Between a rock and a loud place

Imagine sitting in a classroom and hearing all the noises in the room as if they were in an amplifier next to your head. And then imagine trying to follow the teacher's directions through all that noise. Imagine trying to figure out what the teacher said when you miss 30% of the words or the words themselves become garbled in your mind. Imagine you cannot quickly recall what someone just told you.

Sounds miserable, right?

In fact, after 10 minutes of experiencing these things in a simulation, I had a splitting headache and felt homicidal. It was exhausting. 

It's my son's life.

A year ago, testing showed my son had an auditory processing deficit - and that his ability to process auditory information was dramatically lower than all his other intellectual abilities. It wasn't until a chance conversation with an Otolaryngologist that we realized we could understand the details of this deficit and potentially help.  We had him screened by a pediatric audiologist who diagnosed him with Central Auditory Processing Disorder - CAPD - a disorder that impacts 2-5% of the population with twice the incidence happening in boys. It's often undiagnosed because the children can hear well. In fact, many children with CAPD act out in school because they are so frustrated by what they hear or they just need the sound to stop - leading to being designated a "bad" or "wild" child, "willful" or "ADHD".  ADHD can exist with CAPD - but they aren't the same thing.

We are very lucky.  Our son's CAPD did not coincide with reading dyslexia or speech issues. In fact, so far, it's only really impacted his behavior. As soon as we received the diagnosis, it was recommended that he complete Auditory Integration Training.  This therapy was developed by Guy Berard, MD and consists of frequency optimized 30-minute intervals of music where they modulate the treble and bass as well. The sounds train the brain stem - and help address imbalances in processing sound.  My son's AIT focused on reducing the volume of sound at 4000 Hz - the frequency of crowds. He diligently listened for 30 minutes every morning before school or sports and 30 minutes every evening. 

The results from the mid-program audiogram were amazing - and when we drove to Montana after he completed the program, he sang on key for the first time in his life.

It will take anywhere from 1-6 months for the full impact of AIT to be seen. In the meanwhile, he has to learn to restate what he hears, advocate appropriately for himself when the sound is too loud and we have to work with his teachers to have compassion, provide him information in visual modalities, and help him unlearn the behavior patterns he developed out of frustration.  The coping mechanisms that he uses to excel academically must be reinforced as the work becomes more challenging - CAPD is a lifelong disability, but it doesn't need to hold him back.

To learn more about identifying and treating CAPD - here are some resources.

• Recognizing and Treating Children with Central Auditory Processing Disorder
• Central Auditory Processing Disorders - An Overview of Assessment and Management Techniques
• What are Central Auditory Processing Disorders in Children?

What a child screaming in frustration sounds like...behavior problem.

My son is amazing.  For the last 8 months (ending 8 weeks ago), he was expressing extreme frustration at school and no one understood what was the cause.  Looking back, he was feeling like in spite of doing what his parents and teachers suggested, he was failing at writing.  And he was really trying. It must have been awful for him.

We subjected him to a barrage of occupational therapy, academic and cognitive testing which he endured with a great attitude. We sent his au pair to school with him as an aide and scribe. His au pair also sensitized him to his own disruptive behaviors.  The OT determined he needed some fine motor adjustments which we started immediately.  In his very first session, he was like a sponge – grabbing on to the modifications his therapist suggested.  A slant board. Well lined paper.

Within two weeks, he started doing his own writing, by choice.  Still not very neat – but not frustrating either.  For months, he had been frustrated because he was trying to fix himself and failing.  No one – his parents or teachers – was helping him or explaining to him why all his efforts (and he was working hard) were failing. It was excruciatingly frustrating – he doesn’t give up and he knew he wasn’t succeeding.  But once he saw the path – he ran for it and never looked back.

Would you believe that from the day the au pair arrived in school, my son completely stopped having behavior issues? 

It took longer to get the results from the academic and cognitive testing – and even longer to synthesize those results into something that fit my son. It’s easy to fall into a diagnosis with the justification that it would give everyone a common language – but that was never our goal.  Our goal was to figure out what was making our son crazy at school but happy at home and with his friends. 

We learned that he’s exceptionally bright and that his brain processes information exceptionally quickly.  Meaning that he’s easily bored and needs a lot of challenge. We learned that in contrast to all that, his auditory processing abilities are below average – meaning that he actually cannot process auditory inputs very well. This means that when you give him spoken instruction, he’s not getting all of it. And he’s working double time to get what he gets.  He needs instruction and information provided in writing.  Not surprisingly, so does his Dad.  His Dad graduated with honors from Harvard and didn’t go to his lectures because he got what he needed from the books. But he knows he likely could have gotten even more if he dealt with his auditory processing challenges. So we’ll help our son with that issue to see if we can help him get more out of spoken instruction. 

To top it off, when he’s frustrated or bored, he’s impulsive and energetic. It’s not a reaction he’s choosing – it’s his wiring.   For years we’ve joked that he doesn’t idle well – we were right.

But the amazing thing is that he took advantage of the information from his au pair and his OT to self-adapt. Once he realized that he can keep himself busy with a book or an art project AND that he enjoys being in class reading, writing and participating – it was a self-fulfilling prophecy. He’s articulating when he needs to go burn some energy or needs something else to do. And his class is doing a lot more project work and he’s loving it.

Looking back, I think we should have done the OT testing in second grade as soon as we knew his handwriting was a problem.

More importantly, it took a psychologist who deeply considered the academic, cognitive and behavior data all together (and had unlimited observation of my son, to be fair) to discern the true root cause of his frustration - and the reason that his frustration was manifesting in disruption.  My suggestion to anyone going through this is to keep pushing until you get an answer that makes sense - do not let yourself be intimidated by professionals (pscyhological or educational) into accepting a description that simply doesn't fit. And when you have something that fits, move swiftly to help your child. Mine felt like suddenly everyone understood and was giving him the tools to succeed.

Naturally, with all this testing, we also got a plan from the school.  It’s a reasonable plan – but my son is way ahead of all of us. We threw him a life ring – and he grabbed on and learned to swim.  Amazing.

Back to School Traditions

Somehow, the first night all my children slept in their beds since June 20 was tonight (August 30) - and it's the night before school starts. They had busy, wonderful summers visiting family back east, attending sleepaway camp and spending time with family out west - no complaints. But no time to really transition into a school mindset.

Time constraints forced me to focus - to identify the most important back to school activities:

• Clothing that fits and is suitable for something other than rags. 
• School supplies 
• Dentist, orthodontist - check and check.
• Haircuts...not crucial.  Not done. 
• Buy books for summer reading - did this in June. Whew.

My time jam also put the sleep routine at risk. Luckily, our children have a pavlovian response to their own bedrooms - or to the exhaustion of their summer - bedtime was on track, without resistance and should lead to a solid 11+ hours of rest before school starts tomorrow.

Beyond the practical, I fantasize about having back-to-school traditions. Thus far, the tradition is taking a day off from work and spending it with my school-age children doing something. Mini-golf is popular. So is bike riding. And lunch. And I fantasize that this experience opens meaningful discussions about goals and concerns for the upcoming school year.  Realistically, it reinforces that I am a better Mom when I work and spend evenings with my children because my patience for sibling rivalry and bickering is, well, not great. 

Most of the families I know from other schools have already started - we start tomorrow. The kids are excited and the parents look estatic. Our big family tradition is to take a picture outside our house before school on that first day. It's not time consuming and it's never particularly calm, but I do enjoy seeing them over the years.

What's your back-to-school routine and tradition?  Is it for you or your kids?

How zero tolerance punished the wrong child

My son started kindergarten with exuberance and within a week was sullen. Soon after, we started receiving notes from the school that he was harassing three girls. As a consequence, he was not allowed to run on the field; he had to stay on the playground so that he and the girls could be separated. He was devastated.  We were confused and concerned. We believe in logical consequences and if he was bringing these girls to tears, he had to be restricted. But it was totally out of character. In 5 years of day care and pre-school, he never bothered, harassed or did more than horse around with another child.

Nothing I’ve experienced in my life compares to the hurt I felt when my son was hurting. We couldn’t figure out what to do. We talked with him – but he couldn’t explain what was happening. We didn’t know if one of us should stop working to help him to figure this out. We asked the teachers to tell us what they saw. I even tried to surreptitiously observe recess. We asked friends and parents for ideas. Maybe he was too young for school.

Then my husband tripped on a toy train and put his arm through a plate glass window severing his ulnar nerve.

His reluctance to tell many people how he got hurt led him to sequester himself with the children at a community event and he saw an older girl, a third grader, approach our son.

“Chase me?” she asked.

“No” he responded.

“C’mon, chase me!” she said

“No” he responded.

“Please, chase me!” she goaded.

“OK”.

And he did. Caught and tagged her. Then she burst into tears and headed for her parents. She didn’t count on being observed and intercepted by his Dad. My husband told her he saw and heard everything. After a feeble attempt at denial, she acknowledged that she was asking my son to chase her.

It was a game – three third grade girls discovered they could control the teachers by provoking my son to chase them, crying about it and getting him punished.  He was just 5 and had no way to put together that the invitation to play tag was the bait to get him in trouble.

Suffice to say, the game ended that night. My husband spoke immediately to two of the girls’ parents (with the girls whimpering alongside) and I informed the Head of School about what was transpiring.

To the Head’s credit, he immediately apologized; spoke to the on duty teachers and the girls and the behavior stopped. And that same day, my exuberant, giving child re-emerged.

Zero tolerance was punishing the WRONG child. It’s so much harder to observe and prevent verbal/emotional bullying.  Kids are smart and they hide it. 

I wonder how else we could have figured out the problem.  Any ideas?