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Tot Therapy


Girl With Crossed Arms (2001). Ilfochrome print.   

Marie Leo, an occupational therapist, traces some of her business to children whose coordination is delayed because their preschools are teaching things like computer skills and the position of the planets rather than letting them play. “It affects their gross motor skills,” she says. “The schools are more and more academic.”

Flynn recalls the father who called about enrolling his child in her program—at 8 months. “I said, ‘Are you looking for child care?’ He said, ‘We want to get him ready for preschool.’ ”

“There came a point where there wasn’t time for natural development,” says the head of a Park Avenue preschool who asked to remain anonymous because she regularly has to deal with kindergartens, which, she says, set the milestones. “Essentially, we need things to be in place earlier. There is no real recognition of child development. It’s about achievement, so the programs are geared towards academic skills.”

She laments, in particular, efforts to mold perfect English speakers at the nursery-school level. “There’s no room anymore for idiosyncratic speech,” she says, citing as examples words like “perspaghetti” for spaghetti or “It’s mines.” “Children do that and say that and outgrow it. Now people look at it as a possible language problem, and that means they won’t get into kindergarten, and if they don’t get into kindergarten, life is over.”

The efforts to craft flawless children while they’re often still, literally, in the cradle begins with valid science about childhood development. The problem is that intervention may have its own costs. “Clearly, unequivocally, early experiences affect the architecture of the brain as it emerges,” explains Jack Shonkoff, dean of the Heller School for Social Policy and Management at Brandeis University and a pediatrician. “If a child has needs, then intervention by trained specialists is helpful. Is there harm in sending your child who basically has a variation of normal? Well, it depends. The harm could be if the family starts to think of the child as abnormal. Or if the child thinks of himself as abnormal. If it’s basically enjoyable and fun-and-games and not stigmatizing, it may just be a waste of money.

“The key element that influences brain development,” Shonkoff adds, “is the quality of and stability of the relationships kids have. It’s all about relationships. When they’re nurturing and responsive and protective, kids develop in a healthy way. Can I produce superkids? Brain research has nothing to tell parents who want to produce superkids.”

Panic among parents sets in because development is not linear, nor do all children develop at the same hectic pace. “There’s incredible variation,” says Michel Cohen, Clotilde’s pediatrician and the author of The New Basics, who frequently has to talk his patients’ parents out of therapy. “Some roll over at 2 months of age, some not until they walk. Fortunately, most babies develop relatively on schedule. The problems arise when the child takes a little longer to do what they need to do.”

And if the child is still behind the curve by 3 or 4, red flags go up. “Anytime a kid behaves just a little bit differently, the school is too quick at calling the parents,” Cohen continues. “The typical story is ‘Your kid is not playing the same way as other kids, he’s not very social.’ There’s the referral to the psychologist.

“New York is a great place for services,” he adds. “And once you put the kid under the microscope, you’re going to find something.”

“There’s no room for words like ‘perspaghetti,’ ” says a preschool head. “People view it as a possible language problem which means they won’t get into kindergarten.”

The official report deeming Clotilde’s 14-month-old eligible for New York City–funded early intervention would be worthy of a satirist like Molière were not the future of an actual little boy hanging in the balance. While acknowledging that he was a spontaneous tyke who separated easily from his mother, the therapist who examined him wasted no time in tackling his deficits.

The boy “exhibited a hypo-aroused proprioceptive system (position sense),” meaning that he didn’t seem especially coordinated. Though there was a plausible explanation for the little boy’s lack of athleticism, as the report dutifully admitted: “It should be noted that [he] has only begun to walk independently approximately one week ago.”

The toddler also reverted to crawling, with little apparent remorse. “[He] ambled around the apartment by creeping. He crept placing his left leg down in a quadruped position while his right leg was up, his hip abducted and his knee straight.”

Performing difficult, unpleasant tasks—perhaps the dictionary definition of adulthood—was beyond the baby’s ken. “He did, however, demonstrate a poor frustration tolerance and often threw toys across the table,” the appraiser reported, adding that the child also had an aversion to hats.

The report, which left Clotilde anxious and confused, concluded in a dust storm of jargon that pronounced the baby an excellent candidate for therapy with “a three-or-four-month delay in his fine motor and visual-perceptual development.”

Fortunately, if Clotilde needed a support group, she had to look no further than her West Village playground. Half the kids she encountered there seemed to be in therapy, too. “I spoke with one of the mothers and said, ‘You’re doing therapy?’ And she said, ‘Isn’t it wonderful!’ And I said, ‘No, it’s not wonderful.’ But she said, ‘Why not do it? It can’t harm them. It’s good and it’s free.’ ”

Her little boy also qualified for speech therapy after a tester came up with a diagnosis of possible “verbal apraxia,” Clotilde says. She looked it up on the Internet and was alarmed to discover that it was a neurological condition that could, among other possibilities, afflict those who suffered events such as catastrophic car accidents.

“They know the words,” Clotilde explains, “but for some reason they can’t speak them. I called her and said, ‘I really have a problem with this diagnosis.’ It’s a neurological disease. She said, ‘Maybe in your country. But here it’s not. The cause is unknown. And, by the way, it can be fixed with therapy.’

“At first, he was cooperative,” Clotilde says of her son. “And then he just hated it. He just wanted to run around and play. The therapist would go ‘de-de-de-doo,’ for, like, ten minutes. And ‘ce-ce-ce-saa.’ I’m looking at her like, Is there something wrong, or is it me?

He no longer sees a speech therapist. “He’s delayed in language,” his mother admits. “I know it, and it’s fine. Eventually, at 3 years old, they’ll all walk. For speech and language, it’s the same. The difference is that he’ll be bilingual.”

The toddler started preschool last fall. “He’s happy, content, nothing to report,” Clotilde says.

“He’s perfectly fine,” says Cohen. “It started with a doctor who voiced concern when there was no concern. That’s how the cycle starts.

“He’s quiet,” he says. “But still within the normal range. He’s not the bubbly kind. But then what?”

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