In the Exam Room

Jasper locked the door of his office and headed for the parking lot, sighing deeply in fatigue and frustration. Parents. Parents are so often the problem, he thought. With every single patient he examined, even the children who were too young to speak, he tried his best to get time alone. Of course, parents usually wanted to hover, especially with the toddlers and infants, but they simply couldn’t conceive of how their attitudes, expectations and nonverbal cues were signaling their children to behave in certain ways. Jasper’s job was to determine whether or not the issues parents were reporting resulted from physical problems, which could be anything from a congenital defect to an undiagnosed injury, or from something harder to detect … which, often as not, he could trace back to the parents’ hypervigilance, unreasonable demands or expectations, too much coddling, not enough coddling, inattention or over-attention. It was hard for some parents to simply let their babies / toddlers / young children develop in their own time and rhythm, allowing the spirit of communication to move into through them however it would.

Today was typical. An anxious mother had brought in her 3-year-old son who’d never said a word but otherwise appeared to be right on track in his development. His mother was quick to point out that he was in the 86^th percentile in height and 80^th percentile in weight for his age, and the moment they entered the exam room she began instructing the child to demonstrate his motor skills with the puzzle toy she’d brought along with her. Jasper calmly explained that wasn’t necessary; their job in this appointment was to focus solely on the boy’s listening comprehension and ability to speak, or lack thereof. Jasper’s job, he went on, was to determine: was her son deaf? Was there something wrong with his throat or his speech apparatus? Did he have a learning disability? The mother stiffened in her chair. Could some emotional factor be preventing him from talking? At this the mother defensively launched into a description of her home’s loving atmosphere and Jasper politely interrupted in order to gather the facts he needed.

During the intake interview the boy’s mother wove a tapestry of useless information and irrelevant stories, overflowing with the speech her son lacked. She and her husband had, in her words, done their “due diligence,” had researched books on child development, consulted the internet (“Damn the internet!,” he thought for the umpteenth time) and multiple doctors, and the whole time she spoke she was touching the child, managing him, making sure he didn’t…what? Misbehave? Touch something he shouldn’t? Indicate curiosity about something that – – heaven forbid – – might be dangerous? No chance of that, as Jasper’s exam room was well equipped with soft and fluffy things to invite a child’s interest.

Did this mother unwittingly inhibit her son from talking by her dominating attitude and endless prattle?

It took a great deal of cajoling, but finally, at long last, and only with the promise that she could observe his interactions with her son from behind a one-way-window, Jasper convinced her to allow him a few precious moments alone with the little boy. Jasper sat across from him, leaning forward to make sure the boy would both hear him, assuming he could hear, and could read his lips, if indeed the boy had learned to do that by now. Jasper introduced himself and said a few words to reassure the boy that his mother was right outside and she could come in at a moment’s notice if the boy needed anything. Then Jasper asked him: Can you hear me? The boy smiled gently as he stared into Jasper’s gold-brown eyes. Jasper said, “If you can hear me, please nod your head.” The boy nodded. Jasper asked, “Have you ever had a birthday cake with candles on it?” The boy nodded.

“OK then, we’re going to play a game. I’m going to light a tiny match and hold it up in front of you. I’d like you to blow it out, like this: “puh!” Can you make a “puh” sound? The boy nodded. Jasper lit a match and held it up in front of the boy’s face. The boy said, “Puh!” and blew out the match. Jasper clapped gently, saying, “Good job, young man, that was really excellent.” He reached behind him, turning briefly to make a few notes in the boy’s chart. While he was writing, Jasper heard a sound. He turned toward the boy. “I’m sorry? Did you say something?” he asked the youngster.

“Again!” said the boy.

Photo credit: Gift Habeshaw on Unsplash