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"Is My Child Normal?"

Most children reach each developmental milestone  -- from first step to first word to first friendships-more or less on schedule. Others clearly have major delays. But then there are those who seem to be on their own distinctive path, varying just enough in development and temperament to cause worry, but not enough to make it clear what the problem is  -- or even whether there definitely is one. As pediatricians, we see these kids  -- whom we call "quirky"  -- often; as moms, we know how scary it can be to suspect your child might have a problem. It could be the infant whose crying jags don't end at 12 weeks like most colic does, or the 2-year-old whose tantrums seem out of proportion to the "average" toddler's. Maybe there's unusual social behavior: the preschooler who plays obsessively with one toy, or the third-grader who doesn't have any pals. It may even be a child who reads astonishingly early but is clumsy and uncoordinated on the playground.

If this is your child, you may have a sense that she just doesn't quite fit  -- doesn't fit the books, doesn't fit the group, doesn't fit your expectations. You listen to other parents talk about their kids, and you feel certain that something in your own home is out of step.

On the other hand, you may have moments when you look at that same child, who's healthy and obviously intelligent, and wonder whether the problem is all in your head.

Many kids go through quirky stages and outgrow them. But others spend their childhood contending with their different learning styles, their complex temperaments, and, perhaps above all, their peculiar social skills and styles. So if your child is struggling or suffering, you owe it to her to find out what's going on. Thirty years ago she might simply have been labeled eccentric or even weird (especially by her peers). These days she's likely to undergo medical, developmental, neurological, or psychiatric evaluation, and, depending on the results, she may benefit from treatments ranging from various therapies to educational programs to medication.

So how can you decide whether something's really wrong with your child? Consider three common areas of concern:

* Her temperament and behavior

* Her speech development

* The way she relates to other people

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Behavior & Speech

Temperament and behavior

Maybe your child seems unbelievably irritable, as if he's not quite comfortable in his own skin, or he's desperately needy or constantly frustrated. This would be the infant who arches and shrieks, as if in pain, who never seems able to settle down. It would be the fitful sleeper or the toddler who doesn't seem to need any sleep, or the kid who spins, flaps his hands, or rocks repeatedly. It may even be a remarkably placid baby who appears to demand nothing.

In older children, these same temperamental variations may show up as trouble with transitions or outrageous tantrums, or as such extreme sensitivity to sensory stimuli that they can't tolerate the noise of a movie sound track, say, or the sensation of water on their skin.

How extreme is extreme, though? One way to tell: Ask yourself if your daily routines are dictated by your child's behavior. Do you live in fear of the meltdowns that occur if you don't stick to your rituals? If so, it may be time to look into what's really going on.

[BLUE_TEXT_BOLD {Speech and language}]

Quirky kids may be slow to talk, but there are other reasons for talking late, such as hearing problems and oral-motor difficulties, so make sure you discuss this with your pediatrician. Many kids outgrow speech delays and benefit from therapy and help from their parents. Or a child may speak more or less on schedule but have deficits or peculiarities in how she uses language socially  -- seeming uninterested in what other people say to her or ignoring loved ones but responding to a certain tune or TV show. On the other hand, she might speak clearly and precociously, but only to talk about one thing obsessively or to make requests. In other words, maybe she can say "I want juice," but she can't follow up with "This juice is good!"

Specific speech patterns may also raise an alarm, as when a child repeats the last few words of whatever is said to her, she asks the same question over and over, or she speaks in a monotonous tone. These can be clues that even though there isn't technically a speech delay (she knows the right number of words for her age; she pronounces them correctly), there's a developmental issue to be dealt with.

Socialization & What's Next

[BLUE_TEXT_BOLD {Social interaction}]

Most babies should be making eye contact and smiling like they mean it by 4 months; waving and pointing by age 1; and interacting with one another, even if it's in a tug-of-war over a toy, by age 2. Look out for deviations in these milestones, as well as:

* Showing little interest in toys or playing with them in an unusual way (such as lining up little cars) or fixating on certain textures (for example, stroking a stuffed bunny again and again).

* Not seeming to care whether you're nearby, or showing no interest in looking at or talking about something together.

* Not responding to simple games like peekaboo; being unwilling to acknowledge another child, let alone join in a group game.

* Bonding with an inappropriate object, like a CD, and toting it everywhere.

* Seeming totally uninterested in other kids or  -- and this is so hard to watch  -- wanting to be accepted by other children but going about it all wrong and always ending up in tears, or making someone else cry, or just being left out.

[BLUE_TEXT_BOLD {What now?}]

Set up a time to talk to your pediatrician. Making a special appointment will signal to your doctor that she needs to give this issue her attention, and it will also ensure there's enough time to answer your questions and plan the next step.

Your pediatrician may do a formal exam to assess your child's motor development, cognitive skills, language, and social interaction, and she'll ask you to describe behavior at home. If, after that, she isn't concerned, that means something  -- though it's not a guarantee.

On the other hand, if you don't feel you're being listened to or the doctor assures you there's nothing to worry about but your gut tells you there may well be, request a referral to a specialist in child development and behavior. Some families will be reassured that nothing's wrong, but for others this will be the first step toward identifying and classifying a child's developmental strengths and weaknesses. You may get a single diagnosis, or you may be told that your child has several issues  -- for example, he has some autistic features and sensory integration problems and is a little hyperactive. And as he grows, such a child may be reevaluated and rediagnosed many times.

Living With a Quirky Kid

It can be devastating to discover that the child you love so very much has a problem. Once you've gotten past the initial shock, though, your love for her and your commitment to helping her grow and learn and develop are going to get both of you through. This may mean accepting that she's not the child you were expecting, and even allowing yourself to grieve the loss of that fantasy. Keep sight of the fact that everyone has only one childhood and one family, so focus on ways to enjoy the child you have, even as you're looking for answers and help.

Everything looks different in retrospect. If it turns out that your child has a developmental disorder, you may be tempted to berate yourself  -- or others  -- for not recognizing your early hunches as warning signals and acting on them sooner or more aggressively. Try not to be too hard on yourself for not understanding right away that your child would be frightened at parties, for instance, or skittish at the beach. By exposing her to these situations, you weren't being blind or obtuse. You were just figuring it out as you went along. All kids are a work in progress. Your job with your child is a harder, more complex version of every parent's job: to find what works, to help and protect and teach, to shape the world to fit your child even as you help her learn how to handle the world.

Above all, try not to let your worries overshadow your relationship with your child. You need memories of her early years outside the realm of doctor visits, testing, and therapy. You have a relationship to shape and memories to create. Build in time for whatever comes most easily and gives the greatest pleasure to you, your family, and, most of all, your very special child.

From Quirky Kids: Understanding and Helping a Kid Who Doesn't Fit In, by Perri Klass, M.D., and Eileen Costello, M.D. Copyright 2003, by Perri Klass, M.D., and Eileen Costello, M.D. Published by Ballantine Books, a division of Random House, Inc.

What Might Be Wrong

Some of the most common developmental problems (a child may have just one or a combination):

Speech delay Simply means a child whose progress in this area isn't on par with what's normal for other kids his age.

Pragmatic language disorder Describes idiosyncratic difficulties in talking. While some kids may be able to wax eloquent about an interest, they may not know when it's time to stop chattering.

Or they talk in monotonous tones, change the subject midstream, or don't understand the facial expressions of the person they're talking to and therefore don't respond appropriately.

Motor delay Can refer to a specific skill or milestone a child hasn't reached or to the quality of the child's movements: clumsiness, unsteadiness, or muscle weakness. It may show up in a baby who doesn't sit up or walk on time, or in an older child who can't hop or kick a ball or who loses his balance easily.

Motor-planning difficulties (dyspraxia) The inability to plan an action with the brain and then carry it out with the body. As in a stroke victim, one part of the brain doesn't work right, so  -- despite intelligence, memory, and understanding  -- a child may struggle with something as simple as jumping in place or as complex as getting dressed and tying his shoes.

Sensory integration dysfunction Extreme sensitivity to being touched or to textures, loud noises, or visual stimulation, such as the child who can't stand the feel of the wind or sand at the beach or who hates the seams on her socks. Some kids are less sensitive than normal and will seek more stimulation than most people can tolerate, by turning up the volume on the TV too high, putting everything in their mouth, or spinning around ad nauseam. Yet another group of children experiences extremes from both ends of the continuum.

Autistic spectrum disorders Include various problems with communication and social interaction:

* Asperger's syndrome These children have normal language development but impaired social interaction and repetitive behavior like hand flapping, motor delay, and clumsiness. They tend to excel at a particular skill, sometimes to the point of obsession. They have trouble making friends and aren't able to see others' points of view.

* High-functioning autism Compared with those who have Asperger's syndrome, children with this disorder are slower to acquire language and have weaker verbal skills and stronger visual-spatial skills. They're not particularly interested in other people.

* Atypical autism, or pervasive developmental delay  -- not otherwise specified (PDD-NOS) This term is reserved for children who have some of the signs that meet the criteria for autism, such as poor eye contact and social relations, obsessive behavior, and a communication impairment.

One Mother's Story

Learning to love the differences: one mother's story

I hear about her, now and then, through friends. I hear about her son: He's not speaking; he won't focus; his fingers fumble with his toys as if the right hand isn't aware of the left. He's going on 3. He doesn't attend to the words she says, to the things she points at, to her laughter. She prays that this confusion will pass, consults books, and calls doctors, only slowly yielding to the idea that her boy is different. She's where I was years ago, and I feel an immediate kinship.

My husband and I are the parents of a child who once bore an infuriatingly vague and unhelpful diagnosis. Twelve years ago, Jeremy was unlike the other children on the street  -- preferring not to say hello, obsessing over patterns and toys, presenting a lopsided vocabulary of nouns and few verbs, and showing few signs that he understood such real-world dangers as the cars that drove past our house.

The blessing  -- and of course it is a blessing  -- is that Jeremy no longer struggles with these things, and that other families are reaping the myriad benefits of the scientists and therapists who've begun to zero in on genetic connections and treatments, new therapies and educational alternatives. Most inspirational to me is what other parents are doing  -- seizing answers for themselves and bringing bravery, humor, and faith to bear.

For our own son, the key to overcoming the hurdles was found in the very obsessions that some doctors encouraged us to dissuade. Back then, if we were quiet and respectful, we could lie with him on the floor and discover the logic behind the organization of his toy cars. We could give them names, talk about where they were going, get him to imagine people behind the wheel. We could enter his world, gain his trust, provide him with language to talk about what mattered most to him. We could more than meet him halfway; in return, he reached out toward us and, eventually, toward other activities.

We were guided by specialists. We read as much as we could. We adopted ideas that made sense. But in the end, we mostly took cues from Jeremy, waiting for signs that he was ready for the next step.

I know that this is what the mother of that boy going on 3 will soon be doing too. I know that from the enormous wellspring of her heart, the talent of therapists, the wisdom of books, and the intuition of teachers, there will emerge a strategy, a scaffolding to support her son. I want to reassure her that parents grow into the challenges they're given. I want to say that her little boy does feel her love  -- that he's relying on it, looking for it, in his own remarkable way.

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