Posted by: Hannah | 07/26/2012

the alphabet conundrum

In the West we have a greater understanding of what makes our children tick than at any other time in our history.

Sensory Processing Disorder. Attention Deficit Disorder. Attention Deficit Hyperactivity Disorder. Auditory Processing Disorder. Dispraxia. A host of others. Sometimes it seems like there are letters of the alphabet to explain every negative or undesirable behaviour a child ever experiences.

It is wonderful that there are so many supports in place for children who suffer from these and other disorders that interfere with their quality of life. As awareness builds, more parents seek help and more children are given the resources they need to cope with their world. In no way do I want to take anything away from that. Nor am I a skeptic (and there are many; SPD isn’t recognized in the Diagnostic & Statistical Manual as of yet despite it apparently being a relatively widespread problem).

But as a child care provider, I’m a little concerned about how often people suggest to me that a child in my care might have a disorder that requires testing, evaluation, and intervention.

I have three toddlers in my care; current ages 28 months, 26 months, and 22 months. They are irrational little creatures. One day they love bananas, the next day bananas are poison. One day they find a ladybug in the backyard and let it crawl all over their hand, the next day a blade of grass touches their foot and they freak out. They don’t like tags in their clothes. Or they do. They love tight hugs a hundred times a day, or they don’t want to be touched – or even looked at (“he’s YOOKIN’ a-me, Han-NAH!”)

There is no understanding them.

This blog is my lifeline, my place where I talk about some of the more frustrating aspects of my job. I don’t often blog about the really good days, or the lovely moments – because when those days & moments are happening, I’m enjoying them with my whole self and can’t be bothered to even jot it down on a piece of paper to blog about it later. Because of this, my stories skew to the horror-show side; the panic attacks, the aversion to splash pools, the screaming fits. I’m sure from the outside looking in, it may seem as if there must be something more going on, something beyond the usual utter weird & off-kilter crazy that is life with the Toddler Brigade.

And so people helpfully ask if I’ve considered SPD, or autism, or Asperger’s. In many cases they have kids of their own with these issues, and getting a diagnosis was the beginning of better times for them all. They remember whirling in confusion, needing help, needing answers. They don’t want to see me or the kids in my care going through the same thing. They mean well and I love them for their concern.

But.

Nine times out of ten, these kids are just being kids. Kids who are away from their parents from 7:45 until 5:30, five days a week. Kids who are thrown in with older children and a nursing baby. Kids from pet-free homes who spend the day with two cats and a delightful but large Labrador Retriever. Kids who are expressing themselves and their worries & fears in a way that seems completely appropriate to them, if painful and upsetting to everyone around them. (Pixie darling, I’m looking at you and your ultra-sonic screaming).

In the past, I’ve had concerns. My very first full-time client, my dear Very Quiet Boy, had a speech delay. He didn’t really react to pain. He slept ridiculous amounts of time. He didn’t make eye contact very often or when he did, nothing short of a neutron bomb would make him break that. He wanted to play with the other kids, but he didn’t know how.

His mom’s a teacher. She and I had several frank discussions about his delays. She mentioned her concerns to his doctor, who evaluated him and pronounced him “fine”. And almost two years later, he *is* fine. His speech is still a little garbled but it’s getting better all the time. He likes to play, is looking forward to attending preschool with Ron in the fall, and is generally just a happy little guy who mumbles a bit.

Marie and Unnamed Boy from a year ago were my two “challenge children”. Unnamed Boy was violent. He couldn’t control his emotions. He lived entirely in a fantasy world populated by TV characters. He didn’t understand personal space. He was a tank; a mean-spirited tank who crashed through here every day disrupting things and terrorizing the other children. I spoke to his parents about his behaviours many times; his mom seemed receptive but his dad was not. The plan when they left me was to have his grandmother care for him; that lasted all of a month, and the last time I saw him he was at the community centre with a group from the local Big Daycare, sitting sulking in the corner and not participating.

Marie was a completely passive child who couldn’t follow simple instructions, preferred the company of a stuffed elephant to other children, and disliked me almost as much as I disliked her (it’s true. I don’t automatically love all children.) After leaving my care, both kids ended up in licensed facilities with many more children and multiple caregivers, and in Marie’s case anyway is doing much better.

In every case when I have a kid who just isn’t fitting in, who doesn’t seem to march to the same rhythm as their peers, I seek help. I ask questions. I talk to their parents to try and find out if it’s a pattern of behaviour, or if they just aren’t suited to the home care environment. I try different approaches.

But, again.

These aren’t my kids, and as their (unlicensed, non-certified, my qualifications are experience based only) caregiver, there is only so much I can do. A friend of mine also runs a dayhome. She has had one child full-time for close to a year, and in that particular case, the child has obvious issues. She stims. She hurts the other children and the pets, and has no empathy. She can’t follow two-word commands – she’s three – and is barely verbal. My friend showed me video and there is no doubt that the child needs more than a mom with six kids in her charge and no specialized training can give.

She spoke to the parents. Several times. She showed them the videos. She started by gently hinting, then progressed to “have you noticed this at home” questions. Eventually, she point-blank said “I am not a diagnostician, but I’ve read up on some things and I really think your daughter has a developmental delay. Would you consider getting her evaluated by a professional?”

And they flat-out refused to even acknowledge what she was saying. In the end, she gave them notice because she is unqualified and unequipped to deal with a special-needs child in a dayhome situation. She feels terrible about it, but she is the provider – not the parent. Beyond alerting them to the problem, there really is nothing she can do.

Same with me here. Let’s take Unnamed Boy as our example, because of all my kids past & present he’s the one that I’m pretty sure has more going on than a lack of proper socialization and inconsistent discipline at home. His behaviours were so out-of-control that I took to keeping a daily log, to give to his parents every day at pickup. I had other kids his age here at the time – three of them – and so was able to say with confidence that he was not reacting in a way that could be considered “normal” or “developmentally appropriate”. But it was incumbent on them to take that information and decide what to do with it. In the end, they did nothing; they pulled him from my care and put him in a bigger daycare where (I’m guessing based on the day I saw him) he gets lost in the shuffle of 30 other kids and his odd behaviours are perhaps not as disruptive & therefore go unnoticed.

I’m losing the thread of my original thought a little bit, so… to sum up. Kids are weird. Toddlers are irrational. If they are operating outside “the norm”, we caregivers notice. Yes, we’ve “considered SPD / autism spectrum / ADHD”. In most cases, we’ve looked at it objectively and are confident that it’s either a phase or just one of those wacky things toddlers do sometimes. No, we can’t “get them evaluated”. All we can do is our best, talk to the parents, and hope.

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Responses

  1. We have been through a fair amount of the alphabet soup with E, and we began asking questions at 18 months. But I always appreciated that our home daycare at the time treasured him for his quirks. It was daycare workers who first suggested testing when he was 3.5 and doctors were still dismissing our concerns. The validation spurred us to find what we could do without a doctor’s referral. But I also completely get where you are coming from. Toddlers are supposed to be irrational creatures, and in most cases, especially SPD and Asperger’s (the two I know), they are too young for a definitive diagnosis.

    As a middle-school teacher, I run into unreceptive parents. Their kids can be really strugglung, but they see no reason for testing. It has been my experience that teachers (and I include daycare here) are not going to bring these things up unless the kid clearly needs help.

  2. YES! YES! YES!

  3. Sometimes our society just wants to slap a label on kids. “He’s like that because of x”. Sometimes this is helpful – early intervention, etc. – but sometimes kids are just kids. I’ve always kind of thought in my heart of hearts that if Mark ever had testing, he would be on the autism spectrum. But. He has not had testing, because he is social, bright, chatty, has lots of friends, is polite, can follow instructions, isn’t disruptive in class, etc. But. He is also obsessive about details, highly perfectionist, prefers to play alone on the playground. I’m not really expressing this how I want to. What I’m saying is that Mark is fine, and I bet a lot of engineers and scientists would be on the autism spectrum if they were tested. But we don’t need to “fix” everybody. Kids like the Unnamed Boy – yes. That’s a problem. But sometimes little quirks are just that – quirks that make someone the person that they are.

  4. It’s the whole damned instant gratification / fix culture we suffer with, isn’t it. Ball of energy? ADHD! Fat? Lazy! Social awkwardness? Autism! Doesn’t enjoy big, loud crowds? Agoraphobic!

    People slap labels on people and walk away with a smug grin thinking they’ve solved everything. Kids are wacky, full of energy and still learning how they ought to react to the world at large. Issues are so much more complex than that. Maybe I don’t like crowds just because I’m an introvert who prefers quiet. Maybe a kid’s being a bit odd because something’s changed at home.

    @ Mouse: It was a dedicated and impressive primary teacher to helped us understand that my younger brother was neither deaf or (as some people suspected) from a bad home. He’s developmentally delayed. I’m eternaly grateful for the fact that she had to courage to say something and that my parents had the brains to listen. He was hard to handle at the best of times, but knowing that he wasn’t just being a jerk made a huge difference in our lives. So, for all the effort you make to help your students: Thanks! Know that someone, somewhere truly appreciates your efforts.

  5. I was very, very uncomfortable last week (or was it 2 weeks ago?) when you posted about Pixie’s bug-induced histrionics and people were proposing she suffered from a variety of Alphabet soup sounding conditions. As you noted here, kids are quirky and fickle and diagnosis and labelling are tricky and sensitive. It’s best left to professionals be they caregivers, teachers, or doctors.

    As an aside: I’ve noticed an increase in the number of adults who self-label themselves as ADHD or obsessive-compulsive or Asperger’s. It’s so goofy. I don’t understand it at all.

  6. Interesting perspectives, all. I wish that along with all this awareness and public education came a clearer indication of just how prevalent – or not – these various disorders are. Like, do statistics indicate that it’s 1 child in 20? or 100? or 1000? I have no idea.

    As a caregiver I know that I spend more waking hours with some of these kids than their parents, and that responsibility is a heavy one. If there *were* a problem, in theory I would be the one to see it first. That’s scary. On the other hand, a generation or two ago someone in my position wouldn’t even be looking for anything… it’s a little staggering to me sometimes how much things have changed.

    Thank you all for your thoughts on this.


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