What Should the Doctor Know

Kathleen O'Brian (although this is based on an actual case, I have altered the names and places to protect the privacy of those involved) became worried that something was wrong with her son, Michael, in the winter of 1986 when he was about 16 months old. Other than a few ear infections, the little boy's health was good. He ate heartily and was big for his age, but he was just beginning to stand on his own, and he had yet to utter a word. When Mrs. O'Brian talked to her pediatrician, he was reassuring. "Each kid develops at his own pace," he said, "and it's too early to get worried." Still, he agreed to evaluate Michael's development again in three months. Michael was Bill and Kathleen O'Brian's first child, and her upbeat husband had repeatedly told her she was worrying too much about him. She went home a bit reassured, and waited for the evidence that she was wrong. It did not come.

Three months later, when Dr. Tarkington next saw Michael, their state was in the sweltering grip of a late southern spring. As Kathleen drove to the appointment, she thought about all the neighborhood children she knew who were months younger than Michael and already running about the playground while he could barely stand up on his own. She studied the pediatrician's face as he carefully performed the developmental exam, and she knew before he spoke that he now shared her concerns. "Michael is behind in his milestones," he acknowledged, "but I cannot find a reason to explain it." Together, mother and doctor again reviewed the pregnancy, her health, and family history on both sides. Everything seemed fine. The pediatrician arranged for a workup by a team of specialists.

During the next six weeks, Michael was evaluated by speech patholo-gists, physical therapists, social workers, occupational therapists, psychologists, audiologists, and a pediatric neurologist. His hearing was fine. Across the board, on every test, Michael, now about 20 months old, was scoring about the same as a child of 11 or 12 months. Once given a start,

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