Tag Archives: Child development

When something is just not right

Sometimes it takes a while, especially for first-time parents, to realise that something is not right with their child. Often, they do have a gut feeling, but the denial mechanisms that protect us from seeing things we can’t really deal with are extremely strong.

The little boy had lovely curls. I first met him at our house, but my professional eyes cannot be turned off, just because we are having a barbecue party…

At a bit over three, he used single- or two-word sentences, and even those utterances were difficult to understand – not good. He was in constant motion, wandering around the house, and was challenging to occupy with a single activity for more than a very short period of time.

He had difficulty accepting rules, such as not touching my son’s Lego castle, which he ultimately broke into the hundreds of pieces it was carefully crafted from. Ever since, my son screams “oh, no!” every time we mention the little boy’s name.

When the little boy was not happy with something, he lay down on the floor and screamed. As did the little girl on the beach where we were yesterday. I really had to keep myself from staring at that poor mother with her child; the screaming was of a high-pitch, annoying tone and it kept on and on until the child got what she wanted or was forced otherwise. Such as putting on sunscreen. Which made her wail for several minutes, long after the mother was done.

The reason I tried so hard not to look is because of the interview study we had done with parents of children with autism. In their stories, parents told us the countless occasions on which they were stared at in public because of their children’s “meltdowns”.

In Hungary, where public knowledge about developmental disorders is limited, but people’s self-perceived right to interfere with other peoples’ lives isn’t, parents were told innumerable times what ill-disciplined children they had. Even within the family, in-laws or sisters instructed mothers that it was only a matter of proper discipline, and the child would start to behave.


Of course, by the time of these public meltdowns, parents knew something was wrong. It was all those early signs they could not put together into the notion of some kind of developmental delay.

We also had examples of parents who did know. One of the interviewed mothers in our study said:

We started pushing that we ought to start doing something about the child because he is still not speaking, not a word. (…) Both of them (GP and district nurse) just brushed me off. ‘Boys are slower to think, slower to talk, don’t worry, once he starts talking you’ll have more then enough, it will even give you a headache.’ They tried to reassure me. But I did not settle for that. I took him and checked up on things.

So this mother listened to her intuition. She even got lucky and found adequate services. However, the problem with early childhood services is that they are patchy.

Even in countries, such as Sweden and Australia, with well-established child health surveillance systems and high coverage, kids get lost. It’s not that they don’t attend services. It’s that services do not talk to each other, do not coordinate their efforts, so parents have to.

A solution to this is the so-called ESSENCE approach, developed by Professor Christopher Gillberg. It is to consider Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations as an entity, needing attention. What diagnosis the child will eventually receive is less important. What counts are the child’s and family’s needs here and now.

In the end of August we will visit the only ESSENCE-clinic in Sweden. I thought we could make our own one in Uppsala. A place where parents and clinicians, who feel that something is just not right with a child, could get a proper evaluation and advice. Here and now, before the humiliation of public meltdowns becomes their everyday life.

No pain, no gain!

No pain – no gain has been my internal working model as long as I can remember, although I wasn’t always aware of it. If I put my mind to something, I would get it, but it would cost me pain. For all I knew, this was the way of things.

So I was pretty chocked when the therapist at a group session turned to me and said, “Anna, you know that there are other ways than pain to get you where you want to be”. How did she know that this had always been my deepest belief and I never even knew? Clearly a blind spot of mine there!

Okay, so she knew because it was her job and she was good at it. And I was relieved: there is another way! Wow! Life with less pain, here I come!

This was ten years ago. I still don’t think I have figured out any of those other ways. Maybe I have become more tolerant of myself and others. Maybe I don’t throw my whole existence into things – I try to keep my innermost self safe. But I definitely do not “play it cool” and so the no pain, no gain axiom seems to be my companion still.

I don’t know about anyone who has achieved a lot without great effort. And although great effort is not the same as a lot of pain, I imagine that those who have followed their dreams or passions have had to make sacrifices and I believe some of those would have been rather painful.


Photo: Fanni Sarkadi, Victoria market, Melbourne

So I admit: I clearly have a more desperate take on our soon leaving Melbourne than my children. Apparently, they know more about the world than their sulking mother. Our youngest one, 6.5, says he feels two things at the same time which he thinks is a bit strange, but okay: he both wants to stay with his friends and teacher here AND is eager to start as a first-grader in Sweden and play in his room.

The oldest one is even more sophisticated and says she is ambivalent – she has made so many friends here and knows the best bargains in town, but has really missed her best friends from home as well as her music and is looking forward to those things, but not the weather. Not bad from kids when people spend years in dialectic behaviour therapy to accept conflicting feelings as a normal part of life.

Our younger daughter (11) is also beyond her mother in development: she has developed object constancy (most 18-months-olds have) and knows that just because she won’t see her Aussie friends for some time they do not actually disappear. Whereas I behave as if everything that matters here would just be blown away at the bursts of the jet motors soon lifting us up in the air.

So while I sulk I try to tell myself: no pain – no gain, remember? For all the wonderful gains I have had during my sabbatical here, it is now time to cash in the pain.

During my walk today I really did try and consider some other possible ways that allegedly exist. But to no avail. All that happened was that I ended up asking myself: Why did we have to do this in the first place? I hate change! My temperament likes predictability, I am not especially tolerant to the stresses of packing and moving, and I hate the idea of changing seasons to opposites. Especially when it means going to cold and dark from warm and light.

It would be nice to finish on a more hopeful note, but hey, guess what I felt when my group gave me a signed photo of themselves to take with me on my journey when I left Sweden in August? And I really didn’t want to leave and asked myself why on Earth we wanted to do this in the first place…

So I listen to Hey Jude played at the Monserrat concert finale by Paul McCartney himself:

For well you know that it’s a fool who plays it cool
By making his world a little colder…

I remind myself that “playing it hot” costs and roll with the punch.

It’s not fair

Although our six-year-old has to practice handwriting and using scissors a bit more to produce neater results he knows and uses the term “fine motor skills”. He reads in three languages on grade levels higher then his own.

He could learn to read because he can focus his attention on a certain task and persist until he is done. Sometimes when we play chess and I am ready to give up he’ll tell me: “No, mommy, we’re not done yet, you need to keep thinking!” He gets along well with his peers and makes new friends easily. Although he sometimes bites his older sisters when he is furious, he has the self-control not to use that behaviour at prep. He knows he is loved and is capable of extending his love to others. These skills are essential for children’s academic and social development.

What is not fair is that these vital building stones of human development – focused attention, self-regulation, and a healthy sense of self-worth – are not equally distributed among children. Some enjoy the effects of a nurturing environment, whereas others fall behind early on.

By age five there is a 30 million word-gap between children who belong to the highest and the lowest socioeconomic groups in society in Northern America. So the least advantaged children have been exposed to 30 million less words by their immediate environment, and consequently, the development of their impressive and expressive language skills will lag behind.  Differences in focused attention are huge because the brain is an organ where the rule is use it or lose it.

In countries with no access to universal early childhood education services the social gap – and with it, lost potential – is enormous. In Scandinavia, the preschools serve as a compensatory mechanism and are especially useful for children coming from disadvantaged families. The U.S. has launched a number of successful programs for early childhood education for low-income families, such as Early Head Start. Australia has got some catching up to do in this area!

The excellent book From Neurons to Neighborhoods (Shonkoff and Phillips, eds, 2000) summarises evidence from neuroscience, child development research, and molecular genetics. They shatter the controversy of “nature versus nurture” as a cause of developmental differences by presenting strong evidence that it is both. They make the case that no society can allow itself not to do everything in their might to provide safe, healthy, nurturing, and developing environments to all children.

The importance of the equal distribution of these commodities is described in a book I refer to as our ”bible”: Developmental health and the wealth of nations, edited by Daniel Keating and Clyde Hertzman, 1999. There is a Latin proverb: Nomen est omen – your name predicts what you might become. Hertzman can be translated to The Man of Heart and it is exactly what Clyde was.

I met him at his favourite breakfast place in Vancouver and he generously shared his experiences with me. He stressed the importance of speaking a language that politicians will understand and be able to act upon. Clyde Hertzman died recently, but if you want to see a truly inspiring video where he explains the complex issue of environmental effects on brain development in a simple way, do watch him speak here.

So what is not fair is that our son is fast asleep in his bed after a dinner with his family and a story read to him, while other children never get a chance to experience that. The tragedy is that so much of the ingredients of suboptimal development, such as insecure attachment, prenatal environmental hazards, chronic life stress, violent relationships, economic disadvantage, and low academic achievement seem to be “inherited” from one generation to the next.

The good news is that even if you are not in a position to make a difference for many children you can always be a significant adult in the life of at least one child – and I don’t mean your own. Children are wired for interaction and learning. So extend your love and attention to a child who needs it: read a story, show them affection, tell them everyone is good at something and the trick is only to find out at what. Show them they are worth loving for just whom they are. That will oil their brain wires for learning and experiencing.

If you are in a position to make a difference: do your part in making high quality early education accessible, affordable, and equitable.