Loving our labels

I have an amazing and beautiful family and I am so grateful for them.

That being said – our life is not a simple/easy life. Our life is chaotic and often feels like more than I know how to handle.

Kids screaming, being impulsive, crap everywhere, things forgotten, running late for everything, nobody on schedule…. Chaos.

You know… “life with kids”

Or that’s what people like to say.

“Life with kids is just like that; don’t worry about it. It’s just this phase of life - you’ll get through it. “

But it didn’t feel good.

It didn’t feel good when we were fighting all the time.

It didn’t feel good when my 6 year old was rolling around under the table at the restaurant.

It didn’t feel good when we got notes home from school that our child couldn’t sit still on the carpet. 

Our family was struggling and I knew we could do better.

A recent diagnosis within the family made me think we should head down the path of a psycho educational assessment – I wanted to know if anything else was going on, even if the teacher didn’t think there was anything to worry about (I asked).

We went for it, and what did we learn?

ADHD. Gifted. 7th percentile for working memory.

Really fast brain power, with not very fast processing power and very little working memory. Ok – so what’s working memory anyways?

“Can you go put your lunch in your backpack?”

“Sure.”

“Umm… why are you in the basement playing lego – did you put your lunch in your backpack? 

“What lunch?”

“Don’t be ridiculous! Get up here and stop playing around!”

Except it turns out – crappy working memory means it really IS in one ear and out the other and he didn’t know what I was talking about.

Lightbulb after lightbulb went off from the assessment. He wasn’t being a jerk or misbehaving, he was forgetting things. He wasn’t violent, his internal processing made it so that impulse control was low and he truly didn’t always have a reason for doing things.

And as we kept talking I learned that ADHD is HIGHLY hereditary – chances are a parent also has it.

Do you know an adult with ADHD?

Adults are getting diagnosed with ADHD a lot lately but it’s not because it’s some kind of new found craze, it’s because when we were kids the only people who got diagnosed with it were the REALLY problematic kids. The kids who were disruptive. The kids who weren’t passing in school.

Not the kids who mostly did what they were told, had decent grades, and definitely not girls.

The psychologist told me that most adults with ADHD have simply come up with adaptions throughout their lives and think of themselves as “lazy”

Oh! Me! I tell everyone all the time how lazy I am. Ha ha ha.

As we talked some more I realized it was my turn to get assessed - maybe there was more going on than being lazy.

I ended up seeing a psychiatrist instead of a psychologist so I didn’t go through the same battery of tests as some other adults I know or that my kids went through, but we talked. We talked A LOT, because ADHD doesn’t start all of a sudden in adulthood, you’re looking for signs that something has been up since childhood.

So let’s look at my childhood:

• School aversion starting in kindergarten - “would do better if attended more frequently” was probably the most common comment on my report card throughout my life.

• MASSIVE emotional outbursts from 6 or 7 until my teens years - I still apologize to my parents for these.

• Depression as a teen – continued school aversion.

• Messy. Really messy.

• Terrible at time management.

• Terrible at waking up and getting out the door.

• Hyperfocus on school work (when necessary) – which really was me not paying attention in class, missing class A LOT and then cramming and passing. The key here is passing – I lowered my bar to “passing,” and that was all I ever expected of myself. “Don’t fail and you did a good job”

Let me tell you a bit about ADHD 

What can ADHD look like?

• Never stops moving

• Easily distracted

• Problems with impulse control

• Hard time regulating emotions

• Poor time management

• Disorganized and messy (wants everything in sight)

• Forgetful

• Problems completing tasks

• Highly sensitive (noises, touch, taste, smell, etc)

Other ADHD Facts

• Highly genetic. If your child has it, chances are high on parent does (or an aunt or uncle)

• 25-40% of those with ADHD have a co-existing anxiety disorder

• Up to 70% of those with ADHD will be treated for depression in their life time

• 2x3 times more likely to have a sleep disorder

• Children with ADHD have delayed brain development (by several years) and can often seem less mature than their peers 

ADHD looks like a lot of things that can also just be part of childhood.

Nobody ever flagged me for anything other than “would do better if attended school more often.”

My parents brought me to see psychologists and psychiatrists to try to help me (due to the emotional outbursts I mentioned above) – I was not simply forgotten, nobody knew what to do or what to look for back in the 80s and early 90s.

But even now when we know so much more, nobody flagged my kids and two of them have diagnoses because nothing was EXTREME. But just because things weren’t THE MOST TERRIBLE didn’t mean I was going to ignore my intuition that things could be better.

My second child’s diagnosis was really different and I never would have thought to have him diagnosed if it wasn’t for MY diagnosis. His is coupled with anxiety and depression (which we know is quite common.) He has a hard time paying attention, he is easily distracted by sounds and chaos or just having to focus on one thing at a time.  

ADHD can look like a lot of things, including a kid who feels like they never fit in and they just want to pull back from the world instead.

So let’s bring this back around to the “it’s no big deal” argument. The people who tell you not to put people or kids in boxes but just let them be themselves, whomever that might be. The ones who balk at the idea of any labels.

I want you to know that labels can be good!

I’ve witnessed these labels make life easier – higher grades, better impulse control  (and therefore not getting in trouble as much), being able to focus to complete a task, knowing how to compensate for terrible working memory.

I’ve seen how labels mean better support, access to alternate ways of learning and doing things, and increased compassion for people who struggle in traditional learning environments.

My diagnosis helped me realize I’m not lazy, I just do things differently. It helped me understand the supports I need in the places I struggle.

It helped me beat myself up a bit less for not being a good housekeeper at 42 (aren’t I supposed to grow into that?!) 

It helped me learn about ADHD quickly.

It helps me be innovative and willing to try new things.

It makes me a good entrepreneur. It makes me a great business coach.

Things aren’t perfect though – I’m not going to pretend an assessment and some words are a magic solution.

We’re still trying to find different answers – but we know where to look for them because we have a better idea of what’s going on.

Here’s what I want you to know:

• Diagnoses and labels aren’t shameful, they are power.

• Diagnoses aren’t rules and boxes, they are opportunities to learn and grow.

• Every diagnosis in our family has helped me learn more about myself and has made me a happier person, more accepting of myself and decreasing the shame I felt for the things I couldn’t do.

A diagnosis isn’t a magic pill that fixes everything (though pills can really help some with ADHD!) 

School is hard and we don’t get the kids there every day.

I almost fired the house cleaner because I got all angsty and full of shame that the house had gotten so messy since she’d last been there.

We all have a lot of big feelings and we have issues with time management and not losing forms and getting places on time. 

But we have so much more knowledge to help us get through. We hired a parenting coach (Success in Steps) to help us figure out strategies to manage the family. We kept the cleaning person and made a deal that she would come MORE often and I would worry less about the state of the place when she arrived. I keep learning and talking to people and finding out what we can do to make our lives smoother.

I talk a lot about our ADHD journey because I know that it’s helping others. I get messages regularly from people realizing that maybe they need to look at ADHD in their families and me talking about it makes it less scary to do that.

Not everyone will see things our way but my experience is that labels aren’t boxes that puts us in a corner in shame.

They are lights that help us see how many people are dealing with Anxiety. Autism. ADHD. Depression. Dyslexia. They are labels that provide us with knowledge and knowledge is power and it helps us do better.

Things You Didn’t Know a Physiotherapist Could Do for Your Kids

Marie is my physiotherapist and I've learned so much from her about what doesn't need to be painful and what I need to pay attention to, both for myself and for my kids. I asked her to share some advice to parents when it comes to some of the things that we don't think of physio for when it comes to our kids, but that can be SO helpful. Both my twins have REALLY benefitted from physio for their growing pains. Read on!  ~Lara

I have been a physiotherapist for too many years than I care to mention.  I have worked with everyone from premature newborns who fit in the palm of your hand to the elderly facing end of life issues.  I must admit though, school aged children hold a very special place in my heart.  Don’t they just say the darndest things sometimes?  I love their absolute candor and their ability to call you on your you-know-what.  When you are working with them you had better be prepared to answer questions honestly or you will pay. 

When people find out I am a physiotherapist they often ask me questions about things like their kids’ sports injuries or maybe their own back pain.  However, there are some things people never ask me that I wish they would.  There are a number of things a physiotherapist can help your kids with that no one knows about, so I would like to share a couple of them with you. 

Growing Pains

Let me tell you about a stellar parenting moment of my own.  When my daughter was about four years old she started complaining about pain in her legs.  She would be walking just fine and then suddenly stop and say she couldn’t go any further, or she would complain at bedtime.  I just wrote it off as drama queen behaviour and ignored it.  Then one night she was really crying so I gave in and checked out her legs.  The moment I got hold of her muscles I felt horrible.  They were incredibly tight through the entire length of both legs.  My heart sank because I knew that all this time she was having growing pains and I could have stopped them. 

What?  You can treat growing pains you say?  Despite everything you will read on the internet that says no one knows what causes growing pains and the only thing you can do for them is give pain medication like Tylenol, yes growing pains can be treated and here’s why.

I believe growing pains are caused when the long bones like the ones in the legs, which is primarily where growing pains occur, grow rapidly.  The problem is the muscles lag behind and this is what causes the pain.  These growth spurts are not just your imagination.  They are indeed very real.  Studies in which kids were measured daily have shown that kids don’t grow about 90 – 95% of the time, so all of their growth occurs within a very small timeframe. 

The bones have specialized areas from which growth occurs.  These are called growth plates and they are found at each end of a long bone.  When growth occurs the bones sprout new cells to either side of each growth plate so lengthening can occur rapidly.  Muscles do not have these specific growth areas so they take longer to lengthen. 

The obvious result when a growth spurt occurs then, is the muscles get tight since they can’t keep pace with the lengthening of the bones.  It is the tightness in the muscles that causes the pain, particularly when kids are active.  They are running around trying to use their muscles but the muscles aren’t happy because they are too short. 

This begs the question, well why can’t we just have them do stretches to make these pains go away?  The problem with stretching is that it indiscriminately pulls the ends of the muscle in opposite directions.  This applies a stretch along the entire length of the muscle.  That’s good right? 

The reason this isn’t terribly effective is that tightness in a muscle never occurs evenly throughout the entire length.  It is localized in small bunches of tight fibres, so you have very tight parts interspersed with loose parts.  When we stretch the entire muscle the loose parts happily give while the tight parts huddle together giggling and saying “why should I lengthen when my neighbour is willing?” 

To release the tight parts and relieve the growing pains you have to get your hands in there, find the tight bits of muscle, and manually release them.  This stops the growing pains every time, usually with one or two treatments.  I knew this and I still let it happen for a while before I did something about it, so don’t feel bad if you didn’t know. 

Preventing Knee Injuries in Girls in Early Puberty

Did you know that girls who play sports requiring quick changes in direction such as soccer or rugby are far more likely to sustain knee injuries when they hit puberty than boys?  In fact, girls who play sports are four to six times more likely to injure the anterior cruciate ligament (one of the main ligaments of the knee) than boys. 

Dr. Google will tell you that this is due to things like lack of strength in the hamstrings and gluteals (buttock muscles).  But why would muscles that have been working perfectly fine suddenly quit in puberty?  And why just in girls and not boys?  The reason is alignment. 

When girls hit puberty one of the biggest changes in the skeletal structure that occurs is a change in the shape of the pelvis.  They go from stick figures to curvy figures.  The pelvis widens and they suddenly have hips.  This changes the angle of the long bone in the upper leg called the femur.  As the pelvis widens it pushes out the top end of the femur farther to the outside.  This then changes the angle at the other end of the bone where it forms the upper part of the knee joint. 

When this significant change in alignment occurs the muscles get discombobulated.  The angle at which they are used to pulling is all wrong suddenly and they don’t quite know what to do with themselves so they just up and quit.  This leaves your daughter with instability through the hips, pelvis, and down into the knees and ankles, which sets the stage for a catastrophic knee injury.  This is so prevalent now that physiotherapists are seeing girls as young as 20 who have had two or three knee surgeries and are having to quit their sport of choice.

These injuries are preventable.  All that is needed is to manually realign the muscles in their new slightly different-angled environment.  They need a little guidance to settle into their new angle of pull.  Once this is accomplished stability is restored and the risk of injury is greatly reduced. 

While many people seek physiotherapy treatment when they are injured, no one ever thinks to seek help to avoid injury.  I would love to see this change.  We tune up our cars to avoid a breakdown, why don’t we do the same for our bodies?

If you are wondering if your daughter is having issues with stability, here are a couple of simple things you can check out.  Have her try a single leg squat making sure that she stays aligned square to the front.  If she can’t do this with solid balance then there is likely a problem of stability. 

Hopping on one foot with both arms in the air is another good test.  By raising the arms we take away one major balance cheating strategy and we can better evaluate the stability in the core.  If she can hop several times in one spot without travelling all over the place, losing her balance, and remaining square to the front then things are good.  If not, she may need some help to restore balance and alignment.

Physiotherapy Can Help

Sometimes when kids fall or have an accident we make the assumption that they are fine.  After all kids, seem to bounce like rubber and carry on.  While they may do so, they often need treatment after an incident just like we do.  If your child is complaining of pain don’t ignore it.  Even if it does go away, their movement patterns are likely off as they compensate around the affected area and this will have consequences down the road. 

Get your kids treated when something happens to them and don’t forget to consider physiotherapy for injury prevention.  Let’s keep them all active and healthy!

Marie has been practicing physiotherapy for almost 30 years.  She has extensive paediatric experience having worked the first decade of her career at CHEO.  She has two kids who suffer growing pains periodically and is the owner of M.A.P. Physiotherapy, a physiotherapy clinic in Orleans.  

Autism on the Hill - April 2

Did you know that 1 in 88 children have autism? And if you're looking at stats for boys (it is more common for boys to be diagnosed with autism than girls), the number jumps to 1 in 54. This statistics are from the U.S., but are often quoted her in Canada because the prevalence of autism isn't being monitored here. These stats are from 2012, so speculation is that these numbers have likely increased. Province to province there are vast differences in the amount and type of support that parents receive. If you start to look at what's going on, it can make your head spin. This is why it's important for government leaders to be aware of what families are facing - both on the federal and provincial levels.

Autism on the Hill is a peaceful event designed to raise awareness about autism. On April 2, families and friends of children and adults who are affected by autism will gather at Parliament Hill for the second year in a row. This event is being coordinated by Suzanne Jacobson of QuickStart - Early Intervention for Autism (a fantastic organization you'll want to connect with if you have a young child on the spectrum).

Before I ever had kids, I knew there was a chance I'd have a child with ASD because I have three families members who are all on the spectrum. Autism has brought a lot of unexpected challenges into our life, but I wouldn't wish it away for even a minute. My son wouldn't be the person he is if he didn't have autism and I adore my sweet little boy.

More and more children are having special needs identified - from developmental disorders (like autism) to food allergies and intolerances. The more we raise awareness of the diversity of needs to be met amongst our young children, the easier it will be for them to find support and understanding within the community as they grow into adulthood.

*****

Karen Wilson is a mom to Brandon, wife to Matt and business owner trying to juggle all three while laughing through each day at the antics of her husband and son. So, it's understandable when she drops a ball here and there. Right?

Getting Sick: Before and After Kids

Getting sick in my pre-kid days was a simple, three-step process: 1) Get sick

2) Lie in bed. Moan. Coerce loved ones to take good care of me, bringing cool cloths and ginger ale.

3) Get better.

Getting sick with kids is slightly more complicated:

1) Feel the onset of sickness. Panic slightly.

2) In anticipation of sickness, rearrange all plans - find alternative rides to school, reschedule appointments and cancel all extracurricular activities.

3) Get sick.

4) Keep taking care of kids and cleaning house, despite horrible sickness. Lie on the couch only when children are occupied by the television, lest they try to destroy the house. Carry plastic bags with you for school drop-offs, just in case of sudden bout of vomiting.

5) Husband stays home and lets you lie down. Baby needs to be nursed every 2 hours, and 3 year old bursts in on you several times throughout the day asking for random stuff. "Where is that pink shape I cut out yesterday?" To which you answer, "I don't know, jerk, go away!" Or if you're a really Good Mother like I am, you say "I'm not sure, sweetie, why don't you go ask Daddy?"

6) Continue to nurse throughout the night, while running out of the room several times to get sick. Wake baby more often by running out of room.

7) Begin to feel slightly better.

8) Get a sore throat instead.

9) Get woken up in the night by vomiting 3 year-old.

10) Seven days later, your family is finally healthy...

Until next week of course!

Hoping your family is happy and healthy this Spring Season!

The Allergic March

Earlier this month I wrote about the ups and downs of peanut allergy diagnosis in our family. On one medical visit for my son Dexter's lingering cough,  the doctor used a term I had not heard before, but have since come to know well, "The Allergic March". The Allergic March refers to a cluster of allergy-related diseases that occur in childhood. These often occur in a typical se­quence, appearing early in life, continuing for many years, but often disappearing or lessening with age.

Here is an example of a typical sequence of Allergic March conditions  and symptoms. My son's Allergic March followed this typical pattern:

1. Infant eczema
2. Food allergy
3. Environmental allergy and associated stuffy nose
4. Childhood asthma

In our case, the infant eczema was not severe. It appeared simply as very dry, chapped skin. Now, at age 7, he still gets very dry wrists and hands in the winter, but my home remedy of olive oil and aloe seems to help.

I have already written about the food allergy and while we had been cautious about introducing nuts early because of a familial predisposition to food allergies, I am sure we did not expect that he would actually have an allergy.

The asthma was a surprise and took several months to diagnose at the age of 5.

Dex never had what I would characterize as an asthma attack. It was simply a lingering dry cough for several months that bothered him at night and upon any, and I mean ANY, physical exertion. For instance, a 10 minute walk to school would set off a cough every 10 seconds for a good hour.

On a vacation to Mexico, I finally clued in to the cough's duration and implications when I kept asking him to sit down for a minute until he stopped coughing. At one point in my life I suffered from exercise-induced asthma, and genius that I am, I had never made the connection between my post-exercise coughing asthma fits and his.

Treatment with inhaled-corticosteroids (flovent in the orange puffer), was effective within 2 weeks and he stayed on the medication until the end of that winter.

Since then, the asthma seems to only show up after he has a cold. That annoying cough comes back. We have explored various treatments with both our family doctor and our allergist. We were given the following therapies to consider:

1) Singulair - a once daily pill

2) Flovent (fluticasone: orange puffer) - an inhaled corticosteroid taken once-daily

3) Ventolin (salbutamol: blue puffer) - taken as needed up to 4 times per week, sometimes more during a cold.

We looked at the various options. Singulair, while not a steroid and good prevention, has some rare mood-altering side effects. Our son is moody on his best days and this slight risk was a strong deterrent for us.

Inhaled corticosteroids were effective for us, but studies have shown that long-term use of Flovent can cause statistically significant differences in height. My husband wants my son to play in the NBA (or at least the NBL), so growing to his full potential is important to us.

We have chosen option number 3. Dex uses his blue puffer (Ventolin) during a cold to prevent coughing and bronchial irritation. He uses it no more than four times a week before hockey games or practices where the cold plus the exercise is likely to set him off coughing. So far this year, we are happy with this course of action.

So, asthma under control for now, we now march on to the next issues: the anxiety associated with the food allergy and the recommended influenza immunization (flu shot) which will bring on an anxiety of its own. Stay tuned.

While this describes our family's account of asthma diagnosis, treatment, and management, every individual is different. Please consult with your family physician for any asthma or allergy-related concerns.

References:

1. A Liu. The Allergic March of Childhood. Medical Scientific Update: The National Jewish Medical and Research Center. 2006; 23(1):1-7.
2. The Canadian Lung Association
3. BR Gordon. The allergic march: can we prevent allergies and asthma? Otolaryngol Clin North Am. 2011;44(3):765-77.

Liisa is mom to 2 boys, ages 5 and 7. She is a medical writer and a book lover. She blogs at FitforKid.net andLittleBookLovers.Wordpress.com.