Wednesday, November 25, 2009

How do you check for normal?

I'm beginning to notice a pattern with our incoming kindergartners. Every year they register for school with papers from their doctors telling us that everything is ok. These papers go into their files to sit in the office and nobody really thinks to look at them again- until we start to have concerns. Once you get to know a child- and sometimes it can happen within the first day- sometimes you start to see that something isn't quite right. Maybe it's their lack of eye contact. Maybe it's that they refuse to speak. Maybe it's their gross motor skills. Regardless- we, as kindergarten teachers, start to get concerned. We give them the benefit of the doubt for a couple weeks, but as time goes on, when we realize it wasn't just a shy child, we call the parent in. The parent usually ends up confirming our suspicions. Yes, they have concerns about their child. Yes, their child has never used oral language to communicate. Yes, their child is very different from the siblings in the family. Yes, the mother asked the doctor and the doctor said everything was normal, not to worry.

The doctor said everything was normal? We smile to ourselves, knowing that sometimes parents don't always hear what the doctors say. It's a lot to take in, sometimes there is a language barrier, the child is probably pulling out all the cotton balls and tongue depressors stored in the office and making a mess-but regardless of whatever chaos happening in the office, surely the doctor did not say that a 5 year old child who has not yet begun to speak is developing within the normal limits.

So we go to their file to check what this doctor actually said. And most of the time, most of the time, the parent is right. The doctors say that everything is normal.

I'm going to start making a list of these doctors, rent myself a child, go to the doctor and see if the doctors actually look at the children- talk to them, listen to the parents, and watch the children. We're starting to suspect these forms can be mail ordered, or at least bought on the black market and no doctor is involved.

There are a million reasons a person may perceive a child with gross developmental delays as normal, except that- they are doctors. They are suppose to be the parent's first line of defense. How many times do you hear "consult your peditrician?" And when the parent brings their concerns to the doctor to say "I'm really worried because my child is showing extreme delays in all of his/her developmental mile stones" the doctor is suppose to know that not speaking, or even trying to imitate sounds, is a huge red flag.

The worst thing is, there are programs in place to prevent this. All the doctor has to do is call Child Find. Or give the parent the number of Child Find and tell them to call themselves. Under IDEA children are eligible for special services at the age of 2 through Child Find. CF will do all the work- the doctor isn't involved after making that initial recommendation.

The children I've seen come to us with these concerns have made tremendous progress in their first year in school. They are not on the level with their peers, but every day we take baby steps at learning skills to be successful in the world. I can't help but think- where would they be if they'd be in a special education preschool starting at the age of 2? Or even if they worked with a special education teacher in their home once a week? If their language skills were being addressed at the age of 3 instead of at 5 when they are suppose to be learning to read?

The doctors may be too busy to listen to parents. Too busy to take the time to look at the children, speak to them, make eye contact, watch them. But they are putting these children years behind in life. And how long would it take to actually listen to the parent's concerns? The parent is voicing them anyway- saying, "My child doesn't speak." I'm sure the doctor gives an answer anyway- why not make it a truthful one instead of a stock "your child is fine".

Of all the things these children are up against- not enough healthy food, living in apartments with multiple families, speaking a different language, having parents working multiple jobs- they don't need to be fighting against their doctors as well.


jwg said...

I teach Early Childhood teachers and administrators. I tell them to never tell parents to check with their pediatrician about anything to do with child development for the very reasons you discuss. You'd think they get some training along the way but that doesn't seem to happen. By the way, the law states that childen are entitled to Early Intervention services from birth to 3, and the access services through their school district.

Anonymous said...

Thanks for the information about child development. Most of this stuff is invisible to us by the time they get to middle school, but sometimes we find out about issues in 1st-3rd grade that might have predicted the problems now...

It's comforting in some way to hear that it's a long-range problem, and that it may often start with harried and confused doctors. If they don't notice these things at the beginning, then problems escalate or snowball. Hmm. How to solve these problems? Not sure.