Tag Archives: child development

Autistic? ADHD? SPD? Or Just “Quirky”?

As a parent educator, and as a parent of autistic children with ADHD, I’ve had multiple discussions with parents who are wondering whether their child is autistic or has ADHD or “just” sensory issues or whether there are developmental delays. Parents who are wondering whether they should have their child tested. Parents who received testing results of “well, we can’t say it’s autism, but we also can’t rule out autism.”

I’ve also had conversations with colleagues about children in their classes, where they’ll wonder about a child’s unusual behavior, but also say things like “I see some symptoms, but I don’t think they’re autistic, because they don’t ______.”  [fill in the blank of a stereotyped assumption about how “all” autistic people behave].

It’s tricky to figure out what to do about these “maybe?” cases, and trickier still when parents see that their child has challenges, and think they would benefit from support (like occupational therapy or social groups) but their insurance won’t cover it unless they have a diagnosis.

The Spectrum / Gray Areas

When I was a kid, we tended to think of autistic people as ones who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking). Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky.” I don’t remember anyone being called ADHD when I was a kid, but there were absolutely “hyper” kids, and “head in a cloud” kids.

We understand far more now, and have clear diagnostic criteria for ADHD, a better understanding of autism and sensory processing disorders, and solid research-based developmental milestones which help us more accurately diagnose delays.

But within these criteria, there’s still a spectrum…. a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home. Some children present very obvious symptoms very early and get a quick referral for services. Many take longer to figure out.

When you look at any behavior scoring, there’s the “typical” kids. In this bell curve, the kids in the green zone of scoring are considered normal. The kids in the red zone are two standard deviations off of “normal” and typically qualify for things like IEP’s (or gifted services) or SSI disability payments. The kids in the yellow zone – one standard deviation off – would often benefit from some services / accommodations, but may not get diagnosed early or ever.

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To Test or Not to Test

I have been a childbirth educator for over 20 years. In that field, we often say – before you get a test, think what you will do with the results and whether it will be helpful to you to have the results.

If you are a parent deciding whether to test, or an early childhood professional deciding whether to refer for testing, it’s worth asking that same question.

If there are services that you believe that a child would benefit from that they can only access if they have a diagnosis, then they should be tested. If you believe they are being labeled as lazy, or spoiled, or whatever judgmental label, and you are wondering if there may be an underlying cause, they could be tested. If it would be helpful to you as a parent to have a “label” that helps you better understand your child and learn more about what they need, then it’s worth getting them tested to learn more from a professional, whether that’s a diagnosis or just resources for more ideas and support.

I’ve talked to parents who worry that having a diagnosis will harm the child’s self-esteem, and wonder if it would be better to try to “pass” and get by without the diagnosis. I have talked to multiple adults who received diagnoses as adults (whether it’s a diagnosis of autism, of ADHD, of dyslexia, of auto-immune diseases…), and they pretty much all said that receiving a diagnosis was a relief. They’d always thought, or been told, that there was something wrong with them, and if they just “tried harder” or “quit whining” they would be successful. When they had a diagnosis, they were better able to understand their needs and felt more able to ask for the accommodations they need to be successful. And they’ve also discovered more about what their unique strengths are now that they’re not trying to be just like everybody else. They wonder how much further they could have gone in life if they had the diagnosis and the correct accommodations earlier in life.

To refer or not to refer

As a parent educator, I observe the kids in my class. I had one toddler where I had no doubt she was on the autism spectrum and would benefit from early and intensive services. I spoke to that parent early in the year, encouraged her to seek testing, and got her connected to services.

I’ve had lots of other students who were “quirky” or have asymmetrical development issues.

I do developmental screenings in my classes, and this can start the conversation with parents about developmental issues. If there’s a minor delay in one area at one time stamp, I just talk about ways to enhance learning in that area, but if I see more delays or persistent delays in that one area, we have a broader conversation about what might be going on there. Sometimes, I have shared “here are some things about your child that are a little different than what we see in other kids their age. It could just be a temperament thing or just where they are in their development, but it does make me wonder a bit, so it’s something you could keep an eye on, and check in with me again if it becomes a concern.”

If I suspect a specific condition, I use the word, because I’ve spoken to parents of 7 year olds who have said things like “I can’t believe no professional we worked with ever mentioned the word autism to us before last  month or told us that those behaviors might be signs of autism. If anyone had the courage to have that conversation with us, we wouldn’t feel blindsided now, and we could have learned more about accommodations that would have helped us parent him more successfully and access services earlier.”

Re-Framing A Diagnosis

I also talk about autism, ADHD, and SPD differently than the common dialogue. Autism is often treated as a tragic thing. ADHD is often viewed as bad behavior which would be fixed if the parents only ______. Kids with sensory processing issues are viewed as over sensitive and told they just need to get over it.

I think it’s better to just think about these as a developmental difference which creates some challenges but can also be accommodated. If a child is blind, or deaf, we don’t expect them to be able to change that, just by “choosing to behave better.” We don’t assume that “learning to act normal” will “cure” them. We try not to let their label limit them and try to maximize their access to a full life. We figure out what accommodations they need to move through the world, and to maximize their potential for a successful life. It’s an accessibility issue. The same is true for all accommodations.

And many of the “challenges” of these conditions actually come from societal attitudes or lack of understanding. If the neurotypical community understood more about neurodiverse people, it would greatly reduce the challenges of each condition. It turns out that some of the things we do to accommodate them also benefit all the other people in the room.

Screening

If you’re wondering about your child, or a child you know, start with a list of symptoms, or red flags to watch for. Or with a screening test. Here are some resources to try:

  • Milestones Checklists from the CDC. (And here’s info about other developmental resources)
  • Overall Developmental Screening: the Ages and Stages Questionnaire assesses fine and large motor skills, communication, problem-solving and social emotional development. Here’s how you can do your own ASQ screening and the ASQ-SE which focuses on social-emotional development.
  • Autism screening: For children under 2, check out Baby Navigator. If your child is 16 – 30 months old, try the Modified Checklist for Autism in Toddlers, available at www.autismspeaks.org/screen-your-child
  • For ADHD, consider the checklist of symptoms. Think about other children the same age as your child. Compared to them does your child have several of these challenges? Do they have these challenges only at home? Only outside the home? Only when doing things they don’t enjoy (like cleaning) or that don’t interest them (sitting still at a restaurant table)? If they have these challenges in all circumstances it is more likely to be ADHD. If you only occasionally see the symptoms, there may be another cause.

Diagnostic Testing

  • If you’re still concerned after completing a screening, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system.

I have a full post here on: Accessing Testing for Developmental Concerns.

What if they’re NOT diagnosed with a condition?

Sometimes you go through the steps of testing to be told your child is fine. Or that they’ll outgrow the challenges. Or they’re a quirky kid but only one standard deviation off, and thus don’t qualify for services.

If you feel strongly that your child needs services now and you can only access them if you have a diagnosis, you may have to do a fair amount of advocacy and may need to seek second opinions. Know that some clinics will refuse families who have already had an evaluation elsewhere – they worry that some parents may just be shopping around for someone who will give them the diagnosis they want. That wouldn’t be in the best interest of the child.

If it is possible for you to wait to pursue a diagnosis, that may work out better. A few months or a few years down the road, you may discover that they did outgrow it. They moved through a phase, and are now doing well in school and social occasions. Or, you may discover that things have gotten more challenging for them, and more professionals are on board with a diagnosis, given more evidence.

In the meantime, try not to be overly focused on finding a label – an answer to “WHY is my kid different than other kids.” Or on how to “fix” them.

Instead, you may find it more helpful to think: “given that my kid is who they are, what can I do to support them?” Learn more about how other people have accommodated kids with similar challenges, and try those those things. Figure out simple things that help them be more successful. Adjust some things so they’re not under continuous stress and pressure, while still giving them appropriate challenges so they learn and grow and reach their potential. Don’t let the possible label limit them more than necessary.

More resources

  • To learn about autism, read my overview of autism which includes a lot more info on signs and symptoms, and also on supportive tools that help make it more manageable.
  • For possible ADHD: If you’ve got one of those kids whose brain and body are always moving super fast, leaping from one thing to the next, make sure to check out my post on “the race car brain.”
  • If you have a very “shy” kid who holds back, hovers on the edge, and observes, check out my post on the Slow to Warm Up Child.
  • Read about Accessing Developmental Testing.

A sample decision-making process

I can share my own experiences about developmental testing for my youngest. I’m not saying it’s the ideal story or the only approach, just one example.

As a parent, I suspected something was unusual about him from when he was about six months old – signs like when he got overstimulated, he’d purposely bump his head into things. If the usual routines were disrupted, he’d have big meltdowns. When he was a toddler, he would perseverate – like during one gymnastics class where he told his coach “I am an ankylosaurus” at least 20 times. He had singular obsessions – like the month where he wanted nothing but Cat in the Hat, or the periods where he only wanted to talk about the planets and could easily be calmed out of a meltdown by just handing him 8 objects and asking him to decide which one was Mercury and putting them all in order.

However, he didn’t fit some key stereotypes of autism: he’s very verbal, OK at eye contact, and seeks out social connections. So no professional ever told us that we should seek an autism diagnosis, but I suspected that was where we’d be someday.

I learned  about autism and sensory processing disorders, and what accommodations help kids with those challenges, and I just did all those things for him. We chose preschools and activities that were a good fit for him, not ones that we knew would push his buttons. We didn’t have him tested yet, because having results wouldn’t have changed anything about what we were doing.

However, when he started kindergarten, things got more challenging. Luckily his kindergarten teacher was fabulous with him and just naturally did the accommodations he needed. But all of school didn’t accommodate as well. So, at that point, we had the testing done, and received an autism diagnosis, and that has made it easier for us to access the services he needs. For school, he has an IEP which ensures he gets extra support. And now our insurance will cover OT treatment and therapeutic social groups for him. Having access to therapies and supports are the upsides of having the official diagnosis. (There is a downside… some summer camps and other programs say they can’t take children with autism or can only take a limited number, so there are some programs that are no longer an option for him.)

In second and third grade, when kids are expected to sit still and pay attention for longer periods, he was having challenges with that, so we then learned more and had him evaluated for ADHD. That diagnosis allowed us to adjust his IEP for more accommodations which has helped him be more successful in school. And when he was 10, he was assessed to determine whether ADHD meds would be helpful for him, and they have, in fact, been very helpful. So, doing each of those evaluations when we did worked out for us. Your needs may be different.

We were hesitant to choose ADHD medication for my son, but again talked to adults we know with ADHD, and they universally recommended them, saying “on days without my meds, my brain just spins and spins and I can’t get the things done I need to get done and then I feel bad about myself and then I get less done… having my meds helps me be more the person I want to be.”

He will start middle school next year, and is far more focused and more organized than he used to be. We know that’s partially due to his meds, partially due to the extra supports he’s gotten from us and from school in learning organizational skills and executive function skills that might come naturally to others. He has far fewer emotional regulation issues and meltdowns than he had in the past. We know some of that is developmental, but most of it is due to the additional supports we have sought out (like pyramid model tools, Floor Time, ideas from Ross Greene and the Zones of Regulation) and the extra supports he has gotten from school due to his IEP.

Wait for it…

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As a parent educator, I often tell my students: we can’t make our children do something before they’re developmentally ready. We can encourage them, provide opportunities to try a new skill, model behavior, try praise and punishment to motivate them, and create an environment that encourages them to master that skill. But sometimes, we just have to wait for them to be ready.

Sometimes when it comes to raising my own kids, the advice I give to other parents just flies out of my head…

Just 4 weeks ago, I was despairing that my child would ever want to write or draw anything. He is five years old, and was about to start kindergarten. Yet, I could count on one hand the number of times he’d attempted to draw a picture. The only time he would write was if we made him do it to earn something. “Want a chocolate Kiss? OK, write the word kiss and you can have it.” His grandma started paying him a penny for every letter he writes for her, and despite that, he didn’t write much.

This is in stark contrast to my older kids, but especially to my daughter who started drawing and trying to write when she was less than 18 months! And in contrast to one of his buddies, Jelly Bean, who sent him a lovely card covered with flowers and butterflies she had drawn when she was 3 and he was 4 and didn’t want to draw a straight line.

Any time your child seems developmentally behind where you feel he should be, or behind other children, it’s always worth checking into. Look up developmental newsletters and checklists to check whether your expectations are reasonable. It could be you’re expecting too much, too early. If he’s not meeting the exact questions on a checklist, ask yourself whether he is doing other tasks which show that same developmental capability.

For example, with my son, he was generally right on track developmentally. When it came to writing, I knew that the issue wasn’t that he didn’t understand letters, or the power of the written word. He was an early reader – beginning to read words at age 3, and reading chapter books by age 5. The issue wasn’t small motor skills – he could easily manipulate small lego pieces and small pieces in “experiments” he was working on. He just truly had no internal motivation to draw or write or paint.

From time to time I’d suggest it. I would show him the fully stocked cabinet of art supplies, and he would walk away and do something else. He even took an arts enrichment class, called Creative Development Lab for a full year, and managed to never paint or draw a thing.

So, there we were, on the brink of starting kindergarten and wondering if he’d even be willing to write his name.

Then, overnight, for no external reason, he started drawing. And writing. A lot! And talking about how exciting it was that he had his own “art studio” (the art supply cabinet). And producing drawing after drawing. We went to the meet-the-teacher session at kindergarten and she asked him to draw a picture of himself. My husband and I looked at each other with doubt – what would he do? He happily sat down, drew a stick figure drawing (his first!) and wrote his full name next to it. Now, one week into kindergarten, every day he brings home pictures he’s drawn, coloring pages he’s completed (mostly coloring inside of the lines when he chooses to do so), worksheets where he’s traced every letter carefully and well, and craft projects where he’s easily mimicked the teacher’s sample project.

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Over and over, we wondered whether he’d ever be willing to write or draw. But then, when he was ready, he leaped right into the deep end of non-stop creative work. It reminds me of the validity of the advice… sometimes you just have to wait for a child to be developmentally ready to make that leap in skills.

My duplicate did it!

calvin-and-hobbes-duplicator

Last week, my five year old was playing with friends on the playground. One of the children stomped past me, saying “He’s being mean to me.”

I went to my child and said “X says you’re being mean to him.” My child said “I wasn’t mean. It wasn’t me. It was my duplicate #6.” (He’s been reading Calvin and Hobbes, and loves the part where Calvin build a duplicator and makes duplicates of himself.)

So, was he lying? Should he be punished for lying?

When talking about discipline, it’s essential to understand child development. A five year old is in the midst of the magical thinking stage. If you teach them one day about planting pea seeds and growing peas, then the next day, you may find them hovering over the garden plot, waving a stick ‘magic wand’ over the seeds to make them grow now. Or, you may find them planting their favorite toy in hopes that many more will grow.

Sometimes their magical thinking is terribly cute. A friend of mine was making a toy jet pack for a 4 year old, from recycled 2 liter bottles. As they worked, my friend talked about how cool jet packs are and how fun it would be to fly around the neighborhood. When she finished the jet pack and put it on, the 4 year old stood there with her eyes clenched tight in excitement, saying “I’m ready! How do I make it go?” She truly believed that her jet pack would help her lift off and fly.

Sometimes magical thinking is very frustrating. Your child believes that if they do the special magical thing, then they have the power to shape their reality. Sometimes they believe they have the power to change the rules. My middle child knew that our rule is a maximum of “two sweet credits a day” (a sweet credit is a candy or a cookie or a soda, or whatever.) But she kept coming up with one reason after another why that rule shouldn’t apply to her today. It wasn’t that she was trying to talk me into changing my rule (she knew that wouldn’t happen), it was more that she was saying things like “when it’s a sunny day in February, all mamas give their kids four sweet credits” or “Remember, we read that book where she ate lots and lots of cake at a summer picnic and never got sick. So it’s OK to eat lots of cake in the summer.” In other words, the whim of the weather has declared that today is different from a regular day, so what can you do but adapt your routine?

Just as children use magical thinking for things they wish would happen, they also use it for things they wish wouldn’t happen, or didn’t happen.

When my son told me that duplicate #6 was the one who’d been mean, you might jump to the conclusion that he was lying to avoid punishment. But it’s more complex than that. He was actually feeling bad about being mean to his friend. He was sad that his friend had walked away and didn’t want to play with him any more. My son (like all of us) wants to think of himself as a good person, not someone who does mean things. So, he used his magical thinking to say that someone other than him was really the mean one. He was a nice kid who wanted to play with his friend still.

So, I get from a developmental perspective why he’s doing this. But how do I respond? Honor his thinking, but also reinforce that taking responsibility for your actions is important.

“You and duplicate 6 both want to be good people, don’t you? But for both you and duplicate 6, sometimes you forget and you act mean, is that right? Being mean is not OK for either of you.” I pause to be sure he’s heard the message, then say “I see your friend is feeling very sad right now. Can you go over and apologize for being mean, and see if he wants to play again?”

He did go and apologize and they went back to playing happily.

If he’d come back to me with “I don’t need to apologize because I didn’t do anything. Duplicate #6 did”, then I would have said “Duplicate #6 is still figuring out how to be nice. I know you know how to be nice. Can you show #6 how by showing him how you do a really nice apology to your friend?”

This was a one time incident. I might respond differently if I felt like this was a chronic problem that he was frequently behaving badly and blaming it on his duplicate. If that was the case, I would be stricter about calling him on his lie, while still acknowledging the reason for the magical thinking: “You’re not telling the truth. I know you wish that it was duplicate #6 that did it, or you wish it was anyone other than you who did it. But that isn’t true, is it? You did it and you need to apologize for it.”

Pathways Developmental Screening Tool

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Pathways has a sensory motor checklist for ages birth to 7 years. It’s available at https://pathways.org/wp-content/uploads/2014/09/sensorymotorchecklist_english.pdf

Parents check off how their child is doing in these areas: play and social skills, coordination, daily activities, and self-expression. The instructions state “It is important to look at your child’s overall tendencies and clusters of behavior. One or two concerns should not cause alarm. However, if your child is not frequently and consistently demonstrating more than a few of the listed items in each category, print the list, check your concerns, and discuss them with your healthcare professional.”

While I don’t know if it is validated by the same rigorous testing as the ASQ (Ages and Stages Questionnaire) or PEDS (Parents’ Evaluation of Developmental Status), it does look like a helpful and easy to use tool. And it’s free, and you are encouraged to copy it freely. They also have good information on their site about Sensory Integration and signs that a child has a sensory issue.

I have added it to my list of Resources for Understanding Child Development.

Growth Based Mindset

Carol Dweck, a psychologist at Stanford University, has spent decades studying achievement and success. She has developed the concept of a growth-based mindset, summarized here:

Fixed Mindset Growth-Based Mindset
Belief Intelligence and talent are static. They’re something you’re born with: you have it or you don’t. Intelligence develops with effort. The brain is like a muscle that can be trained.
Goals To look smart in every situation.
To never fail.
To push myself and try new things.
To take on new challenges.
Success Proving I’m smart or talented. Stretching to learn something new.
Evaluation of a new situation Will I succeed at it or will I fail?
Will it make me look good or bad?
Will it allow me to grow?
Attitude to challenges I avoid challenges.
I stick to what I do well.
I embrace challenges.
I persist when things get tough.
Response to setback I’m a failure. (identity)
I give up.
I failed. (action)   I’ll learn from it and move on. I’ll try harder next time
Effort Why bother? It’s pointless. Effort is the key to mastery.
Criticism Ignore criticism or deflect: “It’s not my fault.” Learn from criticism: how can I improve?
Success of others I feel threatened by it.
If they succeed, I fail.
I find lessons and inspiration in other people’s successes.
I feel good When it’s perfect. When I win. When I try hard. When I figure something out.
Results They plateau early. Never reach full potential. They achieve ever-higher levels of success.

Mindsets in the classroom:

Students were given a test. Then some of the children were praised for their intelligence: “that’s a good score. You must be smart.” Some were praised for the process: “that’s a good score. You must have worked hard.” The kids were then asked what they wanted to do next, and they were given the option of something easy where they wouldn’t make mistakes or something challenging where they might make mistakes but would learn something important. Those who were praised for intelligence chose the easy task. Those who were praised for effort chose the hard task they could learn from. Later, they gave everyone a very hard test – the kids praised for intelligence lost confidence and lost their enjoyment of the task and later lied about their scores. The kids who were praised for the effort and the process stayed confident, worked hard at the problems and remained engaged and didn’t lie about their results, because they felt they had done as well as they could on a hard test.

In other research, by Dweck and Blackwell, a group of low achieving students attended a class that taught that intelligence, like a muscle, grows stronger with exercise. As they learned to believe that intelligence was something they could learn, rather than something they could never achieve if they weren’t “born with it”, their motivation increased. They worked harder. When they had difficulty, instead of saying “I’m just not smart enough”, they would say that they needed to work harder or smarter. Their math scores improved, and continued to improve in the following year.

Another example of where these mindsets play out is in the math classroom. 3 out of 10 American describe themselves as “bad at math.” This leads to the belief that “I will never be good at math, so there’s no point in even trying.” Parents and teachers often reinforce this perception. Research shows that while genetics and inherent intelligence can help children initially score well, over time the kids that do best in math are the ones who work hard, have good study habits, and enjoy doing math.

To help your child develop a growth based mindset:

  • think about how you praise them: praise effort, not talent. Praise process not product.
  • pay attention to how you talk about your own abilities… do you say “I’m just no good at…” or do you say “this is hard for me right now, but if I keep trying I think I’ll do it”
  • think about how you respond to their failures and frustrations. Do you let them give up, or encourage them to keep trying? Do you say things like “I know it seems hard now, but I also know that the more you practice, the better you’ll get.”
  • encourage them to tinker: play around at something – try and try again until you get the result you were hoping for

Learn more about growth mindsets at http://www.whatkidscando.org/resources/spec_growthmindset.html and Mind-sets and Equitable Education: http://www.principals.org/Content.aspx?topic=61219

Read more on math at “The Myth of ‘I’m bad at math’” at www.theatlantic.com/education/archive/2013/10/the-myth-of-im-bad-at-math/280914/ and “’I’m not a math person’ is no longer a valid excuse” at www.businessinsider.com/being-good-at-math-is-not-about-natural-ability-2013-11

If you’re in the Seattle area, you can attend a lecture on the Growth Mindset by Tracy Kutchlow on Wednesday, April 29. Learn more here.