“It’s not a test, it’s just a guide.”
These were the first words of the lovely staff nurse who was about to go through my son’s 9 month health check. I had sat down mumbling something about not knowing what to put for some questions in the Ages and Stages Questionnaire (which I rant about here) . I was supposed to be able to say if Bubs did the random things listed such as poke for a Cheerio in a clear bottle (again, see previous rant). The options are ‘yes’, ‘sometimes’ and ‘not yet’. But the thing is my son hadn’t fancied playing with the blocks I wanted him too in order to make it all into a game “that is fun for you and your baby”. I surround him with stimulating and creative baby activities and he decides whether or not he’s up for them. He can sniff out a remote control/phone/ipad at 20 metres so something like that usually distracts him. That or climbing around the furniture.
Well, it didn’t matter any way, because it’s not a test. Not a test, not a test, not a test. Aaaaaand breathe…
As she went through the form, all of the ‘yeses’ I’d ticked were passed over quite quickly. One section she read over herself and said, almost to herself, “that’s perfect”, which is obviously good, except that I didn’t really know what she was referring to. However, any time she got to a question for which I’d ticked ‘no’ or even ‘sometimes’ she’d stop and say something like “so, we’ve not got 3 words yet?” and I’d confirm that we hadn’t. Obvs. She always responded to this with the phrase “that will come”, which was lovely and I am sure meant to be reassuring. But the thing is I didn’t think I needed reassuring, because there’s nothing wrong! Of course immediately the irrational anxiety fairy pops up on my right shoulder and starts to whisper “are you sure there’s nothing wrong? I mean you’re not exactly a baby expert are you?”. Shut up anxiety fairy! Shut the F up!
Then we came to the ‘problem-solving’ section of the guide-not-a-test. I hadn’t ticked ‘not yet’ at all, I don’t think, but I had ticked ‘sometimes’ a lot. Mostly because my son doesn’t often hold two toys simultaneously for a minute or poke at crumb inside a clear bottle. ‘Sometimes’ seemed the most accurate. He’s actually a pretty good problem solver. For example the other day my mum brought round some figs in a plastic box for him to try. She put them on the ground in the garden whilst I went inside to cut up a fig up nicely for little Bubs. Meanwhile, had got into the box and bitten and squeezed the fig until he got at the fruit himself. Pretty nifty I thought. But still, that was not such a ‘perfect’ area according the ‘guide’.
I am open to the possibility that there are some really good medical and psychological reasons to test ‘problem-solving’ at this age, but I am not sure I like it. They can say ‘it’s not a test’ til the cows come home but it feels like we’re already assessing children’s ability/intelligence against each other before their first birthday. I’m a bit like, can you not?? Okay, I know comparison is not the objective here, it’s more about catching any developmental problems as early as possible, but some of the stuff it’s looking at is quite advanced (in my humble opinion) so a mum does start to fret. I mean, does the fact that my son only ‘sometimes’ plays ‘pat-a-cake’ with by banging two toys together really point to any significant developmental issue? I don’t think so. O do I? I said SHUT UP, anxiety fairy!
Any way, I think all would have been fine in this “not a test” scenario, except that when we’d gone through the questionnaire the nurse went to get the scoring sheet, and totted up all of my baby’s totals for the different categories. Right…
Sorry if I’m being a bit dense but I thought ‘questionnaires’ that are scored and assessed were, well, you know, tests. The score sheet looked like a bit like this…
So she adds up it all up and then she says that, yeah, everything’s great and he’s doing really well. All of his scores are ‘in the white’, it’s just problem-solving that is in the ‘grey area’, so can she get in touch about that in a month or so? ‘Yes, that’s fine.’ I reply meekly, despite the fact that I actually think it’s over the top and will just worry me. I then tell her about some other ‘problem-solvingish’ tasks that he does regularly and she agrees that that’s great and says that the questions are specific so there are other examples you can use. But she’s still going to call me to check up. I don’t feel particularly listened to at this point. Breathe, Aileen, breathe.
Does anyone else get this weird thing when they’re with health professionals that they become meek and mild and eager to please? It happens to me all of the time. I mean, I am gobby to put it mildy. I can rant on with the best of them (oh, you’d noticed that?) but when there’s a nurse or a doctor there I lose my nerve. What if I’d said ‘I don’t really see the point of you chasing this up, I’m sure you’re really busy and we are very attentive to our son’s development so I’ll call you if I need to.’? It would have been perfectly polite and within my rights. But I am inexplicably drawn to agree with whatever the person who has the ticklist and the medical training says. Now, yes, this is partly because they have the medical training, fair dos. But these professionals will be the first to say that you’re the best ‘expert’ on your own child.
No, I think I’m afraid. Not quite sure of what. Of being told off I suppose. Of being seen as something less that a perfect, attentive, give-my-all sort of mum. I don’t think I’m the only one with this feeling. There are thousands of mothers out there who can talk the talk of relaxed parenting but, ultimately, can’t bear the thought of not being seen as Supermum. We really do need to chill out, guys, like, seriously. Or even, God forbid, have enough confidence in our own parenting to be open to a bit of criticism without it destroying our very being.
I don’t think the anxiety I experienced was the fault of any of the health professionals I encountered. I am quite capable of whipping myself up, not to mention what happens when that pesky anxiety fairy gets involved! But I do think it was partly the fault of that bloody questionnaire. It is sent out so long in advance you have plenty of time to ruminate over any ‘not yet’ you may have ticked, wondering what the answers to these questions, which are frankly bizarre at times, all mean. Someone may well be screaming at their computer screen right now, saying ‘Well pull yourself together woman, the checks are for your child, it’s not up to them to look after your precious little feelings’. Fair point, except that it sort of is. Especially as this particular centre were key in supporting me through PND. Healthy mother, healthy baby, right? In the dream scenario all parents would look at the questionnaire objectively and not fret on any level about their own child’s strengths and (more pertinently) weaknesses. But that ain’t gonna happen any time soon, so let’s work within the a-lot-of-parents-are-easily-worried parameters.
So, I have two suggestions:
1) Don’t send the questionnaire out in the post. I know it saves time, but you go through it all any way and Health Visitors et al have a MUCH better idea the real issues that the questions are actually getting at any way. (Dear Mr Stupidface Health Minister, this will involve actually funding preventative children’s services, grr).
2) Don’t show the parents the bloody score sheet! The nurse I saw (who was lovely and good at her job, just to say again) pointed at the grey area she had marked next the problem-solving section. This was not the mental image I needed. Then I got to thinking that, actually, what if all of his scores were in grey? Or a few were in black? There are a lot of 10 month olds that don’t do all the crazy malarky on those lists. I know people who didn’t crawl before they were one, or speak before they were two. Guess what? They are very clever and can stand up on their own and everything! So, yeah, we just don’t need to see that. Tot it up after we’ve gone on our merry ways. Because, let’s give credit where credit’s due, these people have trained for 3+ years, they will know if they need to follow anything up with having to look at a score sheet.
Actually, on second thoughts, I just have one suggestion:
1) Scrap the questionnaire! Bin it! It’s a stupidface!
The nurse we saw made a few jokes like ‘who wrote this questionnaire, hey?’ with the accompanying comedy eye roll. She also said this check used to be a more informal chat but that now it’s more ‘thorough’. I have worked in the public sector, ‘more thorough’ may well have been code for ‘a crapload of extra paper work’.
The thing is that when you put a list of questions between two human beings it automatically shuts down any natural conversation. You’re both focussed on the piece of paper and not so much as each other. It can leave parents feeling like they haven’t been listened to, though this is often not the fault of the Health Visitor.
Apparently the Ages and Stages Questionnaire is now being rolled out UK wide. I’d like to read the evidence that says it picks up things better than the previous system of letting trained health professionals talk to and spend time with families. I haven’t had any luck googling it so far (please comment if you know about these things). But I have a horrible suspicion that has more to do with the governmental obsession with standardisation and stats. Oh no, we can’t just trust professionals to do their jobs well and their managers and colleagues to flag up any problems, no no, what they need in more forms!
And then of course, there’s the fact that sending that getting parents (who are more likely to over- or under-estimate their children’s abilities for varying reasons) to fill in the form and having a more ‘ticklist’ approach in the meeting saves time. Which saves money. Which means you need less health professionals. Which means you can make more cuts. Bleurgh. Boo. Naughty naughty Tories. Etc.
So, parents of Britain. Don’t worry too much about the ‘not yets’. You and your Health Visitor will know pretty quickly if there is a glaring issue. And maybe think about raising the ‘what the F is this ASQ business about???’ issue with your MP. People power and all that.
But, most of all, just bloody chill! It is possible you have produced a child that will not be ‘top of the class’ in every arena at every stage. That is OK. They will still love you. And it takes a lot more than the lack of a pincer grip for social services to be called.
*I feel both heartily amused and slightly ashamed that I have captioned my 10-month-old son using a swear. Ah well…