Tutoring student with likely neuro problem isn't getting help. Course of action?

August 16, 2012 3:29 PM

I have been tutoring a teenage student for several months and have observed some unusual things, some of them quite worrying. His parents asked me to help him get his online classwork done (he's in a full-time online high school). He had done next to no work on his own, but it seemed he was capable enough, especially with his math assignments, although he needed a lot of prompting and hand-holding for written work. However, he seemed to have trouble walking (odd gait, sometimes crashes into walls) and couldn't type or write very well (holds a pen very awkwardly, very poor handwriting, types with one finger and literally can't strike two keys at the same time). More worryingly, he can't seem to concentrate and often just stares off into space with his eyelids drooping. This problem seems to be getting worse, and on a recent day he told me he needed to "keep [his] brain absolutely empty to get rid of [his] tiredness." I get the impression his vision may be deteriorating too; he seems to have trouble reading text on his computer screen now, which I had not noticed until recently.

Cognitively he doesn't seem normal, although he's good at math. He doesn't write or read at an appropriate level for a teenager. He occasionally makes strange, tic-like whining sounds.

I usually speak to his mother, since her English is better than his father's (complicating matters, they come from a different cultural background than mine). When I first began tutoring the student she told me he was "special," and when I drew her out more about this she told me that he'd had hydrocephalus as a young child. However, he'd been able to attend regular high school until this past school year, and she told me that he had "recently" developed "balance problems," but that the doctor said there was "no medication for this." I'm worried that something serious and new may be going wrong in his brain. I have repeatedly expressed concern to his mother, and a few times she told me that they would try to take him to a doctor again, but it's never gone farther than that.

The student himself continually denies there's a problem and apparently refuses to go to the doctor. In my experience he refuses to do virtually everything else, too: several times he's locked himself in his room when we were scheduled to meet, and getting him to work is often like pulling teeth. Sometimes he wears the same clothes several days in a row, he usually appears unkempt, and it seems he almost never goes outside. His mother tells me he sleeps most of the day. Apparently his parents think he's just lazy and shy.

Finally, a couple of weeks ago, I thought I had gotten through to the mom; after the student refused to come out of his room I had a sitdown talk with her about my observations. She seemed concerned and said she would talk to a doctor. I told her that until he'd seen someone I thought it would be better to discontinue tutoring (they care a lot about his school work, and I thought that as long as he was making progress with school they might not think the situation was urgent). I called back earlier this week to check in, and she said they had decided not to take him to a doctor after all because his father "doesn't think it's necessary."

What, if anything, can I do? Since he is not in a physical school I don't think there are any services to be had that way (the online school's website does list counselors, but they seem to be all about helping students choose which courses to take). I'm willing to try talking to the parents again if it would do any good, but I doubt I'm going to get anywhere with the mom if the dad is against it, and he doesn't want to talk to me. And none of this really feels reportable, just weird and worrying--am I wrong there?

I strongly suspect that I can't do anything more and will just have to let this one go, but I wanted to ask in case anyone has any insights, bright ideas, or relevant knowledge, or in case everyone thinks I'm crazy, which would also be valuable information.

posted by molybdenumblue to human relations (30 answers total)

Call child protective services. This is a no-brainer.
posted by murfed13 at 3:32 PM on August 16, 2012 [26 favorites]

they had decided not to take him to a doctor after all because his father "doesn't think it's necessary."

murfed13 has it: Call child protective services. This is a no-brainer.
posted by headnsouth at 3:53 PM on August 16, 2012 [1 favorite]

If this is in the United States of America, even if he is in an online school, he has a home school district that is responsible for his education and that will be required to provide services for him to be able to get his Free Appropriate Public Education. Talk to the home district's guidance department and/or their Assistant Superintendent for Special Education.
posted by JohnnyGunn at 3:54 PM on August 16, 2012 [4 favorites]

Please report this to child services. You've seen deterioration in a span of only a few months. Don't let stubborn parents decide the fate of this kid, something serious is going on.
posted by effigy at 3:54 PM on August 16, 2012 [1 favorite]

This is in fact reportable, because the parents are endangering the welfare of their child by not providing appropriate medical treatment. Please do call Child Protective Services. If this kid is spending most of his days sleeping and is so fatigued that it interferes with his lessons. It is not just "weird and worrying" and into the realm of "this child is seriously ill."
posted by Rosie M. Banks at 4:06 PM on August 16, 2012

Child services will take the child away. Given the cultural /immigrant barrier, there's a very high chance they will never get back custody of their child again - even with great legal help.

There are other sources of help before taking such a drastic step, one of which is to have another person see the situation in case the OP has a misinterpretation.
posted by Kruger5 at 4:15 PM on August 16, 2012 [1 favorite]

I knew someone would start telling scary stories about CPS. Kruger is wrong- they don't just "take the child away." Even if they remove the child from the home, which isn't a first step, there's a legal process to terminate parental rights where parents are entitled to a lawyer (free if they need it).

The second person to view the situation should be a trained social worker.
posted by murfed13 at 4:20 PM on August 16, 2012 [36 favorites]

I've noticed that some people are embarrassed when their child has special needs or cognitive or physical disabilities -- kinda, ashamed. Of course that's ridiculous, but is it possible that the parents know exactly what is causing these symptoms but do not want to discuss the medical details with you (as you are not part of his doctor's medical care team)?

Of course, CPS immediately if he's being neglected or abused. But if it's possible this is because the family doesn't want to share medical details, maybe consider a different approach, because they may lose him forever and he may be placed in foster care or a state-run facility and that would be a shame if there was no neglect or abuse but instead just different ideas about cognitive/physical disabilities and sharing of medical information between a patient and his parents with his tutor.
posted by Houstonian at 4:26 PM on August 16, 2012 [3 favorites]

Are they legal immigrants? They may be resisting medical services out of fear of deportation?
posted by matty at 4:28 PM on August 16, 2012 [3 favorites]

Some Florida-specific information about reporting child abuse. All school personnel are mandated reporters, as are child-care workers. OP is a tutor but I am not sure if someone who is an informal tutor qualifies but it's possible.

I know other people here have concerns but IMO people don't speak up enough on behalf of children, and that's how bad situations continue.

If the OP is not comfortable reporting this to CPS (who aren't boogeymen eager to sweep children out of their homes; in fact these days they try their best to keep kids and parents together), then call the school district and ask to speak to a social worker or counselor in the kid's district.
posted by Rosie M. Banks at 4:30 PM on August 16, 2012

Houstonian- if it's as simple as that, it will be obvious to CPS when they get his medical records.

The information OP currently has is that this minor child has visibly serious medical issues and dad won't let him see a doctor. With that information, OP's obligation is crystal clear.
posted by murfed13 at 4:31 PM on August 16, 2012 [5 favorites]

But if it's possible this is because the family doesn't want to share medical details, maybe consider a different approach, because they may lose him forever

This doesn't make any sense. CPS will not just snatch a child away without an investigation. If the child is receiving appropriate medical care by the family's arrangement, they can explain that to CPS and CPS can follow up with the doctor. It might be an intrusive and unwelcome process for the family, but there will be an investigation and CPS will have more standing to look into the matter than molybdenumblue does.

molybdenumblue, even if you decide not to call CPS, I think you should stand firm in your refusal to tutor the student any further until his medical problems are addressed. You don't necessarily have to know the medical details, but the family is asking you to do something you're not qualified to do by tutoring a student with increasingly severe special needs. Either his symptoms need to get better or, if they are unavoidable despite competent medical treatment, you need more guidance from his medical team on how to work with him given his limitations.
posted by Orinda at 4:41 PM on August 16, 2012 [3 favorites]

This is the kind of thing that could be the symptoms of a malignant brain tumour (they don't get to assume that it isn't a tumor because of his past issues). They could "lose the child forever" through death unless a responsible person takes action. Ignoring this is no better on their part than beating him about the head every single day.

If the CPS-monsters did come swooping in and tear the screaming child from the arms of his sobbing parents and disappear into the night with him, never to be seen or heard from again - maybe it would be because that's what he needed.

But I really doubt that it would come to that. More likely they'd just make sure he got the necessary healthcare.
posted by tel3path at 4:42 PM on August 16, 2012 [8 favorites]

Child services will take the child away.

Maybe Florida has way more CPS workers with tiny caseloads and foster families qualified to care for a special needs teenager than any other state in the country, but the kid being removed from the family based on what you've written here as a first step is really, really unlikely.

The thing to remember is that you aren't qualified to make an assessment. Caseworkers are. You can't force the parents to take the kid to the doctor; you can't force the kid to go to the doctor with you. And you can't force the parents to do what the doctor says. If you really want to help, begin (as you have, by asking this question) by assessing what you are and are not qualified to do, and what you literally and legally can and cannot do. Then figure out who can do those things, and call them.
posted by rtha at 4:45 PM on August 16, 2012 [3 favorites]

You don't mention exactly what their cultural background out, but before calling CPS, I would see if you can find an immigrant services group who might be able to send a social worker or counselor that understands how to get through to this family.


The International Rescue Committee might be a good place to start.

Another list of organizations in Florida.
posted by brookeb at 4:47 PM on August 16, 2012 [2 favorites]

I'm just thinking that the family already knew he was getting worse. They said as much, and that's their stated reason for homeschooling. They took him to a doctor, and he said there was nothing to do. The poster has known this boy for a few months, and she's obviously concerned but just because you want to know more about someone (their medical condition, the color of their underwear, whatever) doesn't mean that you are owed a detailed explanation. Even the poster feels that this isn't reportable, and the boy thinks he's not experiencing any new symptoms or problems. "Recently" experiencing balance problems could mean last year when he was still in a public school, or even several years ago.

molybdenumblue, I'm not trying to be hard on you. Your heart is absolutely in the right place, and the world needs more caring people like you. And if you feel he's being abused/neglected, by all means go to the authorities with it. CPS also tries very hard to make the right determinations and not break apart families unnecessarily, but it's not very hard to find instances where this went wrong for the families.
posted by Houstonian at 4:53 PM on August 16, 2012 [3 favorites]

Failing to provide your minor child medial care is neglect.
posted by murfed13 at 4:55 PM on August 16, 2012 [5 favorites]

Who among those advocating CPS as a first call can guarantee the outcome?

It is not unreasonable to have *one* other responsible person take a look at the situation before the step of Child Services being called.

The option to call CPS doesn't go away - They can just as easily call CPS immediately after.
posted by Kruger5 at 4:56 PM on August 16, 2012

A social worker from Child Protective Services *IS* the one other responsible, appropriate person to come take a look at this situation. This child is experiencing medical neglect. This child needs to be seen by a doctor, as soon as possible. A social worker can help the family access appropriate medical care for this child. A social worker can help hook this family up with other social welfare services. A social worker is not a boogeyman. They are there to help. Please call.
posted by fancyoats at 5:13 PM on August 16, 2012 [4 favorites]

If this kid has a brain tumor time is of the essence. Why waste time?

Talk to the school district if you won't call CPS. They are mandated reporters. Let them do it if you aren't comfortable.
posted by St. Alia of the Bunnies at 5:13 PM on August 16, 2012 [2 favorites]

Ok, I'm convinced. I'll call the school district tomorrow, and if that doesn't get me anywhere I'll call CPS. (They'll definitely know it was me that called, but that's not the end of the world.)

Thanks for the resources.
posted by molybdenumblue at 5:17 PM on August 16, 2012 [4 favorites]

Anecdotal, I know, but every experience that I've heard about with CPS in the last 10-odd years or so indicate that they are very, very reluctant (in some cases where the parents are particularly good at covering neglect/abuse, maybe a bit too reluctant) to remove children from their families unless it's absolutely necessary. Most likely, they will follow up with prior medical care, they will send someone who is familiar with the parents' culture/language to speak with the parents, and they'll arrange for follow-up medical care if there are financial or other barriers that the parents might not be willing to speak to the OP about. CPS is the best call to make in this situation. They're trained in how to deal with this.
posted by kagredon at 5:20 PM on August 16, 2012 [1 favorite]

Molybdenumblue, good for you. CPS workers don't get a bonus for taking children away, and they generally care about the children and want the best for them, even if their caseloads sometimes make that difficult.
posted by jeather at 5:21 PM on August 16, 2012 [3 favorites]

More anecdotal stuff, give it weight or not as you like: My sister is a foster parent who has looked after many children, including a large number of children with special needs. Children taken by the "boogeyman" CPS. In the vast majority of her kids' cases, the children were returned by CPS to their parents' care, after the parents completed counseling, drug rehab, parenting classes, whatever, or got the job or healthcare needed to support their kids.
posted by nicebookrack at 5:57 PM on August 16, 2012 [4 favorites]

It's probably also possible to call, describe the situation without including any identifying details, and ask whether or not the situation warrants an actual report.
posted by windykites at 7:21 PM on August 16, 2012 [1 favorite]

You need to tell someone if you can't intervene no matter what, please do it asap, this child needs help.
posted by irish01 at 8:16 PM on August 16, 2012 [1 favorite]

One way or another, my bet is that your best point of entry with the parents is his vision. Tell them he needs glasses and they should take him to an optometrist. They are unlikely to push back on that one compared to neuro issue evaluation and it's possible that an optometrist might spot something that's going on if the vision issues are more than simple nearsightedness.
posted by bq at 8:34 PM on August 16, 2012 [2 favorites]

I do think that the symptoms you describe could potentially be explainable by other issues. Maybe he's staying up all night playing computer games and that's why he can't stay awake during the day. Maybe he is developing some nearsightedness and having trouble reading from the computer because of it. Maybe a lot of this relates back to behavioral issues. The OP mentions he does not read and write well for his age, but also that his parents are not native English speakers and this could be part of the reason for his difficulties with language. However, balance problems can result from hydrocephalus (amongst many other things, but it's hard to explain it away using any benign explanation if it's new and not just klutziness) and I do think either a recheck or a second opinion or both are warranted (perhaps a neurologist, instead of his primary care doctor?).

I would also like to point out that the parents are not withholding medical treatment, it was specifically mentioned that they have taken him to a doctor recently. I find it a bit doubtful that there is neglect going on here. Just wanted to offer a differing opinion from the rest, I will agree with other answers that if there is doubt and a child may be harmed, having CPS look into it is the right thing to do.
posted by treehorn+bunny at 9:43 PM on August 16, 2012 [1 favorite]

My mother was a caseworker and investigator for cps in florida for years. While florida isn't a "progressive" state, they don't take children away unless there is immediate danger. I'm not saying the caseworker wouldn't thing sever medical issues pertaining to the kid's brain won't qualify- but I sure as shit wouldn't to take the risk.

I'm glad you've decided to call the school district. Go you.

Btw- The very few horror stories about CPS that you hear are reported on because they are horror stories. The vast majority of cases end with no action or with a happy ending. Caseworkers, judges, everyone knows the best place for a child is with their family, even when that family has problems. Removal is a last desprate attempt to stop a childs distruction.
posted by Blisterlips at 7:52 AM on August 17, 2012

Is he on any kind of medication? That could be affecting him this way, and the side effects can change as a kid gets older. Is there any chance he's taking illegal drugs, or smoking pot?

Is the school district paying you, or are the parents? If it's the parents then the local school district probably won't have any input. Is his online school publicly funded? The online school, whether it's publicly funded or not, should have some kind of supervisor to whom you can address your concerns.
posted by mareli at 9:36 AM on August 17, 2012