It’s a Girl

Just over a year ago, Delphine started therapy for developmental delays. She has since seen a physical therapist, a speech therapist, and a rotating cast of occupational therapists, plus two different caseworkers through the county school district. Now she’s in part-time preschool, which constitutes therapy of a more social sort.

As her parents, we are her therapy managers. During the initial evaluation process in May and June of 2010, it quickly became apparent that no one — from our family-care doctor to Delphine’s pediatric-development specialist to her private therapy nonprofit — was willing to take the lead on managing her care. Everyone clucked their tongues and said, yes, she’s behind by several months, she needs assessment and therapy — but no one, apparently, was expert enough to manage her care. So we do. And since, ultimately, the responsibility for our child resides with us, we’re fine with this.

In some 14 months of varied therapy services, we have learned a number of crucial points:

1) Therapists are working with the parents, not just the child, but few of them seem to realize this. As a result, they need to be asked, over and over again, to speak in ordinary English, to demonstrate therapies instead of just describing them, and to write their tips down.

2) If you don’t start a massive electronic spreadsheet tracking all of your child’s various doctors, specialists, therapists, and their advice, you will a) forget most of what they tell you and b) get buried under a snowdrift of handwritten, impossible-to-read “tip sheets.” (Oh, well. Too late now.)

3) Therapists and specialists are excellent at offering tips, but dismal at offering world views. In other words, they generally have a zillion little ideas for things to try, but no Big Idea about how to think about your child’s needs. And, frankly, a Big Idea — an attitude, a strategy, that vision thing — is what sticks best in the brain, not a scattered, scribbled, handwritten list of seemingly random tips.

4) So parents need to develop the Vision Thing on their own. Over the course of the past year, Caleb and I have come up with a number of working approaches to helping Delphine with her speech and physical and cognitive skills.

Sometimes it’s best for us to try to remember that all these skills blend together — that, for example, asking Delphine to hand over a block, and waiting until she makes eye contact to show that she understands the request, and then helping her balance her body while she reaches for the block and picks it up, and applauding her efforts and successful completion of the task, is a hodgepodge of mental and physical and verbal skills, all working together.

At other times, it’s easier to break the skills down by type — speech, physical, cognitive.

For her speech, my chief strategy is to vary the types of questions that I ask her: simple yes-and-no questions (“Delphine, did you go to the park today?”), either-or option questions (“Would you like broccoli, or cookies?”), and more open-ended questions (“What color is the couch?”).

Sometimes Delphine answers, sometimes not. Sometimes she imitates us, sometimes not. And sometimes, when she’s not sure of an answer but wants to reciprocate, she’ll say, “Ummmmm . . .” as if she’s thinking really, really hard about it.

This strategy, however, means that I’m directing the interaction. Caleb tends to follow Delphine’s lead instead, providing narrative commentary about her play or responding verbally to her actions.

For her physical skills, Caleb and I flip roles; my overall goal is to help her just enough, so that she can help herself, while he tends to force her to do things, such as rolling on a yoga ball or putting her on his shoulders so they can dance around the house together.

My strategy works best for physical skills Delphine can mostly do by herself already, such as picking herself up after a fall or walking up and down stairs. It’s trickier for things she longs to do, such as climbing ladders, but really can’t figure out how to do more than get started.

Caleb’s strategy works best for the unconscious physical strength that Delphine needs to develop in her core muscles; the balancing and strength skills she learns from his more strenuous games aren’t skills she necessarily needs to concentrate on with her conscious mind.

As for the cognitive skills, that’s still a fuzzy area. Delphine seems to understand, for example, that her mother is pregnant, that there’s a baby in Mama’s tummy. Sometimes she even asks about it, pulling up Mama’s shirt to take a look. But the idea of a sibling? Of a permanent baby resident showing up in her home? Despite the sibling-propaganda books Caleb drags home from the library, I doubt that Delphine grasps the very abstract concept of siblinghood.

Teaching all of these skills is a daily struggle for us, as we’re not natural teachers. Most parents aren’t; after all, most parents never have to think about their children’s language acquisition or motor development, since their kids seemingly learn them by osmosis.

“Oh, it all goes by so fast!” most parents lament. “They grow up so quickly!” Well, not if your child struggles to learn a skill that comes naturally and easily to other kids. Delphine is growing, yes, and developing. But we don’t find ourselves wishing she would slow down.

We are trying to strike a balance between our child and ourselves, between what she wants and what she needs, between following her lead to see what captures her interest and pushing her to try new things. As Caleb summed it up the other night, “I don’t want us to expect less of her because she’s behind.”

Our child may never “catch up,” as the experts say. But that doesn’t mean we should leave her behind.