Long wait times and high costs put pressure on parents whose children need early intervention

When Elizabeth Yuanita Purwadinata’s older son, now aged six, was diagnosed with autism in 2022 and her younger son, now four, was also suspected to be on the autism spectrum, she knew that she needed to get them some help beyond enrolling them in preschool.

Other children the same age would typically be more verbally expressive, but Ms Purwadinata noticed that her boys were showing signs of speech delays, prompting her to seek medical advice.

She searched for early intervention programmes, designed to help children with developmental delays and other learning difficulties catch up with their peers in the early years.

She opted for the government-subsidised Early Intervention Programme for Infants and Children (EIPIC).

She was told the wait for a place would be about a year. She eventually waited more than a year to enrol her older son in the programme.

Ms Purwadinata, 42, a quality system engineer, is the family’s sole breadwinner. Her husband is suffering from kidney failure.

She said that although early intervention programmes offered by the private sector had shorter waiting times, the costs of these would be too much of a financial burden for the family.

“I had no choice but to just wait ... for when the call comes in saying, ‘Hey, your kids can enter and can start (the early intervention) this month’.”

Ms Purwadinata’s situation is not uncommon.

Of 10 parents interviewed by CNA TODAY, six waited between six months and 1.5 years for a subsidised spot in an EIPIC centre. The rest went for a place in a private centre to avoid the long wait. 

Responding to queries, the Early Childhood Development Agency (ECDA), which oversees EIPIC, told CNA TODAY that the average wait time for a spot last year was 7.5 months at both its public centres and those that are privately run but offer government subsidies.

The cost for these centres range from S$5 to S$430 per month at public centres and between S$9 and S$730 per month at the privately run centres after subsidies. 

With more centres opening up, the agency is hoping to further reduce the waiting time for a spot. 

The goal is to increase spaces so that by 2027, 80 per cent of children requiring medium to high levels of intervention will be able to receive early support, ECDA added.

This is cold comfort to homemaker and mother of three Valerie Tan, who said that enrolling her six-year-old son who has cerebral palsy in a private centre was too expensive for her family. 

The 44-year-old applied for a place for her son in EIPIC when he was about six months old. He eventually secured a spot about 1.5 years later, at two years old.

At the same time, his condition meant that he required constant, consistent therapy even while he waited for the spot at EIPIC.

“Every moment you wait makes a difference,” Ms Tan said.

To get her son the help he needed during this interim period, she approached two non-profit organisations that provided visual therapy and home-based physiotherapy at subsidised rates.

The family also downgraded to a smaller house so that they could afford the necessary therapies and equipment such as wheelchairs for the child, and Ms Tan found a therapist in Kuala Lumpur, Malaysia to save costs. 

SHORTER WAITING TIME, HIGHER COSTS FOR PRIVATE PROVIDERS

Faced with long wait times, a number of parents, anxious about the repercussions of further delaying early intervention, have chosen to enrol their children in a private alternative, despite the cost. 

The waiting time for a spot in a private setting is typically shorter, between one and three months, but it can also cost thousands of dollars more.

Like EIPIC, these programmes support children with varying developmental needs including those with mild speech delays, social or motor skill challenges and more complex conditions such as autism.

Some centres also have a lower child-to-teacher ratio compared to government-subsidised institutions. 

Ms Isabel Tromans, whose four-year-old is on the autism spectrum, said that when she was looking to enrol her son in an early intervention programme, she was told by government agencies that the estimated wait time was “anywhere between six and 28 months”.

“Time is ticking for your child, because you’re aware that (intervention) needs to be done very early, and the waitlist (for a public EIPIC centre) is very long,” the 44-year-old speech therapist said.

“So my initial thought was to get him in a private programme first, before he secures a spot in the public one.”

She applied to a private centre in May this year and was able to start her son there when the new term began in August.

But Ms Tromans estimated that she pays about S$4,000 a month in fees at the private centre. This excludes other therapy costs including for occupational therapy. 

Early intervention programmes are not full-day programmes because such sessions are intensive and can be tiring for children. Most range from two to three hours.

Depending on the child’s needs, they attend such programmes two to five times a week. 

This means that parents often supplement the early intervention programme with a combination of preschool or kindergarten classes and other private or public therapy services, which add to their overall monthly spending.

Given the high costs involved, many of the parents have had to make sacrifices.

Ms Purwadinata said: “I need to be very mindful of how I manage my finances to make sure that I have enough. Yes, I do some budgeting and I prioritise: What are the things that need to go first and what are the things that can wait?

“For clothing, or maybe a bag, if you can still use it, you can wear whatever you have ... unless it’s really already (worn and torn) then we have to buy a new one.”

THE EARLIER, THE BETTER

Notwithstanding the challenges that families face in securing a place for their child, the parents unanimously agreed that they have seen positive changes since enrolling their children in these programmes and therapy sessions.

Ms Na Hwee Fang, 45, a compliance officer, said that she has noticed several positive differences in her four-year-old son since he began attending an early intervention programme this year.

The mother of two said that since he was enrolled in the programme, her younger son has been able to express himself better compared to the past.

He is now able to speak in a full sentence and is also able to better regulate his emotions in a "meltdown".

Noting, however, that the family had to wait for more than a year for an opening at a public EIPIC centre, she said that she wished she could have enrolled her son earlier, especially since early intervention is crucial for children this age.

Indeed, the benefits of early intervention in overcoming developmental delays cannot be overlooked, experts said.

Mr Edmen Leong, director of specialised education services at the Dyslexia Association of Singapore, said this is because young children are highly adaptable and capable of rapid learning.

Dr Eunice Tan, head of the special education minor at the Singapore University of Social Sciences (SUSS), said that for many children, the largest window for improvement is between birth and six years old.

Dr Suvi Pitkola, founder and director of Kaleidoscope Therapy Centre, said: “During this time, a child’s brain can rapidly form new connections, making it an ideal period to introduce interventions that can shape their developmental trajectory.”

Professor Kenneth Poon said that conversely, delaying early intervention could lead to existing developmental competencies stacking up over time. He is dean of education research and centre director at the Nanyang Technological University's Centre for Research in Child Development.

If early intervention is delayed, it will make it harder for the child to catch up with peers in areas such as communication, motor skills and social abilities, Dr Pitkola said.

In turn, this gap may cause a child to feel different, especially if they notice they are struggling with skills that seem easier for their peers. This could lead to them feeling frustrated or even lower their self-esteem, she added.

The longer intervention is delayed, the more likely it is that children may also develop unhealthy habits that might become harder to eradicate later in life, experts added.

Dr Tan of SUSS said: “There will be so much more that the child needs to catch up on, and during this one-year wait … additional issues may surface. Sometimes, the added problems could have been because the initial difficulty was not worked on.”

Generally, the longer the wait, the more significant the consequences, she added.

Dr Pitkola said leaving developmental delays unaddressed will increase the need for ongoing therapy and intensive intervention in later years, which incurs high costs. 

Due to financial constraints, not every parent in the same situation can choose to send their children for private therapy sessions while waiting for a place in a public EIPIC centre.

For these families, the experts said there are interim measures parents could take.

These include getting tips from doctors, enrolling in online courses, or attending workshops offered by ECDA, which are often free or low-cost. These can provide parents with the structured guidance they need to engage their children in developmental activities at home.

The experts also suggested that caregivers may join parent support groups such as CaringSG, which can provide them with emotional support and practical advice from others facing similar challenges.

Dr Tan of SUSS said: “In these support groups, there is a wealth of information that are shared by other parents. A parent of a newly diagnosed child can glean some important information from them.”

Such support can go a long way for parents, who might otherwise feel isolated in their caregiving journey.

“I think (as a parent) you can feel very alone. Your life is very different from people with typically developing children," Ms Tromans said.

"On one hand, this is the child you are given, and he’s perfect – you wouldn’t change him. But at the same time, you worry if you’re doing enough, if you’re doing too much, is he in the right setting, did you make the right decisions … and that’s quite heavy.”

Additional reporting by Nicole Lam