To Treat or Not to Treat, That Is The (Million Dollar) Question Part II

To Treat or Not to Treat, That Is The (Million Dollar) Question Part II

Treatment always involves an investment of time and money. The return on investment (ROI) has to be worth it. There are a few questions that must be answered to help assess ROI.

Handicap (see previous post) is not a simple measure.

You need to identify the areas that may be impacted by the disability and then check those areas to see if they are affected in this particular instance.

You also need to consider that certain diagnoses are termed “presumptive” because research has taught us to expect handicap down the line. A child who is born with a hearing impairment is expected to have a serious handicap in learning speech and language skills. There are no language measures given to a newborn since all newborns lack speech and language skills. In anticipation, treatment will be given so as to minimize the potential future handicap of the hearing disability. We also know that even with presumptive diagnoses the degree of the disability predicts the severity of the handicap. Charlie is an adorable little guy with Down syndrome.  Since his Down syndrome is a presumptive diagnosis, he was provided developmental intervention. This was mom’s first child and this diagnosis overwhelmed her. Thanks to that she was very diligent about doing his exercises with him. But she was completely taken by surprise when I told her that if not for his presumptive diagnosis of Down syndrome he would not qualify for services since thanks to all the intervention he was age appropriate in his developmental milestones at 6 months old. Anyone who knows this population knows that there is a large range of cognitive abilities and therefore variability in performance between such children. This cannot be tested in a newborn. At the following Early Intervention assessment, he was whittled back to once a month intervention (which is simply to ensure the situation is monitored and he did not fall behind). With such a proactive mom he went far without the need for a team of therapists. Caroline was also born with Down syndrome. She was also the first child. Mom left the remediation work to the therapists and did not do homework. As a result at age 3 Caroline was hard to understand and not toilet trained.

Was Charlie perfect? Who is? More importantly, the next question you need to ask is; “how much is too much?” One of the trends I am seeing in adolescents is, brokenness. Well-meaning parents are providing all kinds of therapies and tutoring, so their child will be an A+ (i.e. successful) student. The consequence of this is the child now feels like they are broken and need to be fixed. More and more when there is no significant handicap I am advising parents to quit therapies and instead spend the time with their child letting them know what you like about them and that you enjoy spending time with them. It is o.k. to be a B student so long as it is not because of laziness or a handicap. It is not o.k. to make being a B student a handicap, and as a reader of this blog you know there is a lot more to learn besides for academics. I am not a fan of history. I find memorizing meaningless names, dates and places tedious and irrelevant. That may be why I work in a profession where history has no bearing. I am not handicapped by my lack of history knowledge.

Another consideration of ROI is motivation. In the MEPE student graphic depicted above (this name and graphic is copyright protected under the Child First educational model copyright) you will notice her legs look like the letter M. This symbolizes motivation. Motivation was chosen for the legs for it is motivation that dictates the direction a person goes. Without motivation you will get nowhere. It is for this reason an important handicap consideration is frustration. A parent or teacher may not think a certain behavior or performance is troubling, but if it is greatly frustrating the student then they need to address the issue. It may be the issue that needs to be addressed is how to handle frustration or it may be this student is very sensitive and needs to learn how to handle what they perceive as a handicap by compensating. If someone struggles to take notes in class you may teach them to compensate by typing their notes instead, use a slant board and/or pencil grip or photocopy someone else’s notes. On the other hand, if the “patient” sees no need for treatment and will be unmotivated to cooperate, progress will not be seen and the ROI is not worth the investment.

However, there are certain skills that do significantly impact quality of life where even if the student is not frustrated and does not see the need for intervention as the adult you may want to insist on attempting treatment. Such areas include but are not limited to: learning how to read, or someone who is doing poorly socially but may be so socially clueless that they do not even realize this, basic math, etc.

 

Next time: How to treat

Best,

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