For many families, the first trip to a developmental pediatrician is a major turning point. A common hope is that the doctor (me) will hear the parents’ concern, but upon seeing their child, will assure the family that all is well. The child is developing “typically” and the symptoms and behaviors that brought the child here are a false alarm. I love that scenario. I relish the feeling of having a family leave our clinic happier and visibly relieved.
The opposite scenario is unfortunately a common one: A family is faced with autism, intellectual disability, hearing impairment, a language problem, genetic syndrome, cerebral palsy, ADHD or another developmental problem. I don’t get an opportunity to assure the family that all is well.
It usually becomes evident to me in the time it takes to walk with the family from the waiting area to my office that a child has significant developmental issues. The child may look unusual, not respond when I call his name and engage in an atypical set of behaviors. I don’t know what the problem is, but I know there is a problem.
Soon, I begin formulating an image of the struggles likely facing this very young child and his family. This is what I refer to as “the crystal ball effect.” I know so much about what is likely. Meanwhile, the family is holding its breath hoping the child is fine.
The rest of that two-hour session becomes a sort of debate in which I argue both sides, collecting data supporting those initial impressions or happily dashing them as an error, inaccurate for any number of reasons.
In a field where there is no blood test for confirmation of diagnoses, our observations are what developmental pediatricians have to go by. Observations are data. We seek to increase the data’s validity through standardized tests, rating scales completed by parents and outside sources such as daycare or preschool and sometimes multiple visits over time with the child. But in the end, we are using the clinical skills of observation and experience to draw conclusions.
One of the things I struggle with is balancing the knowledge I possess—my crystal ball, based on 20 years of experience of the outcomes of children with similar findings—with a parent’s right to and need for hope.
That is not to say that treatment will not be effective and that we can’t optimize the functioning of the child. There are always statistical outliers. We can never know for sure a given child’s outcome. The younger the child, the more natural variability comes into play. The crystal ball effect is based on playing the statistical odds. But, much like the weather, the outcome of the World Series or the state of affairs on Wall Street, statistics take us only so far. After all, it snowed 10 inches on October 29, 2011. Need I say more?