Are We Over­diag­nos­ing Our Tod­dlers

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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.”

Great ex­pec­ta­tions

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.”

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