Sometimes, I think my greatest challenge as a mom is discernment: “Is this really a mountain? Or just a molehill?”
For about the last two years, I’ve been concerned about my 6yo son Wesley’s speech and language processing, and to a lesser degree, his social interactions. I decided that before I took him for an evaluation by a speech and language therapist that I would take him to see the same developmental pediatrician, Dr. Mark Ruggiero at the Melmed Center, that my 8yo son, Grant, sees.
Grant has been a patient of Dr. Ruggiero’s for nearly four years now, and I really like him. Like me, he’s not anti-medication for children, but his approach is more like, “Well, let’s determine what we can do first without medication” using medication more like, hopefully, a last resort, instead of as a silver bullet. Also, he’s very supportive of homeschooling. Plus, I think Dr. Ruggiero and I just communicate well. Where he’s most helpful for me, though, is his ability to put things into proper perspective, honestly laying out both the positives and negatives in each situation, and giving his opinion on what needs to be done (if anything) about it, evaluating whether it fits under the cagegory of ”mountain” or “molehill.”
And that, indeed, is just what he did in my hour-long appointment this morning. (Technically, it was Wesley’s appointment, but 95% of the time was he and and I talking while Wes played.)
In short, he told me that he was both validating and assuring me about my concerns. “Validating” because he does see some issues with Wes, but “assuring” because, right now, there’s really not any problem that needs intervention. He said that the operative word should be “dysfunction” and in his opinion, Wes doesn’t fit into that category yet. Does he have a few developmental delays, and a few oddities and quirks and difficulties? Yes, he does. But, at this point, it’s not detracting from his ability to have successful home relationships, nor his schooling. Wesley’s not very social — quite avoidant of social situations, even amongst our family, usually preferring to be alone. And, maybe that will require some further attention in the future, or maybe he, like Grant, will just gradually improve in that area.
Speaking of Grant, though, something Dr. Ruggiero said that I had not even remotely considered is that Wesley’s ”profile” of strengths and weaknesses is really similar to that of Grant, who has Nonverbal Learning Disorder. But, since Wesley’s personality is so very different from Grant’s, it manifests in a much different way.
He said that Wes shows bits and pieces that are Asperger-like or high-functioning-autism-like, or NLD-like, but not enough in any one area to give a diagnosis, and not enough to be concerned about, just enough to keep an eye on.
He also said that even Wesley’s speech and language problems, which appear to be situational, not universal, even fit into an autistic/Asperger’s/NLD sort of pattern. In other words, he has problems some times, but not others. Wes read aloud from Dr. Seuss’ One Fish Two Fish, and had near-perfect diction and pronunciation. Even words and sounds that he typically struggles with (like “ld” and other dipthongs, and the “th” sound and “j” sound), he pronounced correctly. I think it helped that he was seeing the words/sounds in the book while he read, instead of just making the sounds from memory and habit. Dr. Ruggiero said that kids with Wesley’s sort of profile typically can have speech problems that show up — rather like stuttering — in either high stress/excitement, and/or in low stress/excitement. I have recognized that Wes’ speech struggles are most pronounced when he’s excited, but Dr. Ruggiero said that it’s also common to find that they show up when he’s very relaxed and careless, like when he’s talking with me. But, when he was talking with the doctor, he was more carefully considering his words and thoughts, leading to better diction. I had never noticed that.
The doc recommended that I keep a log of the Wesley’s mispronunciations, sound-substitutions, word-swapping (Wesley’s sentence structure can have him sounding Yoda-ish at times), and the like, noting the situation, as well as the word/sound itself. That way, if I do make an appointment with a speech and language therapist, I can present them with a sheet of information of problems that may not show up in an evaluation setting.
So. I do find all of that both validating and reassuring. I’m not just neurotic and finding “problems” that simply don’t exist. But the problems that do exist are minor, and I don’t really need to do anything with Wes right now, other than continue what I’m already doing, and keep an eye out for any the possibility of any current minor problem escalating into real dysfunction.
In my book, that makes for a fantastic visit to the doctor. :)
