Dr. Karen Landmeier is an advisor for Wayfinder and has served as a developmental and behavioral pediatrician since 2017. She currently serves on the board of Clear Child Psychology in Broomfield, CO. Karen specializes in helping families understand their child's strengths while managing challenges and delays. She recently sat down with us to share her wisdom about child healthcare in a disability context.
"You’re the Expert on Your Child"
What does a developmental-behavioral pediatrician do?
I’ve spent most of my career evaluating and diagnosing developmental disorders such as autism, ADHD and other intellectual or learning disabilities. After a diagnosis, I help families connect with other providers or services that will help their child.
What initially piqued your interest in the field?
I just love people with disabilities. I went to school at a place called Bal Swan Children's Center (an inclusion school here in Broomfield). I always just liked the aspect of how kids with disabilities could teach me things, and I could also help them — truly a two-way street. Later in life, I worked at Bal Swan and I grew to love working with parents. As a parent, receiving a disability diagnosis for your child is kind of like stepping into a foreign land, so I wanted to serve parents and kids together.
You talk about seeing and serving children through a “holistic and hope-filled” lens. Why is that so important to you?
As you journey with parents, you realize that nobody has a crystal ball. Every kid is so different, so it's really important to provide parents with evidence-based information, but then also to remind them: You are the expert on your child. Look for your child’s strengths, and build support around those strengths. And enjoy your child for who they are! A diagnosis doesn't change who your child is, and starting treatment doesn’t have to be like starting a new life.
After Diagnosis: Mental Health, Cultural Considerations and Collaboration
Why is it so important to emphasize mental health for kids with disabilities?
That can be the most challenging aspect for a child with a disability: not the physical or the intellectual struggle, but the anxiety or the depression that comes with it. For kids with “high functioning autism,” it does mean their intellectual and language levels are high, but sometimes these kids actually can struggle the most — because what is challenging for them, nobody else sees.
How do cultural considerations influence care for children with disabilities?
In some cultures, it's really stigmatizing to have a disability. So when I provide a diagnosis, a big piece is de-stigmatizing the label or what that diagnosis means. If your child has autism, it doesn't mean they are any different than who they were when I first saw them. A diagnosis just confirms they’re wired differently and their brain makes different connections. So I encourage parents to learn and share knowledge with their family to give the “label” less power.
How does collaboration help with holistic care?
I always tell families, my piece is just to explain what's going on. What comes after the diagnosis is most important: getting families connected with really good service providers, with people who can help them navigate the system. Nobody knows how to get down that pathway on their own.
What are some important trends you’re seeing in developmental-behavioral pediatrics?
Numbers of practitioners are dwindling. There may be a breaking point in front of us: where and how are these kids going to get diagnosed? The numbers of kids with autism are growing, but the support systems for them aren't keeping up with those numbers.
Success Stories: Evidence-Based Treatment
Can you share any memorable success stories from working with children with disabilities?
There was a boy I worked with who was diagnosed with autism at 18 months, which is pretty young for that diagnosis. His parents asked me which treatment options were worth their time and resources. I told them about evidence-based therapies, and advised them that screens were going to be problematic for their child. They set their efforts and time on what I recommended. A year later, the mom came back to me and said: “I still see the effects of his disability, but he’s talking now and he is able to do his tasks independently.” It was just such a success story for applying evidence-based practices.
Do any other stories come to mind?
There's a girl I saw who had significant intellectual and physical delays. Her specific diagnosis carried a pretty poor outlook in terms of language and intellectual abilities. However, with strong evidence-based care and a great support system at home and school, she was learning new words and picking up the things that she was being taught in kindergarten. It just goes to show — each kid is so unique and will always surprise you.
What do these stories mean to you?
For parents of a child with autism, for example, I think there can be a lot of mistrust because there's no cure for autism. So families sometimes just grasp at anything that's offered to them, and it can sometimes waste a lot of time, money and resources. But to see families applying evidence-based practices and witnessing the outcomes firsthand — that’s amazing and powerful.
Disparities and Dependence: Building a Better Future
Why is it harder for kids with disabilities to access healthcare than the general population?
I would actually say those kids can access it. Where it becomes really complicated, though, is that a child might need to see three medical specialists and they all might be an hour drive from the family. If the parents are working, that may require time off of work. Care can become a really big demand on a parent's time.
How can parents help their children become independent adults?
I think our education system does a pretty good job of supporting kids with disabilities until they finish high school. Then it can be like dropping off a cliff. Families who have the foresight to start thinking ahead tend to have the most success. They can put groups, activities or day jobs into place. It’s never too early to start thinking about priorities: “I don't need my kid to excel in math, but I do need him to know how to manage money that will help him be independent.” Or, “I need him to know how to ride a bus so he can get to and from a job independently.” Think outside the box for your child: What will help them be independent?
Why do you think there is such a shortage of providers who specialize in intellectual disabilities despite a large (and growing) need?
The American Academy of Pediatrics tells us that it’s largely based on what insurance will pay for. The reimbursement rate for providers is lower for pediatricians (especially behavioral pediatricians) than for other specialties. Providers are paid the most for procedures and hospitalizations, and in pediatrics you don't have a lot of that.
Looking ahead, what are some opportunities to improve healthcare systems for kids with disabilities?
It’s not an exaggeration that kids will wait on a waitlist for 18 months to be diagnosed with autism. Their pediatrician could already tell you that they have it, so at that point, they're losing 18 months of services. That lost time is crucial because we know that the earlier you start treatment, the better the outcomes — because the brain has more neuroplasticity. So that backlog of accessing care would be a huge opportunity for improvement — in how the diagnosis is made, and when and how support can be obtained.
Technology, Screen Time and Autism
How do you see technology helping or hurting kids with disabilities?
I actually can see technology helping us shorten the time to diagnosis. Researchers are studying how scans of a child’s eye can diagnose autism. That’s a huge difference from me conducting tests with a child for six hours. On the flip side, overuse of technology at a really young age is not helping with kids' brains, social skills and attention.
Tell me why screen time can be so detrimental to the development of kids with disabilities.
Technology is such a frustration for me from the behavior and development side, because kids are in front of screens earlier and for longer. We know that it impacts executive functioning, which then affects their impulse control, their attention, and their emotional regulation. They're not learning the skills that they are going to need to be successful even in preschool and kindergarten. Exposing kids to too many screens is detrimental to their brain development, and it becomes something that then is hard for parents to take away later.
Why is screen time so important to monitor for kids with autism?
Children with autism have an especially strong pull toward visual stimuli. So they are even more captivated and motivated by it. When nothing else can compare to a screen in terms of motivation, kids’ other activities can fall away and parents can't even get them outside. What kids with autism need developmentally is social interaction. And what you're not having when you're in front of a screen is social interaction.
Day-to-Day Support for Kids with Disabilities
What advice would you give to other healthcare professionals interested in serving the disability community?
Pace yourself. The people who come into this line of work are naturally passionate about the work and the families they serve. And so it's easy to overdo it, giving so much more of your time and getting burned out. Set up boundaries, and remember that you can only do so much. But also, try to make connections and kind of outsource the work that other people can accomplish, so you can focus on the work that only you can do.
How can Wayfinder improve the day-to-day reality of families?
I love anything that can help make a family's access to resources easier. Having information centralized that can help put those resources at families’ fingertips is a huge bonus. And when you engage with the website, you subconsciously understand that other families are on that journey too. Families that feel like they’re on an island can realize that there are other people out there in a similar situation.
How can readers better engage with children in their lives who have disabilities?
Talk to an individual with a disability, even if they can't respond. Even if they're nonverbal, tell them a story or engage with them and be okay with the fact that they're not going to respond. I can tell you that the engagement is still really worthwhile.
How can readers better support parents of children who have disabilities?
One of the best questions anyone can ask of a parent is: “What really delights you about your kid?” Ask a parent about their child — not about the child's diagnosis, but about the child.