Miriam's Advice Column

Tips and help for parents

by Miriam Darnell

This is a collection of short articles in response to questions parents have asked me regarding their twice exceptional children.

The articles feature issues such as anxiety, medication, occupational therapy, individual educational plans, vision therapy, unique learning styles, sensory intergration and more.

If you have a question, please feel free to write via the contact us page and I'll do my best to post an answer.

Coping with Obsessive Anxiety in 2e Children

Most 2e kids suffer from generalized anxiety problems. They tend to think in abstractions and worry about things that are too big for their young minds to cope with. In other words, they perceive far more than they understand, and what they don't understand, they fill in the blanks with often false or inflated information. Here are some ideas of how I helped my son Connor overcome some of his troubles. Connor still suffers from anxiety problems, and he's 17 now, but he's got much better coping skills and he gets a little bit braver every day. I can hardly believe what he's NOT afraid of now!

When Connor was 6, I took him to a playground, and he saw a kid fall off a swing and get a bloody nose. The child was immediately cared for by his father, and was fine moments later, but Connor was not fine. He asked me non-stop "Is that little boy okay, Mommy? He got hurt. Did his daddy take care of him? Is he going to be okay? That little boy got a bloody nose. He was hurt...." This was all I heard from him for... guess how long? Not hours, not days, but WEEKS! It finally went away, only to resurface again months later for another few days. My poor son! He just couldn't process what happened to that little boy and it truly frightened him. Connor's most recent fear, and this was like, a few months ago, was that he was going to get arrested because a porn sight had popped up on his computer. Every time he heard a siren he tensed up and thought they were coming for him. But he can watch horror movies now, blood and guts galore, and not flinch. I'll leave the room because the film is too violent for me and he'll say, "It's only a movie, Mom! It's not real." This is a huge HUGE change from a little boy who couldn't sit through the animated Aladdin because it was too scary.

So take heart, parents. It does get better over time.

The key is to remember these things:

1) Anxious children come from anxious parents. We're nervous as hell because our kids are so fragile. They're so helpless and vulnerable and frightened. But if we look at ourselves, we can see that we obsess about fearful things too. We're just not so verbal about it. We worry that we might have cancer or that we're never going to make enough money to pay the bills or that our partners are falling out of love with us... We are anxious people because we're gifted and/or 2E as well. Yeah, we may think we were never as bad as our kids are, but when I think back to how I was as a child, I had obsessive nightmares, and I was so afraid of the world that I suffered from asthma and pneumonia all through childhood. The more we learn to deal with our own anxieties the better we'll be able to help our children do the same.

2) We have to be very conscious of not overreacting to their little mishaps or their anxiety attacks. If they fall and we worry they've hurt themselves, we have to laugh and get them to laugh with us, even if the injury is worrisome. It's a hard thing to learn to do. We want to scream "Oh my god! Are you okay?" but instead, we have to say, "Oops! That was funny!" You can't be afraid and laugh at the same time. Try it. It's impossible. Don't forget how connected our special children are to us, how empathic they are. They'll sense our anxieties and just add them to their own. My dad always cured my childhood nightmares by turning them into something funny, like a silly cartoon in my head. If your child is feeling anxious, watch something funny together. Humor is your best weapon.

3) Empower your child any way that you possibly can. Most anxiety comes from feelings of helplessness and being out of control. The more you rely on someone else to do things for you, the more vulnerable and afraid you feel. Our 2Es struggle with feeling powerless in so many ways, from the inability to hold a pencil right to difficulties with reading and math to trouble finding a misplaced toy to feelings that the entire world has gone mad and nothing makes sense on the news... our children feel powerless. So, maybe there's many things they struggle with and can't do well, but you can always focus on the things they CAN do well, and really boost their confidence in those things. Teach them little adult skills of independence at a young age so they can feel like they're in charge of something grown-up. I taught my sons how to do their own laundry at 9 years old and they've been taking care of their own clothes ever since. I also taught them how to cook some basic things, how to start up the car and get it warm in the mornings, how to fix little things around the house, etc. The more Connor knows about how to control his environment, the braver and braver he becomes. He's so much more confident now! I can't stress to you enough how much every little success your child has adds to his defense against anxiety!

4) Make sure your child knows it when you make mistakes. Step yourself through your mistakes out loud so he can see that there is a way you go about correcting problems. There are strategies that get you from step A to step B. For instance, let's say you forgot a key ingredient for dinner at the grocery store. You think in your head what to do about it. Do you want to change the recipe or do you want to go back to the store and pick up what you need? Say out loud to your child, "Oh no, I forgot the noodles! What should I do now? Let's see, my options are, I could use rice instead or I could go back to the store and get noodles. Maybe we have some noodles hiding at the back of the pantry. Can you help me look for them?" Let your child see you make mistakes and watch how you cope with them so he can learn the strategies necessary to overcome his own shortcomings.

Above all, remember to breathe and take care of yourself. Your child will learn from your example how to cope with things when he feels out of control. And don't forget to laugh! This isn't OCD, ADHD or anything else the professionals want to label it. It's anxiety that our children have for obvious reasons and we as parents can help them more than any medication or therapist out there. Be patient, understanding and strong, and it'll all work out.

Good luck!

Medicating our 2e children

by Miriam Darnell

One parent brought up the topic of over-medicating our children, and how we don't look for the true causes of errant behaviors before we pour pills down their throats.

My response to her concern is:

The systems we currently have in place in our schools and support/medical services are so frustrating and toxic to our children! As a culture, we tend to be a bit medication crazy, hoping a magic pill will cure everything and our children will be "normal" like all the others. Well, I hate to break it to you, but there are no magic cures for the complex problems that plague our children today. There are just too many factors that can contribute to behavior challenges for there to be a cure-all pill. We have to look at environmental factors such as emotional problems in the family, allergens and toxins in the home or in the food, and stressors in school such as noise levels, boredom, and unique learning styles that aren't being addressed by teachers. Then there's the internal factors of heredity, chemical imbalances, vitamin deficiencies, sensory integration dysfunction, oxygen deprivation at birth, head injury, food sensitivities that prevent the body from absorbing enough nutrients... the list goes on and on.

At The Brideun School for Exceptional Children (where I taught language arts to 2e students for 5 years), we had an overwhelming number of children who were on 5, 6, 7 medications (the first few to control whatever the problem was that they supposedly had, and the rest to help them cope with the dangerous side effects of the first). It was such a mess to have to sort it all out and get to the bottom of the children's true needs. The first thing we always had to do was take the kids off the meds and put them on a sensory diet right away (controlling the amount of stimulation they had to cope with using headphones, vision shields, letting them wear weighted vests, or body socks, etc.). What we found when we really looked at the various symptoms was that only about 5% of our students really needed drugs to help regulate their systems. The rest were suffering from things like severe sensory integration dysfunction (which could be worked with holistically), anxiety (which could be dealt with in many healthy ways, from counseling to learning coping strategies), food allergies (which, when properly identified, solved a whole lot of ADHD-like behaviors), and most surprisingly, sleep disorders. Three of the most oppositionally defiant and violent students we had at our school, when tested, were found to have severe sleep disorders. They were waking up an average of 150-200 times a night! When these students were given oxygen treatments at night, the difference we saw in their behaviors during the day blew our minds. They were completely different kids.

You can't just say the child has Autism and leave it at that. If they truly do have it, and I agree with the many parents who claim that the numbers are dramatically inflated for the convenience of the diagnosis, you still have to work with the individual behaviors and needs that are unique to each child. There will never be a medication that treats Autism, because it's the variety of symptoms that come with that label that need to be addressed, not the syndrome itself. That would be like giving a kid a drug for having a high I.Q. It's not the intelligence that's the problem, it's all the stressors that come with it that need to be dealt with (such as the higher incidence of physical awkwardness, sensory over-stimulation, depression, anxiety, and suicide that plague the highly intelligent population).

This is not to say that no child has ever benefited from medication. Some meds work for some children, and when administered intelligently and in moderate doses, can sometimes change brain chemistry for the better. I just feel that meds should never be the first thing you try when your child displays undesired behavior. If the behavior is their way of communicating that they need something different at home or at school, it's far better to attend to their needs than suppress the trouble with chemicals.

Oh, and one more thing to ask yourself. How "normal" do I really want my child to be? Very few of the great minds who have shaped this world were quiet, well-behaved, balanced, perfect children. Quiet, "normal" people pass through this world unremembered in the history books. Maybe you're one of the lucky ones who has a child who's here to make a difference. You just have to find a way to get them through these rough early years with their self-concepts still intact. Not an easy task, but if you're reading this, you care enough to make it happen!

Making Vision Therapy Exercises Fun

PART 1: TRACKING

Because I spent three years as a head vision therapist working for a very progressive developmental optometrist, I often get asked how to make home vision therapy exercises enjoyable so children will stick with them on their own. Our therapy staff was committed to making vision exercises innovative and fun, so I'm going to share our secrets here with you.

NOTE: Please consult with your behavioral optometrist before doing home vision therapy exercises to be sure you're focusing on the right skills needed for your child. And please don't use these helpful hints as a substitute for attending regular vision therapy appointments for the full amount of time that your optometrist recommends. In-office visits have a powerful and fast effect on vision skills that you don't want to go without if possible.

OCULAR MOTOR DYSFUNCTION (OMD) OR “TRACKING PROBLEMS”

Ocular Motor Dysfunction is when the eyes can't smoothly follow moving objects. The eyes may jerk, lose track of the object (lose fixation point), get red and irritated when forced to track without head movement, lose their place when reading, and generally feel tired and headachy when reading or playing games that require smooth eye movement in following a target. It's important to understand that an OMD diagnosis doesn't mean that there is a physical problem with the eyes themselves, but a miscommunication between the eyes and the brain. When we teach the eyes to track better, we're actually creating a better pathway of communication, not strengthening the eye muscles, as it may seem. Tracking is a very trainable skill and is absolutely necessary for successful reading.

OMD is one of the most common vision problems, especially for children who have trouble reading, whether through dyslexia or some other reading disability, and for those who have trouble with sports and other visual games. It's easy to spot and diagnose. All you have to do is have the child hold his head very still while you move a pen or other interesting small object about 1-2 feet from his eyes in slow circles clockwise and counterclockwise, up and down, and side to side. Watch the child's eye movements. Are they nice and smooth? Do they stay on target wherever the object goes? Or do they jerk, lose their place, get red and sore? Do they have to move their head in order to follow the object? If you see any of the latter, there's probably an ocular motor problem. But never fear, OMD is the most fun vision problem to work with at home.

You don't have to do boring, repetitive eye movements in order to practice this skill. Any game or sport that involves moving objects will do. All you need is an eye patch and lots of reminders to keep the head still as much as possible, and your kids can play any ball game, video game, etc. that involves a moving target for them to focus on. Make sure each eye gets equal time with the patch and make sure to do the same games without a patch as well so the eyes can spend some time working together. Something along the lines of 10-15 minutes per eye, and 10-15 minutes of using both eyes together should do.

Some of the better games to patch for are:

· Soccer and other ball sports

· Pinball, foosball and other arcade games

· Ping pong, badminton, tennis, racquet ball and other racquet sports (beware, though, your depth perception will be completely off when patching one eye)

· Jezzball, Pong (the old Atari video game), I-Spy, Tetris and other computer games

· SET, Rummy, Concentration and other card games that require the eyes to search from one area to another

· Search and find games and books such as Where's Waldo, I-Spy, Look-a-Likes

· Tracing large pictures, drawing on large paper or a white board, painting with long strokes, cutting along a line

You could also put a ball or other object on a long string, hang it from a high place (so it's about 3-4 feet above the floor, have the child lie on the floor looking up, and (again with the patch on alternating eyes), move the ball or object in wide circles clockwise, counterclockwise, and in horizontal lines while the child is following the object with their unpatched eye. Make sure the object they have to look at is interesting to them or keep switching the object with another one to keep things interesting. My favorite object to use is a softball. I write all the letters of the alphabet on the bottom of the ball (not in order) and using the letters, I play all sorts of spelling games with them as they try to find the letters they need on the bottom of the ball while it's moving above them. Have them find their own name, names of friends, practice their spelling words for school, do alphabet backwards, etc.

Don't underestimate the power of emotion on eye functioning. When emotions are happy and open, the eyes respond much better to what the brain wants, and more gets accomplished in a shorter amount of time. When a child is bored, tired, angry or closed, it's likely their eyes will be just as resistant as their emotional state, and they will make little progress no matter how hard they work it. You only have to read about “hysterical blindness” to realize how much our emotional states affect our vision. Keep the home vision exercises fun and you'll be amazed by the speedy progress your child makes!

Making Vision Therapy Exercises Fun

PART II: CONVERGENCE

Convergence Insufficiency is when the eyes have trouble coming together to focus on near objects, and it is the most common diagnosis in the “Eye Teaming” category. Lack of proper eye teaming means simply that the eyes don't work together as a team. They're each doing their own thing, which causes a host of problems, from double vision to poor depth perception to “lazy eye” or “wandering eye” syndrome.

Convergence Insufficiency (again when the eyes have trouble coming together to focus at near), usually causes exhaustion and headache when reading, writing, or doing other near tasks for extended periods of time. I hate convergence headaches! I have this problem myself, and when one of these nasty buggers sets in, nothing gets rid of it but a nap. Painkillers don't work for some reason. You can easily recognize a convergence headache because it's usually right behind the eyes and in the forehead, and it can get bad enough to cause nausea, so it's often misdiagnosed as a migraine headache. Convergence Insufficiency has nothing to do with the physical ability of the eyes to focus on near objects. It's not the same as farsightedness (the ability to only see things clearly at a distance).

According to optometric testing, your eyes may have perfect 20/20 vision and not need corrective lenses at all, and yet you still may have convergence insufficiency and regularly enjoy the lovely headaches that come along with it. When treating convergence insufficiency, most developmental optometrists recommend glasses that enlarge near objects, even though you're not farsighted because the magnification takes some of the strain off the eyes when trying to focus near for reading. However, they also recommend exercises in-office and at home to train the brain to have better communication with the eyes, thereby reducing resistance and strain from looking near.

There are a few more things you need to know about eye teaming and convergence, and then we'll get to some exercises to do at home. There are different levels of severity in a convergence insufficiency diagnosis, from the eyes just getting tired after looking close for a while to eso/exotropia that may require surgery to fix (explained further below). All kinds of things could be happening with the eyes; for instance, one eye may converge correctly while the other is reluctant to turn in, or both eyes may have trouble pulling inward together. When one eye is stuck turning outward and doesn't make the natural turn inward that it should to view near objects, it's called “exotropia.” Marty Feldman (Igor in the movie Young Frankenstein) is a famous exotrope. Of course, his case is severe. Many exotropes are hard to spot because their “wandering eye” is only a tiny bit off the target. Milder cases of this phenomenon, where one or both eyes tend to travel outward but aren't fixed outward all the time, fall under the lesser diagnosis of “exophoria.” Likewise, if one or both eyes turn inward in a cross-eyed fashion, it's called “esotropia” if it's constant, or “esophoria” if it's just a tendency. Exotropia/phoria is the one that has the most trouble with convergence, however, so I'll address that one here.

Exotropia or exophoria requires in-office visits where the optometrist may prescribe prism lenses (glasses where the lens is thicker on the outer edge and thinner near the nose, thereby forcing the eyes to push inward), or an eye patch to be worn regularly (but beware of patching one eye for more than a few hours at a time because it can weaken the “good” eye), occlusion on the glasses (taping the outer edge or near the nose of the glasses so that you can't see through those parts and it forces the eyes one direction or the other), and in extreme cases, surgery. An important note about surgery... if you have it done to correct an exo or esotropia, you have to do vision therapy exercises for at least a year after the surgery is done because without the vision training, the eyes will eventually move back to the same position again and nothing will change. My mother had to have numerous surgeries for her esotropia when she was a young child because the eyes kept going back to their inward position, but this was in the days before vision therapy was invented. Surgery is not a quick fix for eye turn problems. It can help, sure, but if you don't follow it up with vision exercises, the eyes will go right back to the position that was comfortable for them in the beginning. This is true of lasik surgery as well. If you just got a correction for near or farsightedness, it's a good idea to do some vision therapy and retrain your brain how to use the eyes to their maximum potential.

Now for the exercises at home...

Convergence is just a matter of getting the eyes to focus together on a close object, so you can do that by wearing an eye patch (10-20 minutes each eye, and then no patch at all) while sewing, reading, doing crafts, coloring, cooking, cutting, pasting, etc. But you have to make sure to take lots of breaks to look far away (out a window at the farthest object the eyes can find) to keep focus flexibility in good order. Look near for a bit on the project you're working on, then look far for a minute or two, then back to the near again.

Convergence can also be practiced in the car quite well. Just put a small sticker on the window nearest the child and instruct them to look at the sticker for a few seconds, then to look outside at the farthest thing their eyes can find, then back at the sticker again. It's hard work to get the eyes to come back to the window itself after looking at something far away through it, but it's one of the best exercises you can do. Have your child do this at least 10 times every time they get in the car. There you go, no extra time out of your day to do this! Or they can practice the same thing with the bathroom mirror when brushing their teeth. Look at the sticker on the mirror, then look at themselves through the mirror, then back to the sticker again.

The optometrist will probably give you something like a yard stick or a Brock String to work with. Both have pins or beads at varying lengths along the stick or string and you're supposed to look at the farthest pin or bead and try to force your eyes into double vision (because if you're using both eyes correctly, you'll get doubles of whatever you're not looking directly at). It should make a backwards V shape when looking at the farthest fixation point. Then you look at the middle pin or bead and you should get a double image that looks like an X. Then to the nearest fixation point for a front wards V shape. This is a really good and very important eye teaming exercise, but it's also not very fun. So I'd do it just a few times a day, in-between the other more fun convergence activities that you're working on.

There are other eye teaming exercises your optometrist will recommend, such as red/green glasses, but not all of these have anything to do with convergence, so I'll leave the other suggestions for next time when I talk about eye teaming.

Parents, please use caution and take it slow with the convergence exercises because they can cause headaches, exhaustion, irritability and even nausea (just as all eye teaming exercises can). Be patient with your children and allow them to work their way up from just minutes a day to longer spans of time as they can handle more. And don't forget to consult with your optometrist BEFORE doing home vision exercises to be sure you're focusing on the right ones for the child's needs.