Therapy Thoughts--"Every Child Is Different"

[Since I can't seem to stop "talking" on facebook this afternoon, it is obviously time to blog.]

I have taken care of a lot of children. And, before our lives collided with the world of therapy, evaluations, norms, and percentiles, I would have been the first to tell you loudly, convincingly, and aggressively that each child is vastly different from any other child. And, in a sense, I believe that no less now than I did then. However, in another sense, I see how that is only true in its proper nuances and setting. One of the main reasons I hear parents and doctors say that their chid does not need an evaluation for therapy "right now" is that "every child is different," and as a parent, I understand; but as a begrudging student of pediatric development, I must beg to differ.

Listen, this was me. So, if you see yourself or your doctor or your spouse or your parents in this line of reasoning please know that I'm not blasting you or any of them. But I do hope you'll read on. And maybe let yourself "go there" with me on this. If it's hard to do that, then you probably really should.

First, yes, every child is so different. Anyone who has spent any amount of time around more than one child will know this to be true. However--this is a big however--there are people who have spent their lives studying children. They've done this precisely because they are all so different. And these people, hundreds, no, thousands of them (so don't feel like you're putting all your eggs in one proverbial basket) study trends, averages, and probabilites. And, you know what they end up with? Lots of helpful information.

This information does not discount that each child is different. It is based on it. It uses averages and percentiles. It gives a broad look at what is developmentally appropriate at different ages--for all different kinds of children. You have to be careful not to tell yourself that all other kids might do it this way, but your kid, he or she is so smart or so clever or so independent or so laid back, that he or she does it differently, and that that is no need for concern.

If your baby or child really is coming up noticeably different when compared to averages, that is reason to be concerned. And here's why: the people making those evaluations and averages and percentiles are not stupid. They are not making money or getting any sort of kick back if your child is delayed or needs therapy. They work very hard to learn what type of things are cause for concern. They have written the evaluations to "catch" those babies and kids. And, look, no one wants to "catch" them to make you feel bad as a parent or to make them look bad as a child or to make your doctor look bad as a primary care doctor. They want to catch them so that they can help them.

They know that on average kids who go on to have no problems do specific things at specific age ranges--they sit, they say specific sounds, they connect interpersonally in specific ways--all, on average, around the same time developmentally. These are not indiscriminate "milestones" so that your pediatrician has something to talk to you about before your child receives specific immunizations at their "well-visit."

In America, kids go on to school around six. At six, they're supposed to be able to do certain things. If they weren't doing the things they were supposed to be doing at 18 months, it will be a problem at six. If they weren't saying the things most other kids are saying at two, it will create a problem at six.  So, even if your baby or child and you are getting along quite fine, thank you, whether or not they are meeting specific milestones, there are future reasons to pay attention to them developmentally now.

So, let's discuss. If your baby is coming up fairly "different" on many general milestones, are they "fine" and "ok" and "different--in the way that every child is different?" Well, yes and no. Yes, they're fine in that they are alive and have bodily health and caring parents. They're "ok" in that they are wonderful little creatures who are most likely very loved and love others in return. And if their whole life could be done in whatever "different" way they learn or prefer to operate, there would be nothing else to worry about. There's not a lot of pediatric speech, occupational, or physical therapy in nomadic communities or in poverty stricken countries or in countries where immediate nutrition is life or death.
But, presumably, your little one will go to kindergarten and will participate in some version of a k-12 American system. If so, then it is very, very worth helping them if or when they come up short developmentally compared to their peers. [I'm not saying it's not "worth" helping all children; but I'm arguing against a "wait and see" approach that is common in America and not compatible with the way school or life is set up here.]

If, after months and months or years and years of missed or late milestones, you continue to "wait and see," you are waiting out precisely the time at which their little brains are so ready and malleable to receive help.  Now, even the adult brain is neuroplastic to a degree; but we all know how quickly and amazingly babies and toddlers learn everything around them. Their brains are wired for learning NOW. What a bummer to "wait and see" through the first five years of their life if there is cause for concern. The earlier they receive therapy (if it's needed), the quicker and better the outcome.

So, to sum up, people study what's normal. Every child is different to a degree, but after that, you enter into "different" that is associated with developmental problems in the long run.

Lastly, I will tell you that unless you are a trained professional, you won't be able to tell the difference between quirky and different-enough-to-merit-a-little-intervention. You really won't. I'm as avid a researcher as you'll meet. I read scholarly articles, talked to SLP's, and I watched Evelyn very closely as her language developed. I did most everything short of going to school to be a speech pathologist. I watched her as she did some of the EXACT same "quirky" speech and language patterns and habits as her older brother Spencer who has apraxia. Honestly, it was a bit concerning. I had her evaluated, and her scores were completely within the normal range--while doing all sorts of quirky things Spencer had done at the exact same age. And, to be honest again, it was hard to rest in that evaluation. But, guess what? The evaluator was right. Her language is average (in a good way). She has no issues.

I don't mean to say that evaluators or evaluations can't sometimes be wrong. Spencer didn't qualify for speech therapy at two, and he really should have. The SLP wasn't good, and I was so sick throwing up for 20 weeks of a pregnancy that I didn't pushed her on his scores. I didn't point out other atypical patterns she may have missed. I didn't ask for a second opinion. Mistakes were made by all involved. But we were told to come back. And we did. And he was behind. So, it's not as if they just sent us on our way.  The evaluation showed enough of a "delay" to flag him. That's what they're designed to do. And, in that way, it "worked."

I ramble to say, please don't decide for yourself that your child is "fine" when he or she is not within the generally accepted developmental norms.

They very well may be fine--Evelyn was. Or, they may not be fine.

My father, a general surgeon, will NOT under any circumstances diagnose a sinus infection, or a rash, or depression, or the chicken pox. If it's not in his area of expertise, he defers to someone for whom it is. Yes, he's been taught all about those things. Yes, some of those diagnoses might even seem easier than diagnoses a surgeon makes all day every day (and night), so, the assumption might be that of course he'd know about those possibly "easier" things. But that's not the way it works. A teacher is a teacher, not an occupational therapist. A pediatrician is a pediatrician, and none of the ones I've met have a degree in speech pathology or physical therapy.  If they do, they probably aren't practicing as a general practitioner. A parent, no matter how many children they've had, no matter how much they know, is a parent. None of them are trained to evaluate for pediatric developmental pathology automatically by reproducing. And that's ok! It just means we all have to be humble enough to defer to another specialist--or two or eight--to get an idea about how our child is doing developmentally if there is cause for concern.

If your pediatrician is "not worried about it," that does not necessarily mean that you should not be worried about it. With all due respect, it's not the pediatrician's child.  Children have parents for a reason. And that reason is they need an adult who knows them intimately and cares for them paramountly to help them navigate life.  They can't do it for themselves.

Every child is different. And that's really true. And that's really great.  As parents, we must work to ensure that all of the differences help them to become the person they were created to be as opposed to letting the differences dictate what will become of the child. This is not about your child being the best reader or the best runner or the best anything; this about your child getting what he or she needs to develop neurologically and physically.  Timely development is imperative for healthy development.