Sometimes this blog serves as a bit of a confessional, providing a forum to voice some concerns regarding the issues that emerge while working with struggling children and their parents.
So, with that in mind here’s a confession. Sometimes I honestly don’t know when a child’s struggling is related primarily to immaturity (i.e., they are not ready and need more time) or whether their struggling is a legitimate disorder/disability.
This dilemma is particularly predominates when the child is between four and seven years of age, that is, from pre-K to second grade.
(As I write this I hear the chorus calling out behind me.)
“Well, Mr. Big Shot. You’re the doctor. That’s why we are coming in to see you – to tell us what it is. What do you mean you are not sure if it’s immaturity or a disorder? Stop rubbing your head! What’s the matter with you???”
I try talking back to the chorus.
I tell them things like, “It’s never clear cut. There is usually a ‘pie chart or a soup pot of variables.’”
At that point the chorus gets louder. They are almost screaming, “‘A soup pot of variables!!!!!’ What does that mean??? Does she have it or not? Does she have a learning disorder???? Does she have dyslexia??? And what about ADHD? She pays attention to nothing!!!! Isn’t that ADHD?”
Relentlessly badgered by the chorus, I think of Chloe, age 7, a child I recently evaluated who doesn’t read very well or stay on task without a lot of reminders.
Chloe’s teacher vaguely spoke to the mom about her not paying attention very well in school, with the implied suggestion that she might have ADHD, always with the caveat that “We are not doctors. We don’t diagnose.”
After running Chloe’ through a bunch of tests, I had one overall impression.
Chloe struck me as immature.
“Immature????,” the chorus cries out. “Are you kidding me?”
Yes, I push back against the chorus. I tell them that Chloe’ seemed more like a five-year old-rather than seven in her manner and way of interacting – that her preoccupations came across as a bit babyish.
The problem there is no test to quantify “babyish,” such as a “Maturity-Immaturity Scale.”
It’s the same with the disorders, like dyslexia or ADHD. Even though there are more objective tests involved in the assessment, there is no X-Ray or blood test to say, “Has it or Doesn’t have it.”
It’s still a weighing of variable to tilt the scales one way or the other.
I am sticking with the view that the Chloe’s needs time and perhaps some tutoring to help her mature and improve her skills.
“Back down, chorus. I’m going back to rubbing my head.”
(*** Please note: Dr. Richard Selznick is a psychologist, clinician and author of four books. His blog posts represent his opinions and perspectives based on his years of interacting with struggling children, parents and schools. The advice in the blogs and in practice is governed by one overriding principle – “If this were my child, what would I do?” The goal of the blogs and the website is to provide parents and professionals with straight-forward, down-to-earth, no-nonsense advice to help cut through all of the confusion that exists in the field.) )
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I think this is the first time I am ever commenting. After working 25+ years with preschool and younger elementary school students, I believe it is best to always give the child more time to mature and not diagnose so quickly. Those little brains take a long time to develop and let’s not rush these kids. Always better to be the oldest than the youngest (at least that is what I believe).
Thanks for the nice comment.
Yes, I couldn’t agree more. I think we have become as a society far too quick to “diagnose” disorders and disabilities.
From my view, unfortunately, the model in most schools is a variation on “wait and fail.” Without calling it a disorder, schools should be identifying “red flags” of concern and taking some sort of action. Even though it is now forgotten in the “way-back” machine, that was the whole notion behind Reading First, which was largely on the money. Give kids a hefty dose of what they need early and many kids will not be seen as “disordered” or “disabled” in the later elementary grades. Sadly , we have gotten very far away from the wisdom inherent in Reading First.
Echoing Susan Chavis’ comment about allowing a little more time before making a judgment, consider expected “windows” for human development — walking between (roughly) 9 – 15 months, talking between 12 – 24 months, etc. So many areas have these windows that actually get larger as a child gets older (considered as a percentage of age). For example moving from concrete to abstract reasoning (check out Piaget experiments with glasses of water, and other materials), can cover almost two years in predicting when it will develop. So often the answer to why is my child struggling is … “just wait for a while and revisit the issue in a few months or so.”
Thanks for the thoughtful comment. I largely agree. The problem with reading spelling and writing development is that the gap widens quickly between the “have” and the “have nots.” If I had my way, in kindergarten and first grade the “red flags” of concern can be easily identified (e.g., word reading development) and some action given to help move things along. This identifying of red flags doesn’t require calling someone “disabled” or “disordered.” We can see how the child responds and then make determinations a bit down the road if necessary.
After seeing you when Jade was in second grade, I agree with you. She has come leaps and bounds in 4th, and 5th grade. Maturity has played a huge part in this. Although I still believe she has ADHD, her emotions and behaviors are way more controlled, making her much easier to deal with when she is stressed or anxious.
Thanks, Sue. Much appreciated