Are We Overdiagnosing Our Toddlers
seen overzealous parents looking for treatment for “pretty typical” children, yet she acknowledges that norms vary. “Behavior that might be redflagged at one preschool might be considered more typical at another; and at certain schools, they are selling a product—an education—and teachers know their clientele is expecting them to notice if something seems off,” Bragg says.
For example, at the private Montessori preschool that Bragg’s son attended in Chicago, the staff is quick to identify potential learning delays. The school has even partnered with a private multidisciplinary therapy practice, which she says is “growing like crazy.” Many of the parents at the school end up pursuing specialized interventions— which they pay for out of pocket or through insurance—after the school suggests an evaluation. “I’m sure there are plenty of families who were encouraged to pursue a therapy for their child unnecessarily, but I think that’s probably more the exception than the rule,” Bragg says. “And who wants to roll the dice when it comes to their child?”
In fact, the preschool staff suggested occupational therapy for Bragg’s son, which he received to improve his handwriting and gross and fine motor skills. “There’s no way my son would have qualified for occupational therapy at a public school, but the issue was raised at a parent-teacher conference a couple of years ago,” Bragg remembers. “Was the therapy he got necessary? Probably not, but it was definitely helpful.”
For Lonny Friedman, a teacher living in Springfield, NJ, no educator or pediatrician suggested that his then-3-year-old daughter Maggie needed extra help, but her tantrums were becoming excessively disruptive, so the family decided to see a behavioral therapist. He’s not entirely sure it was worth it. “The therapist put us on a very standard one-size-fits-all token reward system. I kept saying that the money we spent was for the laminated My Little Pony tokens,” says Lonny. “I thought things improved mostly because she simply grew up a little bit.”
Complicating the issue—and confusing parents further—is the fact that our expectations for young kids have changed drastically over the past generation. One recent University of Virginia study, “Is Kindergarten the New First Grade?” compared kindergarten teachers’ approaches in 1998 versus 2010 and found that teachers in the later years had much higher academic standards, spent far more time on teacher-directed instruction, and less time on play, science exploration, art and music.
“As academics have become so much more important at a younger age, some typical child behaviors are becoming viewed as atypical—or they’re becoming a problem when they’re the same behaviors that were there in preschool and kindergarten 20 years ago,” says Catherine Pearlman, Ph.D., family coach and author of Ignore It! “The idea that the typical child is one who sits, listens for eight hours, doesn’t have stress and doesn’t make any funny noises is unrealistic.”
It’s no wonder parents are sometimes quick to question their child’s development. “Parents are filled with self-doubt, but we have to be careful we don’t overdo it,” says Melissa Cohen, a licensed clinical social worker, psychotherapist and parenting coach in Westfield, NJ. “If you’re seeing normal childhood behaviors, such as biting, it doesn’t have to mean that you need some sort of cannibalism
specialist or high-intervention model; you might just benefit from some parent coaching on how to work with your child.”
When you can’t get help
On the other end of the spectrum are parents like Rachann McKnight, of Austin, TX, who fought an uphill battle to get her son, Sawyer, the therapies he desperately needed because the family couldn’t fund those services on their own. Rachann, an event planner, became concerned about Sawyer’s development when he was 9 months old and stopped saying words he’d already mastered, such as “mama” and “tete,” his name for his beloved pacifier. “I remember holding the pacifier in front of him, and I couldn’t get him to say it; it looked like he was physically straining to say it, but he couldn’t,” says Rachann. “I burst into tears.”
Convinced there was a problem, Rachann—who was living in Greenville, SC, at the time—asked her pediatrician if her son showed signs of autism. “The pediatrician told me repeatedly that I was wrong, that boys just develop more slowly, and he’s probably just tired or cranky,” she remembers. Eventually, she and her husband decided to move to Austin, where they could access autism specialists.
There, at age 2, he was diagnosed with severe autism, and qualified for comprehensive intervention therapies through Medicaid. Now, at 9 years old, he has progressed so much that his diagnosis has been changed to high-functioning autism, and he is flourishing in a mainstream school.
Tricia Catalino, a physical therapist, doctor of science, and chair of the Early Intervention Special Interest Group at the Academy of Pediatric Physical Therapy, sees these discrepancies in services nationwide. “In certain demographic areas, people are much more informed and have access to more services than they ever did. But there are still a whole bunch of people in lower socioeconomic brackets—and rural areas—who do not have the same access to information, nor do they have the same connections, funds, health insurance, proximity to service providers or transportation to get to them,” she explains.
For some families, the only way to access much-needed services is through the Individuals with Disabilities Education Act. This federal law states that children are entitled to a free developmental evaluation, and if they are diagnosed with a disability or determined to have a need, they are eligible for partially or fully funded early-intervention services. While each state has differences in how diagnoses are made and funds are allocated, the services can provide families of any socioeconomic background with much-needed help.
Cohen is swift to point out, though, that not everyone qualifies for the federally funded services, and there aren’t always enough therapists, or money, to go around. What’s more, some working families simply can’t take advantage of early intervention, even if their kids qualify for it. “If you’re a single mom with three kids, working full time, you don’t have the luxury of getting your kids’ services. As much as you might wish you could, if you have a 2:30 p.m. therapy appointment for your toddler, you simply can’t be there or you will lose your job. So a lot of this is a privilege for people who have time and money,” she says.
This inequity is just another marker of the vast disparities that define our time—specialized therapies have become a sometimes superfluous benefit for those with cash to spare, and an unobtainable necessity for less-fortunate families.
Jennaea, thankfully, was able to pay for her son Jake’s therapies out of pocket, since they weren’t covered by insurance. Jake was eventually diagnosed with borderline Asperger’s syndrome (on the autism spectrum). And thanks to consistent occupational therapy from ages 3 through 8, and intermittent behavioral therapy, he is doing great. “There is no doubt in my mind that Jake wouldn’t be at this intensely academic school, thriving socially, if we had not intervened with OT when he was young,” she says. “There is no way.”