Talk to Me

The Allens came to my office looking for a different approach. Alice, their first baby, had been born 6 months earlier, and, they admitted, things weren't going well. They had a hard time articulating the problem, however. Somehow, they just weren't enjoying the experience of parenthood. Why weren't having a good time with their baby the way other people usually do? Was there something wrong with the baby? Was there something wrong with them?

They liked their last pediatrician. When they brought up their vague reservations, she tried to be reassuring, but it just didn't take. The doctor visits were generally brief, and this hazy discomfort was never really focused on.

Baby Allen was a sweet girl with big eyes who smiled at me during her exam. She was growing and developing normally, and had never been sick. She was making some sounds in the stroller, but the parents didn't respond.

“Ack?” she asked when I picked her up. Professional that I am, I knew the answer.

“Ack,” I said.

“Ack,” she repeated, continuing the conversation.

“Ack,” I said, since I wanted to continue too. She paused for a moment.

“Ack?” she asked again, obviously giving further consideration to her earlier question.

“Ack,” I responded, with a big smile. She gave me a big smile in return, which turned into a laugh. The conversation continued for at least 4 or 5 minutes.

Her parents watched the exchange in amazement. It was clearly, obviously, a conversation. She changed her tone of voice as if to convey meaning, so sometimes the same limited sound was a question and sometimes a statement or a surprise. “Haven't you guys ever done that?” I asked them. They said they didn't know she could do that. “How much do you talk to her?” They looked at each other quizzically. I saw where this was going.

What I was doing, fundamentally, was letting the baby steer the conversation. More importantly, it was listening to the baby and allowing her to be in charge. I think of this as an empathic approach, which is applicable to children of all ages. Listen to your children, take wht they say seriously, and, whenever you can, let them lead you.

It turns out that talking to your baby is incredibly important. Though research has barely started on the real impact of these kind of interactions, babies consistently surprise us with the things they can do.

So it didn't surprise me when I read a study, just published, about the conversations of 5-month-olds. They videotaped 37 babies interacting with adults the babies didn't know. The scientists watched what happened to the vocalizations of the babies when the adult made a blank face. Sure enough, the babies stopped their sounds when they got the blank face but continued when they got smiles. Think about this. By the time babies are 5-months old, they have learned how to control at least this aspect of the behavior of their caregivers. From this experiment (and others) we know that babies actively learn what to do by experimenting on us. And what you might not expect is that when these scientists followed up with the babies they studied, they found that the strength of their skills at 5 months predicted their language skills at 13 months. I wonder if there are babies born with great language skills, or if the constant practice of having a caregiver talk to them and with them gives them extra practice and maybe even stimulates the language center of their brains and helps it develop.

Would it help to have a translator for a baby's grunts or cries? This will be the topic of an upcoming post.

I sent this family home with an exercise prescription. I told them not to miss an opportunity to talk to their baby, even read to the baby. It was OK if they read her the newspaper or a magazine.

There was a secret agenda. Empathy, the ability to understand what another person is feeling, is absolutely crucial to successful relationships with others. That includes conversations with babies and complex social skills. The baby will benefit from more interactions with her parents. She will learn to listen and respond, maybe how to initiate and manage a social interaction. She will learn that her parents are interested in what she has to say. But I believed the parents will get a lot out of it too. They'll experience the great things their baby can do and the many ways she will reach out to them.

Epilogue--The prescription really worked! A few weeks later they reported that things have never been better with the baby and between themselves. They each try to outdo the other in how long and complex they can make their infant conversations. They told me that the baby has never laughed so much. Them, too.

The photograph above is from my collection and is by Lewis Carroll.

ADHD: Claire 2--Looking for the ADHD diagnosis

Did Claire have ADHD? She was forgetful, distracted, and had trouble paying attention. After her mother and I agreed on a plan, her mother had to tell her about it. Smartly, she waited for the right opportunity—in the car.

The car is often the perfect place for a serious topic. It’s isolated so you have privacy. No one will interrupt and siblings are not around. There’s physical closeness but there’s no chance of forced prolonged eye contact, so the passing outside world is a helpful relief valve.

Claire’s mother reported following my script closely. She said that she had seen my blog story about girls with ADHD and wondered about Claire. She outlined some of the features of ADHD in girls that often get missed. She talked it over with me on the telephone, and I suggested a formal evaluation, including input from parents, teachers, and Claire herself.

Claire’s eyes started to tear. Her mother didn’t expect this reaction, and asked her what was wrong.

She said that she was incredibly relieved that maybe there was a reason for her being the way she is, and that it wasn’t her fault.

She had been well aware of being ‘spacey’ and disorganized, and she didn’t like it. But both from herself and everyone around her—friends, family, teachers—she kept getting reinforcing feedback that supported the idea that this was just who she was, as unchangeable as her height or her voice. Unlike most of the evaluations I do for kids who are much younger, this one is a crucial new part of this teenager’s identity. We will all have to walk very carefully.

Once through the initial suggestion, Claire was excited about the prospect. I don’t think she liked the idea of ADHD, exactly, but she genuinely liked the plan to figure out what the issues might be.

A therapist, who had not noticed a particular problem when talking to Claire, suggested neuropsychological testing. This is an expensive and detailed group of tests in which every aspect of her learning and understanding is carefully analyzed. It’s the essential tool for figuring out exactly what a kid’s learning disability is. But Claire was a voracious reader who read for pleasure, so it’s unlikely she’s got a reading disability. She’s not great at math, though. But her attention problems are in all her classes, not just math. In addition, a child being tested for hours has to be able to keep focused on the exam tasks. So in general, I try to get an attention issue under control before having kids do this kind of testing.

I sent questionnaires to Claire and her parents, and separate questionnaires for her teachers.

I often feel uncomfortable bringing up a new diagnosis to a parent. It’s hard to tell someone that their child has asthma or eczema or pneumonia. But almost always, this news is met with some sense of relief by the parent. They knew something was wrong, which is why they brought the child into my office and complained of a cough for 2 months or a rash that didn’t go away. Nobody’s happy about it. But now it has a name, and things with names can be discussed, can be treated, can be joked about, and can be looked up on the internet.

Much more to this story as it unfolds....


The photograph above is from my collection and is by Lewis Carroll.