Are We Overdiagnosing Our Toddlers?
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