Category Archives: behavior issues

OT and Non-Disabled Gifted Children

I was asked to write another guest post for Therapro, the fantastic OT equipment and materials company that I have been using for clinic and home items for years.  This time the subject is gifted children:  Do Gifted But Non-Disabled Children Need Occupational Therapy?.

The first time you encounter a young gifted child, you may not know that their advanced skills could be contributing to their behavior.  Giftedness is more than advanced intellectual ability, it is a whole-brain difference.  The fMRI studies done in the last decades have proved that to be true.  Gifted kids can have sensory and behavioral responses that suggest they have ADHD, oppositional disorder, or sensory processing disorder.  Some are conclusively “twice-exceptional” , but many are just responding to a brain that is wired for intense and complex interactions.  Schools are geared to routines and benchmarks.  Let the problems commence!

Occupational therapy has always been focused on helping people achieve their best lives.  Having abilities that are on the far sides of any bell curve can make life harder, so my take is that occupational therapists can be helpful to kids that are struggling because of their talents and gifts, not just due to delays and deficits.

Read my post, then tell me about your gifted child, or the gifted children that you have seen as a therapist or teacher.  They really are interesting kids in so many ways!

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Gifted Or Disordered? The Unrecognized Behavioral Traits of Young Gifted Children

 

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Here is a short list of many common behavioral characteristics of gifted children:

  1. Spontaneous. 
  2. Boundless enthusiasm.
  3. Intense focus on passions.  
  4. Highly energetic.  This is the child who doesn’t seem to need as much sleep or downtime as peers.
  5. Constantly asking questions.  Constantly.
  6. Insatiably curious.  Everything is interesting, all the time.
  7. Impulsive, eager and spirited.  Novelty is a total turn-on, not to be feared.
  8. Persistent and goal-directed in areas that are important to them.
  9. Very easily frustrated, especially when they are unable to meet their own standards.
  10. Volatile temper when perceiving that they have failed.
  11. Chatty; absolutely a non-stop talker.

So…now are you excited to parent a gifted child, or to have one in your class or in your therapy clinic?  Or are you thinking “This sounds more like a child with learning problems, not gifts, and it sounds even be more like a child with autism”.    Or even “Children like these could be really annoying”.  Well, you aren’t alone.  Many of these characteristics exhaust adults, and create difficulties when gifted children try to navigate the world of typical kids and adults.  They may be 5-10% of the population, but they can be the source of 80% of the excitement in your home, class or clinic.  And they are often misdiagnosed as troubled rather than talented, just based on their behavior.

Welcome to the world of the gifted and those who interact with them.  It isn’t all sparkling conversation and shining rows of chess/debate medals.  Gifted children that have many or most of these characteristics may also be amazingly sensitive to others, the world around them, and to their own inner experiences.  That combination of behavior and sensitivity makes for some intense and often exhausting interactions that others find irritating or worse.   It really is the gift that keeps on giving.  And we aren’t even talking about the twice exceptional children. These children have diagnosable difficulties with learning, behavior, movement and sensory processing in addition to their gifted qualities.  They often wait years before clinicians parse out which is which.

So how could you know if the child in front of you is actually gifted, other than a psychologist’s tests?  And even if you know you have a certified smartypants, how can you determine whether their behavior is typical for gifted people or a sign of a disorder?  The answer could be to assess the quality of their behavior while looking at the level of cognition, the complexity of the conversation and the emotional depth and intensity of the interaction when compared to their age.

A three-year old that can eagerly exchange ideas regarding how tornados differ from hurricanes in their potential for damage and their source of power for 10 minutes is exhibiting a level of comprehension, intensity, curiosity, persistence and enthusiasm that you don’t typically see in this age group.   His ability to string together concepts, retain and analyze information,  respond to your own perspective and tune into your emotional tone during the discussion gives you clues that this is a gifted child, not a child with attention issues or autism.

A five year-old that paints and re-paints a picture until the colors and shapes express exactly how happy she was at the zoo may also be showing you some of these characteristics.   Her frustrated insistence on a complete representation of form and emotion, as well as her unique use of media are telling you a lot about her talents.  If you are amazed that all this focus doesn’t tire her out but energizes her more; there’s another clue.  The depth of her joy she has while creating or when opening a box of new pastels, like Christmas has come again, is another hint that she may be gifted.

When a child’s asynchronous development gets in the way, a gifted child can struggle.  Most gifted children aren’t gifted in every area of development, so a gifted artist may not be able to physically draw what she sees in her mind, a gifted writer may not be able to write his book legibly at 6, and a gifted athlete may not be able to handle her team losing.  That is where wise adults can provide strong support and education in managing their talents and explaining their struggles to gifted children.

I am frequently asked as an OT for ideas on how to manage gifted toddlers in class and at home, and I wrote a short post earlier this year in response Gifted at Preschool: How to Support The Young Gifted Child In Class.  For suggestions on how to make life easier at home, my suggestions focus more on building sensory and emotional tolerance for kids, and teaching self-awareness and self-calming skills.

If your child receives OT for any reason, this may be a place to start.  Check out this post for more information:  How Occupational Therapy Can Help Gifted Children (And Their Exhausted Parents!)  Occupational therapists that can see the difference between gifted traits and symptoms of an attentional or learning disorder can help parents on this amazing journey of discovery with their gifted child.

Halloween Fun When Kids Don’t or Can’t Trick-Or-Treat

 

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Kids big and little are anticipating Halloween, but this holiday isn’t always enjoyable for children with ASD, SPD, anxiety or motor issues.  Putting on a costume can be difficult for some kids to tolerate and nearly impossible for kids that have mobility issues.  Kids with endurance and mobility issues struggle to walk up to a front door and ring the bell, but they don’t want to be carried “like a baby”.  Even seeing other children in costume or decorations in their own home can be difficult for children that are very sensitive.

What begins as a celebration and an adventure becomes a minefield.  And yet, your child may be invited to participate in many Halloween events.  You may want to have a party in your own home.  Your child may even beg to be involved in things you know they will end up hating, not realizing the challenges ahead.  Inclusion is a murky pond for some kids.

Perhaps it doesn’t have to be so difficult.  Here are a few ideas that could make this holiday less stressful and more inclusive:

  • Costumes can be anything you want them to be.  Purchased costumes can be adapted or altered for comfort and tolerance.  If you have a child with tactile sensitivity, choosing the fabric that is less irritating is worth a trip to a brick-and-mortar store, or ordering multiple sets online with easy returns.  Instead of an eye patch for a pirate, you can use makeup to create one.  Princess skirts and Batman pants can be shortened to prevent tripping.  They can be bought larger and altered to allow for braces and for sitting in a wheelchair.  Hats and headpieces are optional, and can also be switched out for more wearable choices.  They can be purchased separately or by combining two costumes.  A comfortable costume is fun; an awkward costume will cost you in time, pain and struggle much more than you can imagine.
  • Trick-or-treat is over-rated.  Choose people your child knows, a neighborhood that has flat, accessible front steps, or even an apartment building with an elevator.  The experience of trick-or-treat doesn’t have to be a marathon to be fun: in fact, “fun” is the opposite of dragging stressed children around from house to house.  Remember that children with sensory modulation issues will start out excited and happy and become overwhelmed quickly.  Monitoring and planning for this helps both of you have fun that doesn’t end badly.
  • Many children with sensitivities need to practice wearing their costume until it becomes familiar.  They may protest and initially refuse, but some practice can really help them.  Make the run-through more fun by pairing it with something like watching a halloween movie at home or putting up decorations.  The child that refuses to wear a costume can become the child who doesn’t want to take it off!
  • Choose your home decorations with your child’s tolerance in mind.  It isn’t always about whether they are scary or not, it can be the brightness, the amount of movement or the sounds that overwhelm children.  You won’t always know what will be too much, so prepare yourself and the rest of the family that you may have to substitute/remove/repurpose things that don’t work out.
  • Do fun events that your child can handle.  Bake cookies, including the buy-and-bake-off cookies that don’t require a lot of effort or time.  The end product can be given to friends and family proudly.  Decorate a Halloween cookie house.  Put up cling-on decorations in windows and storm doors that are easy to remove if they become an issue.  Watch a fun movie at home and invite friends to dress up and come over for the show.

Holidays for kids with special needs take more thought, but they don’t have to be less fun, just a bit different.  The important concept is to consider your child’s needs and aim for the essential feelings of the holiday:  fun, and sharing the fun with others!

When Your Gifted Child Is A Perfectionist

 

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Do you know a child who is always trying to get to “perfect”?  Being called a perfectionist is almost universally a criticism in our society.  It doesn’t have to be.  Some kids that are reaching for the ultimate aren’t unnecessarily stressing them selves out.  They may gifted.

The gifted child is capable of seeing what others do not.  They envision a wider and deeper experience, a more complete artistic expression, a better-turned phrase.  And they demand a chance to achieve it.  In this way, perfecting their performance or product isn’t psychological struggle, it is accomplishing what they can imagine.

A gifted child may not beat himself up for not immediately achieving his vision, but he may not leave well enough alone.  He may not have to.  Given the chance, he may work happily on his project for hours or days or even months, not really minding the process that requires failures and one-offs.  This should give you a clue to the source of your child’s persistence;  the gifted enjoy the process as much as the product.  This is very different from the child who tears up a picture in frustration.  There are no tears from a gifted child, but there may not be any negotiation.  They cannot leave their work in it’s current state, knowing that a better outcome is right around the corner.

What if the picture or term paper is due on Tuesday?

Give your gifted child the gift of understanding and teach them that deadlines also have value.  Living in our society requires the gifted child to bend to fit, but not break.  They can continue to work on their project when it is returned to them, or they can accept that reaching the perfect state the they see is something that doesn’t happen with every endeavor.

Let them enjoy the creative process, as this is the true joy for them.  Gifted children need your help to learn how to navigate the wider world, where often their modest efforts are celebrated.  They know that they can do more, but if they can shift off of a demand for perfection in some things, they can reach the heights of their abilities in other experiences.

Address A Child’s Defiance Without Crushing Their Spirit

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Kids that defy adult instructions, even instructions that are ultimately for their benefit, often get begged or threatened into compliance.  Pleading with your child to pick up their mess, or threatening your child that those toys on the floor will be given to a charity shop isn’t always going to work.

Why? Probably because your child is waiting you out.  Children are wise observers of what works and what doesn’t, so they know you will eventually clean things up and they are fully aware that toys never disappear after a threat.

If you are tired of pleading and threatening, I have a strategy that could make you less aggravated and even ultimately boost your child’s self-esteem.  It works best with children that have at least a 30-month cognitive and language level.  This means that if you have an older developmentally delayed child that is unable to comprehend a request with a reward attached (“If you give me the shoe, I will get your milk”) then you should try a less complex strategy until they can understand this concept.

The idea is simple:  you make a request and if no response is elicited, you explain that they have a choice.  Not complying will result in a consequence they can see.  After the consequence is imposed, you offer the child another chance to make things right by following a slightly different direction or offering a “re-do”.  There is no “1-2-3” counting, because if you are certain that your child has understood your initial request and the explanation of the consequence, those were already the “one” and the two” of the countdown.  Your execution of the consequence is the “three”.  Good enough for me!

The trickiest parts of this strategy are the maintenance of a warm tone while your beloved child is defying you, and your quick thinking to identify a later task that allows them to save face while complying with your second request.  Do not think I haven’t had to act warm and friendly when inviting a difficult child to give participation another try.  I remind myself that I am the adult in the situation, and my job is to model calmness and teach skills, not get the upper hand on a 4 year-old.

I have also made up some pointless tasks such as rearranging boxes on a shelf, just to have an easy and successful task to offer them after the first consequence is delivered.  The younger the child, the less they will realize that Job #2 was only a chance for them to know that I am not rejecting them in any way.   I could say it, but actions speak louder than words.

Here is what this strategy looks like with a young child:

Adult:  “Please pick up all the cars, and then we can go have our yummy lunch.”

Child:   Looks at you, shakes her head and runs to the fridge. 

Adult:  ” Here is your choice:  pick up your cars and put them in the bin, or they will sit in their bin on top of the fridge until after dinner.”  Adult points to the fridge and/or taps the top to clarify what that means.

Child:   Gets a spoon from a drawer and stands by the fridge, no acknowledgment of your  directions.

Adult:  Uses The Happiest Toddler Kind Ignoring strategy and turns away from the child and waits next to the car pile for about 15 seconds for a positive response.  If the child doesn’t return, the adult puts the cars into the bin without more discussion, and places the bin on top of the fridge.

Child:  Cries, recognizing that a consequence has been delivered.

Adult:  Uses a disappointed but calm tone :  “I am sad too, because now we have to wait to play cars.” Adult’s body language and tone brightens. “Would you like to try listening again?  Please give me the blocks and I will stack them.”  Adult begins to stack very slowly to allow the child to consider her choice, and warmly welcomes the child’s help.

Child:   Begins to hand blocks to the adult.

Adult:  “You did a great job helping me!  Thank you!  Let’s go have our lunch!”

This can go south with strong-willed children, tired children and even some hungry children. I don’t recommend letting kids get super-tired or starving and then setting them up to lose.   Some kids are feeling great, but they draw a line in the sand and decide that they aren’t budging.  They won’t back down.  I express my disappointment in the outcome (no car play) but not in the child.  I don’t tell them I am disappointed in their behavior, because for a young child, they may not always be able to distinguish themselves from their behavior.  They will always be able to see the result: no cars.

I keep calm and impose consequences unless things go from defiance to aggression.  Then I consider a time-out strategy.  Aggression should never be ignored, because that is as good as approving of aggression.  In this age of zero-tolerance in schools, no one is doing any favors to a child by inadvertently teaching them that aggressive behavior is inconsequential.  They will find out soon enough that other people feel very differently about it.

Young kids will defy you.  I guarantee it.  Responding to defiance with limit setting doesn’t have to damage them or your connection with them.   Addressing defiance in this way can build a more positive relationship while making it very clear that there are consequences to not listening to you.

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Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior

 

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There is nothing worse than using a scientific study that correlates two variables and assuming causation. Translation:  If behaviors typical of disorder “A” are seen in a lot of people with problem “B”, we cannot assume that “A” is the cause of their behavior.   But we do it all the time.  People who love coffee adore studies that say coffee drinkers seem to live longer.  People who hate to exercise are validated by reports that find the number of heart attacks after exercise “is increasing”.

When it comes to labeling children’s behavior, we should take a couple of big steps back with our erroneous reasoning.  And when the label is ADHD, take three more.  Not because ADHD isn’t a big issue for families.  The struggles of kids, parents and educators shouldn’t be minimized.  We should be cautious with labels when two situations occur:  very young ages and multiple diagnoses that are determined largely by clinical observation, not testing.  Seeing ADHD in a child with hypermobility is one of those situations.

Hypermobility without functional problems is very common in young children.  Super-bendy kids that walk, run, hit a ball and write well aren’t struggling.  But if you have a child that cannot meet developmental milestones or has pain and poor endurance, that is  a problem with real-life consequences.  Many of them are behavioral consequences.

Yes, I said it.  Hypermobility is a motor problem that has a behavioral component.  I don’t know why so little has been written on this subject, but here it is:  hypermobile kids are more likely to fidget while sitting, more likely to get up out of their chairs, but also more likely to stay slumped on a couch.  They are more likely to jump from activity to activity, and more likely to refuse to engage in activities than their peers.  They drape themselves on furniture and people at times.

Why?  Hypermobility reduces a child’s ability to perceive body position and degree of movement, AKA proprioception and kinesthesia.  It also causes muscles to work harder to stabilize joints around a muscle, including postural muscles.  These muscles are working even when kids are asleep, so don’t think that a good rest restores these kids the same way another child gets a charge from a sit-down.

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When a hypermobile child starts to move, the brain receives more sensory input from the body, including joints, skin and muscles.  This charges up a sensory system that was virtually starving for information.  Movement from fidgeting and movement by running around the house are solutions to a child’s sense that they need something to boost their system.  But fatigue can set in very quickly, taking a moving child right back to the couch more quickly than her peers.  It looks to adults like she couldn’t possibly be tired so soon.  If you had to contract more muscles harder and longer to achieve movement, you’d be tired too!  Kids  develop a sense of self and rigid habits just like adults, so these “solutions” get woven into their sense of who they are.  And this happens at earlier ages than you might think.  Take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children to understand a bit more about this experience for hypermobile kids.

Then there is pain.  Some hypermobile kids experience pain from small and large injuries.  They are more likely to be bruised,  more likely to fall and bump into things, and more likely to report what pediatricians may call “growing pains”.  Sometimes the pain is the pull on weak ligaments and tight muscles as bones grow, but sometimes it isn’t.  Soreness and pain lead some kids right to the couch.  After a while, a child may not even complain, especially if the discomfort doesn’t end.  Imagine having a lingering headache for days.  You just go on with life.  These kids are often called lazy, when in truth they are sore and exhausted after activities that don’t even register as tiring for other children their age.

How can you tell the difference between behaviors from ADHD and those related to hypermobiilty?  I think I may have an idea.

When a hypermobile child is given effective and consistent postural support, is allowed to rest before becoming exhausted (even if they say they are fine), and any pain issues are fully addressed, only then can you assess for attentional problems.  Occupational therapists with both physical medicine and sensory processing training are skilled at developing programs for postural control and energy conservation, as well as adapting activities for improved functioning.  They are capable of discussing pain symptoms with pediatricians and other health professionals.

I think that many children are being criticized for being lazy or unmotivated, and diagnosed as lacking attentional skills when the real cause of their behaviors is right under our noses.  It is time to give these kids a chance to escape a label they may not have.

Looking for more posts on hyper mobility?  Check out Should Hypermobile Kids Sit On Therapy Balls For Schoolwork? and Should Hypermobile Kids Use Backpacks? for school-related topics and strategies.

Negotiating With Toddlers? Why 90/10 Is A Good Deal To Them

 

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Toddlers can make you doubt your sanity.  They really can.  How can a crushed cookie be the end of the universe as they know it?  Why do they think you can make more cookies appear on demand?  And how to explain to this person that thinks you hung the moon that you simply cannot erase crayon marks?

This post is an effort to explain how to successfully negotiate (most of the time) with children 18 months to 5 years old.  It is based on The Happiest Toddler on the Block strategies by Dr. Harvey Karp.  Once I learned his techniques, I never looked back and became a toddler whisperer.  Really.  You need to embrace his two most important ideas and then you are ready to hit the negotiating table with your toddler.

Dr. Karp’s most basic concept is that you need to understand that the toddler brain isn’t capable of much logical thinking due to immaturity.  This means that they cannot negotiate well, even when calm.  It gets better as they get older, so a 4 year-old will have flashes of rational negotiation, and an 18 month-old may never get it.  She can’t.  Her brain simply doesn’t “do” rational well at all until that frontal cortex is mature.  The other concept is true for negotiation with anyone, including your partner and your boss.  You have to see their side of the story and communicate to them that you are aware of their feelings….whether or not you agree with them!

Agreeing that they get 2 more bedtime stories but not a snack as well, agreeing that they get the giraffe cup but can’t spill half of it on the new carpet to make a pattern, agreeing that they can wear pajamas to the park but only with shoes are all successes.  Tell them that you understand that wearing Spiderman jammies is indeed cooler with Spiderman sneakers helps them negotiate the deal.  Honestly saying that you are too tired to read 6 more books using an exaggerated yawn and a sad look helps.  You need to go night-night too.  They may be able to see your perspective since they are tired as well (but may never admit it to you).

So here is where your paradigm shift happens.  You have to be OK with deals that seem unfair to you.   Adults want a 50/50 split at the very least.  But you aren’t negotiating with another adult.  Be prepared to leave your ego at the door.  If you are the kind of person that needs to be right, you are going to fail at toddler negotiation.  Toddlers negotiate from the heart and with heart.  A mature sense of fairness isn’t going to be helpful with an irrational mind.  Hint:  if you have ever had a totally irrational boss that you actually liked when things weren’t exploding all over the office, you will have had some experience with the toddler mind.

Successful initial negotiations with a toddler often yield a 90/10 split.  90% for them, and 10% for you.  If they walk away happy,  you should too.  This is why this is not only a good deal for you, it is the only way to teach fairness in negotiation: toddlers start out expecting 100%.  A 90% deal is, in their mind, having given in big-time. But if they feel OK about it and life goes on, you won.  If you can manage that, the next negotiation could be 80/20.

Many toddlers cannot manage this when tired, overwhelmed, hungry, etc.  So negotiations can start over something simple, something that doesn’t matter very much to either party, and when things are calm.  You are teaching a skill, not making a business deal.  But the results could make everyone’s life a lot calmer in the end!