Tot Therapy

Study Of A Girl 2 (2002). Ilfochrome print.Photo: Loretta Lux, courtesy of Yossi Milo Gallery

Clotilde, a 32-year-old French mother of two, moved to New York several years ago. But her immersion in American culture, or to be more precise, the hyperintense culture of upscale Manhattan child-rearing, didn’t truly begin until her first son turned 9—months, that is. That’s when the baby’s pediatrician noticed that his growth had slowed.

“The doctor freaked out,” Clotilde recalls in lightly accented English. “She started to say, ‘I think he has a heart murmur. Has he been tested for cystic fibrosis?’ She sent me to a gastroenterologist, who didn’t find anything. So she said, ‘Maybe he has an aural motor delay.’ Which means a delay in the motion of the mouth and the tongue. He doesn’t eat, or he does, but it’s taking him longer to process the food, or God knows what. So she referred us to early intervention.”

Thus began a yearlong odyssey into a subculture of psychologists and occupational and speech therapists issuing diagnoses littered with terms like dyspraxia and proprioceptors and sensory-integration systems, and recommending intensive therapy. “My husband was thinking, They know better, therefore we should just do it,” Clotilde says. “My instinct was telling me, No, your child is fine.”

By the time all the evaluations were complete, the baby was just over a year old. “They came back and said he definitely had a speech delay,” his mother continues. “We’re talking 14 months. And a severe muscle delay in his back. That was because he used to sit with his legs bent in the shape of a W.

“But the language was the main concern. I said, ‘He’s growing up in a bilingual environment.’ They said, ‘No, no. We’re concerned.’ They put a lot of pressure. They recommended we start therapy. ‘It’s a wonderful program, and it’s free.’ ”

In a way, the therapists’ concern was justified. Clotilde’s little boy did have a language delay—and he did sit funny. Not perhaps by the laid-back standards of human evolution and normal toddler development. But certainly by the expectations that now circle any child who hopes to attend a selective private school or one of the gifted-and-talented programs in public schools. The expectation is that by the time they graduate from nursery school, their verbal and counting skills, not to mention their ability to do mazes and chat confidently with adults, will be so firmly in place as to make it impossible for the director of their first-choice kindergarten to reject them in favor of another child.

Early intervention can be a blessing for children who truly need it, diagnosing and remedying their problems while they’re still young enough to alter the very architecture of their brains. Children with a five-word vocabulary at 18 months, who have problems with creative play such as brushing a doll’s hair at age 2, or who aren’t interacting with other children by age 3, are without question in need of intervention. But in New York City in the past few years, the science of early-childhood development has been pressed into service as a tool by parents and educators to correct normal variations in children’s development—so that by 4, or, at the latest, 5, they’ll be prepared to compete with their kindergarten peers.

The question is, what’s lost by all this pressure? Some argue it’s nothing less than childhood itself. “New York City private schools today are demanding such high-level skills that these kids are actually in need of services,” says Janine Pollack, a neuropsychologist. “There’s a private school in Brooklyn where they’ll discuss with a 6-year-old, ‘How do you feel when you look at blue?’ That requires a very sophisticated use of language.

“It’s a cycle,” she goes on. “And it starts in preschool. It is irrational that every child has to be above average.”

Irrational from the point of view of raising happy, emotionally healthy kids. But not in light of the cutthroat competition to get into kindergarten. Pollack believes it ultimately boils down to numbers. “There are so many exceptional kids, they just take the cream of the crop,” she says. But early intervention can sometimes become a way of creating the perfect child, or at least one whose imperfections will remain invisible to admissions directors. “There are no average kids anymore,” says Elisabeth Krents, the Dalton School’s admissions director. “It’s ‘If you’re not making it, let me get you services.’ ”

The core of the problem is that schools have a limited amount of information upon which to base a decision. And those criteria hit at the heart of skills at which the developmentally delayed child may not excel—staying on-task, or taking direction well, for example. The tests for kindergarten admission, which may detect those deficits, represent a daunting obstacle. “The schools take a ruler,” claims a mother who tutored her son, who is in both speech and occupational therapy, for the Stanford-Binet, required for admission to the public schools’ gifted programs. She is referring to the percentile line below which they cannot stray. “And if the scores are under something, forget it.”

To avoid that fate, she’s helped keep Barnes & Noble in business, purchasing test-prep books and games such as Brain Quest and MightyMind. “I find it so much fun,” she says. “My children don’t like it.”

“Everybody thinks they go into the schools and have to be this perfect little family,” says Nina Bauer, director of IvyWise Kids, a school-admissions counseling service. “God forbid their child isn’t separating from them or they untucked their shirt.”

Yet Bauer admits that the schools are more susceptible to the sort of child who interviews well, the one who got dealt a royal flush, genetically speaking, or at least appears that way. “They have such a short time with the kids,” she observes. “Where the process doesn’t do well is these shy, wallflower kids. A good admissions director will see past that, but sometimes these kids’ personalities don’t come through.”

And that pressure to deliver to the kindergartens 5-year-olds with people skills percolates down to preschool. “I have parents who come to me and say their kid only scored an 88,” says Amy Flynn, the head of the Bank Street Family Center, referring to the ERB, the aptitude test given to aspiring kindergartners. “That translates into pressure for children. They need to play. That realm of fantasy is important—‘I’m the doctor,’ ‘I’m the fireman.’ It’s about abstract thinking, and you don’t get that by telling kids to think abstractly.”

Girl With Crossed Arms (2001). Ilfochrome print. Photo: Loretta Lux, courtesy of Yossi Milo Gallery

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?”

“Circle time,” when children gather around to sing a song or listen to their teacher read a book, has become the Heartbreak Hill for the developmentally delayed pre-kindergartner. It’s here that a toddler’s flaws—be they low muscle tone or lack of focus—are made flagrantly manifest.

A teacher for two decades at an Upper East Side preschool says she’s far more attuned to such problems than she once was. “When we were kids and our kids were little, we called them awkward and clumsy,” she explains, adding that problems pop up not so much on the jungle gym or seesaw, where you’d expect them, but at the snack table, suggesting the challenges these children face are as much social as physical. It’s behavior that could conceivably raise a red flag to visiting grammar-school admissions officials—this kid might not be quite ready for the task-oriented rigors of kindergarten.

“That child’s chair is always turned to the side,” the teacher said, offering an example of a problem, “not because that kid is being naughty, but the kid has trouble organizing himself.”

They’re called “sensory integration” issues. It’s the latest buzzword, referring to the problems some children have coping with their environment. The parent of one such kid compared it to the disorientation she experiences shopping.

Poor pencil grip also sets off alarms. “I got sent an evaluation another therapist did with goals for the child,” recalls occupational therapist Rebecca Daniels, recently arrived from Atlanta, where she says such pressure hardly exists. “The goal was, ‘This 3-year-old will use a tripod grasp to draw circles and squares.’ That’s setting the bar really high.”

To keep their toddlers from reverting, therapists, who also sit in on preschool classes these days, employ a number of devices. These include “dots,” cushions the consistency of waterbeds, forcing “low tone” children to use their stomach muscles to stay aloft and occupied during circle time. There are also weighted vests, similar to those one dons before having an X-ray. “The deep pressure helps to ground kids,” says Marie Leo. “You have to wear it for twenty-minute intervals at transition times. It helps them to take the edge off.”

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

Indeed, often the tactics help. One mother’s 3-year-old became adept not only at knowing when his sensory-integration demons were upon him but also how to cope with them. “He had all this energy he needed to get out,” recalls Judith Fox-Miller, the boy’s speech therapist. “We taught him he should jump at those times—learning it was okay to jump on the bed.”

“He would go on my bed and count twenty times,” the mother says. “It helped him get the bugs out.”

Marie Leo’s “sensory-integration gym” on West 94th Street is a kind of toddler finishing school for the developmentally delayed. Scheduling toddlers can occasionally present a challenge. “A lot of the families there do not want anyone to know their kid goes to anything,” Leo says of one preschool in particular. “I have to be careful not to make a faux pas—that one kid doesn’t run into another.”

She also attends “team meetings” at the schools where as many as eight or ten adults—the nursery director, teachers, assistants, therapists, and, it is hoped, the mother—will convene to strategize a single child’s development.

“We talk about what the kid’s behavior is like in class,” Leo explains. “If they need sensory supports—squishy balls, a weighted vest.”

Not all parents readily accept their preschool’s advice to seek help just because their kids can’t cope with the heightened demands of toddler social life. In fact, Anne, the mother of a Tribeca 11-year-old, still gets angry, years later, when she remembers how they pressured her to send her daughter to therapy.

“The preschool said, ‘This child has a problem,’ ” Anne remembers. “ ‘She’s not patterning.’ I said, ‘What’s patterning?’ ‘She’s supposed to go to the bathroom and come right back.’ On her way back, she’d pass the stairway that led to the toddler gym and occasionally she’d take a detour. I said, ‘She’s 3 years old.’ They said, ‘This means she’s not going to read.’ They sent me on a wild-goose chase. I went wherever they sent me. I listened, shook my head, and didn’t do anything.”

Despite her teacher’s predictions of doom, the child became a voracious reader of the newspaper, according to her mother, and even wanted to take The Diary of Anne Frank out of her school library—she got into all the schools to which she applied—at 6.

“It’s rotten what they do to you,” Anne goes on. “Everybody learns how to use the bathroom. They all learn how to speak and hold a fork. But everybody is very impatient and specialist-driven. You don’t learn that with the first child; you learn that with the second one. I knew he wasn’t a big talker either, but I just waited.”

According to therapists, it’s usually mothers, not fathers, who aggressively seek or at least heartily acquiesce to intervention. “It’s always the woman that seems to spearhead it,” says Judith Fox-Miller. “It’s not often I have a relationship with the dad.”

Another therapist suspects she rarely gets to meet the dads because they have a harder time than mothers facing the possibility they’ve helped sire imperfect children. “Fathers have maybe more ego involved and cannot imagine there is something wrong with their child,” she says.

One mother had a less psychologically freighted explanation for lack of paternal involvement—laziness. “I think he is really appreciative,” she says of her efforts to prep their son for the ERB. “He wouldn’t do it himself.”

Indeed, another mother says she really appreciated her son’s Special Education Itinerant Teacher—a sort of personal educational trainer who follows a child around his preschool, facilitating his relationships with his peers—because the SEIT provided the boy the male companionship that was missing in his relationship with his father. “My husband isn’t home a lot,” she explains. “He’s in the financial realm. He works hard and travels a lot.”

Some fathers have a different explanation for their lack of interest. “It’s an expensive indulgence,” says an elementary-school father whose son had a speech problem at 3 for which his wife sought therapy. “The mothers have the children’s best interest at heart, but they’re deceived by this culture, paying for everything to be fixed. My wife agrees with me now. She woke up.”

Perhaps more of a problem than under-involved dads are parents, both mothers and fathers, who are so distracted by the Sturm und Drang of their own lives that they subcontract out most child-rearing responsibilities, including those involving therapy. By doing so, they may be abetting the descent of their children into the very developmental peril they’re trying to alleviate.

That’s ironic, since, as Shonkoff notes, the most important component of raising happy, talented children is the secure relationships they have with their caregivers, their parents in particular. “A lot of the time, the kids come with the babysitter,” says one therapist. “Often the parents are both working. Ninety-five percent of the time, I meet the mothers. When I don’t have the parents in the sessions, I try to have meetings with them.

“It’s sad,” she adds. “Oftentimes, I don’t know the parents as well as I’d like to. But neither do the schools.”

Janine Pollack also says that the majority of her interaction is with mothers, and not only because the dads are usually off at work. “Maybe it’s that the women feel more accustomed to doing things in a community and asking for help and sharing,” she observes.

One mother of a 2-year-old who wasn’t as coordinated as she’d have wished didn’t hesitate to seek therapy, even though the child’s pediatrician told her the little boy was fine. “He’d bump his head when he got up, and he’d fall a lot,” she remembers. “The diagnosis is dyspraxia, which used to just be clumsy.”

In fact, her toddler reminded her of herself when she was growing up. “I knew what it felt to be the last picked on the team. I didn’t want that experience for my son. When you see issues with your child there’s family shame associated with, you want to fix it.”

“There’s a continuum and a wide spectrum of coordination and agility,” Shonkoff explains. “Some of it is related to how the child’s profile fits in with what the family wants. For some families, anything less than a gifted athlete is a problem. For other families, if you’re verbally proficient and a klutz, they don’t care.”

The mother cared. Not only did she send her child to a physical therapist who put him through the toddler equivalent of boot camp—running obstacle courses, fishing for metallic objects with a magnetized fishing rod, etc.—she also had his eyes tested after discovering what she describes as “visual-processing issues” while home-schooling him for the Stanford-Binet. “When he’s tracking,” she explains, “he moves his head to be able to see from one side of the page to another, rather than moving his eyes.”

“Vision is a skill that has to develop over time,” explains Andrea Thau, the Park Avenue optometrist she took the little boy to. Shonkoff chuckled at that notion. “Years ago, people used to think reading difficulties were related to eye-tracking problems,” he says. “And that’s been pretty much debunked. By and large, reading problems are language-based, not visual-based.” Nonetheless, Thau, who claims that eyesight is more complicated than suspected, encompassing such talents as focusing, following a target such as a tennis ball at a match, and finally having the ability to make both eyes work in unison, has a loyal clientele.

Michel Cohen is careful to say that there are many occasions when therapy is warranted. “We get better at diagnosing,” he says. “I want to make sure we don’t overdiagnose. All of a sudden, a kid has to behave a certain way, achieving certain milestones. The referral comes from the school. The parent wants the best for their kid, so they go along with the whole program.”

Julie, the mother of a 10-year-old, grew skeptical of the culture of intervention after her son’s school pressured her to have him tested when he started supplying brief answers to essay questions on tests if he could get away with it. The child was intelligent, perhaps even brilliant. “We prided ourselves a bit on not being torqued-out parents,” Julie continues, “but we realized we can’t say we’re not going to pursue this. It was, ‘Go get an appraisal.’ That’s when I kind of lost faith in the system.”

Indeed, it was balls that proved to be the boy’s downfall. Three hours and $600 later, the therapist determined he wasn’t exactly Derek Jeter when it came to catching; he also favored one side while doing somersaults.

“Into hour two, you could see she was groping to find anything wrong with him,” Julie remembers. “Ultimately, her report hinged on when you threw the ball to him his eyes couldn’t quite master coming into focus. A real tipoff to me was when this therapist said, ‘This is the fifth child this week who has this same eye thing.’ ” Nonetheless, Julie dutifully brought the boy to an eye specialist as recommended by the physical therapist. He couldn’t find anything wrong with him either, and the child went back to school. In the meantime, his abbreviated essay-writing style seems to have cleared up on its own. “The following year, he had a teacher who did not redline every single phrase he wrote,” his mother says. “What was wrong was that the teacher intimidated him into not writing much because he’d jumped a year. “I think it was all done in good faith,” she says, sighing. “They specialize in early intervention. Every kid has been in therapy. It’s how they do things. It’s part of the philosophy—no child goes untreated.”

Clotilde no longer has to worry about running into fellow parents at her son’s physical-therapy sessions. “I’ve decided tomorrow will be the end of this therapy craze,” she announces while her son plays in the sandbox of the playground at Union Square Park—his little legs still folded into that damning W that forced him into therapy in the first place. Though she stopped his speech therapy, she continued sending him to occupational therapy until recently.

“When we do therapy, he’s miserable,” she says. “They’re making him do things he doesn’t want to do, for Christ’s sake. You’d tell me to fuck off, which is basically what he’s saying. They’re at an age where the only thing they know how to do is play.”

A few days later, Clotilde calls to announce that her son seemed not at all to suffer withdrawal from occupational therapy. “He’s definitely more relaxed,” his mother reports. “Coincidentally, he’s talking much more now. He calls his father chéri. I call him chéri. He’s running after his father calling him chéri.”

She says she’s never told her relatives back in France—where she says attitudes toward child-rearing are more laissez-faire—what she and her little boy have gone through. And she’s not planning to. “It’s an alternate reality,” she says. “These kids have no problems. They’d tell me I’m completely nuts. And they’re right.”

Tot Therapy