Speech, Language, Development, Biology, and Why This World Makes No Sense

My son’s psychiatrist is going out of business (I guess you have to say “closing her practice”) because she can get paid only 37% of the time from the insurance companies. She is a developmental pediatrician AND a child psychiatrist so charges health insurance as a primary care physician. I like that mental health treatment can be considered a component of primary care. Alas, the health insurance companies are getting wind that cognitive and behavioral struggles can actually be claimed as an organic, medical issue, and will have none of that. So, the only competent physician in this area in Charlottesville is being put out of business. She has to refer us to someone in Richmond, so bad is the local consciousness about children’s brain issues. But, no fear! The kids she WON’T treat will grow up and be forced into involuntary treatment by our spiffy new laws! Problem solved.

My own health insurance paid for Blake’s sessions with the doctor, but, although there was a prescription for speech and language therapy, and a full evaluation, will not pay for the speech and language therapy. Anyone who has a child struggling with a different brain knows that learning issues like speech and language can frequently exhibit as part of, or in conjunction with, the underlying condition. School psychologists LOVE to parse the chicken and egg on this one, and talk about childhood traumas as a “cause,” as though that’s a way to help “cure” the problem. Zen philosopher Alan Watts said that humans are the only species that bother trying to find out why. To my mind, in matters of psychology and personal narrative, the why can be a barrier — the genius of the why is in the sciences, and that’s where it belongs.

Color me simplistic, but, how about we forget about psychological “why” and treat the whole child’s whole brain: anxiety, executive functioning, speech and language. I must be crazy! It will never work. We need months of talk therapy to find out which psychological trauma specifically caused it. And, we need to get reimbursed for only 50% of the cost of that by our behavioral health (I LOVE that term!) insurance.

In my son’s case, a very low dose of methylphenidate is helping with the impulse control and executive functioning. He is no doubt happier, calmer and better equipped at school. But his anxiety issues are still present, and exacerbated situationally as well as cyclically. Since language processing and retrieval is difficult for him, this heightens anxiety at a charged moment when you’re trying to calm him down: he can’t tell you well what’s happening, so he explodes. The only thing you can do is restrain him from hurting himself, talk calmly, bring him down to the moment (What color is the ceiling? Where are we?) and wait for it to subside. After the mayhem, he manages to squeeze out amazing things like “I was angry and I apologize.” A kid that makes a statement like that is not a kid with issues of maturity, discipline or intelligence. He just has trouble retrieving what to say when the feelings take hold.

Thanks to an amazing teacher at his school (not his teacher, unfortunately), we are using Social Stories to help with the situational anxiety. But, overall, his difficulty with language heightens the anxiety and makes the mood swings worse. To me, that’s a sign that something’s going on in the brain (part of the body, no?) and therefore a medical issue. But, to the insurance company, his language struggles are a “developmental” issue. In order to be considered a medical issue, and therefore reimbursed, our son would have had to have been part of an early intervention program. So, here’s the deal with that.

Since he was born prematurely, we were entitled to an early intervention screening. In addition, in the NICU, he was tested for brain bleed, Apgar, the whole nine and nothing was wrong (or, as they like to say, “remarkable”). I took him for our one complimentary early intervention screening when he was 3 months old. He was right on target, no worries. Therefore, if we wanted treatment for anything that arose, they could provide it, but at a cost.

Here’s the flaw with that: many of the more subtle brain issues that affect learning and behavior don’t manifest until the child is in an environment that demands those skills. We saw at 3 years old that his language was suffering and that there were issues with his mood. His pediatrician said it was fine. His psychotherapist said that his speech was fine, but that he was traumatized by a failed adoption we experienced when Blake just turned 3, and that being adopted was traumatic. The treatment for the former was paid for by our health insurance. The treatment for the latter, over a period of a year and a half, was paid, only 50% worth, by our behavioral health insurance. In neither case was the money well spent.

So, Blake is in school this year, and his language struggles (determined to be normal) are enhancing his anxiety to the point where he runs out of the classroom and acts aggressively at moments when he feels pressured. The school psychologist says that its attachment disorder from being adopted (he’s been with us since he was 10 hours old). I think psychologists in general consider adoption to be a disorder, or a treasure-trove for unlimited sessions of painful and futile inquiry. At any rate, that was a useful diagnosis. I’ll get right on that.

We finally were referred to the person who can help him. This amazing pediatrician/psychiatrist/NEW YORKER (!) who pinpointed his language difficulties in 5 minutes. We felt so validated we could hardly speak. He got the evaluation, diagnosis, and treatment plan he needs. But, it won’t be paid for because THERE WAS NO RECORD OF AN EARLY INTERVENTION PROBLEM.

Now, I could have asked Blake at 3 months old to conjugate verbs and exhibit proper syntax for the purpose of the evaluation, but, I was negligent in that regard. Now, since there is NO apparent neurological problem afoot (according to the records), it’s a developmental issue, not a medical issue.

My friends who fight these issues for their autistic son every day say that this is the medical insurance’s way of kicking back to the school system. But, the school language person can’t get him to speak with her, so says she can’t evaluate. I find that kind of ironic: not speaking seems to be a speech and language issue, no? But, I’m being far too intelligent. I sent her a video from home, showing how he constructs sentences. She thanked me and said that “What I saw was pretty good.” Oops! I guess we’re not getting treatment there either.

So, here’s the deal: If our son had a stroke, or fell on his head, and exhibited the same speech and language struggles, he could get the same treatment. However, if he simply has a problem that our diagnostic tools are not yet sophisticated enough to pinpoint on an MRI, then, well, it’s “developmental”. The bottom line is that we can’t afford $135 twice per week for treatment. We are going to argue this one out until we are blue in the face (I’m a shade of purple at the moment). We will GET him what he needs. But what about all those other kids out there who don’t have a smart, obnoxious mother from NYC, a father in a neuroscience PhD program, whose school systems are even worse than ours, whose parents may have the same issues that have gone untreated (like Blake’s birthmother, whom we offered to get treatment for, but she declined). Will they wind up in involuntary commitment when they slug someone out of panic because they never got the tools they needed to go through life with their brain as it is?

Ask Governor Kaine.