SAN ANTONIO — When her son, Nathan DeKing, was 18 months old, Sarah Pollock took him to the pediatrician for a regular checkup. The doctor asked how many words her son could speak. Two or three, she replied.

“He told me that at his age, Nathan should have been able to say around 20 words, and mama and dada didn’t count,” Pollock said. “That was the first indicator that my son had some challenges.”

The pediatrician referred Pollock to the Brighton Center, a 50-year-old nonprofit that provides in-home treatment for children with special needs, such as autism spectrum disorder and intellectual and developmental disabilities, or IDD.

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Thanks to work with the center’s therapists, Nathan, now 2, has flourished. His vocabulary has grown to more than 50 words.

“Brighton really hit the ground running with him and started therapy right away,” Pollock said.

But, as it has with so many things, the COVID-19 pandemic has hindered the work done at Brighton, one of three agencies in San Antonio that provide so-called Early Childhood Intervention, or ECI, to children from birth to age 3.

Most children are referred by pediatricians or by the staff at schools or day cares — the places where an infant or young child’s delays are often first noticed. During the citywide shutdown related to the virus, those avenues of detection were closed.

Even now, with doctor’s offices reopening, many parents may be reluctant to take their child in for well-baby checkups, for fear of the virus, said Kim Jefferies, CEO of Brighton Center.

With autism and related developmental issues, time is of the essence, she said.

“A great deal of brain development occurs in those first few years of a child’s life,” she explained. “If you miss that critical window of opportunity, when delays or issues can be addressed, then it becomes more difficult and more expensive to intervene later on.”

About 90 percent of a child’s brain development — when neurons make crucial connections — happens by age 5, she said. Studies show therapy is far more effective the earlier it’s done, even before a child may have an official diagnosis.

Before the virus, Brighton received around 350 referrals a month, Jefferies said. In March, the referrals dropped by 100, and it’s only gone down since then, even with the state reopening.

In normal times, some 60 Brighton staff members — physical, speech, occupational therapists and more — go into the homes of some 20 children a week, to provide therapy in their natural environment. Parents learn how to incorporate the therapies in their day-to-day lives, Jefferies said.

When the pandemic hit, Brighton pivoted to teletherapy, with therapists coaching kids and parents over the computer. This has worked well for many families, she said, but around a third have not been able to make the leap to the virtual world.

She and other ECI providers across the state are concerned that children who need services and don’t get them because of the pandemic will fall behind, or perhaps lose ground they’ve already gained.

“We’re worried these kiddos will show up at public school or day care in the fall with significantly more delays, and then the schools will have to take on that burden,” she said.

On average, it costs about $10,000 more each year to educate a child in a special needs program than a mainstream student, she said.

Brighton also operates two child care centers, which reopened in May.

Jefferies said she hopes Brighton will be able to resume in-home therapy in about a month, although the recent resurgence of the coronavirus might change those plans.

Her nonprofit is one of 47 ECI providers in Texas. It receives $3.9 million a year from the state and raises the rest of its more than $8 million annual budget through client billing and other revenue.

The amount of money it receives from the state depends on how many children it serves, she said. At the beginning of the fiscal year, Brighton was providing treatment to almost 1,000 children a month. That number has dropped to an average of 930 children now.

She and other ECI providers worry that statewide declining referrals, along with the broader economic damage wrought by the virus, will end up reducing the level of resources that flow to these vulnerable children and their families.

She also worries about how parents of kids with autism and IDD, already stressed in nonpandemic times, are adapting to distance learning and all the other changes to routine made necessary by COVID.

For Pollock, who has returned to work as a preschool teacher, the teletherapy provided by Brighton has been wonderful. It’s enabled her to get even more involved in the therapy that has helped her young son so much.

“We work with things that the therapists see in my living room,” she said. “I love that it’s helped me be even more accountable.”

Nathan has returned to the Brighton child care center he was attending before the quarantine. Like many parents — including those with “neurotypical” kids — the shutdown was a bit of a struggle for Pollock.

“We were at home all day, every day, and it was hard sometimes to know what to do with him,” she said. “I wanted to make every moment meaningful for him. Before the shutdown, we had a very structured routine. I knew exactly what to do.”

Her goal now is to keep Nathan on track.

“I’m just so grateful how Brighton surrounded me with support, and how they’ve rolled with the punches during the quarantine,” she said.

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