Are We Over­diag­nos­ing Our Tod­dlers?

Working Mother - - Contents - by rachel rabkin peach­man illustration by chris gash

More chil­dren than ever have con­di­tions, but many are not able to re­ceive the help they need.

Jen­naea Gearhart could tell that her 2-year-old son, Jake, was phys­i­cally cau­tious, a bit un­co­or­di­nated and didn’t like to be around too many kids at once, but it didn’t raise alarm bells ini­tially. “He was hy­per­ver­bal, so I just thought one side of Jake’s brain was de­vel­op­ing faster than the other,” says Jen­naea, an in­te­rior de­signer who was liv­ing in Chicago at the time. But af­ter she had her daugh­ter, Maddy, Jen­naea started to ques­tion her logic. “One-year-old Maddy was much more phys­i­cally ca­pa­ble than 3-year-old Jake, even though he was al­most two years older. I be­gan to re­al­ize, Jake isn’t choos­ing not to climb that lad­der at the park; I don’t think he can.”

Jen­naea sched­uled an ap­point­ment with a neu­ropsy­chol­o­gist, who sug­gested see­ing an oc­cu­pa­tional ther­a­pist. “I had heard of an OT be­fore, but I didn’t know much about it,” she re­mem­bers. The neu­ropsy­chol­o­gist ex­plained that OTs help peo­ple im­prove skills needed for ev­ery­day ac­tiv­i­ties (oc­cu­pa­tions) through phys­i­cal, cog­ni­tive and psy­cho­log­i­cal sup­port.

That was 13 years ago, be­fore “OT” had be­come a house­hold term. Jake’s ther­a­pist de­ter­mined he had a sen­sory mod­u­la­tion dis­or­der and fine- and gross-mo­tor-skill chal­lenges. “It was such a rev­e­la­tion to fi­nally have an­swers,” Jen­naea says. “It wasn’t just me be­ing crazy.”

Ther­apy on the rise

Over the past 10 to 20 years, an in­creas­ing num­ber of par­ents like Jen­naea have be­come aware of de­vel­op­men­tal dis­abil­i­ties and are find­ing ther­a­peu­tic in­ter­ven­tions. So, if it seems as though more kids than ever are see­ing oc­cu­pa­tional ther­a­pists, be­hav­ioral ther­a­pists, phys­i­cal ther­a­pists and speech ther­a­pists, that’s be­cause they are. Data from the Na­tional Health In­ter­view Sur­vey, pub­lished in the jour­nal Pe­di­atrics, shows that be­tween 2001 and 2011, par­ent-re­ported child­hood dis­abil­i­ties steadily in­creased by 15.6 per­cent—and cases re­lated to neu­rode­vel­op­men­tal or men­tal health shot up nearly 21 per­cent.

Are kids to­day in­her­ently less ca­pa­ble than they were a gen­er­a­tion ago? No, ex­perts say. There are sev­eral fac­tors at play: Par­ents and clin­i­cians bet­ter un­der­stand the signs of de­vel­op­men­tal dis­abil­i­ties; there has been a rise in cer­tain con­di­tions that ne­ces­si­tate in­ter­ven­tion, such as autism and ADHD; many dis­abil­i­ties that may have pre­vi­ously gone un­ad­dressed have been re­clas­si­fied and given more-spe­cific di­ag­noses; and there is a grow­ing body of sci­en­tific lit­er­a­ture show­ing the ben­e­fits of mul­ti­dis­ci­plinary ther­a­pies for chil­dren. Kids are also more likely to be im­mersed in screens, which, when used in ex­cess, can in­ter­fere with sleep and play— cru­cial build­ing blocks for de­vel­op­ment.

“On the plus side, you’re see­ing bet­ter early iden­ti­fi­ca­tion, bet­ter screen­ing and bet­ter aware­ness,” says San­dra Schefkind, a doc­tor of oc­cu­pa­tional ther­apy and the pe­di­atric prac­tice man­ager for the Amer­i­can Oc­cu­pa­tional Ther­apy As­so­ci­a­tion. Also, be­cause there have been shifts in how prac­ti­tion­ers cat­e­go­rize be­hav­iors in chil­dren, “what might have pre­vi­ously been shrugged off as ‘ boys will be boys’ is now caus­ing us to won­der if there is some un­der­ly­ing con­di­tion,” she adds. And of course, many par­ents are do­ing their darn­d­est to help their kids suc­ceed in a fast-paced and com­pet­i­tive world.

A priv­i­lege for the for­tu­nate few?

Not all com­mu­ni­ties, how­ever, are re­spond­ing in the same ways. Though the NHIS data showed that chil­dren liv­ing in poverty ex­pe­ri­enced the high­est rates of dis­abil­ity, for the first time since the NHIS be­gan track­ing child­hood dis­abil­ity in 1957, the rise in child­hood dis­abil­i­ties was re­ported dis­pro­por­tion­ately among “so­cially ad­van­taged fam­i­lies,” ac­cord­ing to the study au­thors.

In other words, even though chil­dren of lower eco­nomic means are fac­ing sig­nif­i­cant dis­abil­i­ties, kids with more re­sources are more likely to re­ceive screen­ings and ser­vices nowa­days.

Ther­a­pists in af­flu­ent ar­eas have no­ticed an uptick in ser­vices for “typ­i­cally de­vel­op­ing” chil­dren. Jody Paul, a speech ther­a­pist in West­field, NJ, says that par­ents of­ten ask her to work with their chil­dren even if they don’t need in­ter­ven­tion. “I cer­tainly have par­ents ask­ing to cor­rect ageap­pro­pri­ate ar­tic­u­la­tion is­sues that kids nat­u­rally out­grow by age 5,” she says.

Heather Bragg, a Chicago-based learn­ing spe­cial­ist and au­thor of Learn­ing De­coded, has also

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