Two boys. Same age, near enough. The same problem underneath, and not one adult around either of them had spotted it.
The first one was known for his temper. Ask him a direct question and he would come apart. Teachers braced for him. He had a reputation before he had a report card, and every conversation about him started with the behavior, because the behavior was the loudest thing in the room.
The second one was easy. He was the child a tired teacher is grateful for. If he wanted something he could not name, he would take your hand and put it on the thing. He made up his own small signs and used them with anybody patient enough to learn them. He was cheerful about it. He had worked out a way around the problem, and it worked well enough that nobody went looking for the problem.
Both of those boys had the same difficulty. They could not find the words.
Not that they did not know the answer. They knew it. The word simply was not there when they reached for it, the way a name you have known for thirty years sometimes will not come when you need it at a party. Imagine that happening to you all day, every day, about ordinary things. About the thing you want to eat. About what happened at recess. About why you do not want to go in that room.
That is expressive language, and it is worth separating from the other half. Understanding is one skill. Producing is another. A child can take in every word you say and still have almost nothing available to send back. Adults rarely make that distinction, because to us the two feel like one thing called talking.
This is not rare. The estimates are spread out depending on who is counting and how they count, but they average around seven percent of children, or one in fourteen. In a classroom of twenty-five to thirty, that is about two children sitting there right now. It shows up more often in boys. Hold that last part in both directions, because a pattern we expect in boys is one we are slower to see in a girl.
Now look at what happened to those two boys.
The first one got attention. The wrong kind, but attention. Somebody was always meeting about him. He was called defiant and oppositional, and there were plans written about his behavior. Part of one of those plans was that he needed to use his words. So every time he came apart, the adults around him told him to use his words.
He did not have the words. That was the entire problem. They were asking him for the one thing he could not produce, at the moment he could produce it least, and when he could not produce it, it went in the file as refusing. Nobody asked what he had been trying to say in the ten seconds before he lost it.
The second one got nothing at all. He got called a good boy. He got called flexible. Everything he did to work around the problem, the pointing and the hand-leading and the signs he invented, looked like coping, so it was read as a child doing fine. He was not doing fine. He was doing the work himself, silently, and paying for it.
Children like the second boy do get found early sometimes. It happens when somebody close to them knows what they are looking at, and it can happen as young as two years old. Most of the time it does not happen. The ones I met were nine and ten, still pointing, still cheerful, still doing the work themselves, and nobody along the way had ever put a name to it.
That is the part I want you to take away. The quiet one is the one I worry about more. A child who screams gets sent to somebody. A child who works around it gets a compliment, and the compliment is the reason nobody ever looks.
Neither boy was good or bad. Both were doing the best they had with what they could reach.
So here is what to watch for, in a child of any age.
- A child who answers in one word, or with a gesture, when the question deserved a sentence.
- A child who shows you instead of telling you.
- A child who says "I don't know" about things he plainly does know.
- A child whose frustration arrives at the exact moment he is asked to explain himself. That timing is not a coincidence, and it is almost never defiance.
If you see it, the useful next step is not a behavior plan. It is a speech and language evaluation, and you are entitled to ask your school for one in writing. If the school hesitates, your child's doctor can refer you as well. Expressive language problems respond to therapy, and they respond better the earlier somebody names them.
One more thing, and it is the reason I have been writing these letters for a year now. Most of the children I met were not misbehaving and were not lazy. They were stuck behind a wall the adults could not see, and the whole job was to find the wall.
If you work in a school and this describes a child you saw this week, please forward this to that child's parent. They have almost certainly been told what their child does. Nobody has told them why.
Warmly,
Dr. Pat
Patricia McGuire, MD, FAAP
Developmental-Behavioral Pediatrician
P.S. If mornings are the hardest part of your day with a child like this, I made a free one-page card with three lines to say in the ten minutes before school. Send me the three lines.
Responses