Anxiety or Sensory Processing Disorder?

Laura Markham's picture

QUESTION

My 3.5-year-old son seems to have some trouble in a couple of areas. He has a lot of anxiety and fear as well as sleeping and eating problems.

I am a SAHM, he doesn't go to preschool or daycare. I never leave him with other people. There is no one who is suffering that he's aware of at all or any tragedies. We're a pretty balanced, happy family, and this is why I can't figure out what's the issue.

He's very, very bright. Perhaps he's advanced for his age as he's reading and drawing terrific pictures for quite a while. He's never been delayed at any stage.

His anxieties and fears: When I say panic, I mean, screaming, crying, shaking disturbed. He panics in the presence of the swings at the playground, rides at the fairs (the baby train even), dogs (even a bassett hound far away on a leash), flies, sleeping alone.

asked me some time back, "Mama, don't die?" We talked about what death is to him and he knows, although there's no way he can probably understand what permanently really means. But it bothers him nonetheless. I'm expecting and he told me my baby is going to die.

He panics when I'm not home (I went for a prenatal and I came back to a panicking child who was with his father, but very upset. He said he thought I got lost (he says Nemo's mom got lost and that's why they were sad.)

His other quirks are he's not very athletic, meaning he's kind of clumsy and scared looking when he's coming downstairs, climbing at the playground, etc.

He still won't sleep in his bed, he cries til he vomits when I tried when he was little so I gave up for a while, but he still won't sleep even in a toddler bed next to our bed.

He's extremely picky about what he'll eat. He won't eat hardly any junk food, not that I'm complaining, but it's strange. He won't eat a hamburger, hot dog, chicken nuggets, etc. He does eat rice, yogurt, pancakes, fruit, rice pudding, and things like this. When I ask him to eat something else, he gags. If he does put it in his mouth, he vomits it. It seems like this is typical of his age, but I feel it's something different. It's a very strange food choice.

When we sleep, all together, he HAS to touch my elbow or he won't sleep. It's become his security blanket, which he never had.

I look at other kids and the majority of them are relaxed and easier going. He's always been such a very hard child to make sleep. I used to rock him for 2-3 hours then put him down and he'd cry. It was like walking on egg shells.

Now that I have another son who is now 17 months old, I can see that it's not a result of my parenting, and I did used to blame myself. Now I see that it's the child. My 17-month-old is completely opposite and more like other children.

My 3.5-year-old is very social, smart, and kind but I feel something is wrong.

I tried talking to his pediatrician but it just seems like she's blow in blow out and doesn't get it. I always leave feeling like I'm one of those moms who take issue with everything about the child.

I am considering finding a child psychologist.

Do you have any advice? Thank you very much in advance.

ANSWER

Your little guy sounds very anxious. He has extreme fears -- to the point of panic -- in reaction to even things kids normally encounter, including playground swings and flies. He has extreme separation anxiety to the point where your absence signifies that you may never return – which is not unusual in toddlers, but unusual for a three and a half-year-old.

Sleeping in a family bed is fine at his age, but at some point you will want to teach him to sleep in his own bed, and his dependence on your elbow sounds like it will present a challenge. His idea that your fetus might die could well be a normal reaction to his own ambivalence about another sibling, but it could also be a symptom of unusually high anxiety.

It's normal for preschoolers to have fears. What you are describing, though, is on the extreme end of the spectrum. Is it extreme enough to be considered an anxiety disorder? I can't say, from your letter. However, there's another hypothesis to consider.

Your son's eating preferences are odd, which gives us another clue. This sounds like a symptom of Sensory Processing Disorder, which often includes "Hypersensitivity To Oral Input," meaning kids only eat soft, bland, familiar foods and may gag, choke or vomit if given textured or unfamiliar foods.

Sensory Processing Disorder is a neurological disorder in which the neural pathways don't function normally. It can include athletic issues like you describe in your letter (clumsiness on the stairs and at the playground), as well as the food issues you describe. Many kids with SPD are very anxious, most likely in response to their sensory processing issues. (You'll be interested to hear that many kids with SPD are also extremely intelligent.)

Should you take your son to be evaluated? The usual way to make that decision is to ask if the child's normal functioning is being impacted by his symptoms. I always trust a mom's instinct that something is "off."

Another consideration is whether an early diagnosis and intervention would make a difference. If your son indeed has SPD, early intervention is important. Even if he doesn't, and he is simply a very anxious child, I would say from your description that even if your son improves over the next year, he will have anxiety issues in kindergarten. Intervening now will help him to resolve these issues so that he can make a good adjustment when he starts school.

Occupational Therapists who are trained to work with SPD can work wonders in helping kids with SPD to overcome their issues. Your pediatrician can refer you to an Occupational Therapist for an evaluation. (You want a SIPT-certified OT so they can give the Sensory Integration and Praxis Test, necessary for diagnosis.)

Many pediatricians don't know much about SPD. To get her attention, you might want to read up a little on Sensory Processing Disorder, so you can explain which symptoms you’re seeing. The classic book is The Out of Sync Child by Carol Stock Kranowitz, which may be available at your library. On line, check out the list of symptoms at Sensory Processing Disorder

If, after a little research, you don't think your son has SPD, you will still probably want to take him to a Developmental Specialist for an evaluation. At the very least, you can get some help on how to work with him to lessen his anxiety.

I want to encourage you in addressing your son's issues. I know how stressful it is for the mom and the rest of the family to live with a child who is this anxious, regardless of how wonderful he is. Kids with SPD do recover and learn to manage their sensory issues. Anxiety can be harder to manage, but with a good therapist and a loving family, I have seen many kids learn to regulate their anxiety. Intervening now is a gift to your son. Good luck!

Dr. Laura Markham