Helping Our Children With Special Needs Deal with Anxiety

Anxiety displacement is something I have been thinking about lately.  I’ve been researching what I can find about it with very little success.  There’s huge amounts about anger displacement, but what about the very real existence of people taking anxiety from one situation and displacing it onto anxiety about everything that ever happened or will happen.

The Problem:

You see, I’ve run into a pattern in my daughter’s life.  Whenever she has anxiety about something, it spills onto everything else.  If she has a dentist appointment, she’ll have an entire day of thinking about all the ills she has ever suffered in life and worries about them happening again.  She will get into that old stuck needle on the record place where no matter what anyone says or does, she is incapable of not worrying about everything.

I’ve read account after account of other parents discovering the same pattern with their child – particularly with children whom have special needs.  The intensity of the anxiety seems to be so overwhelming, that I believe the child displaces it onto familiar scenarios in an attempt to manage it.   Therefore, I think it is anxiety displacement.  Here is an example of how it goes:

What I’ve learned over the years is that my daughter is displacing the anxiety of going to the dentist onto everything else.  She doesn’t know how to handle the intensity of her fears and she goes to the old stand-bys that she has grown used to.  She has worried about her weight, her reading, misunderstanding, being bullied, having people not understand her, etc.  These are old pains and old worries that we have worked through repeatedly.  She knows the response she will get when she brings them up, and she hopes these responses will make her feel better – make the current fear go away.  The only problem is they can’t.  Hearing me remind her how well she reads now doesn’t make her fear of going to the dentist go away.  So she moves on to the next old fear or pain with the same result.  As you can imagine, this is exhausting and futile for both her and me. 

My Solution:

So what I have finally learned is to not go down that path with her.  I simply tell her that she is bringing up old worries and that they are not her problem right now.  If I know what she is most likely having anxiety about, I talk to her about that and that only. I tell her that we can talk about those old worries later if she still wants to, but not now.  For instance, when she had a dentist appointment, I told her we could talk about her worries about going to the dentist but those old worries would have to wait until after the dentist appointment, because they were probably not real worries today – just triggered from her current worry about the dentist.  (Of course after the dentist appointment was over, she felt fine and no longer wished to talk about any worries.)

We also focus on feeling better right now.  We have talked extensively about how all people’s brains don’t work well when we are in the middle of intense emotions and how we need to calm our mind before it will work well.  Therefore, we focus on doing things that calm our minds.  For my daughter, this is chewing gum, smelling lavender, being squeezed, and doing relaxing activities like singing, dancing, or watching a fun show.

Prevention Works Best:

Furthermore, I’ve found that if I can prepare for the anxiety inducing event ahead of time, life goes more smoothly for all of us.  What this means is as mother, I know an event like a dentist appointment might provoke anxiety, so I plan on doing non-stressful fun events and calming things that day.  I don’t plan other things for that day for her or myself, and I make sure I get enough rest and sustenance to manage the emotional day I have ahead of me.  As my daughter gets older, she learns more how to do these calming things for herself and how to plan her life herself to allow for such things.  That is our goal: to help her learn how to calm herself, deal with anxiety, and prepare for stressful events whenever possible.

My Book Review of the eBook "Kids Speech Matters" by Sandra Ahlquist

Kids Speech Matters: A Mother’sJourney Living with Her Son Who Has a Severe Language Delay and an AuditoryProcessing Disorder from Birth to 10 Years

Written by:  Sandra Ahlquist

Sandra Ahlquist has written a touching e-book about her and her son’s personal journey dealing with Severe Language Delay and Auditory Processing Disorder.  Reading her book is like having an intimate discussion with a good friend; she narrates the story of her son’s birth through his diagnosis of APD at the age of 10 and intersperses helpful advice she would give to any parent finding herself in a similar situation.

Sandra’s motivation to write this book was to spread insight into communication delays in young children in the hopes of bringing awareness to speech, language, and communication disorders.  With proper recognition, she hopes funding will be better provided to meet the needs of the many students struggling with language based learning disabilities in school.

She hopes no parent will have to struggle as hard as she has to get her son the proper diagnosis and assistance he has needed to be able to communicate and learn.  Like Sandra says, “Every child deserves to be able to communicate and learn to the best of their ability.”

Group Lessons??? The Coach Makes All The Difference

Recently my daughter Hailey started to take off-ice lessons as well as her twice weekly figure skating lessons. These are lessons where they do aerobic exercises, strengthening exercises, stretching exercises, and practice jumps in their sneakers - off the ice.  Her lessons on the ice are one-on-one with a coach that she adores and works very well with. Her off-ice lessons are in a group format with nine other girls.  She also has a new coach for these lessons whom she is not familiar with and to top that off, she has an accent.

At first, I was concerned that these off-ice lessons would not work for Hailey.  She generally just falls apart in group lessons: she can't understand what is going on, what she is supposed to do, and the atmosphere feels too chaotic for her.  She also doesn't usually do well understanding people who have accents.

Pleasantly, we have both been surprised!  Her new coach for the off-ice lessons makes a point of telling the students what to do and briefly showing them.  Then she taps Hailey on the shoulder to get her attention and shows her step-by-step how to do the activity with Hailey following along.  It works wonderfully. Hailey understands how and what to do so she doesn't feel like things are out of control.

The other girls can still be noisy and active around Hailey, but she seems to be handling it well.  She just focuses on what she needs to be doing and doesn't let them distract her.  Sometimes one will get into her space a little too close (like they might accidentally kick her) and she either moves herself or the coach motions for her to move to a larger spot.

Overall, I'm happy that Hailey is doing so well in a group lesson.  Not only because she is getting the instruction she needs for ice skating, but she is also tolerating a group of noisy, active kids around her.  This is a milestone!


PS:  I didn't even have to talk to the new coach about Hailey's needs.  Hailey's original coach, her on-ice coach, explained it to her ahead of time.  Yippee!  How wonderful to have people who are so caring and pro-active for my child.

Strategies for Managing Auditory Processing Disorder

The management of Auditory Processing Disorder (APD) consists of three main categories: 1) Environmental Modifications; 2) Remediation (Direct Therapies); and 3) Compensatory Strategies.

As not every person with Auditory Processing Disorder has the same exact problems to the same exact extent, it is important to keep in mind that not all strategies work for everyone nor are all needed for everyone.  Moreover, many times Auditory Processing Disorder is one disability/difference of many for an individual; some conditions such as Dyslexia, Sensory Processing Disorder, Visual Processing Disorder, Attention Deficit Disorder, and various language disabilities are common co-existing conditions.

Environmental Modifications:

Environmental modifications are things that are done to make the environment for a person with Auditory Processing Disorder most able to function at his or her best for learning, working, and/or living.  Some examples of these are*:

• Preferential seating to be nearest the speaker and away from environmental noises such as heaters or fans;
• Visual cues and aids used in presentations to assist with comprehension of the material being covered;
• Written notes provided so that full attention can be on the speaker and not on trying to take notes at the same time;
• Study guides or outlines provided before the lecture so that the person with APD can become familiar with the material and vocabulary ahead of time;
• A school FM sound system or a personal FM system to allow the person with APD to hear the speaker directly without as much environmental noise;
• The speaker pausing at phrases rather than speaking in long, complicated sentences;
• Always insuring that the person with APD has the ability to see the face of the speaker;
• Permitting the person with APD more time to process information - both input and output;
• Provide or allow the use of lists or other devices (such as recording devices) to assist with auditory memory problems; 
• Noise reducing headphones for the person with APD who is sensitive to sound when direct listening is not necessary - such as during a test or when reading;
• For the young child, picture cards are a valuable asset to assisting the child with communication. These can be made at home or purchased; and
• Many publishers of textbooks (Harcourt Brace, Houghton Mifflin, Pearson, Macmillian/ McGraw Hill, Holt McDougal & Houghton Mifflin Harcourt, Pearson Prentice-Hall, Pearson K-12) also have electronic textbooks that are available.  They are interactive and play on a computer.  I've been told that school districts are the only ones that can order them at the k-12 level.  I've also been told that some are accessible to be read by a text to speech reader application such as Adobe Acrobat 6. This is something to look into if reading speed is a problem for the student with APD.  

Remediation (direct therapy):

Remediation is controversial for Auditory Processing Disorder.  There are a number of therapy programs available and all have mixed results.  Some people may find one therapy incredibly helpful while others may find that same therapy to be useless.  

Remediation should also be aimed at the particular needs/circumstance of the individual with Auditory Processing Disorder.  Therefore, if a child is having problems processing speech, a speech therapist would be advisable.  If a child is having difficulties learning to read, a reading intervention program would make sense. Keeping this in mind, here is a list of some possible therapies*:

• Auditory Integration Training: Berard, Tomatis, and Samonas
• Fast ForWord;
• The Listening Program;
• Neurofeedback;
• Speech Therapy;
• Occupational Therapy;
• Movement Therapy/Kinesiology (Brain Gym);
• Interactive Metronome;
• Earobics;
• Lindamood Bell: Lindamood Phoneme Sequencing Program (LiPS); 
• Easyread; 
• Phono-Graphix; and
• Games and computer applications that encourage auditory processing such as Simon, Bop It, Musical Chairs, etc.

Compensatory Strategies:

Compensatory strategies are ways in which the person with Auditory Processing Disorder uses other skills to help him or her best cope with his or her auditory processing problems.  These are language, conversation, organizational, and social skills that have been taught or encouraged and practiced.  Some examples of these are:

• Identifying body language and facial expressions;
• Lip reading;
• Social skills training such as role playing different scenarios;
• Using the practice of rephrasing what someone says as a way to halt the conversation and use that time to better process what was said and compose a response;
• Speaking up for oneself and one's needs such as asking people to repeat or clarify something;
• Utilizing environmental modifications such as making a point of positioning one's self near to and looking at a speaker as much as possible;
• Using texting or e-mail to communicate;
• Using written reminders or lists to compensate for auditory memory problems; and
• Use visualization techniques to remember things: make a picture in one's mind of the event or concept.

* All links posted here are only one company providing the service or product listed.  Please research to find which provider you prefer.

Just Like a 'Normal' Girl

What does it feel like to be 'normal'?  Having Auditory Processing Disorder, my daughter Hailey has had more than her share of experiences where she has felt not-normal.  She has felt like the outsider in social groups where everyone seems to understand what is being said except her.  She has felt like the 'weirdo' who says the wrong things because she recalls the wrong words when speaking.  She has felt like the 'idiot' when she can't figure something out or reads slowly and the other children laugh.  So feeling 'normal', or rather what she thinks other children who don't have processing disorders or learning disabilities feel, is something she craves.

This last year, Hailey started ice skating lessons.  She was fortunate enough to have a private lesson for her first session because she was the only one to sign up for that level.  Her coach was extremely good at teaching using visual and kinesthetic approaches with clear, concise auditory directions.  What Hailey realized is that she excels at ice skating; it was easy!

The next session, Hailey ended up in a class with a different coach and other students.  It was a disaster!  This coach relied on auditory directions without making eye contact all the time, and the other students talking and buzzing around her made it impossible for Hailey to understand what she was supposed to do.  So, being the typical mother of a child with special needs, I went to the director of the ice skating program and told her Hailey has Auditory Processing Disorder and needs visual and kinesthetic coaching with less auditory distraction.  The director had never heard of APD before, but she knows it is something like a learning disability and she is familiar with that, so she decided it would be okay to make sure Hailey has lessons that aren't really private lessons, but it could be arranged to make sure she is the only one that signs up.  I know this sounds confusing, but not really because there are more classes offered than students at her level, so it was just a matter of being flexible in our schedule.  I also made sure to request the coach she worked with before who was so great, and the director changed her schedule to make sure that coach would teach Hailey's class. Yippee!  Asking often does pay off.

So one more session of private lessons - although it wasn't called that because the program doesn't actually allow for private lessons - and Hailey was progressing remarkably fast.  She passed out of the basic skills program and moved into the freestyle classes.  These are arranged a little differently and she has the same coach she and I both adore, but two more students take classes with her.  Each student gets one-on-one time with the coach while the others practice, so it essentially works much like private lessons.  Hailey also goes to extra lessons with her coach where there are four students total and each student practices separately having their own private instruction time with the coach.

So back to the 'normal' feeling Hailey craves.  In the ice skating world, Hailey feels 'normal'.  She feels like she learns and progresses just like any other girl without needing anything special or different to succeed.  The playing field is leveled in this area and she loves it!

(Now there is still the social aspect in the locker room, but she is easing into that slowly.  The other girls seem very kind and at this point, just assume she is shy.  Eventually, she'll probably tell them she has Auditory Processing Disorder and that she needs to see their faces when they talk and can only really understand when one person talks at a time.  Hopefully that goes well, and truthfully I think it will.  Also, her coach is always there in the locker room and she does understand APD (she said she was familiar with it when I told her), so that should help.

Preparing for Daily Transitions Helps Children with Special Needs

Back in the day when I was a student teacher in a kindergarten classroom, I learned a lot of songs and games to use to help my students transition from one activity to the next.  They were fun ways of getting the children to pay attention and do what was needed to clean up and get ready for the next thing.  Like spraying magical dust upon them, it worked miraculously!  At the time, I had no idea what I was doing was assisting the children with transitions by providing them a secure routine which they understood and knew what was expected of them.  In my new teacher mind, I was simply doing what I knew worked to keep those thirty little munchkins from chaos!

Children do not like chaos!

As a parent of a child with special needs, I truly learned that children don’t like chaos any more than anyone else.  Since their worlds are mostly controlled by the adults in their lives, they might feel like the world around them is chaotic when things suddenly seem to happen and everything changes quickly – too quickly - and they don’t know why or what is going on.  These changes are transitions.  Every day we go through multiple transitions; some go smoothly and some knock us around a bit.

It only goes to reason that if all children can feel the world around them is moving quickly and unpredictably, how much more so does the child who processes things slowly or differently.  For the child with Auditory Processing Disorder or Mixed Receptive Expressive Language Disorder, language may be less than 50% understandable at times. Noises and movement in the environment may make things seem encroaching upon a child and always worrying that they just don’t understand can make the world seem out of control – chaotic.  So when a transition, a change from one activity or place to another, is suddenly thrust into the middle of an already somewhat chaotic feeling world, it can simply be too much.  The child understandably reacts with a meltdown.

Case Scenario:

When our daughter was very little, before we realized the significance of transitions, she would cry, get scared, panic, and grab me with such intensity her fingernails would embed into my skin.  In our adult minds it made no sense.  We had told her we were going to the store.  So when we put her shoes on and put her in the car, why did she suddenly freak out?  If we had only stopped to think about how it might have seemed from her point of view, we wouldn’t have been so shocked, and we would have been able to prevent it.  Eventually, with the help of our occupational therapist, we did.

From her point of view, she was sitting playing nicely with her toys in the comfort of her living room.  She heard some blah, blah, blah talking, but who knows what that was.  Then we came with shoes and put them on her feet.  She never had to wear shoes in the living room before, so that seemed weird. Besides, shoes aren’t comfortable.  Somewhere in the recesses of her mind she remembered wearing shoes before and it involved going outdoors, but maybe she sort of remembers this and maybe she doesn’t.  Suddenly we are picking her up and putting her in the car.  She was in the middle of playing and she didn’t want to stop playing.  She hates car rides because they are loud and sometimes there are weird smells.  Cars stop and go and things whiz past outside.  Moreover, she doesn’t want to go anywhere: home is predictable, usual, has the same sounds, smells, people, etc.  Other places are stressful, loud, smell funny, and may be too cold or too hot.  Even more frightening, what if people try to talk to her?  What if they touch her?  What will be expected of her?  Leaving home is always stressful and she wasn’t prepared.

Preparing for Transitions Does Wonders!

So we learned how to best prepare her for transitions.  We learned to use picture cards to show her the car and the store.  We told her we would be going in the car to the store.  We gave her time to process this information.  We helped her put away her toys.  We made sure she had her special blanket and her special chew toys.  We showed her the pictures again.  We encouraged her to repeat to us what we were doing. We reassured her that she was safe and we would be with her with our words and with pictures of us at the store with her safely sitting in the cart seat with her blanket and mommy beside her.  Yes, it took some time.  Yes, we had to plan and prepare for transitions.  It was well worth it!  They went smoother and without meltdowns – visibly she was still stressed, but they weren’t full-on panic meltdowns.

She still had to deal with the stress of being in the car and at the store.  She had to feel the panic when the cashier made eye contact and tried to talk to her.  We also learned sensory calming techniques to help with these things as well – her special blanket with scents on the corners and a vibrating chew toy or spicy candy, rubbing her hands, and speaking for her to the cashier (yes, she is a sweetheart – do I swipe my card here?) while comforting her all helped significantly.

It Gets Better With Time:

Okay, for all you poor panicked souls who are fearful that life will always be this difficult with your young, sensory sensitive child who processes things differently; I have some hope to offer.  This scenario I just described was our daughter at 2-3 years of age.  Today, at 11 years old, she is nothing like this!  She rides well in the car, she loves to go shopping, and she mostly does well responding to the cashiers.  She still hates to be rushed (she needs time to emotionally prepare she tells us) and wants to be told exactly what and when we are doing things.  Mostly we can tell her in words, but if it is a long list or complicated, we usually draw/write a flow chart or list.  And I have not had fingernails or teeth embedded into my skin for at least 7 years!

Suspecting Auditory Processing Disorder in Young Children

Lately I have come across a number of people who are new to auditory processing disorder.  These are people who have very small children who exhibit signs that might be indicative of Auditory Processing Disorder (APD).  I remember when my daughter was young and we knew something was not working right for her, but we weren’t sure what to do about it.  It was a scary, stressful time.

When our daughter was two, we noticed that not only did she not speak, but she didn’t seem to understand anything we told her.  She has a twin brother and he was speaking in sentences, telling us stories, and in every way communicating well.  We wanted to believe that she was just a late bloomer, but when she started tantruming from frustration, screaming from noises we could barely hear, and staring glazedly into space – absolutely checking out from reality – we knew something was not right. (When looking back on it, we realized that she actually exhibited signs as early as a newborn, but we didn’t know at the time what we were looking at.)

I started keeping a diary of her life.  I wrote down what she did or didn’t do that seemed unusual to me.  It didn’t take long to see a pattern emerge.  She didn’t understand what people said.  She was afraid of noises and voices.  She not only spaced out regularly, she did other odd things like smell everything, put things in her mouth, keep food stored in her cheeks, walk with her arms out at right angles, stand with her head on the ground down between her legs, play with her tongue in her mouth, constantly wiggle her fingers, not make eye contact, and try to avoid all people other than her immediate family. 

So I started researching and found out about our state’s infant and early childhood program.  It is a program that provides services such as speech therapy, occupational therapy, etc. to infants and children below the age of three.  They sent an evaluator to our home and decided that our daughter qualified for their services, so we started speech therapy and occupational therapy.

From our occupational therapist, we learned about Sensory Processing Disorder and started a sensory diet for our daughter.  This included physical activities as well as special foods that seemed to calm her and help her to not space out so much.  With a strong sensory diet, she made better eye contact, didn’t tantrum or space out so much, did less odd behaviors, and in general was a much happier and accessible child.

Our speech therapist was working actively on trying to get our daughter to speak and to better understand the spoken language.  I felt there had to be a reason that she didn’t understand, so we went to an audiologist to get her hearing testing.  Her ability to hear sounds was completely normal; she had no hearing loss.  So I started to research and found a disorder called Auditory Processing Disorder.  Our daughter seemed to fit this description perfectly.

I contacted a leading specialist in APD and set up a consultation appointment.  What I found out was that she was too young to be officially tested, but he was more than willing to look over my diary of her and meet her for some informal evaluations.  It didn’t take long for him to believe that she most likely did indeed have APD and that although he could not formally give her such a diagnosis, he felt it was accurate to believe she did have it, and we should start working towards helping her as much as possible.  He gave us a lot of information as well as some techniques to use with her such as always making eye contact, speaking in clear short phrases rather than sentences, watching for signs of stress in her particularly in noisy environments, and to realize that she will most likely not be able to understand what is being said if multiple people are talking at the same time- such as in a restaurant or at a family gathering.

With this information, we informed our speech therapist and occupational therapist who immediately researched Auditory Processing Disorder and tried to incorporate their new knowledge into their therapy.  Our occupational therapist started our daughter on a listening therapy program and our speech therapist introduced us to the use of picture cards to assist with communication.  Both of these things proved to be extremely useful.

At age three, our daughter transitioned into the school district’s early childhood special education program.  She went three mornings a week where she had access to a special education teacher, speech therapist, occupational therapist, physical therapist, and direct instruction and experience in socialization.  Although it was stressful for her to go, she did show great improvement by going there – particularly in socializing.

So this was our start to living with Auditory Processing Disorder (and Sensory Processing Disorder).  If I could give any advice to parents of young children who are exhibiting signs that something just isn’t right, I would say start a diary.  Write down what your child is doing or not doing that seems distressing or odd.  In time, you will see patterns.  You can use these patterns to access the services and help you need.  If you live in the United States, contact your state’s infant and early child program if your child is under the age of three; your pediatrician or local school district should be able to give you the contact information.  If your child is aged three or older, contact your local school district.  These agencies have specialists that can help get you started on the path to helping your child.