by Maude Leroux | Sep 28, 2016 | Parenting
I am sitting at the airport in Missouri and am reflecting on the past ATTACh conference that concluded at noon today. I have so many thoughts, with multiple trajectories to traverse as I try to connect the information in the interstates of my brain. This conference has a fair complement of both parents and professionals and the different discussions were very productive indeed. I stand amazed at how much information we do have about the brain and our inter-connections we have with each other as human beings. I stand equally amazed that in the face of this information and research, we still live in a society that over emphasizes productivity and live in a state of perpetual performance anxiety because of it. It is such a strange dichotomy with no research or evidence that it is making us even a little happier.
Parents perpetually feel that in order to be “good” parents they have to be able to provide as much opportunities as possible for their child to participate and perform. The sense of pride with achievement is well understood and I have real empathy and also joy for sharing in this with the many families we serve. But I also often become quiet in my mind and ask myself what for? If you ask me to reflect on a favorite childhood memory, it is always a reflection of all 5 of our children sitting on my parents bed on a Saturday morning, enjoying our coffee together and laughing so hard that my father has to put his book down because we are shaking the bed too much for him to continue reading. Do I have many memories of singing trophies, acting in drama, playing “netball” (women sport in South Africa), being a sports team leader etc, yes! But it is not my first memory that I welcome in my mind. I think about our many family vacations, driving what seemed like hours and hours in the car to get to our destination. I think of sitting between my two big brothers who kept poking at each other over and beyond me that I have to sit forward in my seat and just let them go at it behind me. These are my memories. They are favorite ones, but not the ones in which I need to perform or “be the best I could be”. I could simply just be! How much do you value this ability of simply just “being” today?
I stand equally amazed that in the face of this information and research, we still live in a society that over emphasizes productivity and live in a state of perpetual performance anxiety because of it. It is such a strange dichotomy with no research or evidence that it is making us even a little happier.
We hear of social media, we have 500 friends on facebook, but whom are we connecting with? How much do we truly listen to each other and truly try to “get” what each other is going through? Parents are pressured in so many directions today. They feel the stress of “the window of time” that is now and we have to do what we can in an effort to cross the bridge. Many professionals fall into the performance pressure and even omit developmental milestones, to enforce skills the child may not be ready for. We have to see the product, the child has to speak, and the child has to perform. We even have families coming to us that are having 3 year olds in 30 to 40 hours a week of therapy, not leaving any time at all for the most productive therapy of all: Play! A number of year’s back 4-year-old twins were referred to me and was already put on a stimulant for ADHD. The brain has not even matured yet, but they have to pay attention! I do not blame parents at all. They only do what we professionals model for them to do, go for performance and live on the fear of the child not catching up in time.
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Development requires of us to attune with each other, to be social and to thrive on human connection. On Thursday Dr. John Baylin said we humans have “fancier” brains. What makes us unique is our unique properties of caring, nurturing and taking care of our young. Dr. Daniel Hill stated that infants can read their parents state of mind within the first day of life. What makes us different is the way we can feel “felt” and connect with each other. Instead we want to compete, fight for our piece of this wonderful earth and live each day with the stress of needing to outperform each other. Why? I am not certain I understand? Is it not great to invite a couple of friends over, break some bread together and simply enjoy being with each other?
Our children with special needs have an even stronger need to feel “safe” today. Because it is harder or them to understand the world, they need even more to be understood and to be given time to process and create a response that would be both creative and reflective. We think because we are more mature we know better than them and we surely have their best interests in mind, therefore we try to fit them in the holes we prepare for them and we are unhappy when they do not follow suit. At school we expect performance that has to be educationally “relevant” and therefore we fit the square peg into the round hole as much as we can. When the child starts to go into fight and flight our next answer is either to label him or her with a diagnosis or to bring in a behavior specialist because surely the child is to “blame” for his or her behavior?
No, my mind reasons that we are doing children an injustice. Children need family to feel secure and safe. They need to be working at their pace in order to understand their world. When they are not stressed by performance demands, they are “freed up” to go on developing and do this at a faster rate than we can plan. We need to think about what we are doing. Of course we need therapy to push at the right time and the right place, but this does not have to be 30 to 40 hours per week with no modeling of family joy and simply playing and exploring the world. We need to bring balance back and as professionals we have to model “connection before correction”, a concept I will write more about next time!
Warm regards,
Maude
by Maude Leroux | Sep 7, 2016 | Parenting
So many times we hear the words at consultations: “I wish I knew this about Paul many years ago!” or “If only we knew that Linda was struggling so” or “ We really thought Justin simply did not have the motivation to do better” There are many more and I always wonder at these statements. The information we provide is ages old developmental information from long ago studies confirmed in more recent studies. Most of the assessments we use have been around for many years and have proven themselves repeatedly in research. What is going on that families are not getting to the right place of knowledge about their child in a more rapid way?
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Digging a bit deeper I found five possible reasons for this:
- Most agencies, including medical insurance, are allowing less time to complete a thorough developmental assessment. This time allowance causes therapists to do “what they can do” in the time allowed.
- Most therapists have a limited arsenal of assessments that they use over and over on different profiles, diagnosis, ages and stages, not really individualizing their battery for specific reasons for a variety of presenting needs.
- Most authorities now are looking at the student / child’s behavior and making judgment calls on behavior, using a non-descript “eclectic” model of assessment and intervention and do not apply a developmental frame to their individual assessments.
- Educational institutions want to stay “educationally relevant” and want to forget that educational relevance today is dependent on the development of yesterday. The student has to fit into their mold of thinking and not be assessed for where the student is really coming from.
- Because of funding constraints, educational institutions do not refer any student out to an agency that could provide a more detailed evaluation; henceforth families trust that their educational team is doing best by them until they realize one year later they are in exactly the same boat as a year ago. If only the educational institutions would do the calculations of cost of educational support over many years, sometimes including mediation and law suits. If one intervenes early at the right place the initial cost would be higher, but the cost in the longer run would be far less.
What does not work in Linda’s favor is that she is intellectually smart and everyone expects her to learn and behave in a way commensurate to her intelligence. The problem is that our developmental pathways provide the support for us to use our intelligence and while we can apply cognitive strategies to cope, there comes a point when too much coping is simply asking too much of Linda.
The truth of the matter is that if typical development was good enough for the typically developing child, it is going to be good enough for the atypically developing child. Applying a developmental pathways model to assessment and intervention ensures getting to the most likely root causes as to why Paul is learning and behaving differently than his peers. A developmental delay means exactly that. Somewhere in the different stages of building blocks to become an organized school student, Paul’s brain had to develop around any number of processing “glitches” and was not allowed to use the “straight, narrow, and most efficient way of responding to incoming input. If we can get to the original culprit for this as far as humanly possible, then we have a better chance of intervening at the “just right place”.
What does not work in Linda’s favor is that she is intellectually smart and everyone expects her to learn and behave in a way commensurate to her intelligence. The problem is that our developmental pathways provide the support for us to use our intelligence and while we can apply cognitive strategies to cope, there comes a point when too much coping is simply asking too much of Linda. Linda might simply tune out or might act out, becoming anxious and even sometimes aggressive. Then the school or organization refers Linda for a behavior plan for behavior intervention while all this time Linda is screaming for someone to understand what she is going through.
Linda has no way of knowing that her body is receiving and interpreting information differently from her peers. She has only one body with no comparison to make an effective cognitive judgment call. She is fighting an inner battle with what her body is asking of her to compensate for, while cognitively understanding what others are expecting of her. Added to this, as Linda watches her peers, the only judgment call she can make is that she must not be “as smart” as them and the toll starts ticking against developing a strong self esteem. Educational institutions however, very rarely recognize this social-emotional toll even if a teacher is warm, embracing and wanting to support Linda the best she knows how. The problem is that you cannot “attack” what you do not know. It is important to know why Linda is not doing what she is supposed to do, not only for her to be in a better place, but also to demystify for her what she is experiencing in a learning or social environment.
One final note also is that families frequently adopt a “wait and see” approach in the face of difficulties. They want to believe that the free public education is going to pull Paul through. In some cases it does, but in other cases it may “take a village”. Families believe that because the educational institution is not referring out, their child might not need the additional support. But then, years later we will receive that distressed phone call when the parent finally realizes their child may need more support. This “wait and see” approach work against the whole notion of early intervention. Every year that the child has to work harder, they feel more “different” than their peers and their self-esteem suffers. It is important to not wait, but to gain the information you need about your child’s learning behavior as soon as possible. Make sure that your child has a comprehensive evaluation that will add to everyone’s understanding and do not wait until report cards come out in November.
Please do not read this as a “bash” against educational systems. We work wonderfully well with a number of schools in our area and there are many well meaning teachers that want to do well by kids and are bending over backwards to support their students. The problem lies in the disconnect between the educational and private sector and many students are falling through the cracks because of it. We need each other to help students thrive and be the best that they can be.
Warm regards,
Maude
by Maude Leroux | Aug 17, 2016 | Parenting
September is around the corner and all of us are enjoying the hot summer month of August while at the back of our minds, the lingering thoughts of a next school year remains. For most going back to school means structure, homework and also seeing friends that we did not see the entire summer. But for some students, back to school seems like “impending doom”! Parents observe anxiety escalating and try to ease the situation, but for the most part feel helpless. Parents that have lived through a struggling last year, are feeling the anxiety themselves and dreading the next year as they achieved some modicum of being “stress free” over the summer.
The first idea is to gain perspective on what school means for your particular situation with your child. Even if you gained ground over the summer, the child’s memory is what he felt during the last school year. He does not think about things he may have learnt over the summer and the great camps he might have had. He is expecting what he left at school to still be there when he returns. In most cases of anxiety, the parent, therapists, and teachers are expected to support him and to be available to “anchor” him in his feelings as they anticipate school starting. It is very important to validate his emotions and allow him to express his feelings without judgment. It is equally important not to gloss over their expressions with an “It will be OK, you will see”. Some parents feel the need to try and take away their child’s anxiety with comments such as these and they do not fully realize how the child is perceiving this type of “soothing”. The child is feeling the emotion of anxiety and when a parent tries to “make it ok”, the child feels that it is not right for him to feel this way and this actually escalates the anxiety. Better to go with: “I hear you, you are nervous about going back to school” and the child feels that someone understands and “gets” him, taking away the additional feeling that everyone else around him does not think he should feel this way, for them it is going to be “OK”!
Second idea: Parents and caregivers naturally want to try and “solve” his anxiety when in actual fact it is only the child that can change his perception of his experience. We must remember that we do not perceive the same experience through the same lens as the child. When the child expresses his nervousness, try to refrain from coming up with a plan for him. Rather acknowledge his emotion with a comment about it and try to open up a conversation to get his thoughts out. Expressing his thoughts is enabling him to sort through it and gain his own sense of control over his thought matter. You could even encourage drawing or writing a story on his own or together with you. Build a Lego constellation while carefully creating an atmosphere of sharing. There is no good parent that would not want to take care of it for their child if they could, and while the inclination is nurturing and caring, it also robs the child of the opportunity of taking care of it himself. He needs to feel in control of his expectations, but cannot do this on his own. Make sure time is made to sit with him to sift through his thoughts, so he could get closer to his own answer for the situation. Having him go with you to go shopping for back to school supplies could be a practical outlet that could initiate opportunities for discussing it with you in a warm, safe way.
We must remember that we do not perceive the same experience through the same lens as the child.
Third Idea: The kind of anxiety she is feeling is not a generalized type of anxiety, but more a performance anxiety. She is looking toward a situation where she has to be confronted with areas of weakness for 6 hours of each day for 5 days each week. She knows her own level of shyness, her own lack of feeling in control in the face of the multi-sensory environment, and the fact that while she is there she is on her own. In addition to this, students with performance anxiety really have a fear of the new and novel experience, a new teacher, a new grade, perhaps even a new school. The new and novel hold the promise of throwing unexpected occurrences their way, and they fear they might not have sufficient time to protect themselves from the onslaught. It is so much better for students like her to be eased into a new school situation with no additional performance demands placed on her, but settling in at first. We ask for IEP teams to consider no homework during the month of September and also not to call on this student in the classroom until she has settled in. Some teachers get it and others do not, but in the case of performance anxiety it is simply a task to be in the class itself; which require a good amount of work on her internal state of mind. Her energy is directed to her anxiety and not as available for the rigor of every day school work. It is important that she bonds with her teacher and knows that her teacher has her back. Some teachers fear she will feel left out if she does not have homework. Students with performance anxiety already feel left out and perhaps better to discuss with her how much she feels up to doing. If the performance anxiety persists she is going to get behind in her understanding of the work anyway and with too much homework, she knows she is facing more hours at home going through the same anxiety. Easing her into the school year and increasing the performance expectation gradually will help to ease the perception of challenge and provide her with a feeling that she could cope with the situation and gain control over her performance anxiety.
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Fourth Idea: Because parents have gone through some years of anxiety at the initiation of each school year and they want to ease the situation, we frequently find that they stop therapies for the month of September to “get into” the new school year. The opposite is needed. Therapies are there for support and now, more than ever, should be continued on a weekly basis as she would be allowed to release pent up anxiety during these sessions. It could be emotional processing sessions, sensory sessions, or physical sessions, but the most important is not to sever the relationships that could anchor her during this time of need. She needs that ongoing relationship to go to that would allow her the space to contain her emotions and give her the relief she needs as she builds up the anxiety in her body over a school day.
Last Idea: Anxiety, whether emotional or sensory, is always helped by a good sensory diet. The parent may need to discuss with his occupational therapist some good ideas to step up to the plate in increasing especially the proprioceptive diet (deep pressure that is calming to the body) for this initial period of time and then to wean it as he settles into the school year. We particularly enjoy teaching families a tactile massage to complete once in the morning and again in the evening. Some students are helped by having an early morning session of OT in the beginning of the day, especially on a Monday to transition back to a school week. The needs will be different for individual profiles, and best to discuss with the occupational therapist on your team.
I sincerely hope these notes are helpful to you, as I know this could sometimes be classified as one of the most difficult times of the year. I wish you a successful transition into the school year for 2016-2017!
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by Maude Leroux | Jul 26, 2016 | Parenting
“Why is it so difficult for Karen to get to a place of calm so she can go to bed at night? We have tried everything and we are exhausted as a family. We know she understands what the expectation is; yet it is virtually impossible for her to get to this point herself. Sometimes she falls asleep from pure exhaustion and we can see how tired she becomes, but she simply cannot turn off the “switch”. Most nights, simply for the sake of all of us, she comes to sleep with us in our bedroom. Honestly, Maude, that is the only way any of us can get rest, even though we know she is old enough to sleep on her own. On occasions when she does fall asleep at a reasonable time, she will wake up in the middle of the night and either yell for us or come to our room and sleep with us.” We can hear the frustration of this family story and know this resonates with so many other families.
Sleep is a wondrous thing. It renews us spirit, flesh and mind and provides a lovely place from which we can attack the next morning’s chores and activities. When this is not possible, we find ourselves running around on pure adrenalin, more stressed than we ought to be, and the energy for working and processing through other needs is simply not available. Children with sleep difficulties simply do not have the same attention to task than their peers the next day and is literally using the available energy to cope with the stress of feeling tired rather than using their energy for the learning process. It is quite remarkable to see how some children cope within these circumstances as they show much more resilience than their behavior gets credit for.
The first step in a sleep-deprived situation is to have it checked out medically and make sure your child does not struggle with conditions such as sleep apnea, breathing regulation or nighttime reflux. This is a condition wherein stomach acid flows up into the esophagus causing discomfort in the chest and throat area and cause waking up in the early hours of the morning. It does not always have to come up in the throat, but could stay in chest area, making it very difficult to determine as an issue.
But if the medical investigation proves a healthy system, the next step would be to check your child’s regulatory or modulation pattern. Sensory modulation is an inability for two major nervous system pathways: Sympathetic (arousal) and Parasympathetic (inhibition) to come together at a “just right” place for an even keel performance in arousal and attention. Think about that first cup of coffee in the morning and what it does for you to wake up. You know what your system needs to get to the “just right” place. Children with modulation difficulties do not. They know they have to get down to rest, but try as they may, that point of calming is ever illusive, causing even more distress and fatigue. In some families this is further exacerbated by the child’s anticipation of bedtime and her inner “knowing” that she is going to seek for this control, but feel hopeless to accomplish it. So just the very mention of bedtime sets this anxious cycle in motion again for yet another night.
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Sensory modulation can look different in different children and there is no “one size fits all” approach. Some kids are calmed by a warm bath before bedtime; others are over-aroused by the prospect of a bath. It is best to work with an experienced occupational therapist to determine your child’s particular profile and work on specific ways applicable to your child. Some starter ideas for you:
- Regular bedtime routine No TV or ipad in the bed before expecting to sleep. It actually alerts the brain.
- Dimming the lights in child’s environment an hour before bedtime.
- Soft calming music an hour before bedtime in the child’s hearing vicinity.
- Spending time with the child with joint attention to a calming activity within the hour before bedtime.
- Reading a story and having quiet family time together.
- Warm baths are good for some children.
- Some families find relief from adding a spoon or two of Epsom salts to the bath.
- The smell of lavender is calming to the nervous system, whereas mint is not.
- Ensure the right texture blanket / sheet on child’s bed, well as the bedclothes.
- Also try tight clothing, such as spandex sports clothes that fit snugly and tight on the body.
- Heavier bed blankets might be a good idea for some even in the heat of summer. There are weighted blankets available commercially.
- A night light might work for some.
- I’m not in favor of white noise, but more pink noise.
As an intervention, we frequently like to train families in a tactile integration massage technique that really works well. The calming touch of the parent’s hands going over the body in an organized way that stimulates the nervous system to the point of calm proves to be a great modulator as well as an emotionally connected time between parent and child.
Just the very mention of bedtime sets this anxious cycle in motion again for yet another night.
We also must consider the emotional connection to sleep. Many children feel anxious about separating from the parent for sleep, as there is an innate worry or fear that they will “lose” their anchor if they do. Emotional development requires that we separate from our parent in order to individuate and some children simply cannot get ready for this phase of autonomy and self-sufficiency. They might be having a difficult time working through fears and worries and might be stuck developmentally. Or they might be having difficulty working on the difference between fantasy and reality and therefore their anxious experiences become far larger than their reality. The child might simply feel threatened by a younger sibling taking her mom’s attention away from her, another developmental milestone to conquer. No behavior technique can replace the growth of emotional understanding that has to accompany the ability of the child to separate. The child needs a safe place of understanding to play out these fears and worries, so she can move on.
Getting sufficient sleep is important and all of Karen’s adaptive skills will be impacted, as she fights to stay alert and available and misses other important information. This topic is far more comprehensive than this blog allows, but hopefully it is helpful in getting started in the right direction.
by Maude Leroux | Jul 15, 2016 | Parenting
I just returned from a wonderful meeting of the minds in Arkansas and am reflecting on some of the points we discussed in more depth. One of the questions stood out: “What motivates a child to progress and learn?”
Let’ s start at the very beginning. Babies in and out of utero are hardwired to develop in very certain sequential steps of development. They grow in utero to have different cranial nerves in place to be ready for the birth process. During this phase of development it is very physical / sensational, but it is also emotionally driven by the voice of the mother that the baby experienced in the womb after 5 months in utero. Mommy’s voice is experienced through vibrations in bone conduction through the spinal cord and allows the baby to have an immediate link to her mommy’s voice as soon as she is born. The baby also is ready to receive mommy’s touch through the tactile-proprioceptive system and there the nature of bonding starts. Good healthy development depends both on central nervous system experience of sensations as well as the nurture of mommy and daddy as their first relationships.
We do not have to tell a typically developing child when to start walking, crawling and talking; they simply start going there.
Through the first two years of life, the baby grows and develops rapidly, often with stressful periods as the baby turns into a toddler and starts getting into all kinds of mischief. One very important hallmark of motivation is the concept of intrinsic motivation. We do not have to tell a typically developing child when to start walking, crawling and talking; they simply start going there. There natural innate drive propels them toward development. Only later, when their cognitive skill has developed into more reasoning does extrinsic motivation start making sense to them. Herein lies our conundrum: The atypically developing child turns away from learning to avoid unpleasant or unsuccessful experiences. The more new and novel the task appears, the more reason to want to avoid.
In order to gain such children back into the world of learning, many different theories have developed. One large theory comes from behavioral science and postulates that atypically developing children require extrinsic motivation to gain skill. So in essence it is a “top-down” approach. We appeal to the child’s cognitive understanding in order to understand that if they do a certain action, they will be rewarded. It goes further in thinking that with enough repetition of this action; it will develop into skill. Sometimes it does, but using extrinsic reward depends on the amount of actions a skilled therapist can pose to the child, which is not always integrative. How can you through extrinsic reward achieve a nervous system ability of looking and listening to a speaker at the same time as eliminating background information that should quickly be judged as non-important? The drive to develop skill comes from intrinsic motivation; it is innate and cannot be replaced by human interference. At best it develops a splinter skill that cannot be generalized to other skills.
The atypically developing child turns away from learning to avoid unpleasant or unsuccessful experiences. The more new and novel the task appears, the more reason to want to avoid.
For me, it is all about intrinsic motivation, even though I agree behavioral intervention has its place. Developmentalists postulate that if typical development was going to be good enough for the typical child, it should be good enough for the atypically developing child. This can be trickier than to figure out a behavior plan, which would be based on what we can observe and see, but once you harness the mind into wanting to use that innate drive, more integration occurs as it was naturally meant. You see the child’s drive coming forward and start leading the way while we support the weaknesses that causes stumbling blocks. It becomes a lovely dance of the child leading, feeling in control, and us intervening at the just right level to support that important intrinsic motivation.
For me, the answer lies in a solid evaluation of the child’s hierarchy of needs, matching the child’s developmental level, implementing methodologies that will motivate the child’s inner drive to succeed, and key to this: Relationships! The child has to connect with you in order to want to learn from you.
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