Embrace the average

When my son's preschool teachers recommended that we send him to speech therapy, I can't say that my husband and I were completely surprised. Clay wasn't entirely easy to understand; his "r" sounded like a "w," his "th" was indistinguishable from an "s," and his "l" was essentially nonexistent. But he was only 3 years old.

We believed his speech would clear up on its own with time, but agreed to have Clay tested for a speech disorder. We did it in part to eliminate nagging doubts of our own that he had a problem, in part to appease the people expressing concern. Several hundred dollars later, we had our answer: Clay's speech was perfectly normal.

The tests that were administered placed him in the 50th percentile for boys his age -- right in the middle of the pack. When it came to speech and language, Clay was perfectly average.

As doctors, my husband and I knew what that meant -- Clay was healthy and on track, and that was good enough for us.

These days, however, average doesn't sit well with many parents. "There's been a narrowing of what's considered normal," says Dr. David Elkind, professor emeritus of child development at Tufts University and author of "The Hurried Child: Growing Up Too Fast Too Soon." Whether considering academic achievement or athletic prowess, some parents have come to believe that the only "normal" kids are those who excel. Unfortunately, meeting these high expectations is impossible for many children, and trying to do so can be discouraging and potentially damaging.

Statistically speaking, the term "normal" is intended to encompass a range of children of varying abilities. What's normal centers around the average child; only children who fall way above or below average -- roughly the top and bottom 5% to 10% -- don't qualify.

About 80% of 13-year-old boys, for instance, are 4-feet-9 to 5-feet-5 in height. Boys at the lower end of this range may be considered short, but they're still normal.

With some characteristics, normal isn't as easily defined. Behavior is more difficult to measure precisely, so identifying the upper and lower limits of normal can be challenging. Still, the principles are the same. The perfectly behaved child shouldn't dictate what's normal; rather, it should be the kid who truly is: one who occasionally breaks the rules, gets into fights with friends or has an emotional outburst.

Most don't excel

When high-achieving or exceptional children are held up as the benchmark of normal, most kids are going to fall short. Unfortunately, rather than examining what's wrong with their expectations, many parents -- often, along with their children's teachers, coaches and healthcare providers -- conclude that something is wrong and jump in to try to remedy the situation.

Six-year-olds with messy printing are sent for occupational therapy to improve their handwriting; clumsy 7-year-olds are made to undergo sensory integration therapy for better balance and coordination; 8-year-olds who have trouble sitting at their desk all day or keeping their hands to themselves are shipped off to psychiatrists to work on impulse control, and educational therapists are hired to help 10-year-olds bring up their grade point average.

These services can be helpful. A child who receives this kind of support may gain a bit of ground on some of their peers. But the benefits aren't always clear-cut or dramatic, and the risks that these types of interventions impose are often overlooked.

Although it's hard to imagine how a bit of extra support could be detrimental, some experts in child development speculate that there may be unforeseen costs. Too much help may interfere with children's sense of autonomy, for one thing. "It makes them think that they can't do things on their own," Elkind says.

Also, children who are constantly being told that they need help may begin to believe it. "They start to think that something is really wrong with them."

There are more tangible costs as well. Many children resist the help their parents provide: What child wants to spend free time with a therapist or tutor? So interventions can wind up undermining the parent-child relationship.

They can also strain families financially. Therapists and tutors don't come cheap -- 45 minutes of speech therapy can run upward of $100, and an hour with a math tutor can cost well over $60.

Also, the benefits of intervening are limited by the natural aptitude of a child. All the tutoring in the world isn't going to turn a bad math student into a brilliant mathematician; all the coaching in the world won't turn an uncoordinated child into an elite athlete. "You simply can't teach talent," Elkind says.

The advantages of intervening frequently don't outweigh those of simple watchful waiting. Children don't mature at the same pace, and time is sometimes all it takes to level the playing field. Some infants walk when they're 10 months; others don't take their first steps until they're close to 1 1/2 years. Some toddlers articulate in full sentences at 2 but many don't string together a thought of more than two or three words for at least another year.

Different speeds

The same goes for more sophisticated behavioral and academic traits. For some children, sharing is a breeze at 15 to 18 months; others can't get their minds around the concept until 5 or 6. It's not unusual for a child to begin reading in preschool at age 4; many struggle with the skill until the second or even third grade and still go on to be perfectly proficient readers.

Although we opted out of immediately enrolling Clay in speech therapy, it wasn't an easy decision. There was pressure from educators to attend to what they perceived as a problem and, as parents, we were vulnerable to their input. (After all, they were the experts.) There was also the discomforting thought that by forgoing therapy we were missing an opportunity to help our son. Sometimes it feels better to do something over doing nothing.

That's not to say some kids don't need help, because in fact many do. But treating every child is not the answer. Embracing "average" may be.

To be honest, the idea of average took getting used to. But what we eventually realized is that that was our problem, not Clay's. It wasn't therapy Clay needed but a change in perspective on his parents' and teachers' part.


Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month. themd@att.net



A common-sense approach for kids

Whether it's social skills, intelligence or athleticism that's under consideration, children run the gamut. In many situations, determining the cut-off points for "normal" can be exceedingly difficult. But there are general rules that can help.

Most kids hover right around average, regardless of the characteristic. A few children are either well above or well below average. IQ serves as a good example. Most people score near average, or 100; a small number have IQs that exceed 130 or are below 70.

In establishing boundaries for what's normal, the starting point is typically the child who falls smack in the middle of the pack. From there, the limits are moved outward in both directions to include children who are somewhat above and those somewhat below average.

From a medical perspective, the tricky part comes in deciding how far out from average the "normal" boundaries are set, and at what point help may be necessary. A common-sense approach -- rather than a standard formula -- is often what's needed. If being above or below average affects a child's ability to perform in day-to-day life, it's difficult to consider it normal.

The upper and lower limits on normal can vary from one characteristic to the next. Being 40% shorter than most peers might not bother a child; being that far below average in language development could embarrass him to the point that he starts to withdraw socially.

In fact, it's often difficult to establish rigid boundaries for a given characteristic because what works for one child may not work for another. Some children, like my own son, shrug off differences; others are devastated by them.

-- Valerie Ulene

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