Author: Robin McEvoy

A little story about big emotions-shame

oh, the horrors of my actions
Oh, what have I done!

The Queen (my daughter) had big emotions in a little body.  She was called the Queen in part because of this (and in part because her high muscle tone gave her a rather regal bearing).  She was not like the Queen of Hearts in Alice in Wonderland. Her big feelings were not directed in anger at others.  There was no “OFF WITH THEIR HEADS!!  aggression either physical or verbal.  But all of her emotions ran strong and the negative emotions were certainly more problematic than her positive ones (her over-excitement was rather cute for everyone).  Her emotions, though, often ruled the day.  If she found some event anxiety producing, there would be no talking her through, so that event was over for us.

But this story is not about anxiety, but a somewhat related emotion – shame.

Shame is an emotion, of course, but not one we like to think about often.  No one likes to feel ashamed.  I think we would pick anxiety, anger, or even fear over shame if we had a choice.  Shame is so personal.  When we feel anger, we are not liking someone else’s behavior.  When we feel shame, we do not like ourselves.

For children who feel their emotions strongly, shame is a very hard emotion to deal with.

They may become:

  • angry at the person who made them feel ashamed
  • immobilized by the feeling
  • inconsolable about their mistake (really fun in public)

So this is a little story of helping the Queen cope with shame.

The Queen was probably six years old when this happened.  She was a science geek and really into bugs at this stage of her life.  This resulted in having a bin of live bugs in my front room (because I do support the sciences).  The Queen, who was fearful about balloons (they might pop, you know), was fearless about bugs and collected them easily.  There were a variety of beetles and centipede type bugs who seemed to tolerate each other well  . . . living in a small aquarium . . . . on the coffee table . . . in my front room.

It was Saturday afternoon after errands.  I was cleaning up in a back room when I heard a thud, a particular kind of thud.  Upon reflection, I realized this was the sound of a bug bin hitting the floor.  I hurried to the front room (small house, not far) and saw the aquarium on the floor on its side.  Stunned beetles and centipedes had not yet recovered from their trip.  No one else was in the room.

I shouted, “I need a broom!” (not wanting to take my eyes off the scene and risk losing a largish beetle in my house).  A little figure whipped past me (from some hiding place in her room) to the kitchen reciting the mantra I had taught her, “No problem is too big! No problem is too big!”  She grabbed the broom and we quickly scooped the stunned creatures, their rocks, their sand, and their snacks back into their temporary home.  Whoo!

I looked at the Queen and asked, “What happened?!?”

She looked back and said (pretty quickly), “Leprechauns did it.”

“We are nowhere near St. Patrick’s Day, so I don’t think it was leprechauns.”

Her second try, “The bugs did it.”

“You mean to tell me that the bugs engineered their own escape by somehow pushing the bin off the coffee table?”

Silent stare.

That was her story and she was sticking with it.

In a moment of inspiration (lucky shot that day), I asked, “Do you want to hear the five mistakes I made today?”

Breathless response, “Yes”

“When I was unpacking groceries, I threw the loaf of bread on the counter and the bag cooked to the side of my new toaster oven.       When I pulled the bag away, the bread spilled into the sink and ruined most of the loaf.  It was expensive gluten-free bread.      When I was cleaning that up, I knocked over a wine glass (that I should have washed out last night), spilling wine on my favorite jeans.    And I broke the wine glass!

Did you make any mistakes today?”

Relieved look on her face, “I tipped over the bug bin.”

“Well, you are going to need at least four more mistakes today to even start catching up with me.”

And that was the end of that story.  There was no need for punishment.  It was an accident. I did not even feel there was need for an apology.  We cleaned it up pretty quickly and seemed to have found all the bugs (I kept count in those days).

scolding won't help
Scolding does not reduce shame

But it turned into a nice opportunity for a little life lesson.

For her – We all make mistakes.  And (hardly believable to her) life goes on.

 

For me – Distracting her from her strong emotions and giving her some perspective with my own mistakes had brought both relief and the ability to say what had actually happened . . . and to move on (the BEST part of all for parents trying to quell those strong emotions).

Of course, for the next several years (at least six years, I swear), every time shame raised its ugly head in her world, I was asked (through her tears) to recount EVERY mistake I had EVER made in my ENTIRE life.  This included her favorite – The time when I was 12 years old and called my mother stupid.  My mother is a wonderful person and the Queen is still in awe that I could make such an awful mistake.  Any mistake she has made pales in comparison.

And I survived my shame, so she will survive hers.

Top 10 Auditory Working Memory Strategies for Students

My Top 10 Auditory Working Memory Strategies (for students)

Auditory memory
Try not to forget

Auditory working memory is the memory used to remember and work with information that you hear, but it’s the information that does not have a lot of meaning.  Meaningful information, such as a funny story, goes to your verbal memory. It is easier to remember because the story ties itself to other memories, leads to visual images, or triggers an emotion (a fun one for a funny story).  Auditory working memory is for the information that does not have much meaning or connection, such as phone numbers, foreign language, strings of numbers, or even people’s names.  It’s called auditory WORKING memory when you need to hold the information online in your head while working with it, such as solving a math problem in your head. Some of us have a good auditory working memory.  Some people can remember phone numbers easily, never forget a name, or can solve complex math problems in their head.  Many of us can’t do it easily and some of us are really bad at it.

Some memories fade quickly
Memories fade

When a child has a weak auditory working memory, it will impact several academic skills.

  • In early reading, the child may have trouble remembering which sounds go with which letters. Frankly, that ‘buh’ goes with ‘b’ and ‘duh’ goes with ‘d’ is pretty random. If auditory working memory is weak, linking all those letters with all those sounds is tough.  You can see how this weakness is related to dyslexia (though is not quite the entire story).  Spelling and writing can be even more affected.
  • A few grades up, the child may struggle with memorizing math facts. Addition and subtraction facts can be hard enough, but multiplication facts can be particularly tricky.  Simple math facts, such as 2 x 2=4, can be “seen” mentally. But few of us can “see” that 8 x 7=56.  We have to memorize these facts that feel rather random to a young child.  These facts are stored in the auditory memory.
  • Then there is working math problems out in your head. If the problem is written down and you can visually check the numbers, it may not be SO bad.  However, if someone is rattling of a few numbers and a problem to be solved, those numbers may go in one ear and out the other.
  • Learning new words can be hard. When the child hears a new word in science or history, that new word is just hard to hold onto.

    Some memories fade fast
    Some memories fade FAST!!
  • Copying from the board can be hard because the student cannot remember a long string of information. There is a lot of looking up, looking down and copying a word, then looking up to check the copy, find the next word or two, write those down.  Because the task is so arduous, the student really cannot comprehend what is being copied.  Later, there are worse problems when trying to take notes during lectures.    The student typically cannot listen and write at the same time, so  . . . notes just don’t get taken . .  .at least with any completeness.
  • Following directions can be hard. In early grades, a teacher has to keep directions short and repeat them several times to get 20-25 young kids on the same page. As kids move up in grades, teachers give longer directions.  By middle school, teachers are not repeating direction often.  If this is combined with new vocabulary, students with weak auditory working memory are at a disadvantage.
  • Learning a foreign language (yeesh) can be a real struggle to those with a poor auditory working memory. Here comes this long string of incomprehensible sounds that a person then has to hold in their head and try to convert it (translate) to something meaningful.  If the auditory working memory is weak, those sounds are gone before you get past the first few syllables.
  • As a person gets older, it becomes more obvious that remembering someone’s name, remembering phone numbers, anything information that is somewhat random is hard.

Weakness in auditory working memory puts stumbling blocks in a person’s day.

For a child in school, the stumbling blocks are occurring all day.

So here are:

The top 10 strategies for supporting auditory working memory weaknesses in students:

We can categorize these in a few ways.

First and foremost-provide back up for the auditory memory.  Auditory working memory is not the ONLY memory we have.  There are lots of memories to use as back up.  Visual memory, motor memory, and verbal memory can all be used to support the auditory memory.

You can also “go around” the weakness by using alternative strategies.

 

  1. Multisensory reading programs can support both reading and spelling skills by providing visual and motor cues for the sounds that go with the letters. They also instruct in visual patterns for words which helps both reading and spelling.
  2. Visual supports can back up the auditory and verbal memories.  Charts, graphs, and timelines can be used to show patterns in the verbal and auditory information. This can be critical for supporting information given in lectures. Use summary lists and outlines to detail the “most important information” with particular emphasis on new vocabulary.  A good outline of a lecture (provided in advance of the lecture) can can act as an organizational chart for the information.  Even a bulleted summary list will let the student SEE what is most important.
  3. Information that is usually stored in auditory memory can be moved to verbal and visual memory with some creative tactics. For example, there are math books that provide a math story and visual picture for math facts (e.g., 6 x 6 = ‘thirsty six’ shows two tired 6’s marching through the dessert to an oasis with 36 written on top).
  4. Recopying lecture notes or developing written notes for a chapter in a textbook builds a strong visual motor memory for the information. For example, the student has scribbled notes madly to get the lecturer onto paper, but has she really “heard” the lecture?  As a dyslexic college student once said to me, “It goes straight from the professor’s mouth to my hand.  I don’t start to process what was said until I go home and re-copy the notes.  Everyone in class wants to borrow my notes because they are visually beautiful.”  (Okay, she was very artistic person who did make the notes visually organized and even color coordinated.)
  5. Use videos to pair auditory and verbal information directly with visual information. This gives some visual context for new vocabulary.
  6. For weak math facts, use a calculator. This lets the student focus on learning math concepts without being bogged down by errors and slow processing due to weaknesses in math facts. Students can take their calculators into college entrance exams, so it is not a drawback.  I find that math facts slowly improve in kids over time (lots of time) anyway. You can’t rush it, so accommodate it.
  7. Use written directions and written steps to support a weak memory for novel directions. With written directions, a child can work sequentially through the task without worrying about what they forgot.
  8. Preview new vocabulary. If a new science unit will be presented in two days or a new chapter in history, give the child a list of new vocabulary words to see and hear them pronounced. Discuss the words a bit until the memory is more of a verbal memory than simply an auditory one.
  9. A structured classroom with a consistent daily routine reduced the need for extra instructions and directions.
  10. Mnemonics-There are reasons that advertisers use mnemonics for telephone numbers (e.g., 1-800- CALL- NOW). A lot of us struggle with auditory memory weakness and we need to make the information more meaningful.  There are mnemonics for everything, from the Wives of Henry VIII to the 12 cranial nerves. You can google them.

And when all else fails, the student will need to have information repeated to him.  He might then be asked to repeat back key information or instructions to ensure they have processed it.

Adults with auditory working memory weaknesses can tell you that some days are worse than others.  Noise, fatigue, hunger and general overload will make recall worse.  But there will be moments when a child is fresh and excited for a task.  Then those facts, sounds, or words just come more easily.  Accept that unevenness, take breaks when needed, then keep plugging.  Accommodations in the classroom (and at home) will be essential, but with the right supports, auditory working memory weaknesses can be managed.

A Little IQ Story

Ok, this was years ago, at least 20 years ago, but it stuck with me because it is kind of funny and makes a good point about “IQ testing.”

Enjoy your kids strengths without focusing on “IQ.”

I was evaluating a brother and sister because their parents wanted to know their learning style and their IQ’s.  I don’t recall if they actually had any learning concerns (the main focus of my work) about the kids, but the parents really wanted to know their IQ’s.  This is the sort of testing that I would not even do today.  If a parent calls with the “I want to know my child’s IQ” I give them my “knowing your IQ is like knowing the day you are going to die” lecture and talk them out of it (unless we can find a good reason to do it).

But this was in my olden days and I did the testing.  The kids had good IQ’s, somewhere around 115 to 120 – above average, but not “gifted.” However, these were nice, go-to-college, be-anything-you-want scores.  These children were youngish, about 8 and 10 years old.  They would  be maturing into some other skills that would also help them achieve.

The parents were devastated.

“But my husband’s IQ is 132 and mine is 150.”  I swear the mother said this multiple times as she tried to process these (to her) terrible scores her children had achieved.  Neither parent could understand how they had produced only-slightly-above-average children.  They were sure, with their own superior scores, their children would also be gifted.

I finally thought to ask the right question.  After another lament of “But my husband is a 132 and I am a 150.  How did this happen?” I thought to ask, “Who did your IQ testing?”

The mother answered, “Mine was part of a group testing done in my school when I was a child. My husband’s testing was done by his mother when she was training to give these tests.”

Even as she said it, she began to understand her years of slightly misguided thinking about these wonderful scores.  I smiled wryly and said, “Those group administered IQ tests don’t really count in comparison to individualized testing .  And the score certainly doesn’t count if YOUR MOTHER gave the test.”   From here, these parents reached a point of being enlightened, somewhat relieved, still a little disappointed, and reasonably amused at themselves.  Instead of getting the gifted children they had expected, they got an understanding of IQ testing and the  slightly harsh realization that they were a family of smart, but not necessarily highly gifted, people.

I told them that highly gifted was not the easiest thing to be.  Being just plain smart was much easier.

I reassured them that they were both smart people and that their children were bright and had the cognitive abilities to do well in life.

Sometimes, I could really do without the concept of IQ.

The IQ Test and your child

Should I get my child’s IQ tested?

The short answer is NO(!)  . . . UNLESS you have a good reason and you understand what IQ testing has become.  It’s better to understand that stuff in advance, but few people do.

IQ (a judgement about a person’s intelligence) is a loaded concept with a controversial  and often dark history.  The IQ test or evaluation also had a loaded history.  But as with most things, the tests have evolved over time and test developers continue to try to make them more useful.  There has been so much evolution in the concept and the tests, that I know longer refer to IQ in my assessments (even though I give those tests).  IQ is just too loaded a concept and why freak everybody out.

But why duck and dodge around “the IQ?”

I remember my first developmental psychology professor talking about IQ testing.  I was 18 and what she said stuck with me to this day.  She said, “Knowing your IQ is like knowing the day you are going to die.  It does not matter what it is, you are not going to be quite happy about it.”

What she meant was – If the number is high, you worry about living up to that potential.  If the number is too low (by your estimation), you think, “Can I achieve anything with that!?!”  And what if it is average?  Our society seems to crave superlatives, average just won’t do.

Back then, in 1980 or so, we were often still focusing on a single score in the IQ test.  That weighty single number that summarized your cognitive ability. . . . set in stone . . . . forever. . . for better or for worse.

I am here to clear that up.

Here are some things to remember about an IQ test.

  • The IQ test is not the oracle. It is not going to produce a magic number that can be used to predict your child’s future.
  • An IQ score is not set in stone, particularly for children. There are a number of factors that can cause a score to go up or down (again, particularly in children).
  • An IQ, even with multiple subtests, is not the sum total of who your child is (it’s not even the sum total of his cognitive ability).

And don’t get me wrong.  I like IQ tests.  I give them all the time.  I just do not tell people I am giving them an IQ test.  I say, “I am exploring your cognitive profile, looking for strengths and weaknesses.”

It’s now all about the cognitive profile

The commonly used IQ tests have evolved into something different.   With each update of the various IQ tests, the singular IQ score becomes less of a focus.  Basically, we gave up on the elusive and singular score that represents thinking.  Now there is a focus on a person’s “cognitive profile.”  We measure several types of thinking and processing.   Although there is a single summarizing score available, we often pay little attention to the single score.  We are more interested in “the profile.”

The most common “reasoning” areas assessed include:

  • Verbal Reasoning – This is how a person works with words and uses language to think and express themselves
  • Visual Spatial Reasoning – This is how a person uses visual and spatial skills to solve problems, such as duplicating designs or solving visual puzzles.
  • Fluid Reasoning – This is how a person integrates information to draw a conclusion either visually or verbally. Think “butterfly goes with butterfly net, so fish goes with . . . “
  • Quantitative Reasoning – This is the ability to use mathematical principles to solve problems
  • Knowledge – This reflects how much information a person has absorbed and retained. This is also dependent on how much information a child has been exposed to.

Most IQ tests also incorporate tests of “processing.”  These are subtests that are sensitive to learning disabilities or other impediments to learning.  Typical areas assessed include:

  • Processing Speed – These are usually fairly simple visual tasks that are assessing how quickly someone works. There is no problem solving or reasoning involved. Just work quickly.
  • Working Memory – These are tasks that require people to hold information in their heads and work with it.  The tasks range from simply repeating number sequences to solving math word problems mentally.

But Processing Scores Often Change the Overall Score

It’s convenient to have these processing subtests in the test, but they certainly color or influence the summary IQ score.  In fact, the inclusion of more “processing” subtests in the last 20 years of IQ test development has changed how school districts determine who gets special education services.  In the past (when IQ tests were not sensitive to learning disabilities), the determination for services was made on the discrepancy between the IQ score and the academic scores.  (IQ score higher than academic score=learning disability.)   But the inclusion of Processing subtests “pulled down” the IQ score for kids with learning disabilities, closing the discrepancy in many cases.  Many school districts had to change their criteria for determining who received special education services.

So, the IQ test has evolved into something that will give you 4-6 subdomain scores (some about reasoning and some about processing skills) and an overall IQ score.  (Most of the major tests have even moved away from calling it IQ. They simple refer to it as a “General Cognitive Ability” score or something like that.  Even the test developers know that IQ is a loaded concept and prone to misinterpretation).  These 4-6 subdomains each have a score that goes into the profile.  This can result in a mountain range of scores from below average to above average . . . . or a series of below average scores . . . . or a series of higher scores . . . are a single low or high score amongst a series of more consistent scores.

The profile is the thing that matters.  This is what gives us insight into a child’s ways of reasoning and learning. For example:

  • If the reasoning scores are high, but the processing speed is low, then this is a child who is quite bright, but will need extra time to show it.
  • A weakness is working memory is often a marker for dyslexia.
  • High Visual Spatial skills, but low Verbal skills means this child might struggle from kindergarten through high school, but sill make a great architect or construction engineer.

A lot of research has gone into what can be gleaned from 10 subtests.  Good evaluators can tell you a lot about your child’s learning by looking at their profile.

So what is an IQ test?

  • It is ten to twelve subtests. It is NOT the subtotal of who your child is.
  • It is a profile of 4 to 5 cognitive and processing abilities and says nothing about creativity, emotional status, social intelligence, academic ability or any myriad of factors that will play a part in your child’s future.
  • It’s a tool . . . an extremely useful one in the hands of a good evaluator. But, like any tool, it can be mis-used and mis-interpreted.  It is also only one of many tools we have at our disposal and only one of many tools that need to be used in a comprehensive evaluation.
Does the IQ test tell you everything
IQ Testing does not measure everything about a child

I like these tests.  I give them all the time.  In addition to scores, I pay attention to the child’s attention, behavior, motivation and all sorts of fun stuff (like who ends up sitting on the table while working) while giving the test.  These tests tell me stuff, but they do not tell me everything I need to know.

If you would like more information about evaluations, learning challenges, attention problems, behavior issues and ways of supporting or treating these, leave a question or check out our book, Child Decoded.

Should I have my child’s learning evaluated?

Should I have my child’s learning evaluated?  And by whom?

New Year, New Start

Decode your child's learning with a good evaluation
It’s time to evaluate

We feel inspired and ready to tackle problems in January.  Fresh starts are great.  I love January for this.  (Sure, it’s random.  We can fresh start ANYTIME, but January is sort of a symbolic and traditional time to do so.  Jump on the bandwagon).

January is a key time for parents to consider an evaluation.  We are about halfway through the school year, so if any problems are going to emerge, they usually have by now.  (or you knew about the problems in August and they are still there).  You might be hearing:

  • She is not keeping pace in reading even though she seems to be really trying.
  • He is still having trouble following the routine and completing tasks.
  • Handwriting is not improving. He needs to try harder.
  • She cries a lot, sometimes over the littlest things.
  • Peer relations are a concern. He does not have any friends.
  • He hit someone, he bit someone, he threw his book at someone.

The teacher may have already put some strategies in place without the desired improvement.  The school’s occupational therapist or speech therapist or social worker or learning specialist may be have been called in to consult, but still . . . the expected (desired) gains are not there.  There may even be a 504 Plan or Individual Education Plan in place, but your child does not seem to be progressing.  What do you do?

Should you have your child evaluated?

  • If the problem or concern has been noticeable for more than a few months, an evaluation of some type will likely be helpful. If the problem emerged recently, particularly in response to a life change (a family move, different school, divorce or other loss), your child just may need more support during this transition time.  Some time with the school counselor (or a private counselor) may help.  A little tutoring to help a child adapt to a new type of instruction may do the trick.
  • If there is a family history of reading disability, attention problems, speech or language delays or academic problems in general, your child might be growing just as the family tree grows. An evaluation may be enlightening for several generations.
  • If your child has had bumpy development for years, a good, thorough evaluation will be helpful. Some children were slow to walk, then slow to talk, then slow to learn colors, then slow to learn to read, then slow with writing.  And maybe with each milestone, a little extra helped seemed to boost them enough to move forward. So you keep hoping things are ok. Then the teacher calls again.  A thorough evaluation may shed some light on the patterns and everyone can build a more comprehensive plan.
  • If your child has a history of chronic illness or significant injury, a developmental evaluation can augment a medical evaluation. Everyone may be attributing the academic problem to missed school, fatigue or even frustration, but some illnesses or injuries do cause changes in the brain (even an illness or injury that does not seem in any way close to the brain). A good evaluation of development and learning can support overall recovery, as well as learning.
  • If you, as a parent, just have a persistent nagging feeling that all is not right. Trust your gut.

What type of evaluation?

  • Your school district can evaluate your child. Your child is legally entitled to a free and appropriate public education. An evaluation is often needed to determine what exactly is appropriate for a particular child. However, school districts around the country (and even schools within a district) can vary wildly as to the depth of the evaluation.  In addition, school evaluations are often not diagnostic evaluations.  The evaluation will try to identify the problem, but not the source of the problem.  The evaluation will not typically come with a diagnosis, simply a conclusion of whether your child meets criteria for extra services. But, hey, it is free and is essential for triggering special education services (and a great team can do a great evaluation).
  • If the school evaluation did not shed enough light on things or if you want to explore issues in more depth, parents will need to look into resources outside of the school. Now there are more options to consider. First off, do you go big or do you go small?
    • If your child is delayed in a single area (language impairment, delayed reading, terrible handwriting, or math confusion), but there are no other concerns, then a small specific evaluation may do the trick. If the teachers (or coaches or you) see that your child has friends, pays attention in class, follows routines, stays with tasks fairly well, and otherwise manages that day, then a focused evaluation of the core issue by a learning specialist, reading specialist, language specialist or occupational therapist (for writing) will likely suffice.
    • If there are concerns in more than one area or if a more focused evaluation (and intervention) has not helped your child make progress, then a more comprehensive developmental evaluation maybe needed. This would be an evaluation that carefully reviews the history and assesses your child in multiple areas.  This would include a cognitive profile, an academic profile, assessment of attention control, language skills, memory, and problem solving,  as well as screening of emotional style and sensory motor processing. This should provide enough information to understand your child’s needs, make a diagnosis if warranted, and lay out a course of action.

There is one clear benefit of an evaluation independent of the school district.  A private evaluation can make recommendations for both private and school-based treatments.  A school district cannot recommend educational or developmental resources outside of the district without being held financially responsible for them.  A private evaluator can help parents explore a wider range of resources (even if they are not free).

How do you find a good evaluator?

Within the school district, you do not have much choice.  Your child will be evaluated by the team of specialists (learning specialist, psychologist, occupational therapist, speech/language specialist) assigned to the school. However, you do have some choices. If your child has unique needs (e.g., non-verbal or English is not their first language or history of head injury), you can ask for a specialist within the district (there often is one) to participate in the evaluation.  If there is no specialist in the district, you can ask that the district pay for someone who has the expertise to evaluate your child.

Outside of the school district, the sky is the limit.  It’s very intimidating.  There are a lot of specialists out there and they are all proud of their work. Quite frankly, child psychologists are your most likely source for comprehensive testing, but even so, not all of us specialize in evaluations.  Here are a few strategies to narrow down your options:

  • Talk to your pediatrician. They often have a list of people that their patients have had good experiences with.
  • Call the local medical school or university to inquire if there is a child development clinic and what types of assessments are done.
  • Call the local learning disability association (or check their website) and see if they have a list of preferred evaluators for children with needs like your child’s.
  • Look for private child development clinics (I practice in one) that can provide both comprehensive and domain specific evaluations.
  • You can check with tutoring centers, but the evaluation there is typically geared to laying out a plan of treatment within that program. While the program may be helpful, the evaluation is likely not a diagnostic evaluation. In addition, the evaluator within that program may not have a broad range of experiences (she may only know that program).

Here are a few questions to ask when considering an evaluator:

  • MOST IMPORTANT-Describe your child and then ask, “Do you have experience with children similar to mine?”
  • “Will you be able to make a formal diagnosis if needed?”
  • “What are the costs of the evaluation? Will that include a written report?”
  • “Do you take insurance?” “Does insurance cover this type of evaluation?”
  • “What if I have additional questions after the evaluation is concluded?

And find an experienced, but humble, evaluator because:

“Not everything that can be measured is important, and not everything that is important can be measured”  ~a quote coughed up by the internet, attributed to Albert Einstein, and based on something said by William Bruce Cameron (but it really fit here)

Evaluation is my life!  There is so much more information than can be included in a simple blog post.  I would love to hear what questions you have and how I can help.  We also included a lot more information in our book, Child DecodedCheck it out for in-depth information about evaluations, as well as a wealth of information on learning, behavioral or attention challenges (and their treatments).

New Years Resolutions-no worries, just reflections

Resolutions
We all need a little me-time, even if it is just some time for reflection

I like New Year’s Resolutions.

Some people hate them.  Some people think they are useless.  Some people think you are only setting yourself up for failure if you make them.

Not me.

Maybe its because I think of them more as reflections, than resolutions.  My New Year’s Resolutions mean I have taken some me-time to consider what is important for me, not just my family or my career.  Every parent (particularly if you have a child with a disability) has been told, “You have to take care of yourself first if you want to take care of everyone else.”  And we all know how that goes.  But, like any skill your child is learning, you don’t have to get it right the first time.  Just remember to keep practicing (and move the goalposts a little when you need to).

So here, on the first of the year, with a cat on my lap, hot tea at my side, and three teenagers still asleep, I am taking some “me time”.  And since I LIKE to write, I am sharing it out.

After big changes in 2017 (publishing a book, adopting two teenagers) and a super busy 2018 (trying to find time to market the book while uber-parenting two new teens), it is time for 2019.  What do I want for me?

  • Eat better– I always make this one and I make little inroads each year. This is also a moving target. My needs change and evolve. I have noticed my metabolism slowing during my 40’s and 50’s, but I swear, last week it stopped.  I have decided I can have all the fruits, vegetables and protein I want, while limiting carbs and sugar.  I will let you know how that goes.
  • Exercise a little more– Yeah, another repeat resolution, but why not? It might re-start my metabolism.  I started over Christmas, lets see if I can finally stick with hitting the gym a few times a week.
  • Mediocre Parenting – Last year, I was the best mom I could be to my two new teens. I don’t get 18 years to model good mom behavior because they are already 16 and 18.  I had to work fast. I am inordinately proud of them for how they have managed this tremendous transition. However, I told them last night that in celebration of our one-year mark, I would be doing less and helping them be more independent so they can launch when they are ready to.  Bring on the bus passes!  Hand over the laundry duty! Yay me!
  • Write more – I love to write, but somehow it gets put in the category of “me time”. Maybe I will have more time when I am not picking up from school or doing laundry.
  • Get rid of stuff – While my new teens have reveled in getting stuff and loved earning money to buy it for themselves (ah, the power of spending money), I want to continue to shed things.  This will be made a little harder by my teens who love to gift me with perfume, make-up, shampoos, lotions, and all things teenage girls love.  No worries, there is lots to shed here without turning down their sincere gifts.
  • Reduce my plastic consumption– In the Reduce, Re-Use, Recycle mantra, I will focus on the first because I have the latter two down pat. What I like most about this one, is it is such a mental challenge.  It requires an alertness to things I ordinarily do not pay any attention to.  And although it is a mental challenge, ultimately, it simplifies my life in deeper ways.
  • Get More Sleep – An oldie, but goodie. I make it with great conviction every year and am still often failing spectacularly.

And failing is ok.  Little bits of progress count.  Partial successes are great.  (Heck, maintaining my current weight would be progress enough!).  These are my reflections upon my life and what would be good for me.  I have to integrate these into a complex of family and career life.  I can’t expect perfection of myself any more than I expect it of my kids.

But I have had successes over the years. A few of my favorites are:

  • Don’t sweat the small stuff – This is a life saver when parenting. I let the small stuff slide.  I may mention little problems to my teens, but why harp, why yell, why spend my precious time over things that do not directly impact their future, safety or health?  So when they fall asleep in their clothes on some weekend nights (because that is the only time their phones are allowed in their bedrooms), I may roll my eyes and say , “Really!!” but I am not going to worry about it.
  • Model the coping I want to see – I think I have mastered this one at least 95% of the time. I want to model calm, I want to model problem-solving, I want to model good decision making (even if that means saying, “I don’t even know what to do in this situation, let me think about it for a bit.”).  This took YEARS of practice!  It is not an overnight skill.  But now, when a teenager is punching a brick wall because I will not let her walk home with their new boyfriend, or when the school calls to tell me someone went off-campus for lunch and was 30 minutes late getting back, or when I walk downstairs after New Years Eve to find the den littered with candy wrappers, dirty glasses, empty bowls, and random teenage detritus, I am calm.  There are important discussions to be had with the first two issues and a simple request to go clean up for the last problem.  They do laugh about this one because I did yell yesterday when I realized that two teens were riding in the car without seatbelts while the third teen was driving through a snowstorm on a busy highway.  I kept the yell short, just one sentence (another accomplishment).
  • Clear pee – yes, staying well hydrated was a goal one year.

Wish me luck in 2019!

Parenting a Child with Poor Emotion Regulation

When little people are overwhelmed by big emotions, it’s our job to share our calm, not join their chaos.  ~L.R. Knost

The Intense Child (an understatement)

Do you have one of those “intense” children, a “spirited” one, a bit passionate . . . alright –  a HARD one?  Do you have the kid who falls apart at the drop of a hat, loses his temper at the slightest provocation, and melts down at the least frustration? Your child has poor emotion regulation.  A more common problem lately in our modern world.

Are you in a constant emotional tiptoe around this child because you have learned . . . the hard way . . . after repeated attempts . . . that the typical discipline approaches do not work?   You tried time out, scolding, removing favorite things, removing privileges, threatening, yelling, and maybe even spanking.  All the standard approaches only seem to make the problem worse.

A more typical child with more typical regulation skills can reign it in when a parent sets a boundary, particularly if the parent’s tone indicates that the child has crossed a line.  More regulated children can zip their lip or modify the misbehavior.   If you yell or take a privilege away, those children may slink off to lick their wounds, but they accept the consequence and soon move on.

The poorly regulated child does not.  This child can’t reign it in.  Emotions ride roughshod over her (and over you).  And as soon as YOU indicate frustration or irritation,  things only get worse.  Your irritability meeting her irritability causes some form of combustion and her emotions escalate exponentially.  Whining becomes a full blown meltdown.  Frustration becomes a tantrum.  A punishment becomes THE  . . END . .  OF . . THE . .  WORLD (!!!).

Sigh

And recovery is slow.  This child might tantrum or meltdown for an hour or longer.  He may not recover that day and may fall asleep upset.  He wakes the next day feeling fine, but you are on edge, waiting for the next crisis over nothing.

The possible roots of poor emotion regulation

Intense children require some specialized parenting strategies, some that even seem a little counterintuitive.  However, understanding regulation issues and providing support instead of punishment can put everyone on a better path.

  • First, let’s look for some reasons for being poorly regulated. Knowing the reason does not change things, but it gives a little insight.
    • Trauma – kids who have experienced neglect or abuse will often have very poor regulation of emotions. They can’t help it.  The trauma and neglect created some hair-trigger emotionality.  Also, dysregulation may have been modeled for them.  Children adopted from institutions or from foster care are likely to have a trauma history.  Building their regulation skills will take time
    • Developmental Challenges – Attention Deficit Disorder, Sensory Processing Disorder, Language Disability, Autism – these challenges can drain a child’s coping strategies pretty quickly.
    • Family History of Mood Disorder – if you have a family history of mood disorder, your child may be showing some signs of this.
    • I DON”T KNOW!!! – no trauma, no (noticeable) developmental challenges, no depression or anxiety. This kid is just intense. You think maybe it runs in the family (not your side, of course) as you give a glowering side glance at the spouse.  (You have heard stories from his mother.) Or maybe you recognize this perfectly clearly.  You remember being an intense child (but, surely, you think you weren’t this bad).  Which brings us to . . .

Pesky contributing factors

  • Next, it’s good to know what exacerbates the regulation problem on any given day:
    • Hunger or Thirst – Hunger will make everything worse, but your poorly regulated child cannot even tell that hunger as crept up on him.
    • Fatigue – Once this child is tired, all bets are off. And poorly regulated children can wear out more easily than other children, so the day needs to end earlier.
    • Lack of Exercise – Movement is calming and alerting.  Daily active play, dance, a sport or exercise can be essential, but organized team sports may be too great a demand.  Keep it simple and fun.
    • Over-Stimulation – Too many people, too much noise or too many demands can wear this child out.  These may be situations that a more typical child manages (and enjoys), but the poorly regulated child cannot handle it for too long (even if they love it at the start).

      Many factors can make a child a little gremlin
    • Screen Time – too much screen time can feel like a good thing when your hard-to-manage child is quietly zombied out in front one, but try taking it away and you can be face to face with the regulation problem. Screen time typically makes regulation issues worse.
    • Junk food – Poorly regulated children can be hypersensitive to poor nutrition.  Sugar, food dyes, processed food can contribute to dysregulation.
    • Illness – I knew a child whose first sign of a strep infection was increased irritability and meltdowns. The physical symptoms would show up a day or so later.

You cannot avoid all of these things all of the time (though you can try).  Just be aware that each can contribute to irritability and hypersensitivity.  Be ready to control what you can when some other events are unavoidable.

Now here are some strategies for building regulation.  (You will notice that there is no magic wand.  Building these skills simply takes time and consistent support):

  • MODEL THE COPING YOU WANT TO SEE!!! (this is most important) – This child is irritated, frustrated and exasperated. She has caused you to feel irritated, frustrated and exasperated, but BECOMING irritated, frustrated, or exasperated will only escalate the situation.  If you would like this child to calm down, you have to start by modeling calm.  This does not mean ignore the behavior or encourage the behavior or give into the behavior.  It just means that you will model a calm response.  It helps if you realize that your child does not WANT to be a dysregulated mess and she really can’t control it.

    When a child melts down, try not to follow suit
  • Look for any “contributors” and resolve them – Feed the hungry child (but not candy or junk food), water the dehydrated one. Get some rest or go play depending on the situation.  Remove the child from an over-stimulating situation (even if it means calmly carrying her kicking, screaming, flailing self out).
  • Set Boundaries – you don’t have to present this as punitive, just matter of fact. “You can’t be at the party while you are screaming.  Let’s stay here (the car, a back room) until you feel calm or we can go home and try a party another day. It’s okay to not stay and it’s okay to try another day.” Screaming, flailing child may not like this, but really, what else is to be done.  An angry threat of, “We will NEVER go to a party again if you do not calm down RIGHT NOW” is just an empty threat.  Do not even present the consequence as a punishment.  Why say, “you are in this room in time out until you calm down.”  Do not bring up punishment because that does not make anyone feel better.  Just re-iterate that she can’t be at the party when she is so upset.  Then be supportive.  Position yourself between the child and the exit and calmly hold your ground in case your child tries to take matters into her own hands.   (I realize this is really hard to do when you have more than one child and the other children are being good as gold.  If the dysregulation is that bad, most outings will have to be a two parent project).
  • Recognize Any Progress – We don’t want to reward a tantrum or meltdown, but we do want to recognize any improvement.  “Wow, the last time you got upset, you cried for an hour, but this time you were done in 30 minutes.  You are learning to be the boss of those strong emotions.”  You don’t have to give prizes, just praise.  Your child needs a little empowerment over the situation too.
  • Use Humor When You Can – Children who can’t regulate their emotions may simply need something to laugh about. This can defuse a situation.  For example, I once worked with a mother who had a very dysregulated 9-year-old daughter. This child would scream at her younger brother for the slightest provocation (such as stepping into the room), however, she was extremely nurturing with the family pets.  She never hurt or yelled at animals.  I suggested that the next time this girl screamed at her brother, her mother should say, “In this house, we treat everyone like an animal.  If you would not do it to the dogs, you cannot do it to your brother.  Now go pet your brother and help him feel better.”  The mother immediately saw that this would help at least a little, “That would make her laugh.”  A laugh is a foot in the door for a dysregulated child.  I added that if her daughter would not go pet her brother, the mother should.  This gives the attention to her brother and models making up for bad behavior in a fun way even if the daughter will not do it yet.
  • Let It Go – After the meltdown, blow-up, or tantrum is over and dealt with as calmly as possible, let it go. Even if the situation did not resolve entirely (Yep, you did have to leave that party), there is no reason to harp on the situation.  Often, once a dysregulated child is calm, he has moved on as if the problem had not happened.  This can be very frustrating and worrisome to parents because it seems that the child does not realize the impact of his behavior.  That’s true and you can calmly work on that in little bits and pieces, but harping on it for the next hour (or two) will only extend the misery for both of you.  If it is possible to have a productive discussion, by all means, try (“I think next time we should leave the party BEFORE the noise starts to bother us because why stay if it is not fun anymore.  What do you think?).  If the child is calm enough to have that discussion, try it.  But do not lecture.  It will be like lecturing a dyslexic child into reading better.
  • Neutral Time Discussions – Do not be afraid of talking about the meltdowns, tantrums or dysregulation during a peaceful neutral time.  Discussions will not work in those intense moments of meltdown, but may work fine when your child is calm.  Your child is not proud of those meltdowns, so she is not going to bring them up.  Most parents want to avoid any triggers as well, but being able to discuss it shows that the problem is manageable.   A weekly meeting can be held with the agenda of previewing plans for the upcoming week and reviewing the past week and what could go better. What was hard to manage?  What might be tried differently this week?  “Let’s try my idea for a week, then your idea the next week and see what works best.”  This is a chance for a child to air grievances as well.  Be respectful of legitimate grievances, but put not-so-reasonable grievances in perspective (e.g., “yeah, I know having a little brother is rough, but he’s staying.  I think you will appreciate him when you are both older.  We are in this for the long run.”). It’s okay to inject the lighter mood because intense kids typically do not know how.  Model “Don’t Sweat the Small Stuff.”

Do seek more support if needed. If your child’s emotional upheaval is endangering to himself or others, or you simply feel that you need some guidance because your child overwhelms you (as well as himself), then seek some professional help.  Counseling around parenting intense children can give some perspective and precision with strategies.  It also ensures there is not a more serious issue at play (such as a mood disorder).

Kids with poor emotion regulation can be exhausting, but in equal turns, their enthusiasm and passion can be exhilarating.  Teach them that their emotions are powerful and that they can use all that emotional intensity to change the world.  Remind them that it is your job to help them use their powers for the forces of good.  Then laugh and go find them a cape.

Workaround-You can’t fix everything at once

It’s okay to go around a problem instead of solving it.  At least for a bit. I hear it’s called a “workaround.”  I am trying to make it feel like less work, but whatever . . . the point is you don’t have to be fixing everything, all the time!  It’s exhausting for both you and your child.  You can’t just let things slide (well, you can and must some of the time for your sanity), but you can develop some workarounds.

Does your day feel like this? Does your child’s?

Even with just a few learning or behavioral diagnoses, your child can have A LOT of challenging behaviors.  For example, say your child has a “disorder of regulation.”   You have the child who feels EVERY emotion strongly.  Happy is over-excited, angry is furious, and anxious is terrified.   There is no lid on THIS child.  Plus, the sensory system is a little too awake.  Every noise, every touch, every taste, even every smell comes on too strong for this one. Most foods are met with revulsion (no small emotions remember).  Most activities are met with aversion.  And trying paying attention when every emotion, every noise, every touch, every smell, every THING is a distraction.  This child is constantly called out for not getting something done that every other child seems to breeze through.  The teacher is trying to be subtle, but you can sense medication is on her mind.

The challenges of each day seem overwhelming.

This child with little ability to regulate emotions, sensations and attention is hard to wake up and then irritable in the morning. Breakfast is a challenge because of texture issues (the first tears of the day), getting dressed is tough because clothes trigger tactile anxieties. You are now running late for school, but this child does not have a hurry button.  Try using a firm voice and this child thinks you are “yelling” (more tears and curled up into a non-moving ball).  You make it to school, so now this child spends the day distracted and disorganized by the noise and demands.  It is exhausting.  The teacher e-mails about some concerning behaviors . . . again. Lunch in the stinky, clamoring cafeteria is a no-go. No lunch = Hungry.  The afternoon is a wash for your child. This child gets in the car starving and irritable; complaining all the way home. Anything any sibling does in the car is worth lashing out physically and verbally.  There is no desire for soccer, or dance class, or chess club or Scouts.  Your child wants to go HOME!  Once home, television seems to be the only consolation.  Pulling away for homework is a battle, as is homework itself.  In desperation, dinner revolves around what this child might eat.  Maybe a calming bath after dinner will help.  Everyone is exhausted, but it is hard for this child to settle to sleep. By 10, things are finally quiet, but you know that 10pm is too late for a complete night’s sleep for this child.  Tomorrow looms.

If your child has a lot of challenging behaviors, it feels like the day is non-stop management.  And really, you have been told that management of the problems is not enough. You need to fix them.  But being a full-time therapist/mom is not really an option when running a household, managing other kids, and working (as is often the case).  So guilt is your constant companion.

But really, you can’t fix everything at once.  And often you simply can’t fix everything.

It’s okay to set some priorities and find some workarounds for the other problems. Some might be permanent workarounds, some might be temporary while you work on other things.  But keep reminding yourself, “YOU CAN”T FIX EVERYTHING AT ONCE!”  Cut yourself some slack because, really, it is the only way to survive sometimes.

First, set some priorities on the most challenging behaviors. These might include:

  • No physical hitting or hurting others – Have a pre-set plan for hitting/hurting with a simple consequence that has been discussed in advance. Use your calm voice because meeting disregulation with anger likely doubles the disregulation (this child really can’t help it).The plan needs to include noticing every possible time the child does not hit (but might have) and compliment that. This may sound like, “I hear from your voice that you found that irritating, but you did not hit.  Be proud of yourself for that.”
  • Limiting screen time to two 30 minute segments in a day – Too much screen time makes regulation issues worse.  So screen time might include some time in the morning, once the child is ready for school, and in the afternoon for a bit. It would be helpful to have a timer on the device so that it shuts itself off without a parent having to intervene.
  • Not bickering with siblings (wouldn’t that be heaven) – This is a team effort and will take team discussion, but is a worthy goal. Bickering can likely be reduced.  Start with some “data collection.”  When does bickering happen the most – in the car, at breakfast, at bedtime?  See if there is a contributing factor – someone is hungry, someone can’t bear to be nudged when over-tired, someone is hot?  Try to fix that contributing factor first.  Then have a frank discussion of what can be done to reducing the fighting (do this when everyone is calm and NOT fighting).  Then start practicing and complimenting.  Its best to point out the “no bickering” times because the kids have to learn to recognize and appreciate those as well.

Some of you are snorting, “My child could undermine any one of those in under two minutes.”  Yes, I know.  It’s hard.  And if it is that hard, do see a parenting therapist.  Parenting tough kids requires some professional support.

But the real point of this post is “the workaround.”  Sometimes we need to just go-around the problem for at least awhile.  Some examples include:

  • Wearing the “wrong” clothes – For the sensory child, just skip clothes with tags, internal pockets, tight elastic, rough seems. For the apraxic child, skip buttons, zippers or anything complicated.  Heck, skip variety.  Find the clothes your child is comfortable wearing and get enough to last all week. A lot of clothing issues dissipate in adolescence with the strong desire to fit in and wear what everyone else is wearing.
  • Getting dressed in the morning – Mornings are rushed and many kids can stall on getting dressed. Simply eliminate that problem in pre-adolescent children by letting them sleep in their comfy sensory clothes.  After an evening bath, put on some comfy leggings, sweat pants, or gym shorts; add a comfy top and you are done for 24 hours.   Before the age of body odor, the clothes can be slept in and not be stinky.  In the morning, there is one less things to worry about.
  • Doing ALL of the homework (or any of it frankly) – Depending on your child’s challenges, the end of the day may be a point of exhaustion. None of us do our best work at that time.  Talk to the teacher and ask for permission to “sign off” on what was possible on any given night.  Sometimes that may be nothing.  That’s ok.  If your child is exhausted, what learning is happening?  Compliment your child on any work completed because sometimes any work is an accomplishment.
  • Eating a wide range of foods – Yes, I believe in eating from all the food groups, but that is not the same as eating a wide variety of foods. Cut yourself and your child some slack if you both need a break.  Do let your child know that fruits and vegetables, as well as proteins, are important and will be on their plates every day.  But then only put what they will eat at this time.  Don’t push the “just one bite” of other foods.  If they will only eat two fruits (and one of those is apple sauce), so be it.  Those foods should show up twice a day at least.  If there is only one vegetable (carrot sticks), then so be it.  Meals may be repetitive for this child, just make sure they are easy for you.  Continue to remind children that you will continue to help them get used to textures and it will get better. Useful “pre-tasting’ strategies include having them just touch new foods, handle new foods (e.g., can you grab me a tomato out of the fridge please), and stir or pour new foods.  If the problem is really bad, an occupational or feeding therapist may be needed.
  • Eating in the cafeteria – It’s loud. It smells funny. And you might touch something slimy.  It is hard to have a calm, enjoyable meal (even though 200 other children seem to be doing it, sort of). See if your child can have lunch elsewhere.  Maybe a friend can come along.
  • Skip the after school activities – If your child is exhausted and dreads after school activities, just skip them right now. Therapies, yes.  Those should be geared to your child’s needs and abilities.  But soccer or piano or swim team, maybe not. For some kids, the right activity is a life saver and a treat.  If you find it, great.  But be willing to forego the ‘well-rounded’ child until you find the right activities. There is a lot to be said for downtime.  It promotes creativity.

There are as many workarounds as there are kids.  You have to find the right ones for your child and your family.  You may also have to let go of some strongly held beliefs about meals, pajamas, and being well-rounded.  When your child is different, you do things differently.  It does not mean you can’t slowly nudge your child towards more typical expectations.

But cut yourself (and your child) some slack.

(And Child Decoded is here to help)

Emotion regulation and the art of the spin

Sometimes, parenting is all about the “art of the spin.”

In every life, a little rain must fall.  For child with challenges, it can rain a lot.  How do we help our children through challenges, set-backs and frustrations?  This can be particularly challenging for children who struggle with emotion regulation. Children who cannot regulate their emotions may (over-)react to problems multiple times a day.  It takes constant practice to help them reset their heads and take things in stride.

I recently got an e-mail from a mother I know. She wrote:

I am writing to you about Abby. We had a really, really difficult first week at first grade. Abby is a bright, energetic and happy little kid. (I know this child.  Effervescent is the word that comes to mind.  She is adorable.)  Abby has Sensory Processing Disorder.  She has a sensory diet and we are diligent about keeping up with it.  There is a plan in place at school for this. Abby is great about knowing what she needs. She self manages fairly well and is pretty cooperative about doing movement, asking for noise reducing headphones, etc. Another thing about Abby is that she likes to do things perfectly (despite teaching her otherwise.) She is a BIG rule follower, particularly at school.  She loves school.

Abby started first grade this year and came home the first day saying, “First grade ROCKS!” All was well until Tuesday. At recess, Abby made a bad choice. She told a lie to a teacher about a peer whom she felt was mean to a friend. This is very out of character for Abby and something she has never done before. When the teacher figured out that Abby’s story was not adding up and asked Abby if what she said was true, Abby wet her pants on the spot (something that has NEVER happened). The fear must have surged through her body.

Because of the lie, Abby had to ‘flip a card’ which is the behavior system her school uses. Abby has NEVER had to flip a card and this is her 4th year at the school. Trying to prepare her, I have said to her periodically, “Some day you will flip a card and it will not be the end of the world. You will learn something and we will move on.”  She would always say, “Mom, don’t worry, I’m never going to flip, I LIKE to follow the rules.” To say Abby was crushed by her mistake is an understatement.  The school had to call me to take her home.

Abby was crying so hard she couldn’t breathe. She begged me not to tell anyone, including her dad. She was so embarrassed. She took her own dessert away and wrote her apology letters to her teachers. The next morning all was well until it was time to go to school and then tears, lots. She went to school crying.  To make matters worse, unbeknownst to me, her teacher decided that the movement schedule would be changed and a new aide was to do them. This aide is certainly nice enough, but knows nothing about giving a sensory break. Abby cried on and off all day and frankly looked glassed over when I picked her up. She hadn’t eaten a bit of her lunch.

I found out then about the change in the movement break plan. I was LIVID! To change a plan that a sensory kid has had in place for ages on the heels of probably the most traumatic event she’d experienced (in her eyes) without consulting the occupational therapist or with me, her mom. So Abby was a complete disaster and didn’t even have a good way to even attempt to get back on track. I respectfully asked that the plan be reinstated until we could meet formally to consider changes in her educational plan.

Despite this, Abby has cried every day at school since then. I ended up taking her home early on Friday. Her teacher was out, the sub wasn’t managing well, and Abby was crying hysterically.

We spent a day “calming down” and working hard.  Physical activity always resets her mind.  I felt like she was pretty well reorganized, so I tried to talk with her about the week.  As soon as I broached it, she started to cry uncontrollably. She doesn’t want to go out for 3rd recess anymore (which is where the card flip and pants wetting happened) She just kept saying “I don’t need 3 recesses anymore.” She does not want to go to school anymore.

Abby has always been a little anxious and I always wondered if it was just part of her SPD or if it was something more. At this moment, I am thinking it’s something more and don’t know what to do. My child is a mess. Can you guide me? Thank you so much.

Building Emotion Regulation with a little spin

So I answered:

Wow, poor kid.  But there are things we can do. Sometimes the sensory regulation issue has an emotion regulation issue.  You tried to prep her for the inevitable, but she was pretty sure it would never happen.  Now the emotion that surged up is too high to regulate.

Certainly, getting caught in a mistake AND wetting yourself would be traumatizing for a child who loved school and was sure she would never have to “flip a card.”  And in the first week!

My thoughts are for some scripting around the reality . .  .  . and a little spin.

Sometimes you have to put a new spin on her perceptions.

The next time you bring it up, start with, “I am so thankful this happened.”  (huh!)  “No one gets through life without making a mistake and most of us make lots of them, it is good to get some practice with them.  I am so glad it was a 1st grade mistake and not a teenager mistake.  Those are bigger and harder to fix.  This one was easy.  You apologized and it is done. You handled it very maturely.”

Keep a matter-of-fact tone for yourself

As upset as Abby is, if you match Abby for gravity of the situation, she may think it really is as serious as she is making it out to be. Model that this was a small mistake.  They happen every day.

The two spins are:

  • I am glad it happened – For a child who has made a (in her eyes, terrible and unforgiveable) mistake, how can anyone be GLAD it happened?  But as we all know, mistakes will happen and we need practice with picking ourselves up, dusting ourselves off, and moving on.  Spin it as something as important as good grades (because it is).
  • You handled it very maturely – Well, there was that wetting accident and multiple bouts of hysterical crying, but there was also an apology in writing.  That was the mature thing for a six-year-old to do in the midst of being a very upset little girl.  Not many of us think to make amends when that upset.

(Just to note, this spin does not downplay the feelings, the spin is to give additional perspective to the event.   The additional perspective will hopefully help reset the feelings.)

And Use YOUR Mistakes!

The Queen (my daughter) was very intense with her emotions and was pretty famous/infamous at school for her breakdowns after any perceived mistakes.  One thing that helped her was hearing about the mistakes I had made.  “Do you want to hear the 5 mistakes I have made today alone?”  The answer was always a breathless, “YES!”  I also covered the WORST mistakes I ever made (keep to your G-rated ones if you go there with smaller children).  The Queen particularly likes the story of the time I called my mother stupid IN FRONT OF HER FRIENDS. My mother was not amused and let me know it.  My horror and embarrassment were immediate and epic.  The Queen was re-assured that I had survived my own feelings.  I had to tell that story every time she made a mistake for several years.  It got old, but it worked for her.  “Tell me about the time you called your mother stupid.”  Since I had survived that, she could survive whatever mistake she had made. (By the way, my mother, as the Queen knows, is a wonderful person who did not deserve my 12-year-old impulsive flippancy in front of her friends).

Plan for the Next Mistake

After mistakes are shared, parents can also discuss the inevitability of the next mistakes. “What do you think your next mistake will be?”  “I wonder what my next mistake will be?”  “I have got some guesses already.”  We all have stuff in our day that can go south on us due to lack of planning, putting too much on the plate, or just getting tired and irritable.  Include our funny mistakes.  Our mistakes are easy to come by.  Then we discuss solutions, but often, it is just moving on.

Other Supports

Abby seems to have really tipped herself over with this.  I told her mother to consider providing more support if possible for a little bit:

  • Joining her for part of 3rd recess by adding some mommy time in the day with a little volunteer time if possible.
  • I recommended Lilly’s Purple Plastic Purse by Kevin Henkes.  It is a similar story of a big mistake made by a little person, complete with notes of apology as well.
  • For supplements, Epsom Salt baths which helps us absorb magnesium might be of some benefit. Magnesium is calming and is depleted in times of stress.  There is also Rescue Remedy, a Bach flower remedy, which is to calm stress reactions.  These strategies may help a little. Being a psychologist, I typically recommend that parents run any supplements past their pediatrician.

Taking Support to the Next Level

I told Abby’s mom if things did not settle in the next few days, check in with the school social worker or psychologist for strategies.  If that does not help, some short-term counseling might be needed.  A good child therapist can help build emotion regulation skills.

Epilogue

A few days later, I heard from Abby’s mom.  “Hi! I just wanted to give you a quick update. I tried almost everything you recommended and she has been tear free for two days. Will continue the coping strategies. Great to have my happy girl back! Thank you so, so much.”

I glad it was good advice, but I am sure time helped a little too. However, with an intense (albeit adorable) child, there will be years of practice off and on down the road.

Putting a good spin on something is just one strategy, but an important one, when building emotion regulation.  The right “spin” on things can help her move forward more quickly.

Your Child’s Diagnosis-or Not

I don’t diagnose.  I mean . .  . I CAN diagnose, but I often don’t.  I am a developmental neuropsychologist and I do reassure parents that I can diagnose any possible learning disability.  But frankly, it’s not the point of my evaluation.  I don’t see my evaluations as diagnostic evaluations, but as comprehensive developmental evaluations with a good dash of neuropsychology.

What’s the difference?

Many evaluations in my field are diagnostic evaluations.  The goal of the evaluation is to converge on a diagnosis (or several) from the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (the DSM-5 for short).  This is the manual psychiatrists and psychologists use to make mental health diagnoses, including developmental and learning disabilities.  It is bible-sized, about as dense, and a little dry.

The DSM gets updated every decade or so.  Some diagnoses are removed, some are added, some are refined and made clearer (some are made muddier).  Our understanding of mental health, cognitive issues, developmental problems and learning challenges continues to evolve at a bumpy, uneven pace.   The DSM tries to keep up.

And this is one reason why I do not focus my evaluation on a DSM diagnosis.  I like the DSM. I own it.  I pull it off the shelf regularly.  I will make a formal diagnosis from the DSM-5 when it is necessary and/or when it is helpful.  (It is necessary for college and, sometimes, other school accommodations.  It is necessary for insurance submissions. It is necessary to enter certain treatment programs.)  And sometimes it is helpful. Sometimes the child is a perfect fit for the diagnosis (or diagnoses) and the treatment protocol.  Giving the diagnosis will help everyone support the child through well-studied and accepted protocols.

But frankly, there are just not that many diagnoses to choose from.  Developmental and learning disorders are categorized as Neurodevelopmental Disorders.  You get six basic choices – Intellectual Disability, Communication Disorders, Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder, Specific Learning Disability, and Motor Disorders. There are more specific subcategories within these labels. There is also a category that is basically “Other” in case nothing else fits.

A child (or teen) can also be diagnosed with a mood disorder (depression, bipolar disorder), anxiety disorder, oppositional defiant disorder, attachment disorder or other more typically “mental health” disorder, but these are in other sections of the DSM.  I typically roam around in the Neurodevelopmental section with occasional forays to the other areas.

But, you ask, why do I resist making a diagnosis?

Here are a few of my problems with simply converging on a diagnosis:

  1. There is the use of the words “Disorder” and “Disability.”  Some of the challenges I see are not a great fit for certain classrooms, but do I consider this a “disorder.”  Maybe it is just a type of normal. For example, we love (and often envy) highly energetic adults, but we are not as thrilled with highly energetic children.  However what may be a drawback now, may be an asset later.  I discuss this with parents and we make a decision to either make a diagnosis (because it does fit well enough and would be useful in some way) or describe the child’s strengths and weaknesses (or both).  The recommendations will likely be the same either way because those are based on lots of other data collected, not just the diagnosis.
  2. There are only 6 general categories. Sometimes I think we are too narrowly defining our range of possibilities for the billions of people (and their styles) on this earth.  Even using more than one category may not fully describe the child I evaluated.  In addition, I really want to paint a picture of this child, not converge on diagnoses.
  3. Not all of my preferred options are in there. Sensory Processing Disorder (or atypical sensory processing) being a good example. That diagnosis was proposed (strongly) for inclusion in the DSM-5, but it did not make the cut.  Sometimes, sensory issues are a leading contributor to attention problems in the child I evaluated.  So if a diagnosis is necessary, I have to make an AD/HD diagnosis (or Oppositional Defiant Disorder or Intermittent Explosive Disorder or something that fits) with an added explanation of the factors causing the problems.  Sometimes I don’t make the DSM diagnosis and focus on what I think it actually going on.  I feel like the diagnosis will actually be misleading.
  4. The diagnosis might become a label. If you lead with the diagnosis – Autism, Attention Deficit Disorder, Intellectual Disability – people may only see the label, not the child.  They may form a mental bias based on the label and not expect a child to be able to learn or change because they do not see a certain skill as within the scope of that label.
  5. The DSM diagnoses still do not connect brain to body very well. It tries to and does discuss various medical factors that may contribute to some diagnoses.  But sometimes there is a diagnosis, such as Oppositional Defiant Disorder, that totally fails to take into account sensory or other physiological factors that take a part in the presentation.

I have reviewed several evaluations lately that collected a lot of information and converged neatly onto a diagnosis.  The diagnosis was justified by the outward presentation of the child and the scores obtained on tests.  In fact, it was the only diagnosis in the DSM-5 that would have fit.  But the diagnosis was not helpful.  The diagnosis did not drive treatment in a way that supported the child.  It was necessary to dig under that diagnosis and find the contributing factors that led to that diagnosis.  Treating or supporting those factors were helpful to the child.

So yes, I can make a diagnosis and I will when it is needed.  But I will also continue to see evaluations as an art, as well as a science.  I want my work to be more than industry standards.  I want to paint a helpful picture.  I want to try to get to the bottom of things.

And that is why we wrote Child Decoded.