The small private school in the little midwestern city that Alice had attended had a curriculum based on “developmental milestones” rather than standardized levels of achievement. It was considered to be innovative and less pressured than the public schools, and since Alice had been “high-strung” from the beginning, the Martins thought it was the better option for Alice. And it may have been, but it had left her poorly prepared to enter any other type of school.
Even in her special school Alice had difficulties, and while she was still in kindergarten the school psychologist had tested her.
Her highest scores were in reasoning and abstract thinking. Her lowest scores were in arithmetic and visual moto tasks. Her full-scale IQ score on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) was 113; the Verbal IQ was 126, the Performance IQ 103 – a 23-point spread. The Bender Gestalt was reported to be “difficult” for Alice, and her drawings showed “signs of stress.” Her teachers reported that Alice’s feelings were “easily hurt” and that she was often on “the verge of tears – and needed more than the usual amount of encouragement to perform.” On the basis of the teachers’ reports and the tests, the school psychologist concluded that Alice’s difficulties were due to “emotional rather than physical problems” and advised “a more relaxed attitude and less pressure from the parents.”
The psychologist never did explain the 23-point difference between Alice’s Verbal and Performance scores.
Alice continued to have trouble during first grade, and her teacher noted that she had “awkward left-handed writing, trouble cutting with scissors, and that she reversed letters.” However, the teacher said she was not concerned, because she felt these difficulties were simply because Alice was not yet “ready.” Since the philosophy of the school was based on “readiness determined by developmental milestones,” this was also the advice of the school director, who pointed out that Alice’s molars were slow in coming in and that her other problems were undoubtedly related to this fact. Consequently, her parents waited patiently through another year. But when there was no improvement, Alice was taken for a neurological examination.
The pediatric neurologist’s report stated that while Alice was slightly older than most first graders – seven years, four months during the spring of first grade – she looked more like a kindergarten child, with “awkward posturing of the hands and fingers accompanying all of her gait performances and twitches of the hands and fingers when she is trying to hold still in the eyes-closed, posture-holding position.” The neurologist also noted a “marked mixed dominance with a 50–50 percent left and right in terms of destination of tasks performed with one hand or the other, although the traditional writing task is done with the left hand. There is mixed eye and foot dominance.”
The neurological summary concluded that Alice showed signs of a “patchy minimal brain dysfunction marked by unevenness in development” and that while she was “not hyperactive she exhibited elements of the dyscontrol syndrome in terms of lack of organization, lack of self control and low frustration.” The neurologist’s report further stated that the “emotional problems are secondary reactions to the MBD syndrome” and recommended “intensive remedial help over the summer.”
The Martins were understandably confused. The neurologist’s findings seemed to be the opposite of the psychologist’s. They were relieved that Alice’s problems had a physical cause and were not due only to pressures they had applied. Their difficulty lay in the fact that they were not quite sure what kind of “intensive remedial help” was required, and instead of contacting the neurologist for clarification, they followed a neighbor’s suggestion and enrolled Alice in a perceptual training program run by an optometrist assisted by graduate students from a nearby university. The optometrist assured the Martins that Alice’s basic problem was “divergence excess,” and this could be “cured by practice in eye-hand coordination, eye movements, visual memory, and balance.”
Alice disliked these weekly sessions and the assorted roster of graduate students, and resisted additional practice at home. She developed gastrointestinal trouble, which increased on the days when the perceptual training was scheduled. Finally, after more than a year, still with no visible improvement, the training sessions were dropped and Alice (and the Martins) struggled along alone through third and fourth grade. Although Alice was absent often and for increasingly longer periods, her academic grades – based, of course, on “developmental milestones” – remained surprisingly high, except for arithmetic.
Now in fifth grade at Bryant Elementary School in Brentwood, New Jersey, not only did Alice have gastrointestinal problems, but her new school psychologist felt there was a “phobic resistance to attending school” and referred her to a Dr. Volpe, psychiatrist. Dr. Volpe confirmed the “school phobia,” noting that Alice’s symptoms were “always worse on Monday mornings or following a school vacation and were accompanied by hysterical crying and protestations of dire consequences if she were forced to attend school.” Alice also had increasing difficulty in concentrating, paying attention, and not forgetting what she had known the day before.
Interestingly, the parents revealed to Dr. Volpe a fact that they had not shared before. Alice had been adopted at five weeks of age through a Catholic charity. A year after Alice’s adoption, Billy, a natural child, was born as “quite a surprise” to both parents.
Alice’s overall intelligence scores done by the school psychologist had dropped slightly between kindergarten and fifth grade, but the same patterns were evident – full-scale intelligence in the bright average range with highs in abstract thinking and vocabulary, and lows in spatial and perceptual tasks as well as those calling for rote memory. Dr. Volpe commented on Alice’s “rigidity, caution, and self absorption,” as well as the fact that she appeared “younger than her chronological age.” The Rorschach, a projective inkblot test used by psychiatrists, showed “good attention to detail, considerable compulsiveness, constriction, and guardedness.” His recommendations were for “family therapy sessions for all members of the family,” for mild stimulant medication (Ritalin or Cylert), for Alice to be monitored by her pediatrician to help her maintain focus, and for “specific expert remedial help in the main area of schoolwork where she is weak, namely math.” Dr. Volpe gave the Martins my name.
I was far from an expert; I had had my own mathematical struggles, but I was enchanted by Alice. She reminded me of a watercolour illustration in an old black leather, gold-rimmed book of my grandmother’s. Her brown hair was almost waist length, held back with a tortoiseshell headband. She was slim, small-boned, and fine-featured. On her first visit to my office she was dressed in a white blouse and an ankle-length blue pinafore that again seemed from another age. There was an overall misty quality about her, almost a physical aura, as if indeed she might have stepped out of another time and place. It was hard to imagine the hysterical storms described in Alice’s file.
But appealing as Alice might be to me, I knew she’d be a joke at Bryant Elementary School. Jeans were not allowed during the school hours, but any and every other style of pants were – and this particular year, the tighter they were, the better. This was not only the world of achievement; high fashion began in second grade. Hair was styled, not cut, at sixty dollars a throw. Designer labels bloomed like daisies, nails were long and polished, and hair was streaked. By fifth grade, childhood was a thing of the past.
Alice was a walking anachronism, a terrified one at that. I wasn’t sure of how best to go about helping her, but I was sure I was not going to begin by doing an evaluation. Valuable as diagnostic sessions are, it was clear that Alice had been tested enough. The neurologist’s report made sense to me. And while we no longer used the term MBD – minimal brain dysfunction – I believed Alice did have some type of neurological dysfunction resulting in what would now be called dyscalculia, or an inability to calculate by ordinary classroom methods, as well as an accompanying dyscontrol. In my practice, language-based problems were far more com
mon than perceptual ones, and, for whatever reason, more girls have difficulties in spatial and numerical tasks. It seemed to me that the major mistake the Martins had made was entering Alice in a perceptual training program, rather than providing her with specific help from a trained learning disabilities specialist.
On Alice’s second visit, she wore a dark red pinafore that was an exact copy of the blue one she had worn the time before. I asked the usual questions – address, phone number, parents’ and siblings’ names, pets.
“Yes,” Alice said. “I do have one pet.”
“Good. What kind?”
“He is a rabbit, a brown and white, intelligent rabbit. His name is Sigmund.”
“Sigmund,” I repeated. “That’s an unusual name.”
“Not really. I thought it would be amusing to have a resident rabbit psychiatrist in the house.”
I’d listened to hundreds of eleven-year-old kids, but Alice sounded more like she was entering graduate school than fifth grade. And yet she was “school phobic” and failing math – and a social innocent.
“Is he as insightful as his distinguished predecessor?” I certainly wasn’t going to talk down to Alice.
She looked up quickly, surprised, and said quietly, “Sigmund doesn’t often share his insights with me, Mrs. MacCracken.”
“Discreet,” I said.
Alice nodded, and then she smiled at me. “And besides, he’s only a rabbit.”
And blip – we’d made our connection. There was no need to be careful any longer.
“Dr. Volpe told me you were having some trouble with math, Alice. That’s why he suggested that you come here. But I don’t know what kind of trouble it is, and I really don’t want to give you any tests right now. Could you explain it to me more clearly?”
Alice shrugged and studied her hands again. “I don’t know,” she said, “everything just comes out wrong. Besides, I don’t care if it does. I hate school, anyway.”
My sophisticated conversationalist of the moment before had reverted to total childishness. Now it was easy to see why the psychologists and neurologist had seen Alice as a much younger child.
“Yes. I heard that you did,” I said. “Do you hate all of it? Or are there some parts you like?”
“The whole thing. Well … maybe not every single thing.” Alice peeked up at me. “The library really is very nice. It’s much larger than the one in my old school, and they let you take out three books at one time.”
“You know my idea of heaven?” I said. “An enormous bed with lots of squishy pillows, a mug of hot coffee, and every conceivable kind of book stacked all over the floor and table and bed right within my reach.”
“And Sigmund could sleep on one of the pillows,” Alice said as I laid out paper, pencil, rods, and blocks and began to explain basic arithmetic concepts.
But now things seemed to have gone from bad to worse, and Alice was dissolved in tears, engaged in battle with both her mother and her teacher. Certainly a solution had to be found for the pill-taking; I agreed with Alice that she shouldn’t have to struggle with medication in public. She was enough of an oddity as a new student dressed in out-of-date clothing.
I lifted Alice’s feet out of my lap and got up and walked around the office in pure frustration. Dr. Volpe had made it very clear to me that he was referring Alice to me for “tutoring in arithmetic, not therapy” and that he would take care of whatever counseling was needed.
“I don’t mean to be rude,” Dr. Volpe had said when we had first spoken, his slight accent rolling across the r, “but I must remind you that learning disability specialists are just that – specialists in learning, not in therapy. Sometimes there is a tendency to forget.”
I had not forgotten. How could I? But what did it matter how well Alice understood math if she was totally miserable both in and out of school?
I sat back down again. “Alice, it doesn’t make any sense for you to be so unhappy and constantly fighting with both your mom and your teacher. What does Dr. Volpe say about all this?”
Alice shrugged. “I haven’t really seen him for a while. Mom goes there during the day when Billy and I are in school.”
Wonderful. Family therapy seemed to have shrunk. Shrunk by a shrink. I debated sharing this with Alice – she could have passed it on to Sigmund. I stopped just in time, reminding myself of my own belief in the importance of working as a team.
Instead I called Dr. Volpe after Alice had left, and he confirmed what she had said. Family therapy had evolved into individual therapy for Mrs. Martin.
“The father is virtually unavailable to either therapy or his family,” Dr. Volpe said. “He is away both physically and emotionally most of the time. Alice is getting a great deal of support from you. Billy is doing well by himself. Mrs. Martin is the one who feels deserted and bereft. Alone in a new town with limited support from her husband, constantly facing criticism about the way she rears her children, particularly Alice. She lets Billy dress pretty much as he wants. And, of course, he’s not on any medication and doesn’t have Alice’s learning problems.
“But Mrs. Martin is much more emotionally involved with Alice, which, as you know, is not rare between the mother and the so-called wounded child. In fact, there’s a touch of symbiosis on her part, and the fact that Alice is adopted and that Mrs. Martin was the one who pushed for the adoption seems to heighten her guilt and her involvement. She is also a very tense, anxious person herself, and of course her anxiety feeds Alice’s and vice versa. In any event, I continue to see Mrs. Martin because she’s the one who’s available, and I believe I can help the whole family best by helping her learn to handle her own needs.”
“But what about Alice?” I couldn’t help asking. “Somebody’s got to do something about Alice. It’s my turn to apologize to you if I sound rude, Dr. Volpe, but the school psychologist did refer Alice to you for help.”
There was a moment’s silence on the other end of the line. Then Dr. Volpe replied in a voice even more distant than usual, “Indeed. Indeed. An excellent point. I think you should be more in touch with the school. Certainly that’s where learning takes place. Or is supposed to. And as I pointed out earlier, you are the learning specialist, Mrs. MacCracken. I, of course, will be reviewing Alice’s emotional state periodically and am in constant communication with her through her mother. Thank you for calling.”
I replaced the phone somewhat more loudly than necessary.
I had worked with dozens of clinical psychologists and psychiatrists and was constantly impressed by their knowledge and sensitivity, but I certainly wasn’t impressed with Dr. Volpe at the moment. “In constant communication through her mother.” Some wonderful communication that was.
By the next morning my blood was a little cooler and my mind a little clearer. The next step was obviously a conference with Mrs. Martin and then with Alice’s teacher and the school psychologist.
Mrs. Martin sat in the same place on the couch as Alice had, but her feet were close together on the floor, her slightly heavy body upright and her brown hair pinned into a tight bun across the back of her head. But leaning forward, her face flushed, she was almost pretty in her eagerness. “Dr. Volpe is helping us – well, me – see how to meet Alice’s needs. But she is so difficult; she resists everything I try to do for her, even to taking important medication.”
I nodded. “I heard about the sandwich.”
“Alice means so much to me,” Mrs. Martin went on. “She’s our oldest, you know, and a girl, and, well, it isn’t generally known but Alice is adopted. Mr. Martin was against it, but I wanted a baby so much and I couldn’t seem to get pregnant, so he finally agreed. In fact, he fell in love with her, too. He couldn’t help it – she was such a beautiful baby. But then before Alice was a year old I discovered I was pregnant with Billy, and with Alice awake and crying two or three times a night, neither of us got much sleep. But I can’t complain. Both our families lived nearby. You see, both Mr. Martin and I went to the same grammar
school out in Kenoba, Kansas, and our families had been friends for ages, so I had lots of company and hands to help with all that needed doing.”
Words continued to pour out of Mrs. Martin. “Besides, Billy was easy. It was only Alice that needed extra care. And I suppose I felt responsible for her because, as I said before, I’d been the one to insist on adopting her. And then, you probably can’t see it now, but I always thought we looked a lot alike.”
Mrs. Martin leaned further forward, inviting me to inspect her face.
“Yes,” I said. “There is a resemblance – the same high cheekbones, the same colour hair. Although your eyes are blue and Alice’s are brown.”
“Yes,” Mrs. Martin said, “and I suppose the likeness is harder to see now because I’ve put on weight since I’ve been here.
“Now that the house is decorated and the children in school all day, there’s not that much that needs doing. And, I have to admit, I miss home. Although this is supposed to be home. Still, it doesn’t feel that way. We were all so close, both families … and it’s different here in the East. I mean back home there were neighborhoods. Nobody would think of letting someone move in without taking them some homemade bread or something or other.”
I looked at Mrs. Martin’s polished navy blue shoes and thought of Alice. I certainly couldn’t hold Mrs. Martin’s feet in my lap; in fact, it was hard even to imagine her barefoot. But how was I ever going to get through to her? She had been in my office for twenty minutes, and we had yet to get to Alice. Somehow her loneliness had a kind of desperate quality, and I understood Dr. Volpe’s view a little better. It must be very hard for Mrs. Martin in a strange town, away from her family and friends. It certainly wouldn’t help for me to rush into criticisms of her handling of Alice’s clothes and medication.
“How does Mr. Martin like his new job?” I asked, trying to move the conversation along.
Mrs. Martin’s face closed, and she leaned back away from me. “He likes it fine,” she said. “Too much, if anything, if you ask me.
A Safe Place for Joey Page 16
