"Is my child developing normally? Should I get my child evaluated for early intervention?"
Why am I so passionate about this topic?
Because we're far too willing to mindlessly reject differences in children as aberrant deviations to be "fixed". Moreover, we're bullied by "experts" into embracing early childhood interventions as curealls for children who defy their peers, by developing at a pace beyond the "normal" swell of the bell curve. A distance that parents, care providers, and educators find so egregious and uncomfortable, that this discomfort drives relentless self-righteous advocacy. In so doing, we trivialize the persistent use of harmful labeling, inherent to the implementation of early childhood intervention services, whose efficacy is rarely potently challenged, despite circumscription by numerous irrelevant and inappropriate forces, including policy makers, bean counters, and zealous "champions".
However, when we describe the wide variances of aptitudes within adults, we rarely identify such differences as horrifying evidence of developmental deficits. For example, my inability to retain the volume of trivia and knowledge possessed by my husband, is hardly a debilitating cognitive lack. Moreover, I would never seek specialized interventions to facilitate progression within this cognitive domain. Rather, I accept that our cognitive differences are simply differences. So, why do such variances reflect individual differences in adulthood, while similar variances in early childhood, infer alarmingly critical deviations from normal?
Because we've been inundated with misinformation. Because most individuals who have an opinion on the topic - professional or otherwise - have an opinion - the basis of which is not the unbiased and comprehensive knowledge of the entire breadth of peer-reviewed, empirically-based literature and research on early childhood development, assessment, and intervention. Moreover, appropriate qualifiers and disclaimers are seldom judiciously balanced against such opinions.
Motherhood Under a Microscope
The most heartwrenching insecurity and subsequent rally for early childhood intervention, often stem from mothers, intent on validating their mothering. For the only extrinsic validation for motherhood accessible to mothers, is our children. Furthermore, whenever we share our children with society at large, we expose ourselves to the judging scrutiny of other mothers. Mothers. Not experts on child development. Moreover, some women brandish their perceived expertise as badges of honor, readily doling advice in the wake of implied extraordinary parenting. From whence do such women derive their enviable competence? Unsubstantiated platitudes opined by educators, care providers, and pediatricians as to the exceptional development possessed by their children.
Needless to say, I'm not a mother who looks pityingly upon children who are crawling, when they are two. Or hiding behind their mothers, when they are three. Or silent with strangers, when they are four. Rather, the behavioral traits of most significance to me, are: flexibility, adaptability, emotional regulation, tolerance, fortitude, sensitivity, social awareness, empathy, and joy. Not surprisingly, these are behavioral competencies that are woefully lacking in too many children deemed otherwise "normal".
Is it vitally important that Johnny and Susan were potty trained at twelve months? That Johnny and Susan spoke four languages fluently at the age of two? That Johnny and Susan did a 2,000 piece jigsaw puzzle and read War and Peace, at the age of three? Nevertheless... while such accomplishments are encouraged, validated, and rewarded within our society, i.e. as entrance criteria for exceptional pre-school programs, we'll continue to devalue "soft" behavioral traits essential for healthy child development.
Expressive Speech Development
One of the developmental milestones that mothers intent on raising a developmentally exceptional child, inordinately scrutinize, is expressive or spoken language. But the most ridiculous scenario for questions of developmental speech aptitude, is usually some variant of the following: a child isn't expressing as loquaciously as his peers, while his parents fail to disclose that they speak four languages at home. Needless to say, while most children learn one word for apple, this child is expected to learn four. Multiply that by the hundreds, if not thousands, of words children hear within the first few years of life. Add to that, a receptive, thoughtful, or introverted temperament. It is unlikely that this particular child will blossom into a babbling orator by two years of age. Even though the status of this child's expressive language acquisition may be a deviation from "normal", as laypersons define it, this rate of development is not alarming given the nuanced context of this child's early language experiences.
What is the benefit of labeling such children as speech delayed, when they simply reside beyond the "normal" swell of a bell curve determined by societal norms and expectations of early expressive language development? Rather, parental insistence on multi-lingual aptitude, based on the misapplication of early childhood adaptability to multi-lingual fluency, is what's egregious. While brain elasticity is certainly notable in early childhood, it's not uncommon for any child, much less children within multi-lingual families, to learn expressive or spoken language slower than other children, including children within mono-lingual families... because expressive language development varies widely, normally.
Notwithstanding the sheer reality of speech therapy for early childhood intervention: speech "therapy" for infants, toddlers, and young children is primarily play, focused on the acquisition of language. How is this different than parenting, focused on the specific needs of a child? Unless you're a parent, incapable of or unwilling to, provide enriching environmental, cognitive, and emotional experiences for your child, speech therapy under these circumstances, is simply a ticket for admittance to the club of parents with children with special needs. Moreover, it's a way to label a child's difference, as a deficit, rather than accept it, as a variant of normal.
To Assess or To Not Assess
Aside from fears of speech aptitude, the most common anxiety of parents who've been subjected to the mass hysteria of media presentations of developmental disabilities, is determining whether or not their child should be assessed for an early childhood developmental disability, especially autism. Cursory exposure to developmental disabilities - via friends, relatives, co-workers, media, etc. - encourages parents to believe that they're depriving their child, if their child doesn't receive early childhood intervention, when their child fails to comply and/or conform with an arbitrary and restrictive definition of "normal" development.
Here's the truth about early childhood development: wide variance is normal. Moreover, there's no definitive test for developmental disabilities. There are a variety of assessment tools that can be applied, in combination with an interview with the parent(s) and the child, to make a clinical determination of the presence of behaviors or traits consistent with the diagnosis of a developmental disability. In other words, a developmental disability is not a disease in the traditional biomedical sense. Rather, the determination of a developmental disability is primarily based on a parent's report of or child's display of social, emotional, behavioral, and/or cognitive variations from a child's peer group. As such, there's a lot of room for professionals to label children, based on very grey areas... not to mention the undue influence of parents, caregivers, and educators, intent on "qualifying" a child for treatment to be implemented by anyone other than themselves.
Hence, it is absolutely critical that any recommendation to assess, is a well-informed one. While, the professional performing the assessment, is appropriately and sufficiently qualified to perform such an assessment. These are often not pediatricians, special education teachers, or other self-identified "experts" on early childhood development. Rather, the diagnosis of early childhood social, emotional, behavioral, and cognitive disabilities is the domain of mental health professionals with specialized knowledge and training. Furthermore, if a child is labelled with a developmental disability, it is also absolutely critical that any individual providing treatment is appropriately and sufficiently qualified to administer effective and appropriate interventions.
Conclusion
The decision to assess a child's development for the presence of a disability is a weighty one. While forums and message boards are wonderful venues for support and sympathy, they are often populated by individuals who do not possess the knowledge, experience, and training necessary to provide expert advice for a child that they, themselves, have not personally witnessed or assessed. Moreover, the risk of misunderstanding is significant, when these conversations do not occur in person, as parents may inadvertently or advertently filter their disclosures in order to maintain a confirmation bias from listeners (intentionally and otherwise).
While in the end, the decision to submit one's child for a developmental assessment is a parental one, caution is wise. As a quick fix society, it is incredibly tempting to pawn our children onto professionals for assessments and subsequent interventions. However, such actions do not "fix" children. More often, such assessments lead to interventions that amount to little more than "focused attention". Among parents who lack the wherewithal, resources, and capacity to provide this level of intentional parenting, such services are invaluable. However, among parents who do possess the wherewithal, resources, and capacity to provide intentional parenting, professional intervention may do more harm (in the long run) than good. (For the label of disabled is unequivocally deleterious to human dignity. Is it not? Else why aren't all of us labelled disabled?)
Ultimately, we as parents, need to encourage each other to resist societal pressure to observe differences in our children, as aberrant deviations to be labelled and thus stigmatized. Instead, we need to encourage each other to recognize the inherently vast variances in child development as perfectly, uniquely, beautifully normal.
Addendum I (2014)
Obviously, there are circumstances in which developmental assessments and interventions are strongly advised by professionals who have observed deficits of note in children. And while such recommendations may be appropriate, it is always important to proceed with caution, due diligence, and careful consideration. Assessments and interventions are not always appropriate for every child who is demonstrating "deficits". Moreover not every child who receives assessments and interventions, benefit from interventions that are accessible via typical avenues (i.e. school systems, mental health systems, social service systems, etc.). For research has consistently demonstrated, that children along the autism spectrum (for example), do not all benefit from early interventions, as they're presently administered, studied, and funded.
There's also something to be said about the methods by which children are successful, as most interventions deemed empirically successful, include behavioral components. Why is this significant? Because behaviorally based interventions often fail to acknowledge the dignity, autonomy, and temperament of children - as such considerations are often disregarded, in favor of successfully modifying target behaviors. Why? Because these interventions are often designed and implemented by individuals without a thorough understanding of the psychological implications, ramifications, and consequences of applied behavioral interventions.
Moreover, non-behavioral interventions deemed successful for children labelled with developmental disabilities, often co-occur with expected progressions of development, in which it is often impossible to empirically differentiate the degree to which interventions are responsible for acceleration of progression. In other words, it's possible that some children who progress, do so as a consequence of their naturally varying progression, rather than as a consequence of early childhood interventions. This is especially likely among children who receive speech, physical, and occupational therapies as infants, toddlers, and young children.
In any case... while this addendum reflects my healthy skepticism of early childhood assessment and intervention... it is certainly true that children appropriately assessed and awarded the remarkable benefit of appropriate treatment, often significantly benefit from such interventions. However, it's not been my experience that such experiences are the norm. Rather, "professionals" defend their competence, regardless of the simple fact that no one is omniscient, omnipotent, or infallible; while many children receive mediocre treatment administered by inadequately trained pseudo-"professionals".
Meanwhile, the behavioral competencies of - flexibility, adaptability, emotional regulation, tolerance, fortitude, sensitivity, social awareness, empathy, and joy - continue to remain lacking in children - and adults for that matter - deemed otherwise "normal". Which merely makes one wonder - what kind of society are we - that we provide early childhoold interventions to children who aren't fluent linguists at two years of age - but we do nothing to facilitate the acquisition of behavioral competencies, so vital to the social, behavioral, and emotional development of children? These skills are not acquired through osmosis; however my point is not to advocate early interventions with such intentional skill acquisition in mind. My point is simply, that acquisition targets of early childhood interventions, are societally, politically, and culturally determined and thus, inherently limited by the fog of our temporal myopism. For... a thousand years into the future... human societies will surely agree... that our "modern" age is a barbaric one.
- M.
Addendum II (2016)
Should all young children by screened for Autism? on CNN (2/16/16)
It is interesting to note that the groups advocating most strongly for universal assessment for autism, are medical associations, i.e. of pediatricians, and special interest advocates, i.e. of autism... neither of which are composed of individuals whose ostensible purview include directly assessing, diagnosing, or treating early childhood social, emotional, behavioral, and cognitive disabilities. Rather the ostensible purview of both groups, is professional, not clinical.
It is important to iterate that the assessment, diagnosis, and treatment of early childhood social, emotional, behavioral, and cognitive disabilities is the domain of mental health professionals with specialized knowledge and training. A mental health background alone does not constitute specialized knowledge and training on the assessment, diagnosis, and treatment of early childhood social, emotional, behavioral, and cognitive disabilities. Notwithstanding that pundits, no matter how exhaustively degreed and credentialed, rarely possess the knowledge of the entire breadth of peer-reviewed, empirically-based literature and research on early childhood development, assessment, and intervention.
Alternatively, advocacy of early assessment for specific populations, i.e. cultural populations, ethnic populations, religious populations, national populations, socioeconomic populations, etc., concurrently facilitates appropriate assessment and treatment within "specific" populations that may or may not be "at risk"... and exploits these same populations, who may or may not lack the knowledge and/or resources to make fully informed mental health decisions and/or advocate on behalf of their dependents.
(Case in point: how often are cultural populations, ethnic populations, religious populations, national populations, socioeconomic populations, etc... much less, any population, permitted to question, contest, or defy the recommendations of experts and/or professionals... pursuant to patient advocacy? To assume that every well meaning expert and/or professional is omniscient, omnipotent, and infallible, especially with regards to advising families within so-called "at risk" populations... and to likewise assume that no population, much less "at risk" populations, is vulnerable to surrendering autonomy in the face of abject manipulation, coercion, and intimidation by experts and/or professionals... is simply naive.)
Likewise, the potential harm of disability labeling, inherent to the implementation of early childhood intervention services, as they're presently administered, studied, and funded, and the persistently inadequate examination of the efficacy of early childhood intervention services, as they're presently administered, studied, and funded, cannot be dismissed by the simple aphorisms: "there's no harm in testing; testing is good; there's no harm in interventions; interventions are good; there's no harm in labeling; labeling is good".
When we neglect to remember that acquisition targets of social, emotional, behavioral, and cognitive interventions (as determined by insurers, school systems, social service systems, mental health systems, etc.), are financially, societally, politically, culturally, and temporally determined and thus, inherently conscribed by the fog of our financial, societal, political, cultural, and temporal myopism... we neglect to remember that we define that which "unequivocally" indicate social, emotional, behavioral, and cognitive disabilities, such that... not only do, have, and will these "unequivocal" behaviors differ across peoples (i.e. cultures, nations, religions, genders, etc.)... these "unequivocal" behaviors also do, have, and will differ across time. Indeed... a thousand years into the future... we will surely agree that this age is an aphotic one.
In the end, when we resist societal pressure to observe differences in our children and our selves, as aberrant deviations to be labelled and thus stigmatized... we give our selves and our children the greatest gift of all... the permission to be wonderfully human.
More
More about the context that informs our societal norms and expectations and scientific norms and expectations of 'normality' and 'deviation': How the Idea of a 'Normal' Person Got Invented from Atlantic (2/2016)
Disclaimer:
The opinions presented herewith are (i) solely my own, (ii) solely for entertainment purposes, and (iii) not a substitute for the advice and recommendations of a professional. Nevertheless, the content presented herewith, derive from - direct and indirect - personal and professional - knowledge and experiences - on the topic at hand.
Hugs, M.
Post last updated February 2016.
