two years, claims Lionel Carmant, referring to his departure from the hospital center to enter politics in 2018.

The minister hopes that the new method, with pediatricians integrated into multidisciplinary teams, will allow to decompartmentalize the process.

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