Although CMT is a lifelong issue, it impacts us in different ways throughout our life span.
Erik Erikson was the first popular psychologist to talk about life in terms of "tasks to be accomplished" in order to successfully pass on to the next stage. Though we all pass through the same stages of life, the variables of our bio-psycho-social being make the journey unique for each of us.
The Impact of CMT on Each Stage of Life
Infancy: CMT is usually not obvious during infancy, although if it is known to run in the family a close observer might notice early signs. The true impact of CMT at this stage is from parental feelings of "passing on" a trait which is less than desirable. If parents have not come to terms with their own CMT and feel guilty or depressed, interaction with their infant may be affected. First born children, especially if they are "only" or late-life children, tend to be scrutinized by their parents - with all deficits and accomplishments magnified and ruminated on. Erikson's life task at this stage is for the infant to develop trust in his parents and in the world around him - something that happens when unconditional love is given and received. What can a parent do during this stage? Ignore the possibility of CMT, enjoy your baby and have your third child first!
Toddler Stage: During this stage our children accomplish their motor milestones: they learn to walk, control their bowels and bladder and handle simple utensils and toys. Some children begin to show signs of CMT at this stage - being slower to walk and/or walking clumsily.

Erikson's life task at this stage is to overcome shame and doubt and to develop a sense of autonomy or "control" over one's body. It is the parent who gives the child a sense of autonomy by praising efforts and successes - this is the beginning of self-esteem. If the parent feels shame about motor clumsiness or doubts about the child's abilities, this feeling is picked up by the child.

What can a parent do? If your toddler's CMT is severe (this would be unusual but not unheard of) therapy from a physiotherapist and/or occupational therapist with a specialization in pediatrics might prove helpful for improving strength and/or normal motor patterns. For most parents, it will be enough to enjoy your child. Keep in mind that having a toddler who is the youngest on the block to get teeth, stay dry, walk, talk or use a spoon does not put you in line for the Blue Ribbon of Parenting award. Each child develops at his own pace, in his own way. And each child needs parents who can accept and encourage him.
Childhood: During early and late childhood our kids are busy learning about themselves and the world around them - from us, from school and from their peers. Their ability to think and reason changes as they grow. During Early Childhood (approximately ages 3-6) their thought processes are concrete: they think in terms of the present and what they can actually see. As they mature their mental capacity allows them to think more abstractly. By Late Childhood (ages 7-12) they can imagine the future, think of different possibilities and appreciate logical consequences.

Children might begin to be aware of their CMT during this phase of their growth. This is the stage when Erikson's life tasks are learning "initiative" and "industry." If our children become afraid to take chances because of repeated physical failures and/or peer teasing, they may have feelings of what Erikson called "guilt" or "inferiority." If their sense of discovery, adventure and willingness to try something new is thwarted by feelings of failure, they may enter adolescence with an inferiority complex and feel guilty for "not trying harder."

As parents we must love our children unconditionally for who they are. This will suffice for the Infancy and Toddler stages of development. During the Childhood stages we must help our children discover their best selves. I believe we can do this by: 1) keeping the communication lines open and truthful; 2 ) helping our children find their niche; encouraging them to do well in all their life tasks and providing extra praise for what they do best; and 3) maintaining "perspective" and a sense of humor. As they leave the Childhood stages, our children should feel competent about their ability to cope with life and should feel they are keeping up with their peers within their capacity.

Puberty: A tricky time of life at best, adolescence is the stage most "adult survivors" (with or without CMT) report being their most difficult. Our children are their most vulnerable and self-conscious at this stage - scrutinizing every thought and action, wanting to appear like everyone else (to "fit in") but wanting at the same time to be admired for being their own unique selves.

Erikson's task during this phase is to form an identity. Our children need to maintain a positive self-image. They need to feel confident in their ability to interact and make their way in the world. Rebellion is a way of testing limits and many adolescents discover their limits by engaging in unsafe, unrealistic or unacceptable behavior. Even if our children acknowledged their CMT in the past, they may seem to deny it during this stage by their choice of physical activity or career. Adolescents tend to feel invincible, immortal and omnipotent - they may be risk takers who feel nothing can stand in their way. This powerful feeling does not compute with having a potentially limiting neurological condition.

As parents, we may recall our own adolescence as the time no pair of shoes fit right, when we were shamed in gym class or in the showers afterwards, when we felt clumsy, puny and vulnerable (and put on a show of bravado or risk taking behavior to avoid our true feelings or make up for our perceived deficiencies). We may hope to give our own children a calmer and less painful adolescence. The communication lines, sense of humor and perspective established during childhood are very important during adolescence. So is an open mind. But the truth of the matter is that forging an identity cannot always be done under the umbrella of parental guidance.

Young Adulthood: At some point after high school, in their early to mid 20s, our adolescents turn into "young adults." We think of young adults as being self-sufficient. Although environmental factors and family values will influence lifestyle, most young adults live away from home and are gainfully employed. Many have started their own families.

Career and mating choices are issues that emerge during this phase. Erikson's life task is "intimacy vs isolation." To become a functional partner in an intimate relationship requires having a positive sense of self, i.e. knowing who you are and liking yourself. From the number of failed marriages we witness, it can be said that this stage is difficult for all young adults, not just for those with CMT.

Choosing a career can be just as tricky as choosing a mate, especially when weighing and balancing the anticipated effects of a progressive neuropathy. Prior to the stage of "Early Adulthood" we focused on the psycho-social aspects of CMT. At some point during the adult years the biological aspects of CMT come to the forefront - foot drop, decreasing stamina, hand weakness, poorer balance. Any combination of these symptoms may necessitate giving up a "dream career." If they become problematic later in adulthood they may necessitate changing careers. It is difficult to plan ahead if you do not know how your neuropathy will progress. Can you plan for the worst and hope for the best?

As parents, what can we do? "Young Adults" are our children only in the biological sense. While they may use us as sounding boards, they are following their own paths and doing their own thing. We can listen to their plans, validate their feelings and support them as much as we are able. We can live our own lives fully and with meaning and hope our example can be appreciated by our children.

(Editor's Note: Susan Salzberg is the mother of two children, a son with CMT and a daughter without CMT. Susan feels she is somewhere between mid-adulthood and old age and is struggling with the issues of those periods. She works as an occupational therapist in North Carolina.)