8/06/2009

Beyond Checklists: How would you diagnose this child (or would you at all)?

Here's an example of why crossing symptoms off a checklist is inadequate in diagnosing and labeling kids.

When Jessie was four or five, whenever she went to a new place, she always touched everything. Her mother was afraid to take her to any store with breakable items, because no matter what she said, Jessie reported that she "couldn't help" touching everything that looked interesting to her. (Thankfully, Jessie never broke anything). Jessie's piano teacher's desk and walls were crowded with toys and posters, and Jessie could not focus on what her teacher said until she had touched most of the objects in the room. Jessie liked the feel of squishy mud, and set up a "mud bakery" in her backyard, making mud "cakes" and "cookies" as well as the usual "mud pies." Her teachers told her bemused mother that they could not seem to stop Jessie from splashing in puddles while wearing a nice dress (her mother was used to this, and didn't really care). Jessie was a cuddly child and hugged everyone, especially when she had to say goodbye (as an adult, she is still this way with her family and a few other people she trusts). As a child, Jessie loved pulling her blankets tight around her and all the way up to her chin, associating it with the feeling of being a bird, safe and high up in her nest. She still sleeps better this way. Far from being claustrophobic, she actually likes small spaces and the feeling of being enclosed. For instance, she enjoyed being in an MRI as an adult and was so relaxed she almost fell asleep inside.

In some respects, Jessie was far from the canonical "sensory-seeking" child. She had terrible balance and avoided fast-spinning, fast-moving amusement park rides or playground equipment. Unlike the typical tactile hyposensitive kid, she seemed to have good control over how strongly she touched things, and was very gentle with animals and babies.

As an adult, Jessie has long since stopped touching everything. But she still gets a lot of enjoyment from the sense of touch.

Time for a pop quiz. Is Jessie a) tactile hyposensitive, b) highly tactile-sensitive, but gets pleasure rather than discomfort from the sense of touch? c) uses tactile sense to compensate for visual overstimulation? d) both b and c? e) ADHD, or at least highly impulsive? f) Some other combination? g) something else? or h) sounds like a perfectly normal child, stop applying labels to her?

Much of Jessie's tactile behavior matches the profile of a tactile hyposensitive that you get on behavioral checklists. My opinion is that d is actually the case, but e, f, and h could all describe her as well. This is a perfect example of how behaviors can mean multiple things, are more complex than is usually thought, and should be evaluated based on the overall context of their behavior.