Q&A: Middle Child with Emergent Sensory Processing Issues?

Question:

Hello! I am an OT in a school system setting. I have an interesting situation with a second-grade child. He is the middle child of three boys. Mom says that up until her youngest son was about 1 year old, this middle child was very laid back and easy going. He started displaying some of the typical behaviors that children often have after a younger sibling is born. However, he also started complaining about tags and seams on clothing. He has episodes at night when entering his room for bedtime.

For example, he complained about a toe nail that was bothering him. Mom clips and files them but nothing she does suits him. He often says things like, “The sheets don’t feel right,” then tells Mom, “I need you to help me.” She has tried seamless socks, tagless shirts, and so on with no luck. She offers him choices and tries to let him have some ownership of what he wants to wear or how to solve the issues. She reports that she tries to remain calm while he is escalating. She did not notice any of this when he was younger. He wasn’t a fussy baby. He didn’t pull at clothing or resist grooming tasks.

The part that is most interesting is that he never displays this behavior while at school. He doesn’t have meltdowns or mention being distressed in any way. He does not have issues at bedtime nor in the mornings when he stays with his Grandmother. He also seems to respond better to Dad coming in and mentioning consequences if he doesn’t calm down vs. how he responds to just Mom. It is really disrupting their home life at this point.

The only things Mom has noticed that help diminish the behavior/outbursts are going to bed early so he’s rested and having a full tummy! Thanks so much for your time! Any feedback is appreciated.

Answer:

Poor little guy! And poor mama! Some thoughts/comments:

• It’s not at all uncommon to see signs of sensory processing disorder somewhat suddenly emerge between ages 1 and 2, which is very similar to when autistic behaviors tend to emerge. I suspect they are ultimately on the same spectrum.
• Anxiety tends to manifest in behaviors of over-responsiveness. The birth of the brother may have initiated anxiety in his place in the family/mother’s love for him, for example. Not that the mom did anything wrong; rather some kids are just more sensitive to these events than others and may be more prone to anxiety in general.
• The fact that these behaviors mostly happen with mom and not with others could mean one of three things:
  • (1) He has figured out he can manipulate mom with these behaviors, so he does. This results in increased attention and coddling. It’s working for him.
  • (2) It’s possible that he experiences the same issues and discomforts no matter where or who he is with but he only feels emotionally safe with mom. Therefore, he holds it in when around dad, grandma, or at school.
  • (3) It could be a little of both. No matter what, I recommend that mom validates his feelings but is firm in the way she handles his complaints. For example, if he says his bed sheet doesn’t feel right, she could say “I’m sorry it feels uncomfortable to you. You can choose to get used to it or use your blanket without the sheet. It’s up to you.” She should not appear too sympathetic or concerned. Her confidence in his ability to deal with it is what he needs. If he starts to escalate, it’s best to disengage. She can say, “I know you can figure out the best option for yourself. Goodnight,” then leave the room. If he continues to fuss, dad may be the best one to go in and reiterate his choices.
• Just in case it’s an issue of wanting more of mom’s time and attention, I would recommend mom plan about 20 minutes a day when she can spend quality time with just him (middle children tend to need that more than others). We need to be sure the only way for him to get mom’s time isn’t through complaints and escalating emotionally.

In general for this type of anxious and over-responsive child, calming sensory activities should be integrated into their daily routines. If you are using BrainWorks, these will be the red and yellow arrow activities.

I hope that helps! Please let me know if I can be of further assistance.Best Wishes,

Gwen