I Hope This Isn’t ADD!

If your child has authentically diagnosed ADD or ADHD, please do not read any further! This is only for moms with ADD-wannabes =)

So my second son, at 6yrs old now, has many of the classic symptoms.  He is distracted by everything.  He has sensory issues, so he hears, smells, and feels everything whether it is the heat coming on, a truck backing up on the interstate, or even the smell of the oven.  This doesn’t help.

But even when I get him “focused” and working, he is very distractable.  He’s an artistic type, so he gets derailed into doodling on his workbook pages, or writing little notes to me on them when he comes to a difficult problem.  He can write a whole misspelled paragraph to me about a one-word blank.  He also likes fonts, so he starts decorating his “Ts” and “Fs” with little serifs or italic/bold-faced type.  Then his pencil needs sharpening, so he spends about 10 minutes doing that only to have it snap off when he gets back to his spot.  He starts that process over.  I homeschool him, and he can easily take from 9am to 12noon just doing two or three tasks.

But he’s extremely intelligent.  So I try not to harp.

It’s hard though.  His ADD spills over into other areas too, like getting dressed, tying shoes, brushing teeth.  It is very frustrating.  And yet, I realize it is partly developmental.  As you know, boys are over-diagnosed with ADD or ADHD.  Sometimes husbands and grandfathers hear about it and believe they’ve suffered with it their entire lives.  If it is maladaptive, maybe they do.  But it could just be part of the male brain.  Male brains are like “waffles,” as one celebrated author says, and topics are compartmentalized–in the brain, each subject has its own box separate from the others, and men jump from box to box, subject to subject.  Little boys do this too, which is how they get so far off track.  Things are just INTERESTING to them, so they think about it, cutting off what they were originally doing.  My girl doesn’t seem to have this problem, but I am sure there are many girls who do, especially creative and  free-thinking ones!

There are many blog posts and books on this subject, so I won’t belabor it here.  The real reason I am writing this post is because it dawned on me just today that there is something  redeeming about ADD wannabes.

Other than the gender component, I had thought that perhaps ADD was personality-related in the sense of learning style.  My second son is very analytical–obviously if he’s into fonts!  But something about this hypothesis wasn’t accurate because my first son is also analytical and has no attention problems at all. He has laser-like focus.  Then this morning I was teaching my third son Language Arts (he’s five) and I saw some of the same ADD symptoms beginning to crop up on him as he worked.  “Oh no!!!” I thought to myself.  “I have to stop this from happening so it doesn’t consume him like my second boy!”

Then it hit me.

He THINKS about his work as he does it.  My third son is not analytical at all.  Not even a little–it took him forever to learn his letters because A and B all looked the same to him.  (My other two sons picked them up before they were 2yrs old).  My third guy isn’t picky about anything, is very independent, talks in general statements, and picks up concepts easily.  But as he was working on his vocabulary and spelling, he was actually trying to think about what the words meant.  He wasn’t interested in just reading them (“cast”… “task”… “track”), he was asking me questions about them.  Then as I would explain them, we would get off track as that led to more questions.  Sometimes we got off for 5 minutes talking about something six degrees away from “cast.”  And I’d have to steer us back to the page at hand.

That’s when I realized that my second son does the same thing.  He tries to really understand things on a heart level.  He is very artistic, very scientific, and has a high IQ.  His vocabulary–especially for a young boy–is excellent.  So he ponders his work and goes slowly, thinking about things as he goes through.  This causes the distraction and “six degrees” problem.

My first son, however, who is 8 and has no attention problems, is analytical but doesn’t think AT ALL when he does his work.  He breezes through it as quickly as possible.  We have trained him to try to get the right answers, so he does know how to slow down and rethink a question with prompting.  But I can tell when I talk to him that he doesn’t like to think!  He is a type A personality and does things by the book, as perfectly as he can and gets good grades for it.  But he’s the type of  boy who can read an entire book and know very little of what he read.  Or misread the directions on a page and complete the entire page according to a rule without it dawning on him that his answers don’t make sense.  Or look up a word in the dictionary and read the definition four times and still have no mental picture.  He’s got a great memory and devours books, but has a terrible vocabulary and makes few connections on his own.  (i.e. he’s a history buff but asked me the other day whether July 4 was an American holiday.)  He just has a superficial understanding of most things and doesn’t know what he doesn’t know.  Terrible commentary on how getting straight A’s doesn’t correlate to comprehension!

So maybe this is just the way it works: quick and brief, or slow and comprehensive.  If you have a child with attention problems too, you can be grateful that s/he’s probably a thinker.  They might grow up to be one of those kids who are terrible test takers but, if they took it correctly, would score extra high.  After all, it’s only if you think about what you’re doing, can you can think enough to get distracted!

I’m not trying to make light of attention problems.  I definitely think the kindergarten age is the optimal moment to teach this study skill– if you can teach your child to sit still and focus when they’re five-six, they will have a huge advantage.  But I have more grace on my boys now.   My kindergartner is clearly building his vocabulary and knowledge base, even though it seems like we labor over getting one page completed.  It’s developmental and important not to skip.

The Autistic Child (NOT)

Does this describe your child?

• 2.5-3.5yrs old
• probably male, probably firstborn
• delayed language; doesn’t put words together yet
• doesn’t use Yes/No correctly– can cry/temper tantrum easily
• doesn’t call for help
• doesn’t use Mommy/Daddy/own name well
• very detail-oriented
• walks on tiptoes
• walks in circles, sometimes jabbering to self or no-one
• spins car wheels, pokes blocks off, or otherwise repetitive play behavior
• repeats your questions/statements
• repeats sounds or scripts ad nauseum
• easily distracted
• bad eye contact
• can’t answer comprehension questions
• no gestures or pointing
• few independent skills
• doesn’t understand taking turns or people skills well
• won’t drink milk, eat fruit, etc.
• constipated all the time
• difficult sleeper

Congratulations!  You have a fine, well-adjusted NON-AUTISTIC child!  No, I mean it.  Your child is likely a finicky, driven, bored and distracted little boy.  He doesn’t care about language, isn’t able to pick it up easily, and is therefore a tough cookie who is behind in some areas that he wouldn’t be if he had better language skills.  But for now, you have to suffer in the world of preschool, playgrounds, and other life adventures that really do require more English and social skills than your child has.  And guess what?  This is totally normal!  Stop worrying that he is on THE SPECTRUM because life doesn’t seem to fit his developmental timetable, and just hang in there until he’s 5.  Get a lot of structure and routine that works for you, adopt a rigid discipline ethic if necessary, and have faith that once the language kicks in, he will make up for lost time pretty much right away.  His behavior will also become less erratic.

How about this child?

• 1-4 yrs old
• picky eater
• messy, clumsy, can’t dress self well
• cries easily
• strange phobias– water, vacuum, dirt
• anxious behavior
• taps or scratches self, has repetitive stimulatory behaviors (i.e. may still suck thumb, fidget with socks, etc)
• seems lost in a group, or plays alone
• deep, focused play skills; strange attention at times
• doesn’t like to engage others
• avoids conflict, checks out
• can talk but doesn’t initiate or sustain conversation; people might not even know how well they speak
• may speak to privileged individuals, in-depth about their favorite subject/question
• unusual talents, or way ahead in an adult area
• retreats to specific activities; self-soothing repetitive play
• takes things apart to study
• handles toys or household objects in peculiar (non-functional) ways
• sensitive to smells, sounds, touch
• “freak out” or “shut down” behavior
• low muscle tone
• allergies or inadequate nutrition

Congratulations!  You too have a sensitive, fearful, NON-AUTISTIC child!   Most people would like to diagnose your little guy with Asberger’s or Autism Spectrum, but more likely you have a misunderstood, sensory-sensitive little person.  This profile is less commonly complained about than the very first profile I outlined, but it definitely represents a portion of toddlers who are very quickly seen as at-risk for autism and usually packed right off to a specialist for a neuropsychological exam.  Whereas the first  profile I listed above is likely to see the child put in special preschool, perhaps with an ADD-type medication, this second profile is more likely to be medicated for childhood depression, anxiety, OCD, or reactive detachment disorder.  But kids come in all colors!  There is no need to panic because your little person isn’t the extraverted, sensible preschooler.  He/She may be an “old soul” or grumpy type who doesn’t fit in with the flashy world around them.  He/She probably needs a little extra nurture and coddling, as well as some occupational therapy or one-on-one play/floortime with a loved one.  Resist THE SPECTRUM curse!

** Note: Of course I am not against true autism diagnosis.  And I am not against checking out whatever symptoms worry you about your child.  I am just making light of the fact that “normal” is a wide range, and MUCH wider than we are told it is.  Usually we are told to worry, from experts, parents, or friends, because of the developmental scare climate out there.  Yet there is no reason to push the Panic Button just because your toddler or preschooler has some delayed or anti-social behavior.  Attention and special education might be necessary…as it always has been, in the case of small children who have individual tendencies and weaknesses.  But usually these are things you can do on your own or with limited intervention.  There is no need to put small children under a microscope and ship them off for multiple diagnoses so they can receive services from the state until they’re 21 because we’re afraid they’re all high-functioning autistic.**

How about this?

Does Your Boy Develop Unevenly?

After hundreds of comments from moms dealing with their speech-delayed boys who walk on tiptoes or have other such idiosyncrasies, it occurred to me to write another post on the boy/autism thing.  This time, with a focus on the developmental timetable.

I have another post on how boys develop differently than girls, but to recap an important point: boys often do not follow the timetables.  In fact, they are spotty.  They grow unevenly.  At times, they will hit the developmental mark right on the money.  Other times, they will be way off.  And often, they will have some abilities way ahead for their age—while at the same time, they will have glaring weaknesses way behind for their age.

For example, when my firstborn son was 2 going on 3, he could do 100 piece puzzles from memory.  No box, no pausing.  Just snap, snap, piece after piece together.  Like a robot actually.  He even found out, by doing the puzzles on top of each other, that some of them used the same template!  For a toddler who didn’t talk yet or even say “Mommy” or “Daddy,” this was strange to us. Then when combined with some of his habits like walking on tiptoe, spinning and crashing cars (but not really playing with them), memorizing long scripts from video, repeating himself, and not pointing or gesturing, we started realizing he had some of the autism signs.

In fact, when we read down the lists of symptoms, he had lots of them.  He had language delays, some social and emotional issues, and some of the sensory signs.  He seemed to have no imagination or interest in crayons or action figures.  But he seemed way ahead in spatial skills, knew all his letters and numbers etc., had great focus, loved to be cuddled, and generally seemed bright and charming.  His motor skills were great, and any non-verbal tests he got, he passed with flying colors.  Or things that needed one-word answers he could do.  He was way ahead in some cognitive areas and way behind in others.

Then my second son came along and was the mirror image of my firstborn.  Extremely verbal, very early, artistic and creative, but way behind in motor skills.  Emotionally unstable and very anxious, he had almost all the sensory problems common to autistic children, including choking issues, hatred of socks and tags, inability to cross the midline, and freaking out sometimes.  He didn’t bond well to others (except Mom) and couldn’t do puzzles or visual tracking activities.  So even though he was talking, imaginative, and sociable enough in his own way, HE was all over the charts.  And thus possibly autistic.

Then my third boy came along.  You know the story by now.  He hit some milestones right on time (i.e. walking), hit some way early (i.e. sentences by 19months old), and some way behind (i.e. toileting issues until his fourth birthday).  And he had some strange issues (i.e. severe fear of water).  By this time, however, we had trashed the charts.  We figured he was fine!  He didn’t have to love everything 3 year olds loved, he didn’t have to talk like 3 year olds talked, and he didn’t have to fit in some “autistic Spectrum” bucket because he had some emotional immaturity. And now that he’s nearly five, we’re SURE he’s not autistic!  (or any of our other boys either).

So this is my encouragement to you if your boys are geniuses at some things but embarrassingly behind at other things.  Do you know that book, “Men are Like Waffles and Women are Like Spaghetti”?    That book effectively describes how my little boys think.  Their brains are like waffles, with separate compartments for each kind of skill or knowledge.  They can dive in real deep within any one box, but the knowledge doesn’t seem to transfer over into other boxes or compartments.  The connections aren’t there, and there isn’t much infrastructure to help them build up their weaknesses. So they grow very unevenly.  It can be worrisome for a time because their strengths get stronger but their weaknesses seem to get weaker, especially when you start comparing them to other kids.  3 year olds tend to be the most diverse.  Sometimes therapy doesn’t even seem to make a difference, at least not right away.  Little boys just plunge ahead with their strengths (what they naturally get) and prefer to stay there, enjoying it and totally oblivious to your concerns that they aren’t “normal” all around.

Consequently it is now no longer surprising to me that my six year old son currently can take apart radios and electric circuits, but doesn’t understand that if he stands close to the stairs, he might fall down them.  My almost 5 year old son can talk to me about heaven and dying, and what he wants to be when he grows up, but still hates even the tiniest drop of water on him or will change his underwear or socks if they get a speck of dirt on them.  My seven year old son currently can pass second and third grade English and Math tests, on paper, but has a five year old’s vocabulary, says “What?” a lot, and uses awkward phrases all the time.  They are just not even developers.  Some things way ahead and some things behind.  Some normal habits and some strange idiosyncrasies.

In comparison to my girl, who is precocious socially and emotionally, and has met every deadline on time, there is just no similarity.  My conclusion: It’s ok for boys to be uneven and worrisome.  That’s just often how it goes.

The Shy Child

I am entitling this the “shy” child, although one of my sons who prompted me to write this is perhaps not the typical “shy” child as much as the cautious or worried one.  I have been studying this behavior a lot recently and, now that he is turning six, looking for appropriate ways to help him conquer fear and anxiety, especially socially.  He has basically had this problem since he was little.

Looking back, I can see that he was even a “shy” baby.  He was small and weak, clingy but happy.  He was easy—didn’t cry a lot, napped all the time, yet sometimes wouldn’t hang onto a feeding enough to get the full amount.  He gave up easily, grew up behind his physical milestones, fearful of trying to walk, and screaming his head off when I walked away from him, starting at about 8months old and ending I’m not sure when.  Probably at 16 months when he finally tried walking, and found out he could do it perfectly by then.  Toilet training was a nightmare, separation anxiety was terrible, and he sucked his thumb for a long time.  (He still does, only at night though).  We found out he had a barrage of sensory and motor issues, got him occupational therapy for that, and would stutter when he didn’t get enough sensory input that day.  He generally liked people though, he was exceptionally bright and talkative at an early age, and taught himself to read.  I never had any real concerns.

This may or may not describe your child, but the point is that the shyness and fearfulness began at an early age and it has been tricky to help him grow out of it.  We have only just gotten to the place where he was ok enough to do kiddie gymnastics at the YMCA.  He breaks down and cries so easily that most classes are a nightmare.  And most teachers don’t have enough patience!  Let’s face it… I don’t always.  I have a unique empathy for what he’s going through, as his mother, but sometimes I can’t handle an avid crier.  I  just can’t understand why games are not fun, competitions are so threatening, and most stuff he won’t even try.  And I don’t mean like trying out for the soccer team.  I mean, like he won’t try to throw a nerf ball through the Little Steps basketball hoop.  Or use a friend’s kiddie tramp in the yard.  Little things, you know?

Well, now that he’s older (6yrs) and so precocious, I have been able to have some good conversations about it with him.  And I’ve been reading up on the subject.  And here are some things I have learned, which might help you deal with your clingy and fearful one.  (I can tell this is going to be a long post, sorry!)

1.  Shyness is not a crisis. Don’t panic!  (Maybe I should have said, “shyness isn’t autism” =)  Even though it seems that everything for little kids in America is geared towards sanguine, extroverted children, eventually the more reserved ones will fit in.  For kids who are wary of excitement, the world can be a tough place.  As parents who want to see our kids happy so much, we just have to accept this.  There are melancholy types, and we may have one.  My second son is a stereotypical Eeyore, Gloomy Gus, or whatever and it has been a little difficult for me to accept this.  Yet I see the wonderful things God has placed within him which are going to make him successful when he’s older.  I see his empathy, thoughtfulness, gentleness, carefulness, and discernment.  He is analytical, scientific, extremely emotionally aware, and will probably end up in a counselor, teacher, therapist, doctor, or otherwise helpful role when he’s an adult.  I don’t want to squelch this even though I get frustrated that he won’t join in the Uno game or kiddie pool =)

2.  Share the positive things with the child. Whereas my other three kids are blissfully unaware of their strengths and weaknesses, and charmingly prideful about everything, my shy child is painfully self-conscious.  This makes it all the more important to start teaching shy children about themselves.  They are ready to hear it, actually, since they are already thinking about it.  And if I don’t interrupt the “bad tape” that my son is playing inside his own head (“I can’t do this.  I’m too short.  I’m not good enough…”) then it will take over.  I have to replace that bad tape with a “good tape.”  So I do this by sharing those good things I see… how neat it will be to see what he’s going to do when he grows up.  Even at 5yrs old, he was thinking about it and whether we have an accurate vision is not the point as much as it is that there is a purpose for his personality.  (Always approve of any idea they have, about what they want to be when they grow up, even if it is ridiculous or a bad fit.)  Subconsciously, I want to shift my child’s perception of himself from “my problems are my identity” to “I’m destined for great things, so I can overcome the challenges.”  Sort of like talking to the average 13 yr old who feels inadequate!

One way to help a little child who’s insecure is to draw a picture of a big bucket and put their name on it.  Then talk about what good things go in that bucket, like “kind” or “thinker” etc.  You can list these things and draw arrows into the bucket, and then put the picture somewhere they will see it a lot, like on the frig, or over a desk.  For non-readers, draw a small picture next to each word, like a heart next to “kind” or a thinking face next to “thinker.”  They will soon come to know these words as they see it daily, and you can bring it out when you have your talks.

3.  Teach positive thinking. This is kind of the same as #2 except more practical.  I actually teach my son to narrate what he’s doing, sometimes, instead of playing his “bad tape.”  The ol’ standby of “I think I can, I think I can” is ok, but my son is such a realist that “I’m putting this lace around this one, and then I’m pulling through” is better for him.  It replaces “I can’t do this, It’s too hard” while he’s practicing tying his shoes.

Also related to this is watching your language.  Shy is not a bad word, nor is sensitive, and the reserved child needs a vocabulary to talk about the issue as they grow.  Yet the shy child already feels like everything they do is under a microscope.  They feel that the problems they have are huge, but their strengths are insignificant.  If you’re careful how you speak, it can reverse this kind of thinking.  Obviously try not to scold or criticize, but more practically, try to give instruction instead of correction whenever possible.  And when appropriate, sandwich the instruction within two loving statements like, “I know you’re trying really hard to do that right, which is great.  I think you have to hold the bow in one hand while you loop with the other.  Then it will be easier.”  Pretending like everything is NO BIG DEAL is key.

4.  One-on-One time is huge. The shy child tends to appreciate the one-on-one time the most.  All kids need it, but the more tender or reserved child often doesn’t get it because they aren’t around as much, or are gentler, or whatever.  So make time and go get them if they won’t acknowledge the need to come to you.  And beware of leaving the child who plays alone in the corner, alone.  They probably don’t want to bother people, or have conflict, but direct eye contact and engagement goes a long way in warding off problems.  In particular, it keeps them from developing passive aggressive behavior later on, when they realize they need things but don’t know how to communicate or get what they need the right way.  Connect, connect.

One of the best ways to do this is create a personal ritual.  It can become very valuable to them, even if it’s just a bedtime story, or a weekly Saturday breakfast out, or whatever.  Even a non-demanding two year old is able to pick up on a ritual like this, and enjoy munching a bagel with you at Panera.  It tells them “I love you, and I like being with you.”  This will counter that negative tape they play and make them happier inside.

5.  Reward and Celebrate courage. The shy child is reluctant to engage social activities often because they have performance anxiety.  They may not know what to say, or to do, and so they are afraid of getting in the game.  And they may feel pressure to get things right the first time, do a good job, etc.  Knowing what “should” happen or what going to kindergarten “should” feel like causes them great cognitive dissonance as things “actually” happen or they experience what they “actually” feel.  Then they feel guilty or ashamed.  It is a very adult-like trap, really.  It takes some undoing.

Part of the undoing is to obviously teach as many skills as possible.  Shy children in particular need to learn eye contact, hand shaking, phone skills, manners, and what to say when they don’t understand or don’t know.   Many cannot turn off the fear or waterworks once they start, and they shouldn’t feel ashamed for it or convinced out of it until they’re ready.  Time-outs are often helpful.  They also need to practice with non-threatening people or contexts (even stuffed animals!) if actual performance is involved.  But once teaching and practice are done, then the key to reward and celebrate when they step out.  For another child, starting a conversation is not worthy of praise, but for the shy child, it is.  Speaking up, telling someone what they need, asking for help, trying something new, going to a party, singing in circle time at nursery school, offering help, etc…. all these things should be taught and then heavily rewarded no matter what the results are.  I’m not against giving shy kids candy for rewards.  It is a very tangible and non-consuming way to tell a 4yr old, “Great job.  I’m happy with your effort.”  Now with my shy child, giving him the incentive of an M&M to do something is different… it doesn’t work because then he feels all this pressure to perform to get that M&M.  This actually shuts him down and makes him cry.  So do negative consequences being threatened, obviously.  But an incentive is different from a reward.  His face does light up when I catch something good and reward him for it, probably because there was no pressure or expectation involved.  Find a balance, but reward based on the effort not the outcome.

6.  Get sensory and motor issues checked out. For my son, some occupational therapy (and now kiddie gym) has gone a long way in helping him deal with his anxiety.  Not every shy child has sensory issues, but probably more do than we know.  When a child actually feels everything too loud, too fast, too bright, etc., the world is an overstimulating and scary place.  Getting some occupational or physical therapy can raise their tolerance levels, as well as give them non-threatening one on one attention in the areas they need strength.  When I first sought testing for my son (then just 3yrs), everyone was so worried because of his fears and crying during the exams.  They thought he was depressed, had generalized anxiety disorder, and needed a neuropsychological exam.  I feared that only medication was down that path, so I persisted in my quest to take the more physical route.  I truly believed strength and self-confidence was at the root of the anxiety, so I insisted we try that first.  What do you know, it worked!  So if your child is afraid of parties, gyms, playgrounds, malls, etc, it is definitely worth checking this out.  My son not only hears the lowest sounds on the hearing machine, and sense all touches and smells more than anyone else, but he has bad visual discrimination skills so he can’t spot things well.  He can’t see me in a crowd, see Daddy coming back to the car, sense where he is when he turns a corner in the library, or get to the trash can and back in a restaurant without getting confused.  This of course contributes to startling and anxiety but is, thankfully, one of the easiest things to work on at home through worksheets, I Spy/Where’s Waldo, puzzles, and other visual tracking activities (try “Slow and Steady, Get Me Ready” by J. Oberlander for preschooler ideas.)   In my opinion, if there are sensory/motor issues behind social anxiety, you’ll never get the shyness to abate just by tackling them psychologically.  They need skills and desensitization too.

Play Therapy

What is play therapy, and how do I do it?

If your child is on THE SPECTRUM or delayed in other ways, you’ve probably heard of “play therapy” by now.  Play therapy became popular in the 80s and 90s as professionals found out that getting down on the carpet with their autistic-type 2yr olds, and engaging them, actually made progress.  You’d think this would be obvious, but it wasn’t something that the professional community had necessarily thought of before—at least, not given at regular doses like “therapy.”  Before that, professionals were… well, professional.  They sat in chairs and had nice offices with toys, but they administered tests, tried verbal exercises, and had children do activities mostly in chairs and desks.  Not exactly the comfort and freedom a child is used to.

Early Intervention is essentially “play therapy,” often mixed with speech therapy.  A trained special ed person comes to your house and plays with your little guy for about an hour.  She has a bag of toys with her and knows what’s she’s doing, but it is essentially play to engage your child with his or her weaknesses right where s/he’s most comfortable… on the living room carpet. Genius, right!

Well, the good news is you can do play therapy yourself too.  If you suspect your child is having developmental problems, if you know they do, or if they don’t but you’re just looking for some more educational time with them, play therapy is a great option.

For the bible on the subject, check out Stanley Greenspan’s book (

Amazon.com: Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think (A Merloyd Lawrence Book) (9780738210940): Stanley I. Greenspan, Serena Wieder: Books

).   But if you don’t have time for that kind of thing, here’s basically what you need to do. (For ages 0-5).

1) Pick a space and time to do it.  Mostly for you so you’ll stick with it, but also because the routine will minister to your child if they are hostile to the idea at first.  Most kids love one-on-one time, but some don’t!   Make sure it’s a nice comfortable place with space to play.  Also make sure it’s not a naturally grumpy time for your child.

2) Set aside some special toys for the time. You don’t have to spend a fortune at Toys R Us, but do consider getting some things that will make the playtime special and familiar.   And imaginative since that is usually an area most playtime kids have trouble with.  Sometimes this means just some props that you think of using a dozen different ways (i.e. a paper towel tube).  Sometimes this is a favorite toy that a child will love going back to (i.e. a little Bob the Builder set or Dora figures).   There is merit in some of those toy companies like Imaginarium and Alex that make educational toys for kids, but use your own judgment.  (Try not to pick anything too complicated or messy, which will discourage you or your child from wanting to do it again!)

Also, check out a book like Jane Oberlander’s “Slow and Steady, Get Me Ready” (

Slow and Steady Get Me Ready

) Her book is based on daily different activities you can do with ordinary household items.  You can incorporate a couple of these into your routine and change them out as necessary.  Love it, love it.

3)  Start with about 10 minutes for a reluctant child and work up to about an hour.  Start a couple times per week (i.e. MWF) and work up to every day (or even twice a day) depending on the severity of your child’s diagnosis.  Think of it like little doses of preschool.  It is the concentrated attention regularly that constitutes “therapy” just like at a real therapist’s office.

4)  Ok, just start playing with your child. Bring out one toy and set them in front of it, to see what they’ll do.  This is child-guided play where you facilitate.  Don’t jump in with your whole script and ideas.  You’re “peering” here.  And you’re building off what your child does.

It helps to have some goals in mind before you start, so know whether your focus is going to be physical, emotional/social, imaginative, language, memory, etc.  Your child may have a combination of goals, but try to target no more than two in a session.  When your child gets frustrated with a toy or can’t use it, then try another.  Don’t go through your props like you’re trying to please the child’s whims, but don’t exasperate them either.  You’re going to eventually spend time with everything you’ve got, so do some stretching.

5)  Engage their attention. Play therapy is especially good for children with social, emotional, attention, and empathy problems.  They may not recognize or want you there in their space, and that’s fine.  That’s part of the therapy.  What you want to do is engage them, or sometimes gently confront them, especially if they are autism spectrum.  If they jump their little horse up and down, you jump yours up and down near them.  If they get stuck spinning wheels, you crash your little car into them (gently) saying “Vroom vroom!”  Try to get them out of their world and into yours.  If they’re verbal but hostile to you, or turn away, aim for the gentle but stubborn approach.  It helps to do this in a room where you can close the door so they can’t run away.  Make sure you hide other toys too, so they can focus on you and the props you have chosen.

6) Use toys vicariously, to get them to verbalize their experience. If they don’t talk, this might be one of your main goals: to get them to “talk” with their pieces. There are some ways to play with toys if your child is having trouble with language or imagination that I have listed in other posts on speech.  This is the first level of play therapy, to get them to be verbal. (i.e. please keep in mind that age-appropriate speech varies widely, and you shouldn’t be making speech a huge goal if your child is under two.)

The second level of play therapy occurs when your child becomes (or is already) verbal.  Now you want to use their toys as “counselors” or “mouthpieces.”  Don’t talk to them directly, use your piece.  Get them to talk back with their piece.  Kids will tell you all kinds of things if you let them talk through their pieces, about all kinds of things that upset them.  You can also teach all kinds of things through your pieces that they wouldn’t listen to you, their mom, about.  Now the playtime isn’t a teaching time, it’s an understanding time.  But a good therapist DOES use toy “mouthpieces” therapeutically, say to discuss the toilet or a source of a bad dream, etc.  Use your imagination.  Keep it pretend and in the realm of playing a game.   And if you’re going to teach or talk about something, stick to one theme per session so the child doesn’t feel lectured.

Hooray!  You’re a play therapist!

Oppositional Defiant Disorder (ODD)

With the exception of branding our preschool boys autistic, nothing makes me madder than a diagnosis of Oppositional Defiant Disorder.  This is one of those retroactive “syndromes” that describes a child’s problem rather than lists a cause.  Getting a diagnosis does little more than relieve you that a professional thinks your child is as bad as YOU think s/he is.

I don’t say this because ODD isn’t real.  It is real.  I have seen the videos where clinical psychologists interview bunches of young children and diagnose some of them with this disorder.  The children are generally younger than you’d think (i.e. 4, 5, 6), violent, swearing, and have a fascination with things that they shouldn’t.  They are precocious, smart-aleck, psychologically astute.   They generally cannot stay seated in the psychologist’s chair, they may spit or verbally attack the professional, and they often make physical motions or get too close for comfort with their caretaker (like getting in their face, literally).

So it’s real.

That said, it’s an awful diagnosis—not worth getting, if you’re wondering.  Now i”m not talking about older children, like teens adopted out of the foster care system, etc.  I am talking about your unhandleable preschooler or kindergartner.  Now regular kids of this age can stretch you to your limits, so be careful how sensitive you are to this!  ODD is an extreme form of disobedient repertoire, and one that an overtaxed parent or teacher might not understand.  But if your child is suspected to have ODD, remember that for the most part, ODD at a young age is something that is created, not there at birth.  Now you may very well remember your baby being difficult from birth!  I am not saying that they weren’t a grumpy baby, or a colicky one, or hostile to affection, etc.  But children do come out of the womb grumpy.  They don’t come out ODD.

A really great book for those experiencing mild ODD with their young child is The Pampered Child Syndrome by Maggie Mamen. 

The Pampered Child Syndrome: How to Recognize It, How to Manage It, And How to Avoid It-a Guide for Parents And Professionals: Maggie Mamen: 9781843104070: Amazon.com: Books

.  This book outlines a lot of ODD behavior but without the label and stigma.    Basically what it comes down to is that a permissive parenting style (mixed with your child’s unique temperament) can create a pampered, bratty child who is characterized by a lack of response to authority—the same major criterion of ODD.  We’re not just talking about the bratty children on Jo Frost’s Supernanny show… these children mainly suffer from a lack of childtraining.  But we’re talking about the next level of difficulty… children who actually don’t seem to recognize authority for what it is.  An ODD or ODD-leaning cihld is not very different from an autistic or Asberger’s child in that they have to be taught to recognize the context of structure, authority, obedience, etc.  They won’t pick it up on their own.  Although here is the good part—they are ABLE to pick it up, it is just that they choose not to.

So that is where you, as the parent, come in.  Your job is to take back the job that was stolen from you.  If your child is 6 or under, you’re lucky because it can be done.  You can use small child behavior modification  tactics that will help a lot.  (Get a season of Supernanny on DVD anyway, just for tips and impartation).  But the main thing you need to do is not enforce time-outs per se, or adopt some parenting trick.  What you need to do is examine yourself.  Examine your sense of boundaries and consider if you have codependent attitudes.  While a spouse might withstand codepedency, a child relationship will not.  Consider why it is hard for you to say no, disappoint someone, let someone not be rescued.  Consider if and how much you draw life from making others happy, or if you overesteem your own relationships in general (i.e. Do you idolize being a mother, wife, etc?).  If any of these kinds of characteristics typify you, as they do in some degree for all mothers, then seek help for yourself first.  Otherwise it will break your heart to do what you need to, in order to rescue your ODD child.

The main problem with the ODD child is the invisible dynamics in the household.  It is the subtext, the unspoken.  This atmosphere is mainly made up by your feelings and beliefs about yourself as a person and parent.  They have to change in order for your child to change.  That is why the kids on the Supernanny show mouth off to their parents but they never mouth off to Jo.  It is because of the spirit of conviction and authority that comes with her.  This is what is right, and what you need to develop.  If you can’t stand that idea, or you think that it’s wrong to be an authoritative (not authoritarian) parent, then this is where Step One begins.   Step One is over when you realize that the results you’re getting in your ODD child is the logical extension of your emotions and beliefs.  It’s not random and you’re not a victim. You have a lot of power in this relationship, power to influence your child for good.  And you’re going to have to use it!

When you finally finish Step One, you’re ready to start boundaries in your home.  You’re ready to stop the welfare state—where you do all the work and the kids just receive.  The sense of entitlement your ODD child has is partially what’s making him or her bitter at authority.  They have to get rid of that entitlement feeling in order to respect authority, limits, work, or whatever thing they hate.  When the bitterness is out, a lot of the anger will go with it.  And so will any depression or anxiety they likely also have.

I’m sorry, but development charts are for girls

I have been waiting for the right time to write this post. In the back of my mind, for the last year or so, I have had this feeling that baby development charts are for girls rather than for boys… and now, as my little girl turns two, I am more convinced than ever.

For the record, let me state that I have three boys, right in a row (5, 4, 3yrs), who are all very intelligent. They are very different from each other, too, and some developed ahead in areas where their siblings were behind, and vice versa. This is post is not about stereotyping or maligning boys. I love them, and they are very, very special.

But when my little girl arrived on the scene (last), I began to notice that observing her development was a different experience entirely than my boys’. Even my husband noticed, and he normally has no eye for these types of things. We mainly noticed that she needed hardly any “education” that our boys needed… just magically, she developed on her own, usually right on or before the standard developmental landmarks. Mere exposure seemed enough to teach her things.  And she picked up vocabulary easily, like with one use of the word. We didn’t have to have little lessons with her, or teach her to talk, teach her to use her imagination, or teach her social/independent skills like how to come get Mommy when there was a problem. With little siblings to watch, she just picked them right up. Her language comprehension seemed way ahead, and she was able to follow one -step then two-step directions very early. She was even ahead (by months) in the physical timetable, walking by 10months etc. We didn’t have one worry about her development, and every time we checked in with her doctor, or we consulted a book, she was right on time.

This was just not the case with my boys, whom we worried over continually, at least in isolated areas. Even with my third son who had siblings to watch, there were still things to teach, to make sure he got, to clarify. Each boy had areas where we felt like we were constantly trying to make sure didn’t decline when we weren’t looking: with one boy, it was language; with another it was gross motor skills; with another, it was independence.  And the charts, with their icons like “two words put together at two years old, three words put together at three…” were absolutely no help; I never saw that with anyone.  We were very diligent about making sure we had educational toys, videos, and ways of interacting. And it wasn’t all for naught, nor was it bad! It was just different: my little girl needed almost nothing to thrive.

Now that my little boys are slightly older, and stronger in their initially-weak areas, I realize that the developmental charts caused more panic than necessary.Their development, as male, was simply different than female. My girl was essentially learning through relationship, imitation, communication, and observation.  And she learns while multi-tasking (i.e. wants to sit in your lap, hug a bear, read a book, and have a movie on, talk to you, all at the same time).  My boys essentially learn individualistically, through personal practice, by analysis, and order/sequence/rules.  They process one thing at a time, not unlike my husband who can’t talk with the radio on, and do well with systems, routines, structures.   My boys, even at 1 and 2yrs, had all kinds of skills not on the charts, especially in their strong areas, but were spotty in all kinds of areas for their first four years.  And their verbal development is very different in nature than my girl’s, even though I had one early talking boy who is still very insightful verbally.  I can see why it was harder for them to excel in some areas because they are more “in their own little worlds” than my girl is. They are also more singularly-talented instead of well-rounded, and personality-typed/consistent.  Socially, they have higher walls to climb, and more carefully constructed inroads, than my little girl.

In fact, when reading special needs literature, I realized there was a careful (but important) boundary in describing the qualities of special needs children from just boys in general!! Many of the descriptions, especially in the areas of language and social skills, sounded like my boys at times; never about my girl. I believe this is why boys are so much more likely to be classified as autism spectrum or developmentally delayed. I am certain this is why so many boys end up in special ed preschool, compared to girls.   They are more likely to be one-sided in development, harder to engage, and/or harder to teach.

So my conclusion, after six years of raising three little boys, and two years of raising my girl, is that we have to be careful not to pathologize our boys. They may be slower to mature than girls (at least, comprehensively) or in some way more delicate, more susceptible to autism and other disorders. But this should call us to perhaps reverse the de-genderizing trend of the world and re-discuss any patterns that are inherent to male development, versus female. Of course we don’t want to confuse personality, gifting, or birth order with gender. We don’t want to say girls can’t be aggressive or boys can’t be verbal.  They can be!  But the human world observes gender differences that the Academy seems adversed to.  I  would be interested in seeing if there is correlation of gender to learning style or processing style. And seeing if there are timetables that are more relevant to boys as opposed to girls, just as height and weight charts have long documented. Perhaps there will not be, and I will be proven wrong. But perhaps there will be, and the mothers of boys in future generations can be spared much anxiety as they have charts and milestones that accurately represent their sons.

Imagination Skills for Special Needs

This post is about how to encourage imagination skills in special needs kids.  Most kids develop imagination skills naturally, and patience is the ideal route.  But a number of delays hinder the appearance of imagination skills, so if your child is around 3 with no significant pretending ability, it is worthwhile to try teaching imagination formally.  The hope is that this formal instruction, while rote, will provide the intermediary steps necessary to trigger the revelation in your special needs child so they can pretend on their own.

There are several levels of imaginative ability.  The first level starts with basic abilities to make-believe.  Some of the first things a toddler pretends are:

• talking on a phone
• racing a car or choo-choo train
• comforting or communicating with a stuffed animal
• drinking or eating

There are obviously all kinds of other things a toddler may pretend, but these things are what I would start with, if I were doing it all over again.  Turn everything into a phone… make one out of legos, use your fingers, get a toy phone or let your child use your cell phone (a privilege most preschoolers love!).  Get them to realize they can “talk” on it even if they aren’t talking yet for real.  Once they start babbling in a phone, rejoice!  They have crossed over from realism to imagination!  Even if it is just “hi” and “bye bye”, that suffices for a developmental checklist.

Do the same with toy cars or trains.  Fire engines and Ambulances with sirens, or planes that whoosh over head are fine too.  Get loud, get obnoxious, exaggerate, and repeat.  Most little toddlers can learn to imitate this very quickly even if they have significant cognitive or verbal delays.  It is a great step for possibly autistic kids too because they stop looking AT the car and start making it do something.  This is an excellent goal for autism spectrum preschoolers.  Just get them to swipe a Matchbox car back and forth and VROOM on the carpet, and you’ve made a leap.  Work on diverse transportation vehicles and noises once you see them offering the VROOM VROOM on their own.  Take the car and encourage them to run it around the room on the wall or over the sofas… lots of boys love the bumps on furniture or the “forbidden” places you don’t want them to run a car.  But take advantage of this with a delayed child because it will trigger interest.  Just make sure they don’t get distracted with the sensory qualities of the car or props.  You want them to focus on the skill of pretending to “drive” and make noise.  “BEEP BEEEEP” when something is in the way, etc.

The same goes for stuffed animals or pretend food.  My girl picked up the animal thing quickly but my boys weren’t really interested.  The developmental tester would always ask if they could feed a bear or put a blanket on a dolly, and my boys in general could not until they were older.  But they could do the pretend food, so go with that if necessary.  For animals, first just get them to hug or pat them, “awww bear.”  That sort of thing.  Then give your child a cracker and say, “Does your bear want one too?” and try to feed it to the bear making the “MMM MMM” noises.  Pretend to feed or give the animal a drink often and they will get it.  Then you can extend to more elaborate rituals including putting to sleep, etc.  Skip the stuffed animal if your child doesn’t understand modeling or empathy yet.  Just get them to pretend eat or drink with you.  Use plastic food, playdoh, legos, or real (empty) utensils… whatever.  But use exaggeration and repetition until your child can imitate and make believe with the food themselves.  “MMM MMM, I LOOOOVE hot dogs!” as you pretend to munch the plastic.  “And orange juice?  My favorite!” as you slurp the empty cup.  Let them just watch you if necessary—sometimes that is the first skill with a disengaged child.  But once your child reaches out to imitate or acquiesces with your prompting, he or she has taken the first step.

Secondary Abilities

Many toddlers and preschoolers can master the first imaginative skills listed above but get stuck on the secondary level of make-believe.  They may be able to mimic simple noises but can’t go beyond or elaborate. My first child who had auditory processing problems was stuck at the basic level for maybe two years.  I would give him crayons and he couldn’t draw more than scribbles or smiley faces.  He didn’t seem to be realizing he could do other things, even when I modeled them… didn’t ask me to draw anything.  I would give him playdoh and he wouldn’t make anything except a rubber “snake” over and over, or squishy “carrots” through the squasher.  I would give him farm animals and he would just move them around.  He couldn’t play with action figures at all, or make different track patterns with his train tracks.  When his scripts did get more elaborate, they were always what we had done before in a teaching session and rarely changed.  He seemed unable to really have fun, think about new things, or make things up.

To this day he still isn’t really imaginative, so I’m not sure how much was just his analytical personality!  But we worked hard for almost two years to get his imagination working for him… he just seemed so bored.  One day when he was four, I heard him talking to himself, “Tell the animals what to do… what to do… what do the animals do…” as if he were articulating the mantra in his head which his preschool teacher had been using.  I knew his breakthrough was coming, but it took six months for him to actually be able to tell his animals what to do!

The main thing which helped here was play scripts.  Play scripts are pictures which show a steps in a play sequence which the child can visually follow.  One of my son’s early play scripts in preschool was with a toy barn and horse.  The first picture (laminated, on a large key ring) was the horse outside the barn.  The second picture was opening the barn.  The third picture was the horse going in the barn.  The fourth picture was the horse eating some hay in the barn.  The fifth picture was the horse exiting the barn.  The last picture was the barn closing.  The teacher had my son run this play script several times until he could do it pretty rotely.  Then she changed the script by taking out a card and replacing it with a new one (the horse taking a nap in the barn). This type of changing the script around, adding new things or taking them out, or mixing up the order helped familiarize my child with the barn and horse until he was interested enough in trying to play with them without the cards… maybe he would run the script on his own during freetime but without the cards.  Then he would remember some of the new cards in the script and start changing things so it appeared as if he were using his imagination or doing some novel thinking.   This repetition was actually an important part of the imagination process because a delayed child needs to be super familiar with things before they feel interested or invested in changing them.  A script makes the child less intimidated; it shows them exactly what to do.  Also a delayed child needs to repeat something many times before they are able to leave the script behind… more than the average learner.

Another thing which helped was getting action figures from Bob the Builder and a number of Bob videos to watch.  Then we’d start acting out the movie scenes together.  Eventually, after doing this for awhile, he was able to start changing things in the scene… just one little thing at a time, but one day the revelation came and he was pretending his own thing with them.  Hallelujah!!! It was worth the money.  From that point on, he sometimes went back to the scripts but could use them as a jumping off point all on his own and he never retreated back to boring land.

Other imagination tutorials I remember doing with my son in his preverbal days were:

• pretending you’re a helicopter (spinning)
• pretending you’re different animals with your body (dog, frog, snake, etc)
• putting on Daddy’s shoes and pretending you’re Daddy
• thinking of as many ways as possible to use a prop (like a bucket)
• making a card for Grandma (let your child decide what to put on it)
• making an impression of a favorite cartoon character, especially with your voice
• pretending all the cars are in a race—who will win?
• pretend camping (using a real tent and sleeping bag are extra fun!)

Preschool Abuse, or IEP Tyrant!

Every day I hear from moms who feel like their preschools are scaring them into believing there is something wrong with their little children.  In my opinion, this is an abuse of authority.  While most people would be so glad to have a top-notch school with excellent staff and resources, there is one negative thing that often comes with this great package: control.

I personally live in a state where the public school’s control is appalling.  Teachers are allowed to teach homosexuality to first graders without notifying their parents first, prophylactics are given to high schoolers, homeschoolers are weeded out, state testing is crazy, and the DSS is called on cue for anything.  I believe in School Abuse.  But to see authoritarianism at the preschool level is more disturbing.  And it happens all the time.

Schools that can afford to have resources and experts often end up usurping parental control. When you are dealing with little children, however, this is unacceptable. A teacher can frighten a parent into thinking their three-year old has a major disorder just because he or she shows some of the symptoms. They have a panel of experts there to test and diagnose, and then the child is put on an IEP with a label until they can convince everybody that they don’t need it (i.e. never!). The IEP is a legal agreement so you can’t just cancel it or take it lightly… it is the manual that now comes with your child unless you refuse services (which in itself makes you feel like The Awful Parent). Incidentally, multiple labels can be applied, which is often the first step towards kiddie medication.  If you reject the IEP or labels, then the school can view you skeptically, as if you were negligent, and challenge you if necessary.  More likely, the kindergarten teacher will just try again to get your child on an IEP by pointing out everything he or she hasn’t mastered yet compared to the other kids.  You have to deal with this community and this school board as long as you live there, and you become tainted goods.

Who wants to go through that?

Most parents are afraid to stand up against a preschool staff of experts, usually because they themselves are worried that the experts might be right. What if their child IS autistic? What if they have some other developmental problem? We’re not experts, so we don’t know. And we’ve all heard for the last decade or two that children who get a diagnosis before they turn 5 (or 3) turn out fine whereas children who don’t have no hope! So the media frightens, experts confirm, and schools overdiagnose.  These types of things frighten parents into ceding control to a preschool… and then to elementary school, middle school, and high school… there is no easy way out

I am not making this up.  I am good friends with the special education teacher for the high school in our area.  I have sat in on many of her classes, and she has told me stories first hand of how kids get on this path from age 3.  The child is unruly or has a learning disability, the parent doesn’t know what to do, then the school becomes the parent.  The child is shuffled through the system with all kinds of diagnoses, growing up into them, and then signing their own IEPs when they have the legal right to.  Teachers, parents, and kids are stunted by these diagnoses on paper.  Now most of the kids I saw did have disabilities and/or some problems, but they were mostly slight or behavioral… “misfits” who didn’t talk or look you in the eye, probably had ADD, no study skills, and a below average reading level.  Most of them you could imagine being the three-year old who wouldn’t “integrate.”  They were NOT the handicapped group you think of when you think of the state so graciously helping special ed kids get an education (which should be commended).

In my own son’s journey down this path, the preschool special ed teachers themselves were excellent. I am not writing this to discredit teachers or special education. I have several friends and two family members who are in the field, and I completely understand their care, concern, and liberty in taking care of special needs. However, as a mom, I maintain that it is completely unacceptable for a group of unknown experts to make me fear what’s wrong with my child. And then to provide the program and solution for me to ease my fears, as if they can handle it from there. This is precisely what happened when we went down the public preschool path with my first son. (And then had to consider it again with my second son.)

There is so much fear out there!

The special education services my child received were good. And he started developing more typically, which was relieving. But the whole experience made me feel so out of control, inadequate, afraid to parent, etc. I was supposed to know my child best and be his advocate, but it was clear that the public school staff were just feeding me a line when they said those things… they didn’t want me to ask questions or get involved beyond visiting the class if I wanted to. They came to my house every month to see if there was anything obviously wrong about it/me, they asked me to implement some of their learning props at home, they failed to call or email me about what was going on (a necessity when you’re sending off a three-year old that doesn’t talk!), and they ignored behaviors we felt were unacceptable. They had me come in for meetings with their directors where they said scary things to motivate me to sign the IEPs, they discouraged me from refusing services when my son turned five (telling me I could have a lawyer present if I wanted), and they threatened me that if I moved him to another school and tried to mainstream him, that everything might look rosy for awhile but then he’d probably take a turn for the worst in third grade when things get substantially harder… after all, that’s what happens to special needs kids who don’t get their special needs met!

It was crazy!

All of a sudden, my life was turned upside down. My child was given a label and a price to fix his label. And i was willing to pay that price because I wanted him to talk so bad. I wouldn’t have been able to live with myself if I’d said, “No, I don’t think he’s that bad. I’ll keep him at home another year and see…” but then he’d turned out to have a “real problem” and needing to be held back. What kind of mom could consider that?!

So I was a victim of Preschool Abuse.

When it came up the second time around with my next son, I was wiser. I skipped the school services route and found a private therapist. This experience was much better, but it was still full of icons and fear. What if he was four and still hated swings?  What does it mean that his stuttering is getting worse?  First he only needed occupational therapy. Then they added physical. Then he started regressing and crying so they wanted a neuropsychological exam. And all this for a borderline kid… not a classically disabled child but for an anxious and sensitive one with some motor delays. It really was over the top but I liked his therapist too much to quit. Plus, I was wiser.

From the feedback I hear on this blog, and from some friends of mine, I believe I am not alone in this experience. I believe many moms in their nice neighborhoods with their nice public schools are going through the same thing.  Mostly this is a first-time mom trap, but not exclusively.  I am eternally grateful for the civil servants in my area, but when those lovely  benefits turn against me to work fear into my heart about my children, I am not a happy camper. And I am certainly not happy when the childraising expert elite (many of whom have not even HAD children of their own yet!) try to talk to me about my child as if they had given birth to him.  Parents need to be bonded to their children completely, and not scared into doing somebody else’s will. Their agenda needs to incorporate professional feedback when it comes to possible developmental problems, but the medical establishment out there has gone overboard… and developmental or psychological handicaps ARE part of the medical establishment now. Your pediatrician, your kid’s teacher, the speech pathologist on staff, the directors of the public school, the media… all are on the bandwagon now. And once the foot is in the door for you to give your authority over to those people, who all know more than you to be sure, you are likely to keep ceding that authority again. You’re likely to feel like your kids are completely out of your control, and you’re just hoping that by the grace of God, they’ll somehow get through it and become successful adults.

This “hang on” approach is not healthy. Boundaries should be permeable but are absolutely necessary.  So when it comes to Preschool Abuse or Expert Abuse, I encourage you to reject it. Don’t throw the baby out with the bathwater, but protect your kids like the mother bear you are. Everyone will be better off for it.

What is Asperger’s Syndrome?

I wanted to write about Asperger’s because many people suspect that their child has Asperger’s from reading symptom lists. As soon as they see their preschool child has some autistic symptoms but not the language delays, they will start wondering. (See my post on “It’s not all Autism” for similar commentary about this problem.)

But very few preschool children will be diagnosed with Asperger’s, and my personal belief is that in most cases, it is better to wait until the child is elementary age to diagnose. This is because most of the symptoms are, in essence, symptoms of relational immaturity. All children start out with these symptoms, to one extent or another. It is not until the child is older that you can tell his/her relational experiences have not led to maturity. In some cases, there are definitely diagnostic tip-offs before age 3. But many Asperger’s sufferers have become adults before discovering the truth. It is definitely one of the hardest disorders to capture on paper.

When you encounter an Asperger’s child, you often know. But you may not know exactly what the problem is. An Asperger’s child has a peculiar orientation to the world. They seem in it, but not of it. They seem interested but not attached. They know a lot, but their knowledge seems impersonal. They give inappropriate or inadequate responses to interactions, such as speaking too loudly, off-topic, unkindly, flatly, etc. They often don’t make eye contact, don’t seem to be gauging your interest as they speak, and are resistant to manners, customs, and teaching about such matters. In social matters, they just don’t seem to be “getting it.”

These are just some of the symptoms, which can be symptoms of other autism spectrum disorders. Essentially, Aspergers is a social/emotional detachment disorder which is neurologically based (i.e. not based on circumstances, stress, or intention). The cognitive hardware that receives and expresses emotional/relational input is damaged. Have you ever had an existential experience, like at someone else’s wedding, where you see all kinds of people having fun and participating, but you don’t really know them? You feel distant from them, as an outside observer, and recognize that however genuinely they are laughing and relating to one another, you have no connection to them. Nor do you have the relational capital necessary to go over and just join in the conversation. This is sort of the way having Asperger’s is described. From self-reports, we get the sense that many of them are having the truly existential (detached) experience of the world where they are smart enough to rationally understand what is going on between people, but they are emotionally and socially hindered from vicariously experiencing it (entering in), interpreting it, and reciprocating it back (expressing to others). Thus they come off as awkward, disrespectful, or self-centered.

But keep in mind, Aspergers is not a character or personality deficiency—it is a neurological problem. The person is unable to recognize or engage within themselves what needs to be changed.

Depending on the individual’s intelligence and verbal abilities, Asperger’s people may be able to overcome a lot. But they have rely on memory for many manners and customs, and have to be taught explicitly about all the rules which other people seem to understand naturally. (Of course, as special needs teachers know, “naturally” is not exactly natural.) They have to be taught to recognize relational cues, including those from faces, gestures, and circumstances. They have to be taught context cues, which is very difficult for the analytical mind to grasp. Until those context cues are mastered (and many can really only be mastered by intuition or discernment), the Aspergers’ patient will have trouble with many holistic concepts such as:

Diplomacy (hurting another’s feelings, being polite, respecting ethnicity/differences, respecting different tastes/styles, resisting sensitive subjects, acknowledging or reciprocating others’ contributions, recognizing when someone is embarrassed, obliging oneself to be charitable, perceiving boundaries, respecting authority, adjusting one’s style i.e. based on family from acquaintance, old from young, sick from ill)

Conversation (letting others talk, using appropriate tone/volume/voice, responding to others, initiating properly, ending properly, chit chat, giving others time to think/answer, asking questions, knowing when they’ve talked enough, reading between the lines)

Posture (giving others space, not leaning, touching others appropriately)

Character (not being prideful, not being bossy, Golden Rule)

Receiving/Expressing (sympathy, empathy, apologies, thankfulness, compliments, praise, congratulations, help, relief, thankfulness, being proud of someone else, humor)

Identity (sense of belonging, understanding one’s heritage, understanding a history/significance of one’s own past, believing in traditions, forming one’s own convictions, experiencing freedom, valuing friendships, perceiving whether one is accepted, wanting someone to be intimate with–spouse, best friend, pet!)

So you can see why these types of things are too hard to judge in a preschooler… none of them have these abilities!

You can also see why other disorders, including learning disorders, auditory or sensory disorders, communication disorders, and personality disorders could also be possible diagnoses rather than Aspergers. One of my sons who has had language problems since he was a baby, for example, was stalled in much of his social development because we could not talk with him about these concepts until he was over four years old. Little kids start picking up things like empathy and manners as young as one and two years old (just little seeds), and acquiring that relational capital for more understanding later. But if you are hindered in relating to your child for any reason in those early years, they can show significant emotional or social immaturity. Firstborns, only children, and spoiled children can too! The key difference between them and the Asperger’s patient, however, is that the Aspergers is not able to understand 9internally witness) what you are talking about. The non-Asperger’s should be able to understand what you mean, even if he or she doesn’t have the skills to talk about it or change their behavior right away.

In closing, Aspergers is an auto-recognition disorder that is hard to describe but causes a significantly socially peculiar spirit to a child. Essentially, they have an overly analytical mind which does not know how to process social/emotional/relational information. They may underperceive input, or receive it but not know how to interpret it, or know how to interpret it but not know how to reciprocate expressively. Because the nature of relationships is synthetic and often highly contextual, the Aspergers child will have to be given an educational program that is able to analytically break down the concepts they are struggling with, as much as possible. And because of the challenge in capturing the Asperger’s repertoire on paper, you do not want to jump to conclusions about your preschooler having Asperger’s unless you have some experience with the syndrome. It’s not one of those disorders you can diagnose in a three-year old who has some autistic-leaning symptoms. It should definitely be done by a professional.

Is there a Problem, or Isn’t there?

You have this precious baby.  Someone you’d give your life for.  In one sense, you probably are never taken up on that commitment.  But in another sense, you are asked for it every day…  You do give your life, usually just slowly.

So what happens when you start to suspect your precious baby is having a problem?  Not a physical one, for which you can just take him to the doctor.  Or the common snap reaction: “Hmm… is that normal?” where you call up one of your friends with kids. But a real social, emotional, or cognitive problem.  There is no place you can rush off to, to get counsel and support.  Every time you look at another child, you have an uneasy sinking in your stomach.  Something that confirms your worst fears, something that shows you, “My child isn’t normal.”  Experienced adults like grandparents or the pediatrician ask you—because you are the Mother and you know All—”Why does he do that?” and that’s unnerving.  Even going to your friends’ houses, if they have the “normal” bouncy and bossy children, starts to make you afraid.  What are you doing wrong?

There is something dreadfully isolating about those types of feelings.  And yet I believe that every mom (or almost) experiences something like that when they first start to suspect.  Why is it that we feel so alone when mothers all over the country are waking up with the same, exact experience?  There are special needs kids everywhere—probably dozens in our own home town—and yet the pit of swirling fear and guilt gets us all, one at a time, and drags us into our own little world where we are trying to figure out the problem, contain our emotions, and present a controlled image on top.

On the other hand, we have to beware that there are fear-mongers everywhere now.  You can’t turn on Oprah or pick up a “Woman’s Day” without ads and feature stories about some new disease or the increasing pervasiveness of a once-unique one.  We have to draw boundaries and protect our families, and we have to put up fences that allow us to praise and hope for our children when outside voices are so pessimistic.  You also know that from first step on a playground that it “seems” most kids are actually fine.  They each have idiosyncrasies that need attention, but they generally fall into an acceptable range.  So you go back and forth trying to figure out if what you see in your own child, which is a yellow flag, is something to be concerned about, really.

So is there a problem, or isn’t there?  Assuming that you are bonded to your child, I hate to state the obvious: a mother always knows when something is wrong with her child.  She may not know what it is, but she knows it is there.

Author Karen Foli describes it like this:

“When the child is not developing as fast as he should, the situation is so overwhelming that denial sets in.  The mother and father talk.  Frequently, the father comforts the mother.  He tells her she’s worrying unnecessarily, that each child is different, that their child will develop at his or her own pace…But I couldn’t keep on denying what was in front of my eyes… Finally, I knew I had to act…I have learned to never underestimate a mother’s intuition.  The people who had these questions about [my child] were highly respected professionals with all the modern diagnostic tools.  They certainly should have been able to know what was wrong with [him.]  But as I looked into my son’s eyes, I knew they were missing something.  I had no idea what the problem was.  But I knew with certainty [that they had missed it.]“

 I had no idea what the problem was…  I definitely felt that way, as I was starting off with my own two special needs kids.  By the time they were toddlers, I had my suspicions and by the time they were preschoolers, I was definitely concerned.  If there is a real problem with your child, you feel this way.  If there is not, you probably don’t.  That gnawing sense of worry, deep in the heart where you are afraid to spill the beans about everything you’ve noticed… that’s when you know something is really wrong.

Now that doesn’t mean to panic!  I don’t believe in panicking!  But it does mean it is time to act.  Stop looking at your friend’s kids, stop reading books at the bookstore (or online), and stop debating about what the pediatrician said.  Stop keeping notes or writing about your woes in your journal, and stop trying to convince your husband that you aren’t just a worrywart.  Call Early Intervention (if the child is under 3) or take the child to the nearest preschool with an evaluation center, and get it checked out.  It will be a step onto a roller-coaster if your fears are confirmed, but stepping onto that roller-coaster is one step closer to getting off.  If you don’t go, you’re only postponing the ride.

Signs of Auditory Processing Disorder

Auditory Processing Disorder (sometimes CAPD) mimics symptoms of autism and retardation, but it is not the same.  Whereas autism is primarily a social disorder and retardation is primarily cognitive deficit, CAPD kids have the ability to be both social and smart.  The processing of verbal information, however, is impeded, which delays their abilities in both social (communication) and cognitive areas.

My oldest son struggles with this and looking back on it now, these were the things that stood out to me most… some were just impressions that, now that I’ve known other APD kids, are common to feel.

• Couldn’t talk by 3 yrs old, or 3.5 when other kids who were slow to talk were catching up
• Couldn’t comprehend the simplest things said
• Didn’t make eye contact regularly; when asked to, eye contact actually seemed to impede comprehension
• anxious or distracted personality, high-need
• reacted to noise, enjoyed noise/sounds; but may not turn when spoken to
• May be eager to go away when spoken to, or may keep listening after the speaking is done
• Just doesn’t “get it”
• Acts as though they are ESL
• I could tell on the inside that he was bright and smart, especially as I watched him do puzzles or watch a video, but his eyes were glazed or clouded when I talked to him
• I used to feel like when I spoke to my him, that I “saw” cotton in his ears that I just wanted to pull out so he’d “hear” me!

Walking on Toes

Did you ever get concerned about your little toddler walking around on his tiptoes all the time?

We used to wonder. We had one super toe walker, one non-toe walker, and one sort of in the middle. Now that we are on our fourth toddler, I have pretty much come to realize that toe walking is developmental and related to 1) self-stimulation and 2) muscle development. So you want a little, but too much or too little is a small sign that there might be a problem.

For my super toe-walker, we got a little concerned because he hit a phase where he was walking on his toes almost all the time. Compared to my medium toe-walker, my super- would walk around on his toes by default. And he didn’t grow out of it very much. My medium toe-walker went through a short phase where he seemed to be walking around on his toes a lot (as if he were excited to discover it). But a couple months later, he was only doing it when he was bored or really excited or needing to reach something. My super toe-walker had to be retaught to walk flat-footed and then constantly reminded in order to do it. Later he would go through phases where we’d have to remind him again for a time. He turned out to have a number of language issues as well as trouble imagining, self-directing, and knowing the rules of social convention.

Obviously the toe-walking didn’t CAUSE those problems, but it was a sign that he was overstimulated, possibly relating to his inability to converse or play in a higher-level way. But, he did acquire good muscle tone!

Another one of my good friends had a super-toe walker and he turned out to have an overstimulation problem, part of a sensory disintegration problem. But he had other hyper behavior, and was an unusually high-need child, whereas my own super toe walker was not. My child was high-need compared to my other children, but by three years old he was not still running all over the place all the time, getting into stuff, making weird animal noises, etc! (BTW I think tiptoe walking is especially common for boys because of higher levels of energy, stimulation needs.)

On the other hand, my non-toe walker didn’t discover the phase at all. I can’t recall seeing him walk around on his toes much… maybe he didn’t at all. He is now my sensory-disordered kid who has very low muscle tone, trouble reaching or extending his body, slight balance problems, and a hyposensitive (understimulation) problem.

Obviously the toe-walking (lack of it) didn’t cause that either, but it was a sign.

So look for a balance. Somewhere around 15-30 months the toe-walking starts, and it can seem a little overboard or strange… especially for boys because it looks kind of silly or even girly. It will stay strong for awhile but should begin to abate over the next year. Directed activity is sometimes the remedy if you sense your child is overstimulated.  If you sense that the toe-walking is becoming stronger, like the child’s default pattern—and especially if other unusual symptoms accompany the tiptoes (repetitive movements with the fingers/hands, or perhaps talking to oneself), then get it checked out by an occupational therapist. Early Intervention can catch it if the child is under 3, but I wouldn’t necessarily call for professional help before the child was 3 years old unless other symptoms were present and disturbing. And on the other hand, if you don’t see tiptoe walking at all by the time the child is four, consider encouraging it or beginning leg muscle exercises to work on muscle tone and balancing skills.

Sensorimotor–Brushing

One of my sons has what the occupational therapists call “sensory defensiveness.”  Basically this means he recoils and tries to avoid any sensory or motor input that he doesn’t like.  Sounds normal—I think I do this too!  Except in my son’s case, what he is sensitive to is exaggerated or inaccurate: he feels pain when his limb has been in the same position for awhile, or he feels tickled if someone touches him at all; he also feels far away when he is not, or he thinks something is wet when he sees water but there is none actually on him.  He recoils from almost all people trying to touch him (except me), and his body is normally in characteristic unfriendly, defensive postures.

So the occupational therapist recommended the standard sensory brush program, which is used to treat a lot of kids with sensory dysfunction.  I thought I’d replicate the worksheet that she gave me here, just for someone else’s benefit…

“The exact cause of sensory defensiveness is not known.  It may be an exaggeration of one’s normal defense mechanisms.  A large number of individuals with sensory defensiveness also have family members with sensory defensiveness.  Sensory deprivation is known to exaggerate defensive responses.  Stress, abuse, ans some kinds of central nervous system problems also seem to produce defensiveness.

“Deep pressure touch, compression or traction to the joints, and heavy muscle action together is a special combination to reduce or eliminate sensory defensiveness.

“Procedure:

The Procedure takes only enough  time to brush the entire surface of the arms, hands, legs, back, with a few firm strokes and to push on each joint for approximately 10 seconds.  It should not take more than 2-3 minutes.

• remove socks and shoes
• pull up sleeves and pant legs
• hold the brush horizontal
• start brushing the palm by brushing backward and forward all the way up the arm until you reach the child’s shirt; turn the brush vertically if you wish to brush over the clothing up to the shoulder
• Turn the hand to palms down and repeat this step only in reverse working from shoulder to fingers.
• Repeat on other arm, legs, feet; both backs and front
• brush the back (hold brush vertically over clothing if necessary)

“General Rules:

It is generally believed that the effects of brushing last for approximately two hours.  By applying the technique every two hours, the individual will feel more normal over a whole day.  It appears that after a period of time, the body’s sensory threshold is reset to be less or not at all defensiveness.

“Each individual responds to the brushing program differently and will need to continue for a different length of time.  It is often helpful to begin for two weeks and then reassess the level of defensiveness.  At that time, the therapist can make a further recommendation to continue or modify the program.

• Never brush the stomach, head, neck, or chest.
• Never brush a child under 2 months old
• Never brush a child who is upset
• Never brush wounds, rashes, or sunburns
• Do not brush too hard (scratches) or too light (tickling).

“Joint Compression (“Squishies”)

Apply 10 gentle “squishies” or presses to the following joints.  Positioning of the hands is very important to this technique.  Do each arm and leg.  Get a model before attempting.
Place both hands on the top of the child’s head and apply 10 gentle presses downward.  Place each hand on a shoulder and press 10 times.

Place one hand just behind the shoulder and the other over the elbow joint.  Hold the arm straight out with the thumb pointed to ceiling and apply pressure inwards toward the shoulder joint 10 times.

Place one hand just above the elbow and the other hand in the child’s hand.  With the elbow slightly flexed, apply pressure into the elbow joint 10 times.

Place your thumb into the plam of the child’s hand with the remaining finger on the back of the child’s hand.  With the other hand, cup the child’s finger or thumb with your fingers placing the tips of your fingers around the first knuckle joint and apply pressure downward into the finger joints—do each separately 10 times each.

Place one hand on the lower back/hip region and the other on the bottom of the foot.  Apply pressure at the foot into the hip joint 10 times. “

Auditory Processing in a Four/Five-year old

I’ve written elsewhere about my struggle to identify my oldest son’s auditory processing disorder when he was a toddler. Now that he’s been through five semesters of preschool, he has made much progress. He has, in fact, progressed so much that most people can’t tell there is anything wrong! We put him in a mainstream private school this year and his teachers, who have no experience with special needs, can’t even tell. But we at home still know and work with him profusely. For those of you with older preschoolers wondering, here are some things we still notice:

• Still repeats me or himself a lot. (“C and K make the same sounds, Mom, right? C! cuh, cuh, cuh. K! kuh, kuh. They make the same sounds. They’re the same. Aren’t they the same, Mom? You hear how they’re the same?”) He might run a script like this even though I acknowledge him, and from day to day as if he forgot he said it before and I heard him.
• Still describes a lot. Whereas my other preschooler’s vocabulary is more purposeful, my almost 5-year old still labels what he or others are doing. Or what he sees and hears. (“You’re holding your book, Mom?” or “Oh hear the airplane? It’s an airplane! NEERRAaWWW. I hear the airplane. You hear the airplane too, David. Mom, David hears the airplane.”)
• Still has trouble with explanations, especially moral ones. Doesn’t understand abstract talks about hurting other’s feelings, being good when he’s away from home, or other concepts that don’t immediately conjure up a picture. Stares through us a lot if we can’t show him what we mean.
• Mishears. The other day I said, “Let’s have chicken again” to Daddy and he said, “We’re gonna mix it again?” Even with clarification he couldn’t get it. Or realize that what he was saying had no context at the lunch table. Or realize that I hadn’t been talking to him but Daddy.
• Cannot reformulate requests well. When I ask him to tell Daddy something for me, he often needs an exact formulation and will repeat it exactly. He can make up something similar or take liberty in his speech, but not very often.
• Does not introduce new words, formulations, or applications very much. He mostly learns from memorizing things he’s heard before, which after five years is a lot of things. But unlike my two or three year old, I don’t hear him saying new words or formulations at his own will. He is not master of his vocabulary yet.
• Hangs onto old talking habits. He still gets down from the table and comes to find me to say “I’m all done” like he did when he was two. He’ll travel all over the house to find me, just to tell me. When I tell him he doesn’t have to do it anymore, he doesn’t change it—not sure if this is because he doesn’t understand my instruction or he does but can’t internalize it. Other elementary skills we taught him like this pervade.
• Still has trouble distinguishing who I’m talking to, when he needs to answer, when he doesn’t need to answer, when I can’t hear him because it’s noisy or I’m too far away, when he should/shouldn’t interrupt, when his sibling hears but just isn’t answering (perhaps because he said something that does not necessitate an answer, like “I’m coloring now.”). He doesn’t “read” verbal cues very well through my face, gestures, or social context.
• Needs acknowledgment all the time in order to stop repeating (i.e. “I hear you,” “ok,” “yes,” etc).

Noticing these things has become easier since his two younger brothers don’t have those problems, or at least not to the same degree. Also, as our oldest has gotten older, the problem has crystallized whereas his strengths have gotten stronger—so the “holes” in his education show more, in a sense. We are no longer worried that he has autism, Asperger’s, or low I.Q. as we did when he was two and the behavior was so confusing. He has now left the formative stages of development enough to see where problems have gone and stayed. The bad news is that he doesn’t seem to have gained the essential skill of discriminating syllables that he hears, so that many sentences don’t make sense.  I think he hears words as all run together, instead of as individual words, so he makes up things to fit what he thinks he heard.  But the good news is, he’s onto the problem and so are we!  The good news is that for auditory processing kids, that they make much progress and can leave a large chapter of their delayed history behind. Hooray!

Just for posterity, here are a list of verbal things he can now DO!

• pronoun incorporation and reversal (I, me, you, us, we, etc)
• at least some past and future tense
• difference between boys, girls; using his/her
• use of intermediary words like “have” “to” “suddenly”
• understanding of sequence words (now, later, soon, next time)
• relay a message, recall a response
• tell what did/didn’t happen in good detail
• ask for help
• ask what something means, or just “what?” if mishearing
• carry out more complicated instructions
• narrate the steps to something well while reasoning (i.e. how to tell time, how to tie a shoe)
• is no longer dependent on visual schedules or cues
• is no longer repetitive in his play, behaviors, or habits

It’s Not All Autism

The world’s radically shifting statistics on autism, plus Jenny McCarthy’s exploding bandwagon, have shaken parents everywhere. Especially those dealing with late-bloomers, learning disabled kids, or otherwise special needs children.

NOT EVERYTHING YOU SEE IS AUTISM!

First of all, I think it is a misnomer to label high-functioning autism children as such. I understand, for scientific reasons, why experts do that. But for the rest of the world, I think it is harmful. If not because most parents (especially dads) are reluctant to think of their behaviorally or socially struggling children as autistic. For them, the word conjures up “Rainman” images of the classically autistic who show deeply impaired abilities to think (metacognate), behave, or relate in the social world. For children with slight (yet signficant) impairments in these areas who will eventually lead “normal” or independent lives, I think it is confusing to give them the same label. I am glad that the face and acceptance level of autistic individuals is changing partly because of this, but I am not sure whether it is the right thing to do, ultimately. There is a significant difference between those individuals who will need institutionalization or assisted living their entire lives, and those who will just need to self-adapt at work, home, and play.

To be sure, high-functioning autism shares a lot in common with classic autism, mainly concerning the types of symptoms (although different in degree). Both types of autism may include relational, emotional, communicative, and behavioral impairment that stem from an inability to learn or engage the social world. Both types may be classified by language delays, social skill trouble, and self-stimulating movements or routines. But the problem is that a lot of other special needs diagnoses share symptoms with high-functioning autism. Many children with language delays, cognitive delays, social or emotional sensitivity problems, attention problems, or sensory issues can have symptoms which look very much like the diagnostic criteria for autism. It can take an expert and some time to know the difference.

What do you do with a child who:

• walks around on his toes, spins wheels, and can’t have a conversation with you?
• doesn’t look at you while talking, repeats scripts a lot, plays with his toys the same ways over and over again?
• can do anything with shapes, letters, or numbers but can’t tell you his name when asked?
• Is slow to ask for what he needs, doesn’t point, doesn’t call for help, and can spend two hours straight doing puzzles?
• Doesn’t notice her self-care needs, won’t toilet, screams when she is hugged, has phobias that don’t make sense to people?
• lacks empathy, can’t read people’s facial expressions, doesn’t seem to understand that people can see or hear him when he misbehaves, talks kind of monotone?
• Memorizes videos word for word, doesn’t put two novel words together, can’t tell the difference between similar things (like breakfast, lunch, dinner), and doesn’t respond to stories or explanations?
• Doesn’t respond to group directions, can’t tell when you’re not speaking to her, chatters all day to nobody, and sleeps only five hours at night?
• Bangs head, walks relentlessly in circles, holds things up to the light, is fascinated by colors, is a picky eater, and oversensitive to smells/chewing?
• Has no imagination or pretend skills, is painfully shy, clings to a security item, doesn’t use gestures, and prefers to be by herself most of the time?

Do you call all these children autistic? They certainly all have symptoms. High-functioning? What about Aspergers?

The fact is that I have parented kids with almost all these problems (even entire clusters of them), and I am happy to say that none of them are autistic! You might wonder, but it’s true. The fact is that symptoms overlap. Some are symptoms of language problems, cognitive delays, or sensory disorder. Some are just weird manifestations of personality! There are perfectly normal kids who have out-of-proportion responses to things like rain, toilets, cereal, or the feel of your carpet. As long as their problems are isolated, or have no real connection to one another, you may just be dealing with a phase or late bloomer. If there are connections to their problems, you may be dealing with delays or hyper/hypo sensitivities. Or you could be dealing with dyslexia, learning disorders, or emotional disorders. You can’t just jump on the autism band-wagon. You need to do more research than that.

Not that you shouldn’t ask if you are concerned. Better to be over- than under-concerned. But realize that you know your child better than an examiner and if you walk in a clinic with a list of textbook symptoms like above, you are probably going to get a diagnosis—maybe one that you don’t want or, worse, isn’t actually the child’s problem. In the young years, this is sometimes ok because special education starts off similarly even for different problems. Giving your three year old a year in a special preschool environment can help weed out what is/isn’t the problem. However, you have to realize that diagnoses can be scary and self-fulfilling. Or they can be confusing, say if your doctor gives your child a diagnosis of PDD-NOS (pervasive developmental disorder not otherwise specified) which is about as helpful as a spoon for spaghetti. And with the autism scare of the century, you need to know what you’re getting into. You don’t want, for example, to axe all vaccines because you think your child has autism and then have them die of hepatitis when all they had was an expressive language problem! These are the types of scenarios that McCarthy-scorners are worried about.

Also keep in mind that symptoms listed in a book can be hard to understand when applied to real life. It is easy to overdiagnose, but it is possible to underdiagnose too. A mother, in particular, might not think [x] is a problem because she has no problem with her child. But in a new environment, the child has a real problem. Or the opposite can happen. Because a child might be testing his mother a lot and acting hyperactive, she thinks he has a real problem. But as soon as he gets in a structured environment like school, he’s just fine. Some mothers overestimate what they read and see disorder written all over their child; other mothers underestimate and see no way their child could have a problem like the medical/technical stuff being described. You want to be balanced.

Keep in mind, too, that symptoms in a book concerning behavior (like echolalia or word usage) are hard to assess because you don’t know what’s normal and what’s not. In one context, not reversing pronouns might be a red flag. In another context, it’s totally normal. Especially if this is your first child, or they are slow in language development, you tend to find the descriptions in diagnostic books overly relevant to your child. In this case I might call the local preschool and get permission to observe a special needs classroom and see what children with the diagnoses really look like. Sometimes this simple act is all it takes to say, “Nope, my child definitely doesn’t need this.” or “Yes, my child definitely has a problem.” Not that you are a doctor, but as I said, you definitely are most familiar with your child and so you can probably sense these things as you get more exposure. Or get a friend whom you trust to observe too. Don’t simply pick up a magazine article or Barnes & Noble book and let it confirm your fears.

So I guess my conclusion is: use your gut, but don’t panic. If something is really bothering you about your child’s development, take it seriously. There might be a problem. And if your gut is REALLY bothering you, like keeping you up nights and causing marital strife etc, there probably is a problem. But it may not be autism. Not even high-functioning.

Why Isn’t My Little Boy Talking?

I entitled this “little boy” because sociologically, moms worry more about their boys’ language development than their girls. It is 100% true that girls generally learn language faster than boys. Girls biologically mature faster than boys too, so it is normal for the average three year old girl’s vocabulary to be on par with a five-year old boy. It isn’t gender bias, it’s just part of development.

That doesn’t mean all boys will be late talkers or all girls will be early ones. It just means that on the whole, language takes longer and may need more support for boys rather than for girls.  In our family, we have had an array of language experiences and early bloomers blossom the most between 20 and 30-months while late bloomers learn more between 30 and 40-months. If by 4 years old, your little boy has not caught up to other boys his age, that is a red flag. You shouldn’t wait that long if you are concerned (because the earlier the intervention, the better), but if I had peace about the boy’s development, I might wait up until that point to make a clear judgment. All children are different and so much can happen even within a couple months that it sometimes pays to wait. Boys especially grow between 3-5yrs old. This is probably why kindergarten begins after age 5, and real schoolwork begins at 6.

Because of charts and pressure, though, too many moms are worried that their boys aren’t speaking in sentences at 3 years old. They hear a friend’s child talking on the playground and get worried because their little boy only says “hi” and “bye” and “no.” But lots of boys are just beginning their language progression at age 3, especially if they are the oldest or only child. Not having other children paving the way is important because little boys don’t come out already knowing that they are supposed to be imitating their parents. They may not even imitate the TV or one another. Whereas little girls are more likely to model and mimic, little boys can be more in their own worlds, relying on revelation that comes from within. They take their own time to process and learn things, usually sequentially, analytically, and in the order that they feel they need. Girls’ language usually develops much more holistically, haphazardly, and practically.

We think little boys are just like little girls and of course need high verbal skills; we look at them anxiously, waiting for them to come but many little boys are blissfully unaware and seem perfectly content on their own timetable. For whatever reason, the little learner isn’t sensing the verbal need as urgently as the parent =).   My oldest boy, who was late in learning language, was (and still is) more preoccupied with what he’s doing or thinking about. At 7 yrs now, I have quizzed him and found out that he remembers all kinds of things he did when he was 3yrs, and how he felt about it at the time, but he didn’t start talking about anything meaningfully until he was past 4yrs old. So his little thinker was very much on at 3, but not expressive or communicating yet.

I have also observed my three little boys playing together for almost five years now, and I see that they basically force themselves into each other’s worlds by competing for legos, playdoh, or whatever.  Their interaction style is very parallel (independent) but very intrusive.  (My girl’s, however, is very dependent on me, interactive, and careful.)  The boys are extremely chatty now, but sometimes talk past one another and don’t listen carefully to what each other is saying. And they do this on almost a constant basis, all day, every day, even past bedtime hours (they share a room). So that’s probably why my third little boy had no trouble picking up language as soon as he was able to play with them as a toddler. But there is no way, as a mommy, that you can model this peering, intervening, competing dynamic with your child.  Your mommy thing is much likely more gentle, direct, and occasional. So if you have a three year old boy, who is the oldest but he’s not talking, don’t be surprised.

(Just FYI, all my boys have this interaction style, even though they are all very different and none of them is the stereotypical aggressive, gun-and-cowboy kind of boy.  I am not trying to overstereotype here, or derive their learning style from their personality/socialization.)

Here’s another case in point: one of my friends is French and her husband is Greek-American. The mother speaks only French to her little boy, and the father speaks English. This little boy was typically developing in all areas except language, and as he neared the 3-year old mark he didn’t even speak much French although the mother prattled to him all day in it. About a month before he turned 3, he suddenly began speaking in French phrases. But he had only a couple English words like names of animals. Within about two months, he had French sentences and some English phrases. Now as he nears the 4-year mark, he is almost fully fluent in both languages. His vocabulary seems lower than my three and four year old’s, but he is on the whole a better communicator. His cognition skills are slightly higher as well in term of concepts like before/after, yesterday/tomorrow, etc. He even talked with me about his mommy being pregnant, having the new baby, and nursing it. Even though my 4-year old witnessed three siblings arrive in our own family, he never seemed to notice any of it, including how big I was: he certainly never talked about it. So this is a plug for all the bilingual mothers out there.

This is not to overgeneralize about boys and language. It is just to provide some perspective that experts aren’t really providing. My now 4 year old was a late talker, my 3 year old was about average, and my 2 year old was extremely early… and they are all boys! Moreover, my latest talker learned his ABCs and first words the earliest! And my earliest talker spoke his first words and learned his ABCs the latest. So it is really hard to generalize about language things. It really takes some discernment and guidance from your “gut.”

So why isn’t your little boy talking? What does your gut say? Do you have any idea? You have a couple options: either he is fine but taking his time to talk (like my third boy); or he is fine but has language delays (like my first boy); or he is not fine and there is something really wrong. I have several posts on language development where I discuss these options, but to recap an important principle: it is not how much your child is talking by a certain age, but whether or not he is making progress. Like I mentioned, my youngest boy actually started his first words the latest of my four kids (17 months), but spoke in complete sentences the earliest (19 months). A kid in my child’s therapy started his first intelligible words very late (23 months) but is now speaking amazingly in sentences after only four or five months of speech therapy. My oldest boy started his first words earliest (11 months) but ended up having a pretty severe language delay through the toddler and preschool years. So don’t get concerned by age of onset. Look more for progress.

So is he developing in other areas ok? Do you see progress in his verbal development every three months or so? Does he seem stalled in an area? Or are you expecting things too early? Too fast? Is the child a firstborn with little modeling? Is the child the baby of the family with little need to talk? All these types of questions are important pieces of the puzzle. I find, as I said in the beginning, that most moms worry about their boys just a little too early. While some boys are prattling by two years old, some are barely putting two words together. By 36 months, however, most late bloomers are at least on the road to becoming communicative. They should have made some progress between the ages of 2 and 3, and lots of progress between 3 and 3.5, even if they aren’t communicating as well as the typical 3-year old girl. If by 40-42 months your late bloomer is not talking pretty “normally” (i.e. able to dialogue with you about appropriate things, able to understand most of your words), then there is probably a delay or perhaps a language disorder. He/She may not have full sentences, but the phrases and responses should be there.

Also, try to take a long term perspective. When your kids are young, everything they do is under a microscope. It seems like every little “d” or “t” they mess up is a big problem. But most kids even out more after the 4th birthday. A delayed child can take until 5- or 6-years old to catch up. But in the long run, make sure it really matters to you. Assuming that you are only dealing with delays rather than a congenital problem (like Asperger’s), does it make a difference, on the whole, if he takes longer to mature or are you ok with him being a little less mature for awhile? I am not saying to ignore problems. I am just asking if there are factors that are making you feel more impatient or worried than must be objectively warranted. After all, your child is who he is. You have to deal with it one way or another, so there’s no use putting extra pressure as if that would make something change by magic.

Remember that there are thousands of moms worrying just like you. I have had three boys myself, in three years, and watched my friends have about half a dozen baby boys in the last couple years. I have walked down the language disorder and special preschool path. So I know moms worry too much about language. On one hand, language problems are some of the most concerning problems a small child can have because verbal, cognitive, and social/emotional development are intricately tied together. Sometimes language problems are isolated, but sometimes they indicate other more serious problems. So I would publicly recommend erring on the side of too much caution rather than on too little. But on the other hand, do realize that probably every first mom, especially with boys, is worried about their language development and more often than not, finds out that there was absolutely no problem. So don’t panic until there is something to panic about.

(I have several posts on Language Development for real signs, symptoms of language disorders.)

Therapeutic Activities for Home and School–Sensory

Therapy for sensory disorders usually include the primary senses of tactile (touch), vestibular (balance/gravitation), and proprioception (posture/position, how one is in space).  If you read The Out of Synch Child, which is largely considered to be the Bible of sensory processing disorders, you can figure out which area(s) your little one might be struggling with. 

Proprioceptive Activities, for postural control and stability/strength

• drawing on an easel
• tracing or finger painting (washable) on a window
• writing on a chalk/white board
• Airplane/Superman (body outstretched on Daddy’s feet)
• hanging things on clothesline
• activities propped up on your belly, elbows
• Wheelbarrow
• Crabwalk
• push-ups against a wall or floor
• Tug of war
• Chin-ups (supported if necessary)
• Sit ups (supported if necessary)
• Row, row, row your boat (two opposing people rocking back and forth while sitting, holding hands)
• Belly on the ball
• scooter board activities
• sit/bouncing on a ball
• sitting on a stool, backless chair
• races while holding something in hands (shoulders at 90 degrees)
• “bulldogs” (trying to knock each other off balance while on all fours)
• exercises with arms lifting, holding suspended

Motor Planning, for sequence skills

• obstacle courses
• bucket/basket ball
• simon says
• hokey-pokey
• Mother May I
• London Bridge
• puzzles
• jacks, pick up sticks
• marbles
• moving like animals (dog, snake, bunny, etc)
• clucking patterns with mouth
• Where is Pointer? or finger recognition games
• pattern recognition with blocks

Tactile Input

• Water play (pouring, spilling, mixing, scooping)
• Sand play
• Finding hidden objects in sand, bean, or rice buckets
• writing letters on a salt tray
• sticking things with velcro
• silly putty, play doh
• Driving trucks over “land and sea”
• finger painting (start with gloves if nec)
• foggy faces on steamed windows, with shaving cream on tile walls
• feely box (wet macaroni, pinecones, etc)
• feely books
• scratch and sniff stickers
• dress up clothes, including hats and masks
• body brushing
• blowing games, instruments
• spitting toothpaste, watermelon seeds

Structure/Routine, for sequence skills and transition practice

• Create a fort
• picture schedules, with or without timers or clock pictures
• cleaning/chore charts
• sticker/reward charts
• rule/discipline charts
• avoid surprises as much as possible
• avoid sudden transitions as much as possible

Hyperactivity

Hyperactivity is a big deal these days. Between the surge of ADD/ADHD diagnoses and the overwhelming sugar + sedentary activity problem in America, more moms are concerned that their little ones are hyperactive than ever before.

True hyperactivity, however, is less common than you think. The typical little boy can make you pull your hair out with all his bouncing, throwing, stomping, running, and yelling. But most of this is normal. Young children have tons of energy and often not enough output. Some kids are more high-need than others in this department, but it is not uncommon to need to go out to the playground every day, even twice. Don’t confuse the unwillingness to sit still with real hyperactivity.

So what does true hyperactivity look like? Real hyperactivity is usually related to a neurological sensory problem which manifests in uncontrollable gross motor movements. A very common symptom is the actual inability to still one’s body. If a child is literally unable to stop moving, sit in a chair, or focus attention on something, it disturbs him. He wants to pay attention but he can’t. One mom friend of mine described how her little boy’s therapist suggested using a lead jacket to help him sit in his chair at school, but he still couldn’t do it. He felt like jumping out of his skin. He fidgeted everywhere to try and get some of the anxiety out but eventually he had to jump up, throw off the vest, and walk around. He was literally driven to move… he didn’t feel right unless he was moving, so in effect, moving from his perspective gave him the same peace that most people feel when they are sitting still.  You could see this problem at mealtime too; he had to eat standing up and rocking slightly because when he sat still he couldn’t concentrate or keep his hands still enough to drink. This type of anxiety, even depression, and maladaptiveness (disturbance to one’s lifestyle) is what real hyperactivity looks like.

Other symptoms in a little child might include:

• inability to read letters unless moving
• inability to keep hands to himself—pulling hair, tugging clothes, wringing hands, pushing or pulling people
• avoidance of activities that require concentration or listening
• tics or nervous twitching
• general inability to keep arms, hands, feet still (rubbing eyes, stroking hair, moving seamlessly from one fidget to another)

Now this doesn’t mean you should ignore your child’s signs if they are more mild. It just means that you shouldn’t go rushing for Ritalin. You might be able to work with a private therapist or in the home, and get good results. In fact, I would definitely try this first.

Several things in the environment can trigger hyperactivity, and you have probably heard of all of them:

• sugar (yes, it really does make a difference)
• caffeine
• other dietary disturbances or allergic reactions
• bad sleeping habits (“wired” behavior comes out when over tired or unable to fall asleep)
• overstimulation (too much chaos, activity)
• understimulation (not enough structured activity, too much TV or video games)
• lack of self-directed play skills (boredom)
• not enough active or outside play opportunities
• stress (parents fighting, school too hard, sibling rivalry, etc)
• lack of discipline in the home; training

I would try addressing all of the above with my child before sending him to the doctor about it. Especially the lack of structured activity and/or discipline in the home… some organized play each day, some outside time for jumping, and some training lessons regarding sitting and quiet play can go MILES in helping your active ones calm down. While some children are definitely more passive and exhibit self-discipline more naturally, the vast majority of them are not going to pick it up on their own without help and opportunities from parents. Simply, you can’t wait for your child to outgrow hyper behavior. They need to be helped.  Hyperactivity that is truly due to lack of behavioral training will respond within months to lifestyle changes like these.

Other hyperactivity can be masquerading as sensory processing disorder.  In cases like these, organizing activities like pushing, pulling, lifting, bouncing or other gross motor actions send calming signals to the brain and can help children concentrate.  This is why preschoolers take frequent breaks and recesses.  It is actually normal for kids to need to run around the playground before they do storytime or math; it is just not normal when it reaches a certain extreme.  Occupational therapists may also suggest deep pressure, brushing, or the weighted vest/blanket if it helps your child organize his sensory input.  Eventually the children usually outgrow the need for these props, or they can be sublimated into something appropriate for school (stress balls, bean bags, etc).

I have found, with three active little boys, that they really need a combination of activities in order to achieve the right balance. They need “monkey time” as I call it—time to jump around and be silly, even if it means running around the house… something my ideals threaten to trump. And if it’s dark, cold, or wet and they’ve been in all day, they need it all the more. They also need structured gross motor activity like doing small jobs around the house or taking objects up and downstairs where their energy can be channeled into purposeful ends. They also need quiet times—naps, listening to music/story, or watching a video each day. And they need low-key play times where I help them organize themselves to think and be controlled. Play-doh, legos, a worksheet, or stringing beads…fine motor things like this are very good. All these kinds of activities put together in a day vary the level of stimulation to the brain and challenge them to use different parts of it, maintaining balance. Left alone, the kids would probably overdose on one type of stimulation (either overly aggressive or overly passive, and always unorganized), leading to unbalance and inability to control themselves.

So the main principle is: a child who is demonstrating mild hyper behavior is likely reflecting hyper emotions, urges, or thoughts within. Your job as the parent is to guide or channel them until the energy works for the child instead of against them. This can be very taxing for a parent of a truly high-need child, and my empathy goes out to you. But don’t give up. Lots of times the preschool ages are the hardest. Chances are that your child is a leader and doer, and this is truly a virtue if you can confront it consistently.

Note: it is probably not a good idea to try and diagnose hyperactivity in the infant year. Babies have disorganized neurological systems, and it takes different babies different amounts of time to organize themselves. Large developmental changes regarding gross motor development and hormones make babies startle a lot, interfere with their sleep, and feel driven to explore. This is usually all very normal. I wouldn’t worry about it unless you see something that is really abnormal, or if something your baby is doing seems to be causing them more distress as times goes on (i.e. your baby used to be able to bring Cheerios to his mouth but now finds himself unable to control his hand, arm, or body when doing this). Bring anything like this up with your pediatrician immediately.

Circles of Communication

The concept of “circles of communication” is a really good one, articulated by Stanley Greenspan in The Child with Special Needs and The Challenging Child. For children with high functioning autism, autism spectrum disorders, sensory or auditory processing problems, or other special needs that have self-centered behavior, working on circles of communication can help them come a long way.

Circles of communication refers to conversation (verbal or non-verbal) where two active participants respond to each other. If you say to your toddler, “Ok, it’s time to put on your coat!” And the toddler responds with “Help?” And you say, “Ok, I’ll help you…” you just closed one circle of communication. That’s good. If somewhere the communication process broke down, the circle is still open and the intended message didn’t get around. New ways of getting it across are needed.

Circles of communication are called “circles,” though, because the parent and child have to learn how to reciprocate one another. There is not real communication (or relationship) if verbal sequences go only one way, from the teller to the receiver. Dialogue takes two. In order for you to be communicating with your child, the receiver has to respond back to the teller. So if you demand your child, “Put on your coat!” and they do, that is progress but not ideal. Similarly if the child demands to you, “Mommy, put my coat on!”and you obey, that is good but not ideal either. There needs to be a flow where the message is on a loop that runs a complete exchange, respectfully, accurately, and on the same emotional page. The message can be non-verbal too, where there is a “flow” between you and your child playing together, understanding and building off the actions of each other.

The goal, as Greenspan explains, is to bring special needs children “into the loop” by getting them to start closing circles of communication with you. Children might not close them for various reasons—visual, motor, cognitive, auditory, social, etc. But extended time with them on their level can help them make progress. For children with severe disorders, the goal might just be to get them to engage you. Eye contact might be enough of a start. For less severe disorders, the goal might be initiation, where the child understands or trusts you enough to proactively suggest an activity. Or to interact with you in a non-hostile way. But no matter where the child starts, you facilitate activities with them (with their toys, games, talking, whatever) that forces the child to confront you and gives them opportunities to leave their self-absorption and join the world of others. Sometimes the self-absorption is unchosen and biologically driven and sometimes it is consciously adopted and antisocial, but the friendly and purposeful confrontation is the tool to getting that child out of the box they’ve locked themselves into.

Greenspan advocates this through his floortime approach, which in modified form, I wholeheartedly endorse. My main criticism is his morally neutral approach, which sometimes makes use of unwholesome speech (teasing) or behaviors (stealing a toy) in order to confront the non-engaging child.  But we have tried the basic strategy with our children for several years with great success. One has auditory processing disorder and the other has a sensory processing problem, and it has helped us open up their worlds and enjoy them so much more.