On Being a Mother with a Therapist's Eyes

By Jordan Sadler, SLP

His name is Will.  He is around 3 years old and beautiful: big brown eyes that twinkle when he makes fleeting eye contact, and one large dimple.  He stands in the center of the circle of children, and when the music starts, he grins and starts to spin, joyfully.  I can't help but smile when I watch him. I also can't help but perform an unconscious assessment.   I haven't heard him utter a word, but I've heard a few vocalizations.  He claps his hands when the song says to, I note.  He seeks out eye contact and returns my smile.  He goes to his nanny for comfort when he needs it.  Should I hand them a report when they leave?, I ask myself sarcastically, wishing I could just focus on the class. On occasion, Will runs from the group and does laps around the periphery of the room, looking at the place where the wall meets the floor out of the corner of his eye until his caregiver corrals him back.  At least once during each class, a particular sound in a song becomes too painful for his over-sensitive auditory system and he screams.  And cries. The intuitive music teacher switches to a lullaby in an effort to calm him.  Sometimes he can be soothed but often his nanny carries him out, speaking kindly to the frightened little boy.  She knows, I think.  She understands this.

Then there is Sam.  He is 2 years old.  He sort of manages in the "gym" part of Gym and Swim, but I notice him engaging in self-stimulatory behavior with the lights up on the ceiling.  If left alone, he seems content but when another child comes close, he screams loudly and pushes the child away.  When it's time to get into the pool, he sobs.  It starts in the locker room and rises to a fevered pitch when he sees the pool.  "I don't understand why he doesn't like this," sighs his mother, holding his shaking body with her own feet dangling into the water.  Clearly, she is the one who wants to be in the pool with the others, singing "Five Little Ducks".  She wears an agonized, exhausted expression.  She too leaves the class early, deflated.   I find it painful to watch.  She doesn't know yet.  She doesn't understand. 

I am not there as a therapist.  I am there as a mother myself, attending classes with my own toddler.   Without fail, there is a child in each class we attend.  A child who may or may not fall somewhere on the autism spectrum, but without a doubt has significant language and sensory needs.  I do not doubt the new 1 in 150 estimate.  Each time, I can't help but watch the child and his mother with both a therapist's and a mother's eyes.  I want to reach out, say something.  Something beyond, "What a beautiful boy," or "Wow, look at him climb!", the words I find to point out all that is wonderful about their children.  Especially to the ones I suspect don't understand yet.  I find their confusion and pain unbearable.  I have to forcibly tear my attention away to focus on my own child, who is so happy to have a special day with me when I'm not at work.

I grapple with this question often:  can I say something?  If so, what?  I believe that it would be in the child's best interest to let his parents know that there are other children who struggle with these things, that there are people who can help them.  Especially when they could be getting early intervention.  Especially when the child's mother looks so overwhelmed.  And yet, when I am there as a fellow parent, dancing around the circle with my own child or negotiating over a toy, it doesn't feel right.  I feel that it would be very intrusive.  What is appropriate? 

What would that mother want to hear that wouldn't put her on the defensive or leave her feeling criticized?  Or, if she is angry at me but weeks or months down the road does hear my words and pursues help for her child, is it worth it?   I welcome any experiences and insights readers want to share.

To reach Jordan directly, email: jordan [at] communicationtherapy [dot] net.

Comments

[Vicki Forman]

This is such a tough one. I had a neighbor whose daughter was clearly on the spectrum, but who didn't understand or get it. Her marriage went down in flames while the girl struggled and caused significant upheaval in the home. I never said anything--I couldn't--other than asking if she was getting "help". That little "h" help should have been "Help" but I didn't think it was my place to say anything.

To this day, I doubt that mother has sought a diagnosis. It's so painful and so hard to know what to do. It must be especially painful when you are a therapist and know the child, and family, would benefit so much. Thanks for posting this!

[Jesse Berrett]

"What would that mother want to hear that wouldn't put her on the defensive or leave her feeling criticized? Or, if she is angry at me but weeks or months down the road does hear my words and pursues help for her child, is it worth it?"

Susan and I were talking about this exact question last night, in fact. (Not sure if you and she had talked about it as well, or if you were just thinking about the exact same things.) I don't feel qualified to address this for anyone else but myself, and even now I'm not sure I can say anything with real accuracy.

My hope is that I would have dealt with such questions in a spirit of honesty, generosity and openness. In all honesty, I don't think I can really say--there's a whole process of thinking (not to go into a whole Kubler-Ross 5-stages bit) involved here that requires you to separate your immediate terror about your and your child's combined futures from whatever diagnostic codes may help you get aid paid for. I think recognition of that distinction comes only with time; at the start, it all feels so overwhelming that you can barely put one thought after another, much less separate various strands of possible future.

So...what should you have said? If it's possible to cram some version of "I'm a speech therapist and I don't mean to intrude or judge you as a mother or anything else, but I couldn't help noticing that, in my professional opinion, there are some ways to get help that might give you a better understanding of the challenges that your child is facing, if of course you want to, and I'm certainly not in any position to judge whether or not you'd want to..." into 30 seconds or so, then I say go for it.

[Joan Drummond]

Oh my gosh. My husband and I face this sort of thing on my typical son's basketball team. We see a child there who's already in first grade just struggling to process the action. We too are flumoxed not knowing what or if we should say anything. In the parent group of kids in my son's 3 year old ASD classroom, I have to bite my tongue a lot. But if someone asks a question or for a resource, I tell them. And I follow up. Then I leave them alone. Those who want to know will keep asking. Like I did.

[Leslie]

This is a tough situation! As a mom of a 3.8yr old pdd son, I would welcome a knowing and understanding conversation with a professional. Even though I "know" that my son is on the spectrum I am sure that I often have an agonized and deflated look on my face as we struggle to integrate my son into his swim lessons with out mom or dad by his side. We watch him cry and scream as he learns to acclimate to a new setting. An understanding glance or conversation would be so nice instead of the usual looks of other parents who truly don't realize that there are unique circumstances behind the behavior!
Thanks for listening!

[Cassie]

That is a really tough one. As a speech therapist myself, I am so communication-centered in my daily encounters with people. If you had speech therapy in the 3rd grade for a lisp, I can probably still detect it. If a 12-month old isn't establishing joint attention, I recognize it instantly. Although I have my own small children, I have still spent so many years with children with special needs that what is "typical" is blurred for me now. This is why I typically keep my mouth shut, unless directly confronted. A brief picture in time is, I feel, not enough information to diagnose a child. Not that I haven’t been tempted. There have been many a City College child observation class that I have wanted to approach a parent or two with my concerns, and yet when I tried to take the perspective of that parent, I chose not to. I would think that if the parent is taking the time and care to involve their child in these types of enrichment programs, they too will be observing and comparing their child with others, as we all do.

[Melanie]

I'm a mom of an almost 5 year old who was diagnosed at 3 3/4 years of age with PDD-NOS. I wish every day we had learned sooner what was really going on so we could have intervened sooner. I was searching and asking people for their opinions--trying to figure out why he had such extreme tantrums and what was behind his language difficulties, etc. but no one ever mentioned the autistic spectrum or sensory processing disorder or anything. We sent him to preschool at 2 in order to have him get used to group activities b/c he tended to avoid them or not participate. We even told his preschool that was the reason for his enrollment but they never suggested anything was wrong or that we should possibly get evaluations from any professional. I asked our pediatrician his opinion about the head banging and was told he'd grow out of it. I think if you really see something, you should--in as tactful a way as possible--try to mention it. I know it's not an easy thing to do, and some parents may not appreciate it--or at least not at first. However, once you know what is going on and what your child is going through, you can talk to professionals and find out what you can do to make his life and your relationship with him and his relationships with other people so much better. The earlier interventions occur, the more effect they can have. I have seen this in the lives of other children and that is what the research seems to show. A number of people told me after we got a diagnosis that they had noticed things (some of these people were professionals). It really, really, REALLY frustrated me that they never said anything to me when it could have made a difference--meaning I could have found out sooner and begun interventions sooner. I know I'm just one parent, but I have to say that I would have appreciated it more than I can say if someone who was a professional, had taken the time to talk to me about what they thought might be going on with my son. I think most people can tell when you are sincerely trying to help. I know some parents have a hard time hearing that something could be wrong--but maybe it won't take them so long to come around if they hear it from more than one source. And, generally, I think most parents in their hearts sense something is just not quite right.

[Emily]

Nice writeup, Jordan, and I know exactly what you mean, although my perspective is that of a mother who has children with issues. My answer to your question, "Or, if she is angry at me but weeks or months down the road does hear my words and pursues help for her child, is it worth it?" is...YES. It is worth it. Who cares if the parent is ticked at you? The child needs the earliest possible intervention. If you saw a child in danger of suffering a permanent injury and your intervention could prevent that, you'd intervene, even if the parent were offended, right? As you well know, this is the period of plasticity, and you could be doing that child years of favors by pointing this out to a parent. Have you considered just printing out info, like DMS-IV or something milder and giving it to them after explaining your credentials? (Possibly on the last day of class ;) )That way, even if they're too angry or surprised in the moment, they will have that reading material to consider with a cooler head later. And as someone else said, many parents probably know even if they don't know they know.

I, too, see many children and would like to say something to their parents, but I do not. I have a couple of times now said something to the teacher, knowing that she would be a better and better-accepted conduit for such information.

{Hi, Susan! Do you remember us? Tom Henry and Will from SF? Your little guy has gotten pretty grown up there. What is this site? I've got to go check this out.}

[Jordan]

Great to hear from you, Emily! It's so interesting how divided parents are on this issue and I'm happy to hear that it's not so cut and dry - which goes to show why I have been debating it myself. Offline, I received a nice email from another parent today, and I will share a bit of what was said anonymously, just because it's also well-stated but on the other side of the debate:

"...regarding your first article about saying something to another
parent: I think you shouldn't. I don't think it's the place. Let's be honest, when there is something "wrong" with your child,intuitively you know it but hearing about it at a place where you are supposed to be having fun would totally "suck". Those classes, I feel, have always been a place where parents are constantly comparing their kids with others. I remember being at a class with [my child] when he was just 5 months old and all anyone could say was how tall he was!!! It didn't bug me, I just thought - wow, we're comparing each other already?? So imagine how a
parent would feel about being called out on obvious differences.

I know you wouldn't say anything to a parent in front of anyone else, BUT you don't know how this parent could react. They could get so frustrated and not return to the class knowing that someone has "found them out". It's hard to have a child with issues socialize, you don't want them to further isolate themselves because they think another parent is watching
them.

I know you want kids to get early intervention services but hopefully
someone close to them will steer them that way."

[Emily]

Oops...meant DSM-IV.

I do NOT think you should walk up to a parent in the middle of the class. I think waiting until the class has ended and talking to the parent is the second-best approach. The best approach--depending on the kind of class, and a swim class probably ain't it--would be talking to the instructor who could then approach the parent through a professional-to-parent relationship that has already been established. If a parent thinks you're "just another parent" in spite of your credentials, that's going to be construed as more officious, I think. Another option would be to find out who they are and to contact them outside of class, after the class has ended. Regardless, it seems to me that applying your professional opinion in these cases can ultimately only help. And I really mean "ultimately" there.

I admit that were someone to have done that to me in the middle of a class three years ago, I'd've told them to bugger off. But, if they had come to me on the last day of the class or contacted me outside of the class after it ended, I would have been much more receptive. I'm probably about as touchy and defensive as they come, so I guess I feel that if that approach would work on me, it probably would work on a lot of people.

What is the case with MDs? Do they have a moral or ethical obligation to act if they see a situation requiring medical intervention? I suppose it depends on how urgent it is. Hindsight makes me feel that there might be urgency in the scenarios you describe because if you don't draw the parents' attention to it, it could literally be years before someone else figures it out. Does your profession have guidelines about what is appropriate in these situations? My guess is that SLPs et al. have this happen to them ALL the time.

[christie]

I'm a psychotherapist primarily serving families affected by ASD and have 4 kids of my own. Part of me thinks that I'd be operating out of the scope of my practice (illegal and unethical) if I were to say something. A few times I have told teachers when I've had a concern and that has been helpful to some families. A lot of teachers don't know when they are witnessing a subtle ASD behavior and are happy to have the input. Other times I have made friends with the parents and let it drop that I am a professional in the area of ASDs, and often they will ask if there might be a concern about their child. I will never directly say YES (after all, I'm not doing a complete eval of their child), but I will often reflect their own concern and offer them referrals. I have found that most parents with kids that might have issues are already sensitive to the fact that something is different but don't know what questions to ask and of whom. They often welcome input. This is a very good question. Thanks for a great discussion.