Do you think you know your child best?

I was dismayed this week to read a pyschologist assessment that was full of assumptions, labels and in some parts, clearly absent of simple child behaviour knowledge. The Foster Carers of the four year old child, showed me the report as if they were showing me the gospel: “this is what the experts say”.
 
After reading “she tends to do x, y and z” – I asked how long the assessment session had been and heard that it was one hour. “Ok”, I asked – “does he do x, y and z always?”. The FC said “the pyschologist said….”.  “No, – you are the experts of his everyday behaviour because you see it everyday – does he do x, y and z always?”. The Foster Carer was unable to answer. In another example, the report stated that the child did not ask for a pen that was taken from him but merely looked distraught and tried to reach up for it without asking. “Oh, okay, and what did they deduce from that?: “He has poor interaction ability”. Oh does he? And does he do that at home? “Erm, I can’t say I ever noticed but he did it in the room with the psychologist”.  Had he met the pyschologist before? apparently not. “Were you allowed to be with him?” only at the back of the room apparently.  So – he was in a strange situation with strangers – hmm, I don’t think I would have asked for it back myself in that situation. 

The Foster Carer asked me what did it mean, the fact that the child did not ask for the pen back – what did it indicate?  “I have no idea” I told her “apart from maybe measuring his peripheral vision”.

On to the social interaction paragraph:  “he does not make eye contact during social interaction”.  I called the child over for a conversation about his lovely drawing – he looked me clear in the eye and told me about it. I had only met the child once or twice but the important difference was that I was in his environment, his home, so naturally he behaved differently than he did in a sterile assessment room with strangers.

Am I dismissing the expertise of the child pyschologists who compiled the report? No but if you ask me whether I was criticising the rush to label without expert knowledge of the child and in the correct environment – then yes, I suppose I am. Who has the expert knowledge? the Foster Carers of course or indeed anyone who spends 24 hours a day, seven days a week with a child because only they know what the individual, little actions of the child means. If the question is “can the child cope with strangers? the Foster Carer will be the best place to start: “he is uncomfortable because he is pulling on his jumper” for instance. Take the Foster Carer out of the equation and you get three pyschologists interpreting the pulling on the jumper as indicative of something completely different perhaps.

I spent two hours once with a pyschologist, over lunch, and noticed how she punctuated her conversation with a sniff.  At the end of the lunch, I asked whether she was a Cocaine user. She was horrified. With a serious look on my face, I told her that she was lucky that this wasn’t an assessment because someone might have deduced, wrongly, that she was a Cocaine user “I have just got over a cold!” she laughed. Ah “but you might not get the opportunity to explain that – in an assessment”, I joked. 

I confirmed that I believed her but my point is: unless a professional carries out an assessment in collaboration with either the expert (the individual) or the expert’s carers (if a child) then its not a truly full assessment and allows for misrepresentation of the truth, of reality and therefore can result in a meaningless assessment which is not good for anyone. Sometimes – people lie, sometimes, pyschologists misconstrue, sometimes children will grow out of mannerisms and shyness (or social phobia as some professionals call it!) or suddenly wake up one morning feeling okay with the world and stop doing x, y or z or indeed carry on doing x,y or z while building a fruitful life. Perhaps pyschological assessments should acknowledge that certain behaviours do not always indicate a pyschological condition – this could save a lot of children being labelled with all sorts of inadequacies. Remembering that the derivation of “psyche” comes from Latin and the Greek psukhe – breath, life, soul: pyschologist does not mean “all-knowing” or “granted with an insight into everything”.  Pyschologists know this – perhaps clients and patients and Foster Carers should also remember this.

For instance – take a moment to offer an assessment (professional or amateur) and a possible intervention for the following 11 year old child:
“First spoke at the age of 5 and is distressed, at the age of 11, without the use of two rubber teats: one for her mouth and one for comforting.  She does not respond in the schoolroom and has not made any effort to make friends within her peer group. Since being held hostage at knife point by a suicidal neighbour at aged 10 – the child does not cope well in confined environments. She has been affected since the age of 9 with a spinal disorder that causes occasional paralysis. Her continued truancy has attracted the attention of Education Welfare and she now has a EWO in place to ensure that she attends school more regularly”.

Well? What intervention would you recommend. Please take a moment to consider.

What intervention was actually put in place?

Nothing. I just grew out of that child and into an adult, taking all the experiences and resilience with me and glad that there wasn’t the services around then that there are now – Lord knows where I would be with the “right label” (but I still don’t like confined spaces!) Just saying…
Eileen Murphy
www.brief-therapy-uk.com