Things that stop you in your tracks

I was doing an evaluation recently - and I should know better than be shocked at the things that come from the mouths of children...

It is important for therapists to be observant: it is a skill that I drill into my staff and my students on a regular basis. There is always a lot to observe with preschoolers beyond the typical issues of how many blocks they are stacking or how they are holding their pencil.

As is usual my mind was operating on two different levels during a recent evaluation. While we were stacking blocks I noticed the double whorl pattern in the hair of the five year old I was seeing and I was drifting away into some articles I read about the controversy over whether or not this was a phenotypical expression of altered neurological development and hemispheric lateralization or if it was just an incidental finding. I think that I need to read more because of the recent challenges to this concept that I am now aware of.

Anyway, then I looked at the hands of the youngster, and he had a rather notable injury to one fingernail. I was wondering if the fingernail injury would be causing him to use that hand less than typical - and then I was considering that if he was using that hand less than usual that I could make an error in the assessment regarding reporting what hand he used to do tasks - and that in total my findings could be in jeopardy because also I had to make sure I wasn't tainting this whole picture with inconclusive opinions based on the double whorl pattern in his hair. At the crescendo of my cognitive crisis in how to interpret all this data that part of my mind that operates 'in the moment' asked in a very caring way "Oh my, what happened to your finger??"

I thought he said that he injured it in a bar, and I wasn't sure I heard him correctly because my brain was so muddled with thoughts of lateralization, Geschwind and Galaburda, etc. that I just had to ask the follow up -

"What do you mean, 'It happened in a bar??!??"

Without missing a beat the preschooler says, "I hurt my finger in a bar. You know what a bar is. The place where you drink beer?"

Now I am certain that there is a simple and innocent truth behind all this, but sometimes the way things come out of kid's mouths just stops me dead in my tracks.

Comments

Neil Denny said…
I love this post. I have just been doing a piece on storytelling and this is such a well told story, packed with information, detail, tantalising whorls off into other lines of reading, and the punchline delivery.

I still can't think what the innocent explanation might have been. Perhaps there isn't one. Perhaps it was a bar. Beer was involved. We'd all had a drink. Anyway, this one guys picks up a pool cue and well, the next thing I know is...
10:35 AM
Post a Comment

Popular posts from this blog

Deconstructing the myth of clothing sensitivity as a 'sensory processing disorder'

Please note first that there is no formally recognized clinical designation of  'sensory processing disorder.'   It is a term constructed by occupational therapists that has not been formally recognized by the larger medical community. In our clinic we receive many referrals from local pediatricians when parents have concerns about children being overly sensitive to their clothing.  Most often the children referred are from four to seven years old and the families are severely disrupted by the children's behaviors and responses to clothing issues.  Commonly, children will have severely constricted tolerance for certain outfits, want to wear the same clothes repeatedly, complain that clothing is itchy/scratch/bumpy/wiggly/ouchie, and this all leads to disruption of daily dressing routines.  There is no doubt that the behavioral concerns are very real. The pediatricians tend to be appropriately conservative and provide families with good behavioral management suggestions
Read more

On retained primitive reflexes

Each year I receive several emails from colleagues about 'retained primitive reflexes.'  I am also seeing an increased number of reports from local 'health care' providers who are documenting these alleged problems so I thought I would write a summary of my opinion on this topic.   Predatory 'health care' providers including some OTs, PTs, chiropractors, and behavioral optometrists are creating a new 'market' for treating this alleged 'problem.'  Parents should be very wary of these practitioners and other professionals should challenge these practices whenever they are seen. The following is the kind of information that causes concern and was provided to me by a colleague as a sample from a student's IEP: The student continues to demonstrate the following retained primitive reflexes that at times interfere with his ability to demonstrate appropriate adaptive responses: Fear Paralysis Reflex, Moro Reflex, Palmer Reflex, Tonic Labyri
Read more

Twenty years of SIPT - where do we go next?

Standardized tests are periodically discarded or updated because the normative group that the test was developed around may have changed characteristics. I am unaware of any 'industry standards' regarding the life expectancy of standardized tests; rather, professionals in a field tend to come to consensus about the relative usefulness of tests on their own. I would be interested in knowing what other therapists think about the Sensory Integration and Praxis Tests - which were published in 1989. I became certified in the administration of these tests seventeen years ago. At first I found them highly useful but the more I gave the tests the more I understood the limitations. Now it has gotten to a point where I do my best to discourage people when they ask for this test - not just because of the inherent weaknesses of the test construction but also because of how old the norms are. There have been some legitimate concerns with the tests including extremely poor test-retest re
Read more