Malcolm Gladwell is one of my favorite writers. Each of his books has taught me to see the world in a slightly different way. Four years after my first reading of the Outliers, I am happy to add it to my list of Great Reads. Parents and healthcare workers should read this book. This quote is from

“My wish with Outliers is that it makes us understand how much of a group project success is. When outliers become outliers it is not just because of their own efforts. It’s because of the contributions of lots of different people and lots of different circumstances— and that means that we, as a society, have more control about who succeeds—and how many of us succeed—than we think. That’s an amazingly hopeful and uplifting idea.”

The power of focusing on the surround of the truly successful is a powerful concept. Gladwell tells stories about a wide variety of external circumstances that influence the individual outcome. It is important to remember as you read, that the opposite is also true. If the community of a child with an early neurological injury accepts limits to achievement, there will be fewer successful children.

In my view, our focus in the field of pediatric rehabilitation is misdirected. We look to the average performance, not the exceptional. An excellent example of this bias is found in the directions for administration of the Gross Motor Function Classification System (GMFCS) for Cerebral Palsy. This is a direct quote. “The focus is on determining which level best represents the child’s usual performance in home, school, and community settings. It is therefore important to classify on ordinary performance (not best capacity).” The authors go on to say, “… not to include judgement about prognosis. Remember the purpose is to classify a child’s present gross motor function, not to judge quality of movement or potential for improvement.” Here is the problem. Health care professionals love a number and our focus is primarily on what the child is unable to do. Whether it was intended or not, a low score is interpreted as a limit to potential. From a current treatment resource book for parents and professionals by Sieglinde Martin, M.S., P.T., “I believe, however, that the information (in the GMFCS level) is very valuable for parents of older children with cerebral palsy. It confirms when their child has reached her full potential.” An adult with choreoathetosis has a wicked tennis volley (read Never Too Late) but would score between Level ll and lll on the classification system. A child who can run better than he can walk (read Cerebral Palsy) has the potential to be normal or better, not Level I or ll on a scale that does not measure true brain function. Much of what is judged on scales such as this one are measures of habit, not true measures of the child’s degree of brain recovery. Our focus should be on the child’s occasional best performance and we all need to study our “Outliers”. We have virtually no information about why one child with an early brain lesion becomes a normal, productive member of society and another child, with an identical lesion, stays at Level lll for life. Malcolm Gladwell’s fascinating book gives us a path to follow and hope for new insights to help more children reach their Personal Best.

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