Category Archives: behavior issues

Teach Kids With EDS and Low Tone: Don’t Hold It In!

People who have read my blog are aware that I wrote a book on toilet training, The Practical Guide to Toilet Training Your Child With low Muscle Tone. This comment didn’t make it into the book , but perhaps it should have. Children that have issues with muscle tone or connective tissue integrity, or both, risk current and future issues with incontinence if they overstretch these structures too far. We teach little girls to wipe front-to-back to prevent UTIs. We need to teach all children with these issues to avoid “holding it in” in the same manner that we discourage them from w-sitting.

I am specifically speaking about kids with Ehlers Danlos Syndrome, Down Syndrome and all the other conditions that create pelvic weakness and control issues. But even if your child has idiopathic low tone, meaning that there is no identified cause, this can still be a current or future problem.

The effects of low tone and poor tissue integrity on toilet training are legion. Many of them are sensory-based, a situation that gets very little acknowledgment from pediatricians. These children simply don’t feel the pressure of their full bladder or even a full rectum with the same intensity or discomfort that other children experience. They are “camels” sometimes, with no urge to pee, and have to be reminded to void. It can be convenient for the busy child to keep playing rather than go to the bathroom, or it can save embarrassment for the shy child who prefers to wait until she returns home to “go”.

This is not a good idea. The bladder is a muscle that can be overstretched in the same manner as the hip muscles that are the concern of children who “W-sit”. Don’t overstretch muscles and then expect them to work well. The ligaments that support the bladder are subject to the same sensory-based issues that affect other ligaments in the body: once stretched, they don’t bounce back. A weak pelvic floor is nothing to ignore, and age doesn’t help anyone. Ask older women who have had a few pregnancies how that is going for them. The stretch receptors in the abdomen that should be telling a child with low tone that it is time to tinkle just don’t get enough stretch stimulation to do so when they have been extended too far. The time to prevent problems is when a child is developing toileting habits, not when problems have developed.

So….an essential part of toileting education for children is when to head to the bathroom. If your child has low muscle tone or a connective tissue disorder that creates less sensory-based information for them, the easiest solution is a routine or a schedule. They use the bathroom whether they feel they need to or not. The older ones can notice how much they are voiding, and that tells them that they really did need to “go”. Understanding that the kidneys will fill up a bladder after a large drink in about 35-45 minutes is helpful. But it can be a trip after a meal, before leaving the house, or when returning home. As long as it is routine and relatively frequent, it may not matter how a toileting schedule is created. Just make sure that as they grow up, they are told why this is important. A continent child may not believe that this could prevent accidents, but a child who has a history of accidents may be your best student.

The good news in all of this? Perceiving sensory feedback can be improved. There are higher-tech solutions like biofeedback, but children can also become more aware without tech. There are physical therapists that work on pelvic and core control, but some children will do well with junior Kegel practice and some education and building awareness of the internal sensations of fullness and urgency.

Good luck, and please share your best strategies here for other parents!!

If you are interested in purchasing my book, please visit my website, tranquil babies.com, and click on “e-book” at the top ribbon. It is filled with readiness checklists and detailed strategies for every stage of training!

Sensitivity and Gifted Children: The Mind That Floods With Feeling

Gifted children are often the most emotional and empathic toddlers in the room.  They are the kids who cry when the ASPCA runs those tearjerker commercials.   They are the teens who want to develop an NGO to provide clean water in developing countries.  Gifted children don’t do this to get a boost on a college application, but because it physically hurts them to think of another’s suffering.  Your gifted child’s mind cannot help but to feel strongly and care deeply.  

How can you help your child navigate these feelings without crushing their altruism and energy? The first step in helping these children to handle their sensitive social and emotional nature starts with adults understanding that this isn’t a personality quirk; it’s a neurological bias that accompanies an impressively active and intense brain that doesn’t “turn off”.

Sensory Sensitivity, Autism, and Gifted Sensitivity
When OTs usually refer to sensitivity, we usually speak about the physical sensitivity that our clients may experience.  We know that sensory sensitivity can lead to avoidance of sensory input and poor modulation of arousal.  The poor modulator is the child who has a hard time staying in an optimal state of calm, struggling to focus attention on accomplishing their daily activities.  This can be true with gifted children, but is not always a feature of giftedness.

We also know that children with ASD find it difficult to connect with another’s emotional experience due to their neurological wiring.  It is not that they choose to misinterpret other’s emotions.  They may long to know what others are thinking and what to do and say in interpersonal relationships.  Temple Grandin and John Elder Robison have written about their difficulties and discomfort in understanding how friends and family feel.

The gifted client is swimming at the other end of this pool:  they have profound emotional connections to people (and sometimes feelings for objects as well!),  even strong connections with the imagined emotional experiences of strangers!  Again, this is not just their temperament or their personality; the emotional flood is coming from their brain wiring that generates deep connections between profound concepts and expansive comprehension of situations. Gifted kids see very clearly how the human race is all one, how affecting a part results in affecting the whole, etc. It can be overwhelming for them to know this at 4. Or 14. Gifted children are not little adults, even when testing indicates amazingly advanced mental abilities. Their asynchronous development means that they may understand concepts but still cry when they lose a game. They are still children.

There is some science behind the idea that gifted children are emotionally advanced as well as academically advanced.  Researchers on giftedness are eager to display their fMRI views of the gifted brain as it thinks, showing it humming along at warp speed, lighting up like a Christmas tree in areas that are mostly quiet for other people.  I would guess that those mirror neurons (proposed to support empathy and interpersonal skills) that seem inactive in ASD are probably switched on 24/7 in gifted individuals.  

Parents get their first taste of this quality when they see how attuned their baby is to their speech and their movements.  “She would just watch our faces all day long!” is a familiar report when asked about early development.  Toddlers begin to be aware of their own emotions and the emotions of others, and the gifted toddler can be quite a handful as she sorts this out. The gifted child may want to volunteer, may become upset when reading news stories, and may insist that the family participate in activities for social causes. On the other hand, a gifted child may become sad and overwhelmed by situations that other children are unable to comprehend. It can lead to feelings of powerlessness and anger when the adults in their world don’t respond in kind or disregard their concerns.

My message to parents and teachers of gifted children, and those who work with children showing strong emotions and advanced skills without a gifted label is to consider that the strong reactions that you see may be a brain effect, not a personality defect. Your next step: supporting a child to handle the flood of emotion, and help them channel their feelings into productive actions and interactions that build social skills, not isolation and a negative self-image.
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Are YOU A Sensory Sensitive Parent?

If you fill out the Infant/Toddler Sensory Profile for your child and see yourself on the page too, don’t be too surprised. Actually, you might feel relieved, and even a bit excited. Because now you know that you aren’t “crazy” or “weird” or even “difficult”. If you have some sensory processing issues of your own, you can address them and improve your situation while you help your child learn to build their sensory processing skills as well.

About one in four of the families I work with will admit that at least one parent has or had difficulties with sensory processing at one time. They rarely offer this information at the evaluation. Only with the reframing that occurs as I explain the experience of therapy for sensory processing disorder for their child do I hear about how a parent only eats certain textures of food or cannot tolerate wearing clothes with long sleeves.

Now, that revelation is just the entry into a conversation about themselves, because one issue with sensory experiences doesn’t indicate a sensory processing problem. Eventually I will hear about all the small and sundry things that this parent (or their partner) avoids or alters in order to manage life as a functioning adult. Then it becomes clear to both of us: the story they told themselves about their preferences or personality quirks are likely to be based in sensory processing, not psychology.

Older children and adults are told (or tell themselves) that they are difficult, rigid, controlling, and too sensitive. This sounds very demeaning, but in fact it is often not intended to be hurtful. Behavior is often seen as only occurring for cognitive or emotional reasons. You have a feeling, and the reason is how you are thinking or feeling. Not always.

The truth is that sensory processing creates the impetus for many behaviors. Not seeing the effect of the body on behavior is a huge impediment to addressing issues effectively. Yes, people who are overwhelmed with sensory input can and do try to control their environment and the people in it. It looks like they are rigid and difficult. But it is not the same as being manipulative and aggressive. Avoiding touch or movement can appear to be relational, when in fact it is a sensory-based issue. The relational problems begin when the person or other people interpret the behavior as indicating something else, such as shyness or social aversion. How you define yourself and how others define you is like choosing which road to travel. It means that you may not see all the reasons for behavior and all the possibilities for change.

Adults rarely receive effective treatment for long-standing sensory processing issues. Sometimes they have come up with their own solutions, such as doing yoga to receive deep pressure input. They may tell their friends that they can’t digest certain foods, when in fact just seeing some foods makes them nauseous. I am more than happy to work with parents and help them creatively explore solutions for themselves when it is indicated. I have even treated adults formally as an OT from time to time. When parents see themselves more clearly as they support their child, both parties can address sensory processing issues more effectively.

Parents of Kids With Sensory Sensitivity Can Feel Like The (Food) War is Still Going On

What do parents of children who have had successful treatment for oral sensory sensitivity have in common with Vietnam veterans? Parts of them do not know that the war is over.

Raising a child that can become unglued over the texture or taste of a new food is like walking through a minefield. As a pediatric OT, I have seen many children make amazing progress. The toddler who once grimaced while watching his mom eat a piece of chicken now grabs it from her hand and stuffs it into his mouth. The baby who screamed when cereal fell onto her hands is now happily swishing it around the high chair tray.

It’s the parent that is still frozen in fear. PTSD is something that people assume only happens to victims of crimes or war. Wrong. The daily emotional rollercoaster of dealing with sensory issues in young children (and older ones too, to be honest) can leave parents with all the signs of PTSD. Anticipating problems, recalling the worst mealtime blowups even when things are going well now, feeling anxious even as your child munches down a snack happily. And reacting to any minor and non-sensory complains with an internal “Oh, here we go again, I knew it would come back!”

It makes sense to me. The stress seemed to never end because the meals kept on coming. You never know if it will be a horror or an easy meal. The level of reaction your child exhibits is not always the same, so you wonder what will happen. All the time. And you feel as if no one could possibly understand how this feels. You feel alone and on edge. The next meal could be the worst, so you have to be prepared for it.

If this description fits you, please don’t think that you are alone. You are not. Good therapy can help your child learn to manage their reactions to food and mealtime. It really can. But you may need some support too. Seek it out, and reject any professional that tells you to just relax. You would have relaxed if you could have. You have been through a lot, and sometimes getting some support helps.

Wait Out Your Whiner (or Whinger) And Everybody Wins!

Whining/whinging can drive a calm parent to the edge. Like nails on a chalkboard, the effect of a small person squealing their demand may unhinge you. Add refusal to comply with a reasonable request, and you have a recipe for disaster. OK, maybe not disaster, but how your react can inflict damage on the warm and happy relationship that you really want with your child.

So what do you do with a small child who whines/whinges? You could come down on them, all threats and authority. Good luck. Your child already knows that you have the power to deny them. They are choosing whining as an alternative to outright defiance, probably as a way to avoid a showdown. Insist on taking it there, and you may get immediate compliance but risk later explosions, or risk teaching your child that threats are the way to get what he wants. Oops.

Giving in to whining/whinging isn’t much better. You may have stopped the noise for now, but you have taught them a powerful lesson: this works! If you think that your child won’t try it again, or won’t try even harder the next time he wants something, you are experiencing wishful thinking.

This is how giving in will doom your plan. Every psychologist knows that the way to get a behavior solidly stuck in a child’s mind is to reward it intermittently. If it works some of the time, it will be tried again and again. Don’t believe me? Visit your local casino to see intermittent reward theory in it’s adult form. Every time that slot machine pays out, the customer is “taught” that it could do so again, if only they will keep playing. And playing. Folks, adults know the house always wins. Your child does not. They will keep trying their strategy on you.

Looking for advice from teachers or other “experts”? You will come away with some plausible strategies that often ultimately fail to bring the whine/whinge to and end. They sound so supportive, so understandable. “I can’t understand you when you speak to Mommy that way” is a common recommendation. An alternate strategy is “Use your big-boy/girl voice please.” I am going to tell you that neither of these strategies work very well with the chronic and committed whiner, especially if the perpetrator is under 5.

Why? Because you are using words to negotiate with children that respond better to actions. I am not referring to very young children or special needs kids with language skills under 18 months of age. But wait: those children generally do not whine/whinge. They don’t have the social and language skills to do so. They can be dealt with differently. This is why peak whine/whinge time is 2-5 years old. At this age, children can create strategies and observe their success or failure. But they are still little. They don’t infer from discussion, and they watch your reactions and the tone of your voice to support their limited language and social skills. Ask Dr. Harvey Karp. Happiest Toddler on the Block transformed my understanding of toddlers, and gave me happier days as well.

If your child clearly understands your request and your response to their request, and you consistently react in the same manner, you can wait out a whiner and teach them how to approach you. If you sometimes give them cookies right before dinner so that you can concentrate, or if you inconsistently administer natural consequences (taking toys that are thrown away from them, for example), then again, waiting them out isn’t going to work. But if you are reasonably consistent, this is the one strategy that will save your sanity and improve your child’s behavior in a lasting way.

By wait-it-out, I mean ignore the whine. Don’t react. You have ALREADY given them a response. Whether you are using Patience Stretching, my favorite move from Happiest Toddler on the Block, or simply a statement that if they want a snack, they need to sit on their chair, your response was already understood and rejected. Now you do nothing. You do not even make eye contact. Busy yourself, if possible, with some task in the room. This could be putting dishes away, folding clothes, etc. You want to be observed by your child to be non-reactive. You need to be able to observe them so that if they improve their behavior, you can respond right away.

The best way to respond to a formerly whining/whinging child who has come around is with warmth and humor. Nothing, absolutely nothing, sends home the message of success to them like an adult that welcomes them warmly. Don’t spend your time reviewing what went right. “You listened to Mommy so well. Nice sitting on your bottom in the chair” only works well with the youngest of the whiners. Most of them already understand that your warm response is in reaction to their compliance. Save the sing-song review for your infant; give your toddler or preschooler a hug, a kiss or some physical response instead.

Good luck, and see if waiting works for you!

Teach Your Child To Fail Today. You Can Thank Me Later

Yes, I said it: fail.  We all will fail at something sometime.  Even, and most especially, the gifted kids who experiment and explore constantly, will fail at something.  Knowing what to do with your feelings when you fail is essential for a happy life.  And that is why you will thank me later.

Angel Duckworth is one of my heroes.  Her focus on building grit is so important in this new world we live in.  In the old days, say 50 years ago, families and religious institutions provided a roadmap for children to handle challenges in life.  Maybe it didn’t always provide the widest highway for people with differences, but opportunities to learn perseverance and receive support after a failure were more available.  I don’t believe we can turn back the clock, so it is time to move forward and create new structures.  And this time, everyone will fit under the tent and get more support.

When we fail, we have the choice to feel bad or feel inspired.  The child who believes that his intelligence and his abilities are fixed will feel worse, perhaps even ashamed.  That child will be less likely to want to feel those emotions again, and will look for situations that ensure success.  At any cost.  Even cheating.  The rise in anxiety disorders and suicide in the college-age population has me worried about how these kids see failure.  It doesn’t have to be a crisis, it can be a learning experience in the truest sense.  Why you failed and what to do differently (if possible) are things you can learn, but only if you aren’t crushed or horrified that you failed.

The child who knows that failure is common to all of us eventually, and is not a sign of weakness or lower ability, will give things another try.  In fact, that child will not want to engage in a “sure thing”, whether it is a class, a sport, or an interaction in which there is no challenge.  The child who isn’t afraid of failure will welcome novelty and risk. They have, as Dr. Duckworth would call it, a growth mindset.   Failure is their clue that some variable in the experiment should change; useful information for their next attempt.

Just imagine what your child could do if she wasn’t afraid to fail!  Solve the many health and environmental challenges we have, broker peace between groups and countries, raise a family that believes in the power of failure….anything!

If you have a fixed mindset about failure, if you were raised to take the sure thing, the easy road to success, use the emergency instructions you get from the airlines.  Change your mindset before helping your child to change theirs.  You can thank me later.

Your Bossy Baby or Toddler May Be Gifted. Really. Here Are The Signs You Are Missing!

Toddlers are known to be a challenge at times.  Tantrums over broken cookies, insistence on hearing “Goodnight Moon” for the 11th time in one night, etc.  They can be adorably cute and amazingly difficult in the same 15 minute period!   But lurking inside chaotic toddler behavior may be signs of genius.  Really.  Here are two important signs of giftedness that emerge before 12 months of age:

  • Makes eye contact early and frequently.  The gifted baby seems incredibly alert and appears to be constantly aware of what is going on around her.
  • Resists being left alone without anything to do; wants interaction with you and with the world.

Yes, the gifted baby is taking notes and making plans.  Once she can move, she is into everything.  The things that fascinate her might be objects you never suspected an infant would even notice.  She may have abandoned those rattles very early in life.  She might not be interested in chewy toys or tags on toys. In fact, one of the signs of a gifted baby can be a distinct disinterest in chewing on books and toys.  They realize that these objects have another (higher) purpose!

Here are some signs of gifted behavior in toddlers:

  • Obvious and strong interest in shapes, shape sorters, containers, letters and numbers in all forms.  This is way beyond being taught to sing the “Alphabet Song” in a cute way.  The gifted toddler is likely watching, listening and teaching herself what those symbols mean!  She may even gather three sorter toys and proceed to group all the circles, triangles, etc in a pile before 12 months old.
  • Completing puzzles and shape sorters beyond age expectations for the toy.  For example:  I expect a child to place a circle in a shape sorter by 12-14 months.  If I see a 9 month-old that can manage it easily, I assess that as significantly early motor and perceptual development.
  • Is eager to please, and feelings can get hurt easily.  Yes, this is one of those gifted characteristics that parents don’t brag about.  Sensitivity, in all it’s versions, (emotions, physical sensitivities, allergies, etc.) is very commonly seen in gifted people of all ages.
  • A long attention span, with insistence on finishing things and completing tasks independently.  This can lead to tears and frustration as a child imagines actions and creations he cannot execute to his satisfaction.  His physical development isn’t at the same level as his mental capacity. The frustration this asynchrony causes is a pervasive issue for gifted children well past early childhood.
  • Other adults describe your child as bossy, stubborn and possibly spoiled.  Yup, the gifted toddler isn’t always everyone’s fave grandchild.  They can be insistent on doing things their way, and only their way.

How can you tell the difference between typical toddler behaviors and signs of giftedness?  It isn’t always that easy.  The behavioral issues of developmental asynchrony and sensitivities can mask the underlying issue of giftedness.  I look for improvement in their behavior when they are given appealing but highly complex problems to solve. I might invite a toddler to join me in a play activity that is complex and intense, but has been selected to modulate arousal states.  The gifted toddler who is given a chance to shine in this environment is a wonderful thing to observe.  A typical child with behavioral issues often becomes more irritable and bossy when given the same situation.

When I am working with a child that is reported to have sensory processing difficulties and I ask the right questions, I start wondering if I am also seeing signs of early giftedness when I hear the following comments come out of a frustrated parent’s mouth:

  1. “From the minute we brought him home, he seemed to watch everything we did”
  2. She isn’t happy unless she has something new to play with, and then she always surprises us with how fast she figures it out”
  3. “He never stops exploring, from the minute he wakes up”
  4. “She put together her brother’s puzzles and then said “Store” so we would go get her more puzzles!”
  5. “He watched his sister drawing, and before we knew it, he drew a face, right down to the eyebrows and ears!”

The gifted infant and young toddler is almost always more work for parents than a typically developing child.  That constantly curious mind likes complexity, it is driven to explore the world and the world of ideas, and their non-stop intensity seems to begin at birth.  Some parents are also gifted individuals, and they recognize the situation right away.  They may be worried about being up to the challenge of parenting a gifted child, or they are overwhelmed by their job, their other family roles, and now the responsibility of supporting a gifted child.

Some parents aren’t gifted, even if they are professionally successful and personally content.  The perspective from their gifted child is hard for them to embrace.  They don’t see the world through the same mindset as their gifted son or daughter.  I believe that is because the mind of a gifted person is as different to a non-gifted individual as the mind of a developmentally challenged person appears to them.  Different processes, different problems.  Every parent can come to understand their child, regardless of brain differences.  Knowing what those differences are is the very first, but very important, step.

Do I rush to tell the parents my suspicions?  No.  I am not a neuropsychologist.  My license doesn’t give me the right to diagnose.  I watch, work, support, and trust that the truth about a child’s abilities and issues will come out in time.  And I go right on doing what I have been asked to do.  Addressing the sensory processing issues that some gifted children face is more than enough of a challenge for an OT, and I am happy to support these kids to have happier, calmer and more enjoyable lives because of my input!