Children with OCD suffer intensely from recurrent, unwanted thoughts or rituals that they feel they cannot control. They may get into trouble for not listening because they are obsessing in their mind. They’re counting to a certain number over and over or saying a specific prayer. On the outside it looks as if they’re unfocused, but on the inside they’re focused on every single word.
Many kids with OCD have an overwhelming fear of germs. It’s not uncommon for them to need to wash their hands until they’re raw. Along with rituals of handwashing may be counting, checking, or cleaning—all in hope of feeling more comfortable.
All children enjoy rituals. It’s not uncommon for a preschooler to demand the same book night after night or to go on eating jags during which he wants to eat only one type of food for a period of weeks. However, when the rituals require more than an hour of attention a day, the sense of perfectionism is debilitating your child, he is fearful that if he doesn’t complete his rituals something bad will happen, and/or there is a family history of OCD, it may be time to explore whether you’re dealing with a kid who is experiencing OCD. Treatments for OCD combine medications and behavior therapy. Your child will deeply appreciate your help in easing his fears.
Autism and Other Pervasive Developmental Disorders
He was wailing, deep sobs choking him. His mother sat on the floor nearby. He didn’t want to be touched. “What do I do?” she asked me. “He’ll do this, just lose it, and I can’t comfort him.” Her eyes filled with tears. “I’m his mother, and I can’t figure out how to comfort him.”
“What soothes him?” I asked. “Nothing,” she responded. “Does he have a blanket or a pacifier?” I asked. “He’s got a blanket,” she said, and went to get it. He took it and pulled it over his head.
Autism and other pervasive developmental disorders, PDDs, are neurobiological in origin. Children experiencing PDDs do not use adults as resources to help them meet their needs. They do not seek interaction.
For example, a normal fourteen-month-old child who wants something from a cupboard whimpers or goes to an adult to get attention. It’s likely that a child experiencing autism, however, would go straight to the cupboard and try to get what he wanted on his own. He doesn’t know that an adult could help him.
The severity of autism varies widely. Some children are more severely impacted than others, which affects what treatments might be suggested.
Some kids with autistic behaviors have limited language skills, but not all. Kids with Aspberger syndrome, a type of autism, have higher verbal skills but still have issues with social interaction. Their language development is often out of sequence. Most children learn the concept of “one” before learning to count to ten. Children with autism learn out of sequence. They can count to ten but don’t know what one cookie is. Or they can recognize a word but don’t understand what the word is.
Ritualistic and/or repetitive behaviors are also common to kids experiencing autism. You may see unusual posturing or finger movements, rocking, or looking or playing with a toy in a unique, repetitive way. That’s what two-year-old Mindy did. Whenever she finished with a toy, she dumped it behind the stereo cabinet. This didn’t seem too unusual since all toddlers dump toys, but then Mindy started dumping everything behind the stereo cabinet, including her dinner plate when she finished eating.
It’s kids with high functioning autism that are often the most challenging for parents and teachers because they look normal but have difficulty with written and verbal language, organizational skills, social skills, and interpreting the emotional and verbal cues of others. These problems make success at school and peace within the home challenging, which is why you find yourself in power struggles day after day.
If your child’s behavior strikes you as unusual, or if you find it extremely difficult to soothe him and connect with him, seek a professional assessment. Help may be as close as your public school’s early-childhood special-education office.
Attachment Disorders
During infancy a child’s most critical developmental task is to learn that he can trust his caregivers to respond sensitively when he needs it. When this doesn’t happen, he mistrusts others and may become hyper-vigilant, depressed, angry, or he may fail to thrive.
Attachment disorders occur in a variety of situations. Sometimes a parent experiencing depression or other medical issues hasn’t been able to respond consistently. Extended separations or hospital stays can cause attachment issues. Children who have been moved through the foster care system or adoption process with attachments formed then broken may also experience symptoms. Frequent changes of caregivers, or moves that separate family members at critical points in a child’s development, or a shift from one culture to another, can also affect the formation of a strong sense of attachment.
It’s the severity of the behaviors that raises a red flag for attachment disorders. If your child’s life experiences include a significant loss or separation, exposure to an adult she could not trust, or the unavailability of a consistent, sensitive caregiver during her early years, seek professional help and intervention.
The most common symptoms in young children are problems with feeding and weight gain. Other kids may be angry, hyper-vigilant, and lack empathy for others. This is the child who responds to a crying child by hitting him, or not only shoves back the child who pushed him but rams the child into the wall. Bedtime is a nightmare for kids with attachment issues. Separating causes them to panic, and the battles can go on for hours. It’s these kids who are often better behaved with strangers than with their family members. Once there is any hint of intimacy, they pull back, ready to do battle. Kids with attachment issues will test and push limits, trying to find out if they really can trust that you will not abandon them. They also vehemently fight limits and guidance because they do not trust you to have power over them.
Hoarding or stealing can also be an issue for kids with attachment disorders. Because they don’t feel safe or connected to others, they may hide food or clothing or steal without any thought as to the impact of the loss on others.
Children with attachment disorders can learn to trust again and to be empathetic. Don’t let the intensity of your child’s anger and pain disconnect you. Seek professional help. Your child can be successful—it’s not too late.
Encopresis
Encopresis is a physical problem that often leads to huge power struggles. The official definition of encopresis, or fecal soiling, is the regular (at least once a month) passage of bowel movements or smears of feces (not just stains from inadequate wiping) into clothing, pajamas, or other inappropriate places by a child over the age of four years. These bowel movements are not voluntary, and the most common cause is severe, longstanding, unrecognized constipation. Encopresis is more common among boys than girls.
When a child experiences constipation or retains his stools because he’s uncomfortable using a public rest room, a large mass of feces gradually collects in the rectum. As it sits inside of the body, it gets dry and dense, making it more and more difficult and painful to pass. The fear of pain causes the child to withhold even more. Finally, the external sphincter and rectal muscles tire from continual stretching, and stool leaks out. This constant stretching may also lead to nerve fatigue and the child no longer consciously feels the urgency to defecate. The result is a school-age child who may be having accidents at school, on the bus, or at home.
You may think your child is deliberately soiling when in reality it’s taking every ounce of his self-control to avoid having accidents in front of his friends. Encopresis starts out as a physical issue but can become an emotional one if not recognized and treated. If your child is experiencing toileting accidents, consult your physician about encopresis. He isn’t just being lazy or stubborn. He is a child who needs your help and understanding. Be his emotion coach, work with him, and stay connected.
This is in no way a complete list of potential medical issues that can affect kids’ behaviors. Enla
rged adenoids and tonsils may disrupt sleep, leading to sleep deprivation. Fluid in the ears and undiagnosed ear infections can cause language delays and coordination problems. Fetal alcohol syndrome, Tourette’s syndrome, growth disorders, diabetes, thyroid problems, and many other medical issues can significantly impact your child. When your child’s behaviors leave you puzzled and at wits’ end, don’t give up. It’s essential that you seek help. This may not have been your dream, but it doesn’t have to be a nightmare.
Seeking Help
When you realize that the power struggles you are experiencing with your child are more than normal, it isn’t easy to pick up the phone and ask for assistance. This isn’t the way it was supposed to be. Your dream shatters, the pieces splintered and sharp. But know as you call that you are doing the right thing. The earlier you seek help for your child, the better. You are taking the steps to help him understand the emotional and physical sensations that he is experiencing and to teach him effective management strategies. You are your child’s emotion coach, but you don’t have to be the only one. You don’t have to do it alone.
Talk with your physician, health insurance provider, or local public-school-district special-education office. Help is available to you. Schools are required by federal law to provide services for children with special needs. Many, but not all, of the invisible medical issues I’ve described for you do qualify a child for services.
As you seek help look for the following:
a team of professionals who work specifically with children
a thorough, multifaceted evaluation
support and encouragement
The Importance of a Team Approach
Many of the invisible medical issues include very similar symptoms. You need and want an accurate diagnosis and quality treatment recommendations. The team conducting an evaluation may include a pediatrician, speech pathologist, psychologist or psychiatrist, and/or occupational therapist; together they will provide you with a very thorough and broad analysis of the issues. While medication may indeed be part of your child’s treatment, you want a plan that includes more than management of medications. Behavior training is also an essential part of treatment. Medication alone is never enough.
Children are not miniature adults, and working with kids under seven years of age requires very skilled practitioners. Preschoolers cannot tell you with words what they are experiencing. The professional has to be able to interpret a child’s behaviors. That’s why your team must include people who see hundreds, maybe thousands of children each year and know the difference between temperament, normal growth and development, stress, and potential medical issues. If your child is elementary age, be sure to include your school professionals on your team.
Getting a Thorough Evaluation
Invisible medical issues cannot be accurately diagnosed with a fifteen-minute conversation in your pediatrician’s office. A complete evaluation includes reports from you, your child’s teachers, and child-care providers. One of the professionals on your team may also conduct an observation in one or more of the settings. Your family’s medical history is also vital. You know more about your family’s history and your child’s than you might think, but it may take a competent professional asking the right questions and allowing enough time for you to come up with key pieces of information. If your child is adopted and you do not have a complete family medical history, it’s worth your efforts to learn as much as you possibly can. Finally, an evaluation conducted over a period of weeks rather than hours also helps to discern an ongoing problem versus a stress issue or a developmental growth spurt.
Finding Support and Encouragement
You have the right to expect that the professionals you work with will be nonjudgemental and supportive of you and your child. Together with this team, you will be making decisions that are critical to your child’s well-being now and in the future. It’s important that you trust and respect them and sense that they realize you know your child better than anyone else. Don’t be afraid to get a second opinion. Find the team and treatment plan that fit your family.
Allow yourself time. You don’t have to rush to make a decision. Initially when you find that your child has a medical issue you’re likely to grieve. Elizabeth remembers vividly the day she learned that her son had attention deficit disorder and her daughter an anxiety disorder. “A team at the university tested the kids,” she told me. “We’d been back and forth numerous times over a period of about six weeks. When it was finally time to review the reports and make recommendations, I remember sitting at the table with three or four professionals. They were considerate and kind people, but I felt so small. Thank God my partner was with me. After they reviewed the reports and told us our options, I remember being asked if I had questions. I couldn’t think of one. I was numb. I guess they expected that reaction because they introduced us to Christine, our contact person. She gave me her card and told me, when I was ready, to call her with my questions.
“I walked out. By the time I got to the car I was sobbing. I couldn’t call Christine. At least not until I called a good friend whose son has attention deficit. When she answered the phone, I sobbed again. She told me, There’s lots of things you can look at. Take your time. You can decide. Taking medication doesn’t necessarily mean taking it for life. And if it works, it’s wonderful’
“I needed to hear it from a friend whom I respected more than just in that cold setting with those people telling me what they knew about my kids.”
Draw your friends and family members around you. Consider joining a support group with other parents whose children face similar challenges. Knowing you’re not alone gives you the energy you need to help your child the most.
Focusing on Your Child
Your child will always be a child first. He is not an attention deficit child. He is a child who also happens to have attention deficit. Always keep that special, unique person in mind. Let go of the expectations that are unfair to your child. Discover his gifts and treasure them.
Kim Cardwell advises, “Look at the positive things your child brings to your family. This may be the child who comes up with solutions or ideas no one else would have devised. Then again this may be the child who has forced your family to slow down and connect more, allowing you to appreciate each other even more.” Don’t let an undiagnosed medical issue disconnect you from your child.
* * *
Coaching Tips
Understand all the issues your child is dealing with in order to be a more effective emotion coach.
Listen to your intuition.
Recognize behaviors that are more frequent, intense, or longstanding than “normal.”
Seek help.
Create a team.
Treasure the unique gifts of your child.
PART FOUR
Developing Competence: Teaching Life’s Essential Skills
THIRTEEN
Stressed-Out Kids
Learning to Deal with Life’s Ups and Downs
“You can’t be brave if you’ve only had wonderful things happen to you.”
—Mary Tyler Moore
One of the most unusual phone calls I have ever received jarred me from my reverie at six-forty one morning in December. When I picked up the phone, the caller desperately asked, “Is this the woman who wrote the book?” “Yes, I write books,” I replied tentatively, not quite sure what to make of this.
“You’ve got to help me!” the caller pleaded.
“I’ll do my best,” I stuttered, still groggy with sleep.
“It’s my four-year-old,” she continued breathlessly. “He’s whacking baby Jesus with a pirate’s sword!”
I have to admit I was taken aback. In more than twenty years of working with families, I had never run into this problem before. I was speechless and stumbled. “Does he have a history of going after baby Jesus?” I asked, unable to think of a more intelligent question.
“No,” she replied seriously, “but he’s always been int
ense.”
I paused, trying to get my wits about me. The caller filled the gap in the conversation. “This is serious! The church across the street just put out their nativity scene. Every time I turn around he’s out the door whacking baby Jesus with his pirate’s sword. I’ve sent him to time-out. I’ve taken away his sword. It doesn’t matter. He picks up pencils, rulers, anything he can get his hands on, then dashes out the door and across the street. This is a small town; people are starting to talk!”
My mind raced. Why would a child be whacking baby Jesus? He must be very angry about something, I thought, and asked, “Has your family experienced any significant pain or stress lately?”
“My father died six weeks ago,” she replied softly.
“Was your son close to him?” I questioned.
“Oh, yes,” she answered. “They saw each other every day.”
“What did people tell him when Grandpa died?” I asked. She paused, sighed deeply, and slowly responded, “That baby Jesus took Grandpa to heaven.”
This child was grieving, but he didn’t know how to tell his parents. Instead, he acted out. Kids don’t tell us when they’re experiencing emotional pain and stress. Instead they whack baby Jesus with their pirate’s sword, whine, complain, beg for help with anything and everything, or become downright nasty. It’s easy to immediately slip into the intimidator’s role in response. And to make matters worse, 90 percent of the time our kids stress is tied to our own. Trying to cope with our own inner turmoil and at the same time be patient with our kids can be a huge challenge. And even if our child’s stress isn’t related to our own, it still distresses us because we hate to see our kids hurting.
Kids, Parents, and Power Struggles Page 23
