Is It a Big Problem or a Little Problem?: When to Worry, When Not to Worry, and What to Do

Part One

THE BASICS

Prologue

Starting on the Right Foot

It’s a nagging feeling. It’s a worry that keeps pushing its way into your brain at night as you lay exhausted in bed, simply wanting sleep. It’s a concern that your thoughts keep turning to during the chitchat of neighborhood moms at your weekly playgroup. It’s something that you hem and haw about bringing up with your pediatrician. You find yourself asking, again and again: Is this a big problem or a little problem? In other words, Should you worry, or should you not?

Problem behaviors come in all shapes and sizes, and at all ages and stages of development. Some are bigger than others, but all cause parents and professionals (and children) some degree of angst and stress. As members of a team of child developmental specialists, and as mothers and a grandmother, we are very familiar with these issues, and have worked with thousands of parents and professionals to help them sort out the challenges faced by young children. Our team is based in Rockville, Maryland, at the Ivymount School’s Center for Outreach and Education (CORE). Our mission is to help teachers and families identify needs and implement strategies for helping young children be more successful at home and at school. The team consists of two occupational therapists, a speech and language therapist, and a behavioral specialist. We provide individualized support, resources, and strategies to help families, teachers, and, most important, children who face big and little problems. This book will do the same for you.

Differences in children’s learning styles, temperaments, and personalities are a given, but when should those differences raise a red flag? What strategies might parents try on their own before getting anyone else involved in the problem-solving process? How much frustration or anxiety should a parent (or child) endure before calling in a specialist? When should a parent seek a professional opinion? And what can a frazzled parent do in the meantime, while waiting for that professional evaluation?

Let’s begin with a list that sums up the most common complaints we hear from parents (and professionals) about young children. These behaviors may represent a little problem, easily manageable with a few specific strategies, or they may be the tip of the iceberg of a bigger problem.

10 Common Concerns of Parents About Their Children

1. He doesn’t listen.

2. She’s stubborn and always needs to have things go her way.

3. He’s constantly on the go, in perpetual motion.

4. She has so many tantrums! She’s so emotional!

5. He has a really hard time with changes in routine.

6. Sometimes she gets so wound up!

7. He’s so clumsy and always getting hurt.

8. She can be so mean and aggressive toward other kids.

9. He’s really shy and withdrawn.

10. She’s such a picky eater.

These ten statements could describe almost every child, on one day or another, at some point during their early years. However, when one or more of these complaints become the norm for a child, a red flag goes up. If these glitches are pervasive and affect a child’s ability to be happy, relate to others, and go about his daily life, there may be a real problem. Only further investigation will tell us whether it is a big problem or a little problem.

Most children have little problems. This book is full of strategies to help parents and other caregivers manage the little problems of early childhood. When we use these strategies to adjust the environment, modify behaviors, and give a child time to mature a bit more, little problems can resolve themselves without outside intervention. For the purposes of this book, little problems are those that are manageable without outside intervention. Big problems, on the other hand, may require the support of professionals. If our strategies and suggestions do not solve the problem, if the problem seems to be bigger than parents and teachers alone can fix, we’ll point you in the right direction for further evaluation and support. Big problems will often seem much more manageable once the proper professionals are involved. A little intervention can go a long way toward keeping a big problem not-so-big!

There’s nothing out there that describes my child’s issues, complained an exhausted mother recently. It is a complaint we hear frequently in our work with families of young children as well as from their teachers and child-care providers. Nice neat labels don’t always describe the children we work with. They are regular children in regular schools, preschools, and child-care centers who, for a variety of reasons, are having difficulty being successful at school and/or home. Most teachers don’t know what to do with these kids: they have tried everything in their bag of tricks and come up empty handed, or have come up with a plan that only works part of the time. Some of these children are even on the verge of being kicked out of preschool or child care because of their behavior.

These children may be enigmatic—happy and affectionate one minute, aggressive or stubborn as nails the next; cooperative and eager to please in one setting, but aloof or bossy in another. They appear in virtually every classroom in the country. Aggressive, aimless, class clown, impulsive, rigid, controlling, explosive, anxious, and disorganized are a few of the terms used by parents and teachers to describe such individuals.

These children don’t necessarily have ADD or ADHD but may have language processing problems, or sensory processing differences. They may have difficulty understanding or remembering multistep directions. They may be extremely touch-sensitive and lash out impulsively when others come uninvited, albeit innocently, into their personal space. They may have trouble getting their body to do what their brain is directing, such as with motor-planning problems that interfere with all sorts of activities in a typical child’s day. Children with any of these conditions experience constant frustration and/or assaults on their sense of self-worth. Not surprisingly, frustration and low self-esteem often leads to behavior problems.

Hitting, biting, yelling, or a thirty-minute tantrum over a Popsicle color certainly gets parents’ attention, and they need to know what to do. Having a speech and language evaluation followed by speech and language therapy may address the underlying issues of auditory comprehension, but in the meantime parents need a Band-Aid—practical ideas and strategies to help them get through the days, or ideas to give the teacher that might prevent another biting incident this week.

Dealing with the immediate behavior problem is only half of the solution. The underlying cause (if there is one) needs to be identified and treated as well, so that it no longer triggers the problem behavior. This book addresses both of these needs. It takes a long-term and short-term approach to helping children become more successful in their interactions with others and in their classroom and home environment.

The chapters of part 2 delve into specific areas of development, what different or delayed development might look like, underlying causes of behaviors, strategies to support children, and explanations of why these strategies work. Sometimes, however, parents do not know what the underlying problem is—or if one exists—but where a child has trouble is obvious. Certain scenarios, be they birthday parties, playdates with certain friends, or trips to the store, are sure to end in tears or tantrums. For this reason, the chapters of part 3 are organized into typical parts of a child’s life. Unique factors present in different environments trigger behavior problems or stress in a child. By understanding the potential stressors in different parts of a child’s life, we can better prepare him for the challenge and support him throughout the experience with situation-specific strategies. Finally, the appendices provide nitty-gritty reference tools to aid in using the strategies described throughout the book.

One goal of this book is to empower parents: to remind them of their strength and influence in their young child’s development. Using the resources and strategies in this book, parents can help a child experience more success and less frustration as he goes through his day, before ever stepping foot into a clinician’s office.

Meet the Children

Sprinkled throughout the book are four children who are trying hard, each in his or her own way, to do what they are supposed to and still get their own needs met at the same time. They have a range of behavioral and developmental issues. Some have little problems whereas others have big problems. Through vignettes, we describe the thought processes and questions we had as we created intervention plans for them, and the strategies that helped them to be more successful in their daily lives.

Perplexing Sean

Sean has a smile that lights up a room. At two and a half, he is a delight to his parents. Still, his mom has a persistent feeling that something is not quite right. Sean has a baby brother who is six months old, and his parents can see how quickly and apparently effortlessly he appears to master early motor milestones.

In contrast, Sean sat up at nine months of age, never crawled, and began walking at seventeen months. At two and a half, his movements appear awkward and clumsy. He is only able to go up and down the stairs while holding onto an adult’s hand. He is beginning to run, although his movements are more like those of a younger toddler.

Sean is generally a good eater but often overstuffs and has to be watched carefully at meals so that he does not choke. He appears to have difficulty chewing, particularly more resistive foods such as meats. He only drinks from a lidded sippy cup and refuses to use a cup without a lid. He has begun to hold a spoon when eating yogurt; however, he quickly tires of utensils and prefers to eat finger foods.

Sean has started to speak using single words and occasionally combines two words together. Generally he does not follow directions (e.g., Give me your cup) or pay attention when asked questions (e.g., Do you want your ball?). At times he does not look at his mother when she is talking, or when he is talking to her. He simply seems oblivious to her presence. However, if his mother goes out, he greets her on her arrival home with a big hug, so she knows he is attached to her and misses her when she is gone.

Sean’s father works out of the home and is a very hands-on parent. His mother works part-time at the local university. In addition, his parents hired a nanny who has been employed by the family since Sean was four months old. She is extremely devoted to Sean and his brother.

Recently, Sean started attending a Mommy and Me class. His mother began to realize that his speech and movement skills lagged behind the other children, even those who were several months younger. He has the most difficulty when the teacher calls the group together to sing songs and play with instruments. Sean refuses to sit with the other children and is only content when allowed to roam the room.

Scott, the Negotiator

At three and a half, Scott is an active, imaginative, articulate little boy. Like most older siblings, he happily bosses his two-year-old brother around and dictates their play. Most of the time, his easygoing brother is happy to comply and follow his lead.

Scott goes to a top-notch preschool five mornings a week, where his teachers report that he is cooperative, social, and full of energy. He follows the classroom routine well and is eager to try new activities. His interests ebb and flow. One month, he may be heavily into block building; and the next month, he may gravitate toward the Play-Doh table for birthday cake–making. He loves outdoor play, and on the weekends spends time at the park with his dad.

Scott’s parents have demanding jobs. His father is an attorney at a law firm, while his mother, a journalist, has tried to scale back her hours at work so that she can spend more time at home with the boys. She, like most moms who work part-time outside the home, struggles to make time for everything: quality time with her kids and enough face time at work so that she stays in the loop and still receives choice assignments, and of course time for household chores and meal prep. She has the flexibility to work from home occasionally, which can be both a blessing and a curse. She also has a part-time nanny, which allows her some uninterrupted hours for work, but when she’s on a deadline she often dips into her mommy time to finish a project.

Scott’s parents frequently find themselves in debates and negotiations with him. They feel as if they’ve been having power struggles with him forever. They chalk it up to his being the first child and being very bright and articulate. He still throws temper tantrums, and they are not sure if this is normal. Since they work so much, they both feel they have so little time with him that they’d rather not fight. They are inclined to let him have his way unless his request seems unreasonable, such as wearing shorts to school on a thirty-degree day or going out to eat when they’ve already begun preparing a meal. Then they end up in a big fight that escalates into the parents yelling, Scott screaming and crying, and his younger brother becoming upset as well. (When Scott is upset, his brother usually is too, out of solidarity!) It is easy to see why Scott’s parents avoid battles with him, but at the same time they often feel as if he is running the show. They don’t think this is the way parenting is supposed to be, but they aren’t really sure how to change things. They wonder if he may have some sort of behavior problem because he still throws tantrums and has such a hard time following directions at home.

Unpredictable David

David is a four-and-a-half-year-old boy. He was born three weeks early. From birth, David has had difficulty with regulation. That is, he vacillates from being wild and overstimulated to being quiet and thoughtful. He is known both at school and at home for being stubborn and having frequent meltdowns. David is a continual challenge to his parents and teachers.

David is less reactive to pain and touch than are most of his peers. He loves to touch, fall, and wrestle even when his siblings or peers don’t want to engage in rough play. At home, David rarely follows directions. He becomes silly and runs away rather than comply. When his parents run out of patience, they usually try to pick him up, but he goes limp and falls to the floor, which irritates them even more. The most difficult thing about David is that his parents and teachers can never trust that he will follow directions when he becomes silly and wound up.

David has attended an excellent preschool program since the age of three. At school he can play with peers cooperatively, but when things don’t go his way, the play quickly deteriorates, with him taking toys from other children or destroying the play setting (knocking down the block village, or pushing all the cars off the bridge). For the past two years, David’s preschool teachers have had concerns about him. They share their concerns at parent-teacher conferences. David’s parents are sympathetic and concerned, but they, too, are challenged by his behavior.

David’s father works long hours and his mother is a busy stay-at-home mom. David has two older brothers who are in elementary school. This busy family, with three children in two schools, lessons, playdates, and so on, keeps mom and kids on the go and navigating many transitions throughout the day. Although this family does not have strict routines and schedules, the other children are able to go with the flow, whereas David is not as adaptable. He seems to have a keen sense of when things are getting stressful. At times it seems he just needs to upset the apple cart for no apparent reason. These out-of-control behaviors range from being silly and uncooperative to extreme stubbornness to a full-blown meltdown or tantrum. He is challenging because it is hard to know when he will fall apart and whether it will be a brief disruption or a major meltdown.

David’s parents have the same basic philosophy of child rearing; however, both admit that at times, especially when time is short, their youngest child brings out the worst in both of them. They become angry and frustrated much more quickly as kindergarten approaches, as they are more and more uncertain about David’s ability to behave appropriately there. They are increasingly anxious and feel pressure to do whatever they can to change his behavior and get him to shape up before he begins kindergarten.

Hurricane Danielle

Danielle is a beautiful blond-haired, blue-eyed five-year-old who was born very prematurely. She spent her first two months in a neonatal intensive care unit. At eight months of age, she seemed more like an infant. Danielle produced very few sounds and had trouble sitting up by herself. Due to her delayed development, her pediatrician recommended an early intervention program.

As Danielle approached her first birthday, with much love and attention from family, supportive friends, and professionals, she began to make gains in all areas of development. By her second birthday, she was walking and talking, with more than fifty words. At two and a half, the developmental team discharged Danielle and encouraged her mom to keep up the stimulating activities.

However, her mother felt that Danielle’s activity level was more extreme than other children her age. She was always on the run and it was hard to get her to sit and listen to a story. She enjoyed getting dizzy and rocked unconsciously when watching TV. Danielle did not seem to notice when it was cold—she went out of the house without a coat and fought her mom when she tried to put on her hat and gloves. Danielle had no fear and jumped from high places without any regard for safety. She would fall or skin her knee without reacting. On the other hand, she hated to get her hair washed and cried hysterically at the sound of a hair dryer or a vacuum cleaner. She tended to make strange noises, simply for the sake of the noise.

When Danielle was three and a half, her family enrolled her in a preschool class. At this point, her mom began worrying about her child’s ability to play with other children. Danielle would run up and push them, although she did it with a smile and a friendly manner. She had difficulty sitting in circle and paying attention like the other children. The teachers reported that she did not like the art projects but did enjoy the Play-Doh and the cozy corner or the housekeeping area. Teachers reported some concerns but thought, since it was her first school experience, she needed time to grow and socialize with the other children. They felt in time she would grow out of it.

Now that she is in her second year of preschool, the bar has been raised. The other children seem to be progressing but Danielle still seems to be playing like a young three-year-old. She has great ideas for play but has trouble executing the sequence of steps needed to put her ideas into action. She continues to crave movement and has a hard time sitting still in circle. She sits in the teacher’s lap for support, and although she loves her friends she tends to hug them too tightly and handles toys so roughly that they often break.

Danielle is very enthusiastic; however, when she becomes excited it is extremely hard to calm her down. Her mom has difficulty with simple routines such as dressing, self-care, mealtime, and bedtime. She is feeling overwhelmed by Danielle’s constant needs and by the child’s ability (or inability) to meet those needs.

Smoothing the Bumpy Roads

Young children like Sean, Scott, David, and Danielle want to be successful and please adults. Children want to have friends at nursery school, go with their parents to the grocery store, enjoy birthday parties, and be able to play with peers on a playground. They want to be good, and when they are not, there is probably a reason for their behavior. They may face developmental challenges that make these regular, day-to-day experiences very difficult for them.

This book was written for the parents and professionals who want so very much to help. By sharing examples of youngsters who have experienced developmental glitches and how we worked with their families and caregivers, we lay out real-life strategies and tips for smoothing the bumpy road of early childhood. We help parents and caregivers to think about behavior differently—to think about plausible alternatives to someone’s being viewed as just stubborn, just like his father, or just the way she is. We lay out strategies to improve a child’s behavior or comfort level in a given situation, and suggest when (if at all) to enlist the help of a professional, and how to go about mobilizing community resources. We provide information about how to tweak the environment so that the child can succeed. With this book parents, who are the foremost experts on their children, will be better able to decide once and for all, Is this a big problem or a little problem?—and what they should do about it. And that will help parents fall asleep a little easier at