Problem Solving

Problem Solving

A critical developmental skill on so many levels

I just finished a round of workshops and training in Singapore and Australia and taking the opportunity of a few days break in Perth, Australia while visiting family. Every day here I get to observe two typical girls (2 and 4 years old) play and simply take from life whatever they can. It is refreshing and I am also realizing how much time I spend on observing human behavior!

What is so very clear; is how much active problem solving is enjoyed by kids developing typically. When I pose a problem for the 4 year old (we will call her Caren), she looks up, makes eye contact and searches my face to see if she could find a non-verbal cue to solving the problem. When I pose a problem to Tanya (2 year old), she stops dead still and stares, gives me her most engaging smile and hops on my lap to solve the problem for her, perfectly trusting me to be up to the job.

Embed from Getty Images

Both Caren and Tanya embrace the problem solving opportunities on different levels. Frustration is quick, but perseverance prevails. Even when we are not able to get to solve the problem before the “meltdown”, the turn around from being upset is fairly quick. It is also amazing to see how much longer they will stay with the problem solving if the adult remains engaged and supportive emotionally, even though not really doing anything physically. They will really keep trying and only get upset if the adult withdraws the attention.

They also create their own problems to solve and truly, anything goes! From wearing packaging bubbles on their heads, to figuring out how to really get at each other; and pushing each others buttons. As they go about their play, they literally are solving a new issue every 5 minutes. Each problem is yet another opportunity to answer a question, to engage in sequence, to figure out the steps, going from initiation to task completion.

And they do not need any rewards from anyone. Just attention, thank you very much, is all they seem to want. They look for validation, but they are not looking for extrinsic rewards. They want to intrinsically please themselves in playing or doing something. Just this morning they were engaged in making banana bread with their mother. Both cuties lined up at kitchen table, each with spoon in hand trying to figure out how to mash the bananas and of course each has to have their own ‘job”. Their inner drive is a sense of ownership which would be their own particular accomplishment. Even though our validation is reaffirming, they smile about what they have achieved before the adult has even said a word. This inner drive leads to the next explorative activity and then, the next.

It is also amazing to see how much longer they will stay with the problem solving if the adult remains engaged and supportive emotionally, even though not really doing anything physically. They will really keep trying and only get upset if the adult withdraws the attention.

It is also the simplicity that counts. I sat at the kitchen table and both had to squeeze into the tiniest corner at the side of my chair. I created a pretend idea of a “jail”. For Tanya it was a physical exercise of figuring how to get out. For Caren, it truly was the idea of a jail and being unlocked that grabbed her. Both were problem solving on their respective levels of development. What am I confirming?

  • Children’s play is rife with opportunity of developing sequencing and imagination important for academic and social prowess later.
  • Think before you do something for your child. They may really enjoy doing parts of tasks themselves, engaging their own self esteem and inner drive.
  • They want us to be available and emotionally supportive, but not necessarily doing things for them.

Thank you Caren and Tanya!

Maude

Let’s talk about Anxiety!

Let’s talk about Anxiety!

So many children suffer from anxiety in different shapes and forms. The first action usually taken is to refer to a counselor and to perhaps partake in medicine and there is nothing wrong with such practice, except perhaps that there is more to consider.

There are different kinds of anxiety. Some have trauma in their origin and is triggered by experiences that remind the child of this other trauma that had occurred before. Consider the child who has experienced multiple meltdowns in his past. Those were experiences wherein the child felt out of control and this was not a comfortable experience. It stand to reason that when this same child is faced with this possibility, he would become anxious in response to the fear of those meltdowns re-occurring. This in effect, could cause yet another meltdown to occur.

Because the child may be intelligent and coping well, have met all the regular developmental milestones, subtle cues are missed in earlier years and the child’s needs go undetected.

Other anxieties have to with the child’s experiences in her early life. There might have been earlier reasons why she was unable to form an effective attachment bond with her biological mother, causing her not to trust relationships. This hyper-vigilance to other people in her life causes her to go into an anxious overdrive, leading to fight and flight, and a continued cycle of more anxiety.

In other situations there may be strife at home and there is worry about the health, wealth and stability of the family, seriously affecting any feelings of well-being, leading to more anxiety.

Embed from Getty Images

But then there is an anxiety that few books talk about. It is related to performance anxiety rooted in developmental delay. Because the child may be intelligent and coping well, have met all the regular developmental milestones, subtle cues are missed in earlier years and the child’s needs go undetected. The child continues the developmental journey, but all through it with consistent edge of anxiety. By the time they are referred to us to check out their development in more detail, most of these children have already been to a counselor and have tried several medications.

Depending on the age the child’s needs are evaluated different profiles may have emerged over the course of time. Nellie may have become a perfectionist as she tries to do everything perfectly, leaving no stone unturned and not feeling good about herself unless she performs perfectly. Johnny was an honor role student all through the elementary years and suddenly started getting failing grades while in middle school. He has come to a point where he has just given up, having worked too hard during his school career and not feeling the rewards of all his effort.

Katie spends hours on her homework as she reads and rereads her work to ensure all is ok before she let’s go of it. Jennifer simply gets to a point where she melts down in frustration at the several different triggers that her homework provides every evening. It has become the most dreaded time for her and her family. Gregory made it through high school, has an above average IQ, and enters college, only to drop out within the first year. These are the most common profiles and can vary over different ages and stages.

The common factor on all is varying degrees of anxiety that continued and persisted through formative years of development and beyond. Every child with persistent anxiety should be checked out for developmental delay, that may be contributing to behavior. Getting to the root cause for the anxiety can change a child’s course for life and is a worthwhile investment. It will be different than treating only the symptoms, but target what is causing these anxiety symptoms to occur in this specific child.

And intervention could be different combinations of therapy aimed at the autonomic, limbic and central nervous system, including working through play or creative experiences. Children generally do not do best verbalizing their thoughts, but they do well expressing themselves through creative play, getting deeper into the subconscious to integrate those bothersome triggers. If we keep trying to understand a child’s anxiety, they will respond with resilience, curiosity and a presence of mind. This would be the child you know was “in there”, beyond the veil.

Pay Attention!!! (Third in series on Executive Function Skills)

Pay Attention!!! (Third in series on Executive Function Skills)

Shane is sitting in his classroom, and the teacher is explaining a new math problem and the steps to solving it. He loves math and is really trying to listen. He looks away out of the window to other kids playing outside while he keeps listening to the teacher. His teacher notices this and requests of him to look at her as she is explaining this more complicated issue. Shane knows he has to look at his teacher, though finds it really difficult to do and after a while, he starts to fidget and move around in his chair and gains another comment from his teacher to stop fidgeting. As far as the teacher is concerned, Shane must have ADHD. He always appears distracted and constantly has to fidget in his seat. For Shane it is a whole other story.

There are so many different reasons why this scenario could be playing out before we need to consider such strong diagnosis such as ADHD or ADD. I will cover these differential diagnostics according to the hierarchy of development. First, it could simply be that Shane has not integrated attentive primitive reflexes such as the ATNR (Asymmetrical Tonic neck Reflex) or STNR (Symmetrical Tonic Neck reflex) or others, and the seated position causes discomfort because of this.

Secondly, it could be that Shane does not have sufficient balance between his postural extension and flexion in order to maintain this seated position for prolonged periods of time. A third option could be that there may be a processing speed delay in either his visual or auditory system, causing him to prefer the stronger of both in order to capture some of the instruction. Or it could be that he is not able to time the visual and auditory instruction together in his brain, causing him to need to look away so at least he can use one channel of information.

Because sensory processing, reflexes, postural control does not carry an official medical diagnosis in the DSM, doctors feel obligated to place him in some category and ADHD appears to be a good fit.

His teacher feels rightly so that a further step needs to be taken in getting Shane in a better position to learn from the teaching environment. So she suggests that his parent and herself complete a Connor’s rating scale and sure enough, Shane is considered at risk for ADHD and the notion of stimulant medication is discussed. Everyone has his best interests at heart, but what if this is not the right route and that chemical intervention might not be what he needs at all? Truth is that if I answer the questions on a Connor’s rating scale and compare with the answers I get from completing a Sensory Profile, we will also find a sensory explanation to the very same questions. Because sensory processing, reflexes, postural control does not carry an official medical diagnosis in the DSM, doctors feel obligated to place him in some category and ADHD appears to be a good fit.

Embed from Getty Images

But what if the teacher referred him to occupational and / physical therapy? And we discover that the underlying building blocks are not in place for him and that rather than seeing him as a “behavior issue”, we discover he is really trying hard with what he has? Shane has no other body to compare himself to. He has no sense of comparison what it may feel like for his peers. All he knows is what he sees. They appear to cope fine; therefore he has to find a way. He compensates, he copes through cognition and long term memory, he tries it all, but as the grades and performance demands increases, his coping strategies become less effective and soon other behaviors start, impulsivity and daydreaming increases. It is not willful, but rather an outflow of a boy who is not in charge of his system, but does not know why.

As professionals we have to support families in “chasing the why” before simply accepting the most obvious route. Human behavior has never been obvious, the subtleties are multiple and we have to address issues at their root cause in order to be the most effective clinicians for every child coming through our door.

One last thought is that anxiety could be another factor that can look exactly like an attention profile. I am doing a webinar on this on May 22, 2017. E-mail me at maude@atotalapproach.com if you are interested.

What is power anyway?

What is power anyway?

I am going to veer off course for this writing and will continue discussing executive functions next time. We are leaving from South Africa today, back to the USA. I completed a series of different trainings and had some time with my mom in Durban as well as some time in the Kruger National Park. We encountered several lone elephant bulls with high levels of testosterone, as they were not close to any females to mate. On one particular occasion, a bull was walking down the dirt road towards us. Normally we would pass by peacefully, even stop to take a picture. This time though, this bull was not a happy camper and we had to reverse our vehicle quite some way, while the bull kept coming towards us. If we went to the left, he went to the left, we went to the right, and he went to the right. Finally, he decided to give and walked off the road. As he started to eat from one of his favorite trees, we put our car in gear and sped up to get past him. He charged out of the bushes, ears flapping, feet stomping, but we finally left him behind.

This encounter made me think. We were visiting his turf, he was on the prowl as his instincts were dictating him, and we were in his way. Our intentions were good, we wanted to enjoy him and we certainly did not want to harm this magnificent animal. He did not know our intentions though, made his own assumptions, and went into fight/flight mode. There was no way we could have whispered to his amygdala, we simply had to leave him be.

So it is with many of our children with developmental delay. When Sarah feels threatened no matter how good our intentions, she resorts to the more primitive parts of her brain and goes into fight / flight. This could look like a real fight, but also be a defensive posture or a “shut down” mode, where reason cannot enter. As well meaning adults we want to be able to use our verbal ability to calm, reason, kindly request, etc., but Sarah’s mind is perceiving threat and even if she was quite verbal, once the fight/flight kicks in, she does not have the same ability to use her verbal skills.

When Sarah does not respond in an equable manner to her parent’s request, her parents feel a number of things. In that car we felt our power dwindling and the beginnings of fear setting in. Likewise her parents feel the same kind of fear when Sarah does not appear to listen or “heed” a request provided to her. When her parents feel out of control of the situation, they themselves can go into a fight / flight as they respond to this feeling of helplessness, but in that car, with a bull looming over us, adult logic simply told us that trying to fight this bull was not going to be the brightest idea we have had so far! We decided to retreat and keep our distance and took our chances at a later moment.

What her parents need to be thinking about is not that she is denying them their authority or their parental power, but rather how are they modeling for her what power looks like so she could follow by example.

So it also would be with Sarah. When she is in fight / flight with no access to reasoning, it sometimes is better to retreat for now, give her time to gain control over her emotions, gain better access to reason, and then to advance in maybe a slightly different way again. Power struggles are often futile ideas, just as it would have been for us to try to overpower that bull that day. And most parents have lived it; the feelings of helplessness leading to not feeling in control and then going over into some action to gain control and so the power struggle begins one more time. The power lies in understanding the game. When Sarah is having a good day, she has access to the best parts of her skill and she will attempt more activities than usual. On a “not so good” day, she will go into fight / flight more often and if her parents persevere with their control over her on those days, she will fight for her own control and pretty soon, we have a blow up on our hands. If we understand that Sarah requires a little more time on those days, if we retreat and come back later, we will not only have provided her the time to get her emotions under control, but also have preserved her (and our) dignity, self esteem and ego integrity. We left that bull intact, and even though a little shaken, we were intact as well.

Embed from Getty Images

The power lies in choosing your battles wisely. Do not assume that Sarah’s behavior is “manipulative” in a negative way. She is still developing, still learning how to use her power and her control, and this process would be under construction until the age of at least 24 years according to research. What her parents need to be thinking about is not that she is denying them their authority or their parental power, but rather how are they modeling for her what power looks like so she could follow by example. Tough one, especially when we all carry our own issues. But it is also true and as parents we can only try. When we “goof up” we need to go back and repair, and model to her what sorry really looks like and build empathy in the process as well.

Nobody won, not the bull, neither did we. Nobody had to “win’! Both gained the freedom of being alive, of feeling important emotions and the compromise did not violate our ego integrity and neither did it harm us or the bull. We have stayed on course in order to gain another day and were wiser for the experience.

Until next time,

Maude

Noooo!!! It is going to be Forever!!! I am Never going to be able to do what I want to do!!! Part 2

Noooo!!! It is going to be Forever!!! I am Never going to be able to do what I want to do!!! Part 2

Time is an elusive skill for Kayla as she struggles with developing her executive functioning skills. As a baby she had to learn to understand different cycles of sleep and wake as well as night and day. She struggles with impulsivity and finds it difficult to wait for someone to finish their thought before she jumps in with her own contribution. She frequently struggles with the ability to bring in the past experience into the present, as she remains in the moment, instead of fully employing past, present, and future, another building block in the understanding of time.

Our own internal sense of timing lies within these concepts, as well as our own body’s ability to anticipate timing. After we develop body timing, the intricate process of integrative timing starts to build. Our ability to look at the teacher, while listening to him at the same time, the ability to listen to kids in the background play, yet still to continue focusing on a task at the same time, relies on the integration of our different senses and their ability to work together. Yet another layer to consider would be reading decoding. Dr. Keith Raynor’s research stated that a good reader would scan lexicon on paper for about 11 to 18 character letters at a time in one saccadic eye movement before fixation takes place. During this visual fixation, phonics kicks in within 5 to 20 milliseconds, and this enables us to decode unfamiliar words in a fairly even way. The timing between the visual and auditory system is important for decoding to become rapid and automatic. Frequently programs focus on one or the other skill, but it is timing them together that makes the difference to reading fluency.

When Kayla has to write an essay, she has to think a thought, plan the sequence of events as well as her sentence construction with language pragmatic skill, while she also has to negotiate her penmanship and grammatical rules in constructing her thought. All the while she has to keep her main idea in mind, while she also pays attention to the detail of her writing. Written expression is likely the most intricate of all in timing different systems to work together in an efficient manner. Therapy that targets integration as a goal, is not complete until this process of timing have also been included and addressed.

Our own internal sense of timing lies within these concepts, as well as our own body’s ability to anticipate timing. After we develop body timing, the intricate process of integrative timing starts to build.

Timing and Rhythm goes together in assisting Kayla to keep pace with her peers. It is that innate sense that transpires into a timely production of task in the time allotted for it. She develops her own sense of pace by the understanding her own body has reached in terms of working with a certain rhythm, while keeping track of time. It simply does not help to ask her to work at a faster pace, because even though she understands your words, she does not have the ability in her body to create an adaptive response to the command. It leaves her feeling frustrated that her mind is willing, but her nervous system cannot comply.

Kayla will frequently be found to ask the same questions over and over. The question with “when” is especially frequent, because the common words we use such as “in a moment” or “in 5 minutes” or “after dinner” does not make sense to her. For her, all of those answers in the space of time could be “now” and the insecurity of this loss of sense of time leaves her feeling vulnerable and exposed as she cannot affect closure and anxiety reigns. For her it is as if she has been left in mid-air. Difficult for us to understand as we rely on this system so much, we take it for granted in ourselves.

One more aspect to cover with regards to time is how difficult it would be for Kayla to be interrupted. Her parents and teachers frequently struggle with transitioning her from one activity to another, especially if the first activity was the preferred activity. If her parent tells her that it will be quick and she will be right back to her video game, two major areas are going to come into play. Number one would be that since she has a limited concept of time, taking her from her preferred activity would be “forever!” and the word “quick” was not attuned to. The number 2 aspect of this is that Kayla may be in the middle of a plot that she is focusing on and knows that when she is interrupted, for however small amount of time, she would have to renegotiate much of what she had already gone through to pick up the thread where she has left off. Even though timing is not the only aspect involved in this (more to come), it certainly is part of the equation. Kayla has to develop the ability to be busy with a task that she have allotted a certain amount of time for, being interrupted by the teacher or another student, and being able to make a quick calculation in her mind with regards to how and when she will be able to make up the time lost.

Understanding time is complex, but this skill can be addressed through targeted therapy that considers the building blocks first and then focuses on timing it all together. Without this skill Kayla would always carry the burden of being late for everything, frequently being last to finish, needing extended time for tests, and frequent power struggles between herself and authority figures that require her to respond at a certain pace within a certain amount of time.

In my next blog we will discuss the important skill of paying and sustaining attention.

Stay tuned!

Maude