Category Archives: toddlers

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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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.

Want A Stronger Pencil Grasp? Use a Tablet Stylus

The trick? They need to use a short stylus and play apps that require primarily drag-and-drop play. Stop them from only tapping that screen today, because tapping alone will not make much of a difference in strength and grading of force.

Why will drag-and-drop play work? The resistance of the stylus tip on the screen builds strength and control at the same time. They gain control as they get the immediate feedback from game play. Too much force? They get stuck and can’t move the styluses the target. Too little force? Again, the target doesn’t move. Could they revert to a fisted grasp and accomplish this? Sure, but that is exhausting, and you are within view of them anyway….right?

For this to work, young children need supervision, but not helicopter supervision. And they need to know that how they hold any utensil matters to you. My best approach to build grasp awareness is to appeal to their desire to be older. Tell your child that you have been watching them, and you believe they are ready to hold a stylus like an older kid. Oh, and you can explain to them how to hold the stylus the easy way. They just have to watch your example and play some games for practice. Yup, you ASK them to play on a tablet!

Best drag-and-drop games for young children? I like the apps from Duck Duck Moose, especially the Trucks and Park Math. Every app has some tapping, but you can select and “sell” the games that require drag-and-drop. There are apps that little girls can play to dress up princesses, mermaids, etc. Pick the ones where they have to drag the items over to the characters. Same with wheels on trucks, shapes into a box, etc. The Tiny Hands series of educational apps have a lot of drag-and-drop play.

Finally, mazes are wonderful, and so are dot-to-dots that require drag-and-drop play.

Have a really young child, or a child who struggles to keep their fingers in a mature grasp pattern without any force? Then apps that require just a tap are fine. I set the angle of my tablet at various heights (my case allows this) to prompt more wrist extension (where the back of the hand is angled a bit toward the shoulder, not down to the floor). When a child’s wrist is slightly extended, the mechanics of the hand encourage a fingertip grasp without an adult prompting them.

Try drag-and drop play with a stylus on your tablet today, and see if your child’s grasp strength starts improving right away!

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!

 

 

 

 

 

 

 

 

 

Is Your Gifted Child Also Your Most Strong Willed Child ?

Parents of some gifted children know that this gift comes with more than a quick intellect.  It can come with a will of iron and incredible emotional range.  Gifted children can be expansively happy one moment, and intensely sad the next.  No, it isn’t bipolar disorder, and it probably isn’t ADD (these kids are misdiagnosed at an alarming rate).  Gifted children have an emotional capacity that often matches or exceeds their intellect.  Here is why.

Their brains are different.  They are qualitatively different, meaning that they notice, synthesize, and experience information differently, not just “more” or “more like an older child” than other children.  Their brains work differently, but they are trying to comprehend how others understand it and why they behave as they do.  When they cannot or when they insist on the world working their way, things can get explosive.

Yes, the same brain that allows a 4 year-old to read chapter books to her preschool class without having been taught to read is also feeling and connecting emotional information differently from her peers as well.  She can’t “get over it” when arbitrary rules do not allow her to take materials out of the reference section of the library, or when she isn’t allowed to finish watching a documentary on sea creatures because you have to take her brother to swim practice.  Functional imaging studies have been reported to see much more diverse brain activity in gifted individuals during simple tasks.  They light up like Christmas trees because they are incredible thinkers.  All that thinking can get them in trouble with the day-to-day world of rules and behavior.

The amazing brains of gifted children are understood to have what one researcher calls “overexcitabilities”.  Only one is intellectual excitability.  The others include motor and sensory excitability.  This can lend itself to some explosive tantrums in toddlerhood and even disabling complaints of clothing or lights being far too irritating and distracting.  The same child that can explain to you how the electoral college works can be sidelined by the scratchy tag in his shirt!

Gifted children with strong wills aren’t always appreciated for their determination and their energy.  They balk at instructions, refuse assistance when they need it, and aren’t easily distracted from their desires.  I think that the first step in handling the emotional over excitability of a gifted child is to accept how difficult it is as a parent or a teacher, and then learn about how this aspect of giftedness works.  From there it is a matter of building skills in self-control and social/communication skills.  Children do not have to get their way because their IQ is in the stratosphere.  They still have to avoid aggression, including verbal aggression (something teenage gifted kids are virtual masters of).

My perspective is that gifted children need more help with social skills since they often have such disparity between their cognitive capacity and their emotional abilities.  Feeling responsible for the world’s troubles doesn’t mean that you are, and knowing that the rules are arbitrary doesn’t mean you have the authority to change them.  Parents who teach their children how to navigate these problems will give a huge gift to their children.  Children need to understand that they aren’t bad, but they are different.  And their behavior is connected to the way their brain works and always will work.  They need to navigate their path within the wider world, making friends and dealing with authorities that do not see things in the same way.  The world may not always understand gifted people, but if gifted people understand themselves, it could be a happier and calmer place for everyone.

Strengthening A Child’s Pencil Grasp: Three Easy Methods That Work

 

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Dreaming of summer fun!

When a child makes fast progress from a fisted grasp to a mature pencil grasp in therapy, parents notice.  This isn’t easy to accomplish, but it is possible.  I spent the first decade of my pediatric OT career thinking that finger exercises were the answer.  Nope.   Here are my three favorite strategies to see quick improvements in children ages 3-5:

  1. Crayons.  Yes, I suggest you go old-school and use crayons, not markers, for scribbling and drawing.  The tackiness of wax on paper  creates slight resistance that builds strength.  Feel free to provide paper with a bit of texture, such as watercolor paper; it is worth the investment!  Just like when you go to the gym, all muscles will respond to resistance by recruiting more fibers and building more strength.  Yeah!
  2. Easels.  Every pediatric OT recommends an easel, and there is a good reason why.  Easels work.  I take if further, and make sure that the paper doesn’t slip at all, and that the target for a child’s scribbling is in the middle 1/3 of the easel surface.  Why?  Unless a child is very tall or very tiny, this will result in a more effective shoulder and wrist angle that allows a mature pencil grasp.  How do I ensure that a child uses the target area?  I color in the top  and bottom 1/3’s, creating either good demos of shapes/designs, or just scribbling away, having fun.  What I draw depends on the child’s needs at the moment.
  3. Tablet Stylus.  I am well aware that some therapists are recoiling in horror at the thought of using a tablet.  They might have to reconsider their stance after reading what I have to say.  Children are using them daily in their homes, many have their own, and sport a newer model than I drag around for work!  Tablets aren’t going away, so use them to your advantage.  Using a stylus (my fave is the iCreate stylus)  produces the tacky resistance that we like about crayons, but on a touchscreen.  When children have to drag-and-drop objects, they are using more muscle strength and better control to maintain a stable yet mobile grasp.  A few years ago, I worked with a very weak child who was dealing with a life-threatening illness.   No one was going to force him to do anything, and all he wanted to do was play on a tablet.  He was told to use the stylus while playing, and 6 weeks later he was eagerly coloring with crayons on paper.  His improved pencil grip was amazing!  As always, my apps are educational as well as fun, and tablet use in therapy is neither a reward nor the focus of my sessions.  I make it clear that lots of fun can be had without it.

As with any therapeutic exercise, I monitor fatigue and adapt my set-up and activities to maximize use of a mature grasp with minimal compensation.  The rule is:  if it looks like a bad grip, it probably is!  If your child insists on using a fisted grasp even with these strategies, you need to use some behavioral motivational tools in addition to good equipment.  Your OT can help you with that!

If your therapists have mentioned that your child has low muscle tone or ligament laxity (loose joints) take a look at Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility? for some clarity on addressing pencil grasp with these issues.

Sensory Sensitivity In Toddlers: Why Responding Differently to “yucky!” Will Help Your Child

Sensory sensitivity and aversive behaviors are among the most common reasons families seek occupational therapy in Early Intervention.  Their kids are crying and clinging through meals, dressing, bathing and more.  What parents often don’t see is that they can help their child by being both empathic and educating them throughout the course of the day.

My clinical approach has matured over the years from the standard OT treatments to a whole-child and whole-family strategy.  One important part of my approach is to alter how adults react to their children.  It isn’t complex, but it is a shift away from thinking about the problem as being exclusively “my child’s issues with sensory processing”.  Once adults understand the experience a child is having from the child’s point of view, they can learn to respond more effectively to a child, and get results right away.

I recently did a therapy session with a toddler and her mom.  When the child became overwhelmed by her dog barking and rushed to her mom to be picked up, I warmly and clearly said “You want up?” twice while using explicit body language to convey calmness, while the mom looked at her child but didn’t scoop her up right away.  The child turned to look at me, stopped whining and dropped her shoulders.   She relaxed at least 50%, stuck her thumb in her mouth for about 30 seconds, then started to play quite happily.  What I know is that this short interaction affected her body’s level of neuro-hormonal arousal, her thinking about how adults handle sensory events, and her memory of how she feels when she is overstimulated changed. I believe that those differences physically change the wiring of her brain in a small but meaningful way.

I cannot take full credit for this strategy; I used the Fast Food Rule from Dr. Harvey Karp  Use The Fast Food Rule to Help ASD Toddlers Handle Change.  I am using it for therapeutic means, but it the same tantrum-defusing method he developed.   I responded with loving calmness to her over-the-top reaction, acknowledging her request while not granting it. She was “heard” and accepted.   I gave her a moment to come up with an alternate response (quick thumb-suck and then search for fun a fun toy).

This little girl has a habitual reaction to sensory input that puts her into a fear-flight pattern on a regular basis.  Cuddling her works for the short-term, but it leaves her seeking adult assistance for any fears, and it doesn’t give her any skills to handle things or suggest that she could handle situations differently.  Shifting her habitual reactions to  these benign events is essential to make progress, and telling her that it was “just the dog barking” doesn’t work.

Why?  Because Dr. Karp will tell you himself that toddlers hear you saying”just” as if you were telling them “you are wrong”.   They protest more to make you exactly see how upset they are.  Explaining things rationally doesn’t help a little person in the throes of emotion.  Modeling calmness while acknowledging their feelings is what helps them learn and grow.

Your child is wiring his brain every moment of every day. Your sensitive child is assessing all of your reactions to learn about what is a danger and what is not.  His brain, not his hands, are interpreting the world as irritating or frightening.  Your reactions to events and to his responses will help to hardwire his brain to believe something is scary, or challenge him to adapt and change that automatic pattern of response.  It isn’t all psychological, it is neurobiological as well.  Most researchers don’t differentiate between the two any longer.  They know that biology drives thought and that thought can alter biology.  The rubber meets the road right here, right now, in your own home!

OTs working with sensory processing disorders generally believe that an aversive response to a benign stimulus (hysteria when touching lotion or oatmeal) is not a skin issue or a mental health issue, but a brain interpretation gone wrong.  There are many reasons why this would happen, but most of us believe that experience and exposure, done well, can change the brain.  Some exposure is done with programs like the Wilbarger Protocol, the use of weighted or pressure garments, and many other great therapeutic techniques.  Changing adults’ responses hasn’t been researched nearly as much, but my clinical experience tells me it probably should be.  I know that teaching parents how to shift their behavior has made a difference for my clients almost immediately.

Good therapy can diminish a child’s aversions substantially, and even create exploration and excitement.  It is wonderful to see a formerly anxious child move through her day exploring and enjoying the world around her!

Does your sensitive toddler struggle with toilet training?

 The Practical Guide to Toilet Training Your Child With Low Muscle Tone is my new e-book (hard copies can be obtained by contacting me directly) that may help you tonight!  Sensory-based strategies can really help children with sensitivity, and good instruction minimizes all the multi-sensory mess that training can become when you don’t know what to do.  Your child doesn’t need to have severe issues with low tone.  Many children have both sensory sensitivity and low muscle tone.

Visit my website tranquil babies, and click “e-book” on the top ribbon to learn more about this unique book!