Shirah Vollmer MD

The Musings of Dr. Vollmer

Child Development

Posted by Dr. Vollmer on October 13, 2010

     Motor, fine and gross, development, language skills, social skills,  cognitive skills and emotional vulnerabilities all unfold to different skill levels and at different rates of change such that a child can seem “odd,” or worse yet, be diagnosed with Asperger’s Disorder, if his development is off track of the majority of other children. Liseth, age six, has an IQ of 170, as determined by the Stanford-Binet IQ test, a test which tends to give children higher IQs than other tests, but even taking that into account, Liseth is a very bright child. She has poor gross motor skills; she has trouble playing catch. She appears not to recognize faces such that other kids that she has seen repeatedly seem unfamiliar to her. However, after a lot of exposure to certain playmates, she begins to recognize them and show them signs of familiarity. As a result, when a child who recognizes Liseth, but Liseth does not recognize him, there is an odd interchange. It is as if there is a facial recognition part of the brain which is either undeveloped or nonexistent in Liseth’s neuroanatomical structure.

    Liseth is impulsive and inattentive to things she does not care about. She loves learning about architecture, so she spends a great deal of time on the internet looking at building design. On the other hand, when it comes to waiting her turn to play games, she struggles with the wait. She does not pay attention to follow instructions such that she will be in her own world while a teacher is telling the class to move on to the next subject. As such, many of her teachers have experienced her as “odd”.

  Liseth also suffers from anxiety; she thinks about catastrophic events and she worries that something bad will happen to her parents. She has trouble sleeping because she is preoccupied with negative and scary thoughts. She speaks about her gloomy thoughts in an articulate manner and she has since she was two. Liseth’s verbal skills far exceed her peers.

   Liseth’s mother, Ella, was just like Liseth when she was a child, except that no one thought Ella was “odd”. Ella grew up before the diagnosis of Asperger’s floated around in our universe. Ella explained to me that everyone thought she was “insanely bright” and so they cut her a lot of slack for her “atypical” behaviors.

   My impression is that Liseth is outside of the bell-shaped curve; both in her basic abilities and in her rate of development. In some areas, like her language skills,  she is far ahead of her peers; in other areas, such as her gross motor skills, her developmental delay is significant. Since her skills are not in line with her peers, both her excellent language skills and her poor motor skills create a social liability. Poor facial recognition hurts her too, in the social arena that is. As Liseth develops, as her peers develop, there is likely to be a leveling off, such that the discrepancies in skill level will be smaller. Still, this remains a hypothesis, a guess, which only time will answer. Time is a large variable in development. The rate of change for each child is different, making the diagnosis of Asperger’s Disorder, at least in some children, premature. Until we have a better understanding of  child development, we have to respect that maturation is a dynamic process; one that humbles clinicians.

9 Responses to “Child Development”

  1. mimi said

    a great reminder that we are all unique and sometimes time heals. thanks! mimi

    • Thanks! Unique is both good and bad. As humans, we want to fit in, and we want to stand out, at the same time. That contradiction seems to be true throughout the lifespan.
      As for the issue of time, clinicians know it is a variable which is always at play. The nagging question of waiting versus intervention never leaves our minds’.

  2. kristin said

    She sounds like Dr. Oliver Sacks, the brilliant neurologist/writer He has written about his inability to recognize faces, his extreme shyness, and his lack of physical coordination. Now of course his oddness – ie the ability to see things from a totally unexpected point of view – is his great strength. is there a risk for a conscientious parent in paying too much attention to the negative traits? could that lead to a lack of nuturance and development of the positive ones?

    • Indeed! The issue is that Liseth needs to go to school and as such she needs to fit in to an environment where her development will flourish. The goal for the parents is to find the appropriate school which recognizes Liseth’s strengths and assists with her weaknesses. This is the goal for all children, but “out of the box” children have fewer resources available to help them.

  3. […] This post was mentioned on Twitter by Lou Lou's PlaySchool, Krista Lee. Krista Lee said: Child Development « Shirah Vollmer MD: Time is a large variable in development. The rate of change for each child … […]

  4. Shelly said

    Is Liseth of grade-school age, or older? Except for the inability to recognize faces, does she have other social issues? Is an inability to recognize faces somehow connected to Asperger’s? How do psychiatrists treat children with Asperger’s?

    • She is six. In addition to her challenge with facial recognition (she can recognize faces, it just takes her longer than other kids-she has to meet people four or five times before they are familiar), she also has trouble waiting her turn, so that creates social issues. Asperger’s means different issues for different kids. If there are social issues, social skills training can be useful. If there are cognitive issues, then a special school might be important.

  5. A reader said

    Regarding her face recognition problem: This is probably an obvious question, but has her eyesight been checked? Also, given her intellect, maybe she is so focused on her internal thoughts that she just doesn’t notice the faces of her playmates. Maybe her playmates’ faces are like the man in the gorilla suit in the famous experiment — when her mind is focused on something else, maybe she just doesn’t notice anything in her environment. Finally, shy kids often find it painful to look others in the eye or to have others look at them. Perhaps if her mom took discreet photographs of her playmates, she could memorize their faces more quickly by studying the photographs.

    • Yep! Maybe she is so focused on her internal thoughts because she has a processing problem which does not allow her to focus on external issues-like faces. The man in the gorilla experiment is very interesting, demonstrating that with intense focus one can miss obvious things. This could be true for Liseth. Yes, eye contact falls in a range. Some kids love it, others avoid it, and most people fall in the middle.

      That is an interesting idea about the photographs.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: