A very sweet friend of mine recently suggested writing a page that defines or describes some of the main issues that affect children with special needs and their families. Huh. I can't believe I hadn't thought of that.
Now, I am not a doctor, a therapist, or a special education teacher (although I am a certified teacher). My only expertise comes from my experience raising my little men who happen to both be on the autism spectrum. Many of their struggles are not limited to autism, however, so there is a sense of commonality within the special needs community. I will try, however, to expand my list beyond only the issues I have experienced. So, here it goes:
AUTISM - Well, well, well...I might as well start here, right? Autism is only one disorder on a spectrum of pervasive developmental disorders. There are actually three; autism, Aspergers, and pervasive developmental disorder- not otherwise specified (PDD-NOS). Many people rank the disorders in severity as they are listed, with autism being the worst, PDD-NOS the easiest, and Aspergers somewhere in the middle. Well...it doesn't really work that way, which may be why, as of 2013, children are no longer given one or the other, but rather an autism spectrum disorder (ASD) diagnosis instead. Essentially. there are a few categories of symptoms that must be present for a diagnosis, although the manifestation and severity of each can vary greatly.
Deficits in social communication and interaction - Examples are: Difficulty understanding the give and take of a conversation, trouble understanding figurative language, minimum or no eye contact, limited or no imaginative play, little or no initiating in social situations or failure to appropriately react to others, lack of facial expressions or body language used to communicate, difficulty making (or keeping) friends, and "scripting" (For example, I called Owen a grump and he said, "And also with you," which he hears every Sunday at church). Although I don't think this appears as an example on any diagnostic tool, I would add the tendency to be very blunt. I once went shopping for a dress and bought a medium. When I got home and tried it on for my husband, Noah overheard me say, "Maybe I should have gotten a small." Noah piped up and said, "No Mom, you need a medium." Owen has also said, during Thanksgiving dinner at my mother-in-laws, "This food is a catastrophe."
Restricted or repetitive behavior, interests, or activities (there must be at least two present for a diagnosis)- hand flapping and other repetitive movements, echolalia (the child echoes what s/he hears, i.e. instructions or lines from a story), inflexible routines, need for sameness (Owen once sobbed uncontrollably during a car ride simply because I had taken a different route home), sensory sensitivity or indifference to sounds, pain, etc. Cool fact about that? Owen cannot get dizzy. His occupational therapist tried it out.
*At least three issues (one from the first group and two from the second) must be present. If a child's delays only fit into the first category, social communication, a diagnosis of social (pragmatic) communication disorder may be given instead.
SENSORY PROCESSING DISORDER-
ANXIETY ISSUES- every one worries sometimes...but sometimes it gets out of hand
General anxiety disorder: Children (or adults) with GAD worry excessively about, well...everything in general. The anxiety can be so severe that physical symptoms, such as headaches, stomach pains, and fatigue, can surface. Children may miss school, dread school, or have trouble focusing or socializing.
Obsessive compulsive disorder: OCD is different from general anxiety. Both are based in anxiety, that's true. However, people with OCD experience pervasive, disturbing, UNWANTED thoughts that relate to a particular fear (i.e. a fear of germs). These thoughts are the obsessions. To try to combat these fears and eliminate the "danger," someone with OCD will engage in long rituals, avoidance, or other behaviors. These actions are the compulsions. As someone who has had OCD since childhood, I can attest that this disorder often interferes with daily functioning (as I'm sure GAD does also). Maybe there will be more on this in a future post?
Social anxiety: Ever seen someone who just seemed to shrink in social situations? Could be that this person is just so fearful of being around people who are outside of their family and close friends, that they are struck almost mute if forced to speak. This goes beyond being shy. It's pretty common for kids with special needs to develop social anxiety as they get older because of speech delays or a realization that they don't know how to decode social behavior.
LANGUAGE DISORDERS
Pronoun confusion: I cannot tell you how many times Owen has referred to me with the pronoun "he." I just look at him with a raised eyebrow and he immediately corrects himself. It's cute now. When he was younger, however, he was often confused with "you" and "me." I remember one time I needed to give Noah an consequence (no Wii) and Owen burst into tears because he wanted to play the Wii. I hugged him, kissed him, and kept repeating, "You can." Nothing helped until I said, instead, "Noah cannot play the Wii. Owen can."
Inability/ difficulty expressing ideas: This just may be the number one culprit behind tantrum behavior. I shudder to think about the level of frustration my Owen must have felt before he became more verbal. I would have pitched a fit, too, if everyone guessed wrong while trying to help me. Often times, the thoughts are there, but there's a breakdown in communication between the brain and the mouth. The way that I understand it is that words are on a spinning Rolodex in a child's mind and s/he can't quickly find the right one or string them together. Therapy is often- if not always- needed.
Responds to questions inappropriately: Basically, you ask a "Who" question, but your child answers a "When" question. For example, when Owen was 5, I asked him, "Who's Noah? Noah is your ___?" He lit up and said, "Seven" (which was his age at the time).
Difficulties understanding figurative language: Many children with special needs are very literal thinkers and will take what you say at face value. If you tell a child with this particular issue "It's raining cats and dogs," you better hide the umbrella. Although it sounds funny, and often is, idioms such as "go play in traffic," "hit the road," or "go jump in a lake," if taken literally, can be dangerous. It's important to say what you mean.
Now, I am not a doctor, a therapist, or a special education teacher (although I am a certified teacher). My only expertise comes from my experience raising my little men who happen to both be on the autism spectrum. Many of their struggles are not limited to autism, however, so there is a sense of commonality within the special needs community. I will try, however, to expand my list beyond only the issues I have experienced. So, here it goes:
AUTISM - Well, well, well...I might as well start here, right? Autism is only one disorder on a spectrum of pervasive developmental disorders. There are actually three; autism, Aspergers, and pervasive developmental disorder- not otherwise specified (PDD-NOS). Many people rank the disorders in severity as they are listed, with autism being the worst, PDD-NOS the easiest, and Aspergers somewhere in the middle. Well...it doesn't really work that way, which may be why, as of 2013, children are no longer given one or the other, but rather an autism spectrum disorder (ASD) diagnosis instead. Essentially. there are a few categories of symptoms that must be present for a diagnosis, although the manifestation and severity of each can vary greatly.
Deficits in social communication and interaction - Examples are: Difficulty understanding the give and take of a conversation, trouble understanding figurative language, minimum or no eye contact, limited or no imaginative play, little or no initiating in social situations or failure to appropriately react to others, lack of facial expressions or body language used to communicate, difficulty making (or keeping) friends, and "scripting" (For example, I called Owen a grump and he said, "And also with you," which he hears every Sunday at church). Although I don't think this appears as an example on any diagnostic tool, I would add the tendency to be very blunt. I once went shopping for a dress and bought a medium. When I got home and tried it on for my husband, Noah overheard me say, "Maybe I should have gotten a small." Noah piped up and said, "No Mom, you need a medium." Owen has also said, during Thanksgiving dinner at my mother-in-laws, "This food is a catastrophe."
Restricted or repetitive behavior, interests, or activities (there must be at least two present for a diagnosis)- hand flapping and other repetitive movements, echolalia (the child echoes what s/he hears, i.e. instructions or lines from a story), inflexible routines, need for sameness (Owen once sobbed uncontrollably during a car ride simply because I had taken a different route home), sensory sensitivity or indifference to sounds, pain, etc. Cool fact about that? Owen cannot get dizzy. His occupational therapist tried it out.
*At least three issues (one from the first group and two from the second) must be present. If a child's delays only fit into the first category, social communication, a diagnosis of social (pragmatic) communication disorder may be given instead.
SENSORY PROCESSING DISORDER-
ANXIETY ISSUES- every one worries sometimes...but sometimes it gets out of hand
General anxiety disorder: Children (or adults) with GAD worry excessively about, well...everything in general. The anxiety can be so severe that physical symptoms, such as headaches, stomach pains, and fatigue, can surface. Children may miss school, dread school, or have trouble focusing or socializing.
Obsessive compulsive disorder: OCD is different from general anxiety. Both are based in anxiety, that's true. However, people with OCD experience pervasive, disturbing, UNWANTED thoughts that relate to a particular fear (i.e. a fear of germs). These thoughts are the obsessions. To try to combat these fears and eliminate the "danger," someone with OCD will engage in long rituals, avoidance, or other behaviors. These actions are the compulsions. As someone who has had OCD since childhood, I can attest that this disorder often interferes with daily functioning (as I'm sure GAD does also). Maybe there will be more on this in a future post?
Social anxiety: Ever seen someone who just seemed to shrink in social situations? Could be that this person is just so fearful of being around people who are outside of their family and close friends, that they are struck almost mute if forced to speak. This goes beyond being shy. It's pretty common for kids with special needs to develop social anxiety as they get older because of speech delays or a realization that they don't know how to decode social behavior.
LANGUAGE DISORDERS
Pronoun confusion: I cannot tell you how many times Owen has referred to me with the pronoun "he." I just look at him with a raised eyebrow and he immediately corrects himself. It's cute now. When he was younger, however, he was often confused with "you" and "me." I remember one time I needed to give Noah an consequence (no Wii) and Owen burst into tears because he wanted to play the Wii. I hugged him, kissed him, and kept repeating, "You can." Nothing helped until I said, instead, "Noah cannot play the Wii. Owen can."
Inability/ difficulty expressing ideas: This just may be the number one culprit behind tantrum behavior. I shudder to think about the level of frustration my Owen must have felt before he became more verbal. I would have pitched a fit, too, if everyone guessed wrong while trying to help me. Often times, the thoughts are there, but there's a breakdown in communication between the brain and the mouth. The way that I understand it is that words are on a spinning Rolodex in a child's mind and s/he can't quickly find the right one or string them together. Therapy is often- if not always- needed.
Responds to questions inappropriately: Basically, you ask a "Who" question, but your child answers a "When" question. For example, when Owen was 5, I asked him, "Who's Noah? Noah is your ___?" He lit up and said, "Seven" (which was his age at the time).
Difficulties understanding figurative language: Many children with special needs are very literal thinkers and will take what you say at face value. If you tell a child with this particular issue "It's raining cats and dogs," you better hide the umbrella. Although it sounds funny, and often is, idioms such as "go play in traffic," "hit the road," or "go jump in a lake," if taken literally, can be dangerous. It's important to say what you mean.