Posts made in October 2017

Does your child have to be PERFECT?

Susan N. Schriber Orloff, OTR/L FAOTA

“He’s just a little perfectionist, like me!” explains the parent when the teacher says that the child cannot be corrected easily. And with that it is blown off as something that either the child will “outgrow” or will learn as part of coping skills later in life.

Perfectionism is more complex than that. Normal perfectionism involves the striving for the accomplishment of a skill or task. This perfectionism is natural and innate in everybody. Healthy perfectionism is the motivation to acquire attainable goals. These children can make errors and still feel they are “OK” and be proud of their effort.

However, when perfectionism impacts life skills, learning, emotional stability and socialization it can be considered maladaptive. These children are hypersensitivity to “mistakes” and interpret them as “attacks” on their self-esteem. They exhibit an often-unquenchable need for admiration from others.

With healthy perfectionism the child can tolerate some mistakes and still feel good about trying. With unhealthy perfectionism the child demands of him/her self an extremely high level of performance in every situation. These children can find it as hard to take a compliment as they do a criticism. For these children the emphasis is on what was done wrong rather than what was done right.

Their feelings of well being are tied to their performances and so when they do well feelings of “superiority” can emerge particularly in group and/or classroom situations. These children have to be first in line, have to be chosen first for the team, often lose attention when the “spotlight” is not on them, rush to start work without waiting for directions (which is counter-productive to their desired outcomes), equate “first done” with “smarter”/”better”, and tend to think that their work will never be good “enough” so why try.

These behaviors are frustrating for both the teacher and the child. The teacher sees the child as sabotaging his own work and “tuned out” and the child is using avoidance to detach himself from what is seen to them as a stressful situation.

It is important to understand that these children do not feel safe. They have generalized feelings of inadequacy to be all consuming for them. Irrespective of the realities of a given situation, their over-riding emotion is a hypersensitivity to (even the potential of) a negative evaluation of themselves. Often theses children are poor risk takers and will only enter into novel situations when assured of success.

The sooner these behaviors are addressed the more effective the remediation. Left unaddressed, these behaviors in children can evolve into more severe manifestations as the child matures.

The Diagnostic Statistical Manual of Mental Disorders-5 places “perfectionism” as a characteristic within the realm of related anxiety and depressive disorders.

Anxiety is not just the purview of the adult world.   Children experience anxiety as well. Recognizing this can prevent its exacerbation and serve as an initial calming force for the child. Letting the child know they do not have to retreat, hide behind an exterior of false bravado or become defensive.

Occupational Therapy with its focus on function, organization, processing and graded self-regulation is the ideal treatment modality for helping these children. Here are some goals that might be included in a treatment plan for children experiencing “perfectionism”:

  1. Recognize their accomplishments through graded successful task experiences creating more realistic and secure self-esteem
  2. Teach self-regulation techniques specific to when a child is experiencing anxiety and/or stress so that they can recognize what is happening instead of retreating from the tasks
  3. Provide realistic task situations to foster prioritizing
  4. Predict outcomes with a variety of alternative choices in order to choose the best one
  5. Differentiate a “criticism” from a suggestion on how to improve results of a given task
  6. Revise original choices, learn self-correction and express appropriate pride in what was accomplished
  7. Employ graded risk-taking to increase participation with tasks that do not have an assured outcomes
  8. Formulate techniques and methods that allow the child to enter into novel tasks more readily
  9. Create methods to inventory tasks and their component parts for both problem-solving and self-evaluation
  10. Design routines that facilitate the ability to follow specific directions and sequences.

 

Understanding that there are not hard and fast rules for remediating perfectionistic behaviors and that there is no cookbook or GPS for navigating through these emotional waters. However, here are some ideas for parents and others within the community including teachers.

  1. Make task expectations very specific: A first them B and you will be done, etc.
  2. Goals should be short term and easy initially with gradually increased complexity
  3. Make sure the child understands the process and recognize him/her for following the steps
  4. Do not emphasize the outcome—focus on the process, required steps/ sequences to be followed, etc.
  5. Pace performance—these children tend to “go fast” make it rewarding to see how slowly they can go—try this first with a familiar task
  6. Create and/or play games that are completely by chance with no strategy and practice “losing”
  7. Talk about “good” mistakes (post-it notes, Penicillin, etc.)
  8. Have fun—watch bloopers on YouTube and laugh together about the “mistakes” that individual(s) made
  9. Practice with something your child will have to work at—in other words practice practicing –do the task together –avoid competition –novel things music, voice-overs to commercials (there is an app for that), etc.
  10. Demonstrate what is needed to be done
  11. Emphasize “your best” and not “perfect”—your best can be excellent and still not be perfect–talk about YOUR mistakes children tend to think their parents are “perfect”
  12. Discuss the worst possible result of not being totally right (perfect)
  13. Snacks—important tension breakers and help keep energy up
  14. Take breaks

 

But most of all, as we encourage relaxation in our children we need to practice what we preach. Parents and other adults in this child’s life need to relax as well. We only get one day at a time so pushing harder cannot make change come faster.

Behaviors Students May Have Who Experience Memory Difficulties and Related Learning Issues:

Susan N. Schriber Orloff, OTR/L  FAOTA

Your child may feel very different from what you think you or their teachers are seeing.  Use this checklist to help you ferret out what is actually happening.

Behaviors Students May Have Who Experience Memory Difficulties and Related Learning Issues:
(1)             Poor organization

(2)             Habitually tardy to turn in assignments

(3)             Loses books, reports, etc

(4)             Anxious

(5)             Overwhelm easily

(6)             Freezes up

(7)             Sloppy

(8)             Incomplete assignments / too brief

(9)             Works without signs of personal investment

(10)          Doesn’t follow instructions

(11)          Overdependence on aid

(12)          Very easily distracted

 

This Causes the Teachers to Assume that the Student is:

 

1)     Lazy

2)     Arrogant

3)     Disrespectful

4)     Uncaring

5)     Not Working To Potential

6)     Inattentive

7)     Excuse-Prone

8)     Rule-Breaker / Rule-Tester

9)     Uncooperative

10)   Just needs to try harder

 

What Students with Memory Difficulties are Probably Feeling

 

1)      Inadequate

2)      Awkward

3)      Unpopular

4)      Defensive

5)      Alone

6)      Confused

7)      Like “everyone” is always staring at them

8)      Angry

9)      Depressed

10)   Feeling unsafe-emotionally and physically

 

 

 

Sensory Self-Soothing and the Pre-school Child: Thumb sucking and other behaviors

Susan N. Schriber Orloff, OTR/L, FAOTA

Small children often suck their thumbs, mouth their fingers, suck the edge of the shirts, bite their nails, twist and/ or pull their hair…and this list goes on.

For children newborn through one-year thumb sucking, fingers in mouth, etc. is both developmentally and sensory appropriate.

Predominant current pediatric and child dentistry advice tells parents not to worry. “They will out grow it.” is the standard response. And they do for the most part.

We rarely see an adult sucking their thumb, or do any of the mannerisms noted above. But we do know adults, who constantly are cracking their knuckles, clicking the top of ballpoint pens, unconsciously bob their knee up and down, tap pencils to a desk, crack gum. All of these are sensory self-calming techniques and we do them sub-consciously and use them as mini-stress breaks.

However there are some medically sound reasons to address these behaviors. Thumb sucking can distort the teeth requiring orthodonture and in sever cases jaw realignment. Prolonged sucking on items can extend drooling beyond the chronological age when it should have been extinguished. Oral stimulation can replace the desire to eat and negatively impact adequate nutritional intake.

In adults these are habituated unconscious motor patterns. In children these are coping mechanisms. They are NEW patterns that have not had the time to have neural pathways. Initially they are just “habits”.

In very young children who start to do a specific repeated motor patterns addressing these quickly can often deter them from becoming imprinted and embedded. In young children these actions can have social consequences. A peer may not want to h old hands with a child with a saliva-wet hand. Kids taking turns on technology might complain to the teacher “Jonny left the keyboard messy”. At lunchtime the child who uses his/her mouth for self -soothing often replaces the (thumb/shirt/pencil top/etc.) stimulus with food. This is the child that seems to be stuffing everything in at once or who is the “messy eater” that others prefer not to sit next to.

Beyond identification it might be helpful to understand what is going on within the sensory motor network that drives the child to choose these patterns. These behaviors start because they are gratifying and serve a life enhancing experience.

In a study with premature infants it was observed that thumb sucking stopped the baby’s crying, decreased agitation and increased the resumption of normal bodily rhythms inclusive of swallowing and eating.

 

Another study surprisingly found that early (0-14 months) thumb suckers achieved higher and faster independent social maturity than their non-thumb sucking peers because the knew if they got stressed they could rely on themselves and not have to run to Mom for comfort. They had their comfort right with them. However the plus of thumb sucking steeply decreased as theses babies approached and became toddlers. That is when the social and physical negative ramifications begin to emotionally and socially impact the child.

Prolonged thumb sucking and other oral stimulatory actions are considered in these older children to be neurologically tied to sensory processing issues.

Our mouths are our first tactile discriminatory pathways. We use our mouths to eat, suck-soothe and touch. Tied to our olfactory (smell) receptors it allows us to taste, differentiate mommy from daddy, grounds us spatially and helps us develop our initial primary sense of security.

Conclusively and without question we all, child and adult, need and seek motor patterns that help us cope when under stress. At work adults can get up from their desks and get a snack, visit a co-worker, go for a short walk. These behaviors totally discouraged in most academic settings.

Susan Heller, PhD wrote in an article for Psychology Today that unchecked habituation of these behaviors can potentially evolve into other addictive behaviors throughout the life span. She continues that altering these behaviors is a mixture of self-motivation and increased self-awareness. Dr. Heller suggests reading with your child the book, David Decides About Thumb sucking.

With sensory issues redirection replace and redirect (the behaviors) is the course of least resistance. Going “cold turkey” will be a source of stress for you and your child. In fact it may even exacerbate the very behavior you are trying to eliminate.

A great starting place is to investigate using CHEWELERY. These fun items are available through ARK Therapeutics, amazon.com, and can be found in therapy catalogues. They are fun colorful and excellent oral stimulatory “substitutes”. The “CHEWELERY” come in necklaces for boys and girls (sports themes, gender neutral and princess options), bracelets, fidgets and more.

It is important to keep in mind that sensory issues rarely stand alone and like dominoes that are standing on edge lined up in a row, one system has impact on others as well. Occupational Therapy can evaluate your child’s sensory stability often circumventing developmental functional deficits that may evidence themselves as age/grade task demands increase. Developmental issues a do not self-resolve. Children do not outgrow them although unaddressed they often morph into other behaviors that can impede academic and social success.

What we touch, hear, smell, see and taste is what we understand, what we relate to, what we remember and process and what we alert to. Simply put it allows us to correctly and efficiently navigate our world. Only a registered and certified Occupational Therapist can competently evaluate your child’s sensory integrity and, if needed, give you a personally customized plan designed specifically for your child.