Thursday, March 4, 2010

Age Appropriate

Yesterday, Li'l Empress played with an Occupational Therapist as part of the yearly evals by our county's Early Intervention service. It was the third or fourth evaluation in the last two weeks, between EI's different therapists and her regular audiology check-ups. I'm amazed at Li'l Empress' capacity to put up with the "performing monkey" stuff that comes with all these appointments lately!

After I finished up the interview portion of the evaluation, the OT got down on the floor with Li'l Empress to to put her through her paces. Gross motor skills, fine motor skills, spatial relations, the whole gamut was on full display. It was really fun to see how far she's come, as I remembered the various delays she had to work through when she first came home. As an observer, I feel good about the accuracy of the eval and the progress that I can see she's gained. Having it marked in "months" notation was helpful. There were a couple areas that we should more intentionally introduce and press, but the thing that struck me was the repeated emphasis on the milestone of potty training.

And by repeated, I mean, "Enough already, I know.
You think she should have started potty training months ago, I get it!"

Now, I've always taken a fairly laid-back approach to potty training with my older kids. A huge part of my approach is that I really would preferred that they be ready, that they own it, and that they feel a measure of success in their attempts. And selfishly, I don't mind admitting that I also know it's less work and frustration for all of us if they do achieve success early in the trying. So I don't mind waiting a bit.

For example, Baby BlueEyes was a month away from being three and I just knew he'd knock it out of the park if I tackled training while all the older sibs were still home for summer break. We made it a whole family event. I was right: he was "on it" - done, dry, and ready to go (mostly) on his own within a week or two. That little potty seat went everywhere with us. The older boys hoisted him up on their shoulders when he succeeded and had a special song they sang for him every time he got it right. It was fun for them all, as I was very generous with the M&M rewards. He earned a huge amount of confidence, and the boys felt pretty good about themselves and the role they played. Added bonus :)

When the OT told me that at 30 months, Li'l Empress was not yet "age appropriate" in the area of self-care and responsibility simply because she had not even attempted potty training, it took everything in me not to give my little spiel. I mean, I know this is her job, this is her life and she's immersed in developmental milestones and all. I greatly appreciate the OT's skills and knowledge. I do, really. But from a Momma's perspective, from the heart of one who knows her girl better than any evaluator could: can we have a little context please? Can we look at the whole picture of Li'l Empress' life and growth to today's singular moment of evaluation? Could we take a step back and recognize all that Li'l Empress has accomplished and all the areas in which she is scoring well above the "age appropriate" targets?

(PLEASE, it's not that the evaluator was suggesting a problem or wasn't appreciative of the "big picture of Li'l Empress' life - although she didn't really even ask about her delays or life experience to this point. I had to offer the information. Context. You get me? That's the point of this post. This is my thought process in the midst of the evaluation.)

So I did what any good Momma needs to do in a moment like that: I gave myself context. I know that every kid is different. All four of my older kids had vastly different potty training experiences and varying levels of success. Bigger than that, within our extended family there has been a wide range of ages, starts and re-starts, regressions, and successes. And even bigger than that, as my good friend M told me last night, many children who have been adopted have a wide range of responses to the readiness and the process of potty training.

That concept of context is a big one in parenting, isn't it? Truthfully, it's been bigger than ever since we jumped into the world of special needs adoption. It's why I've often said that I feel like I went back to school once we received Li'l Empress' referral back in July '08.

Understanding microtia, atresia, and unilateral hearing loss.
Researching secure attachment and healthy bonding.
Studying what a good listening environment really looks like.
Practicing how to improve our home to be that good listening environment.
And more, so much more!

All of this requires that I learn context. Occasionally, context feels as if it's purposely eluding me. Other times, I am confident that I'm really getting a grip on it manner that allows Li'l Empress to grow, even flourish. To step out in new skills and milestones with confidence. It's a balancing act that I'm sure moms of other special needs kids can well identify with. It requires a delicate balance of stepping out and holding steady. It requires a deep breath and that internal conversation of "it's okay - she's not there yet, but she's getting there." And "she's got all this other stuff she's overcome and surpassed for her age, this will come too." I gave myself context.

Yesterday, I had an evaluation, too. And I am proud to say that I think I am age appropriate in the parenting milestone of context.


Stephanie said...

You go girl! Momma definitely knows best.

Beverly said...

Right are absolutely correct -- you do know her best and what is best for her!!

And -- hey -- love your blog theme design...GO IRISH!!

heidi @ ggip said...

I know what you mean. As an addition to your context (for early intervention that is, not exactly your topic) your child will not be at a 1 year level in PT until they are walking. Does that make sense? No! But that is the way it is in EI (in my area at least!)

She is doing really well!

And if I had to do potty training over again with my oldest I would have waited until after he was 3 to even introduce it. :)

joymweaver said...

My Taylor is about the same age at your daughter. (birthday: Sept. 17, 2007) We got home from China in the beginning of December. She will say to me, "Pee-pee potty", but I sit her on the potty and she doesn't do anything. I am not going to worry about potty training until this summer when she can just go around with little on.
My son was 3 before he was potty trained.

I do not consider most children whose parent's claim they are potty trained at an early age to really be potty trained. To me if the parent is the one who is always taking the child to the potty at set times and the child is having accidents several times a week, they are not potty trained.

It will come. All children are different. It will happen when it happens. She will not be still wearing a diaper at her high-school graduation.

Aus said...

OK - 1) early potty training is like housebreaking a pet - it's not the child that it 'trained' - it's the parent! No body has accidents if you sit them on the potty every 60 minutes ya know? ;) 2) when it comes to an eval of your parenting skill - in particular to adoptive and sn kids - I'm guessing you're maybe 18 months advanced? At least 100% spot on (and the target is the 50th %tile!) 3) Suffering from bi-lateral loss - your post reminded me of how 'invisible' this need is - I forget that sometimes and completely had forgotten in this case - ya'll are doing some really GREAT WORK!!

Way to go GM (and the rest of the gang there too - it's a family effort!

hugs -

aus and co.

Classic MaMa said...

Send the OT here. Bubba is not a special needs child, always lived in America, turned 3 in December and has no interest in even talking about the potty. I'm not stressed. There are lots of pottying years ahead.

eeka said...

Ugh, so sorry to hear that.

I'm an EI therapist, and the best practices actually spell out how standardized testing can't account for everything. They emphasize that we need to use our informed clinical reasoning to override the standardized tests when appropriate. The important thing we always emphasize in my program is to give families feedback on whether something that's below the norm is something we find a) concerning or b) not concerning. If it's below the norm, yes, we need to tell you that, but then we also will often tell you something like that it makes perfect sense that the child isn't doing it yet given that the child has experienced x, y, and z, or that the child seems to prefer certain things rather than others, but isn't overall concerning, etc.

With self-care, it's emphasized in all the EI literature that it's really the family/culture's preference when such skills are acquired. Some families have reasons why they don't want to waste food or have messes in their homes, so it's fine if their child doesn't feed him/herself by the age stated on the tools. Same with potty training; there are a lot of kids where it's not appropriate to push it, or a lot of families who just feel inclined to do so just yet. The only thing that matters in the self-care area is that the family is providing some semblance of routines around these things and is talking about them, so the child has some basic knowledge about what self-care items are for, what step comes next, etc. As a clinician, I don't really make it my business exactly when and how a family carries these things out, as long as there are at least SOME areas in which the child is being appropriately responsible. If you dress your kid and feed your kid so you can get out of the house on time in the morning, but the kid can put away toys and feed the dog in the evenings, I'm not concerned that the child "doesn't know how" to dress and eat, yanno?

eeka said...

Oh, and depending what tool was used (the scores being reported in months suggests the Michigan), the tool is likely from the '60s, so it was written when we had Freudian beliefs about potty training and rather racist/classist/sexist norms that the "good" and "smart" kids all had stay-at-home moms who wore aprons and put dinner on the table at 5:30 sharp, and these moms were making absolutely sure that the kids used a spoon skillfully by 15 months and could pour themselves a drink without spilling by three.

We know now of course that kids turn out just fine with the less-structured lives most kids have now, and they learn these skills eventually.