It’s come to my attention that quite a few very young boys are being described as ‘ADHD’ or hyperactive. They seem to be regarded as being overly ‘busy’, mainly by their preschool teachers. Are we forgetting that most young children are highly active, energetic and generally spend much time ‘on the move’? My long years of experience have shown that highly active young boys generally settle down as they grow, perform well at school and fail to develop any attention or other learning related problems.
So why are teachers sometimes labelling youngsters incorrectly? Perhaps we need to consider how they come to this decision and consider what other aspects may be contributing to the children’s inattentive behaviours.
A child who fails to concentrate in one situation is in danger of being seen as a child who can’t concentrate in any situation. If a child doesn’t sit still he is in danger of being called hyperactive. His parents might be panicked into believing hyperactivity and poor concentration are permanent conditions which will need specialist treatment, including medication.
Highly mobile youngsters may show a disinclination to sit down and engage in table tasks. Their preference will be for outdoor play, usually very physical. Or others may seem to dislike concentrating on teaching materials, rejecting colouring-in, crafts, puzzles and so on. They prefer any number of other games or activities that are enjoyed at home. Boys in particular need to be physically engaged and take much longer to adapt to more sedentary tasks. They may not want to concentrate on the teaching events, listen to stories sitting quietly in a circle, or follow the teacher’s instructions.
Check his concentration
You can check whether your child can concentrate by giving him something to do which he enjoys doing, and which takes concentration. If your child can pay attention to the activity for at least five minutes you will know he can concentrate (and sit still). It’s important to emphasise that if someone can concentrate in one situation, then the problem is not an inability to concentrate. If your child’s attention wanders before the five minutes have passed, maybe he does need your help. The nature of the help will depend on your assessment of the situation so let’s consider some relevant points.
- Have realistic expectations.Some children seem to be able to concentrate better than others. If you compare one child to others, you may be unrealistic in terms of what he can and can’t do. Instead, compare what your child is doing this week with what he was doing last week; how he behaved when he went to bed last night; how he played with other children at school compared with how he plays with them at home. When you focus on your individual child and notice changes in his behaviour, it helps avoid becoming trapped into thinking that your child has a problem simply because he’s different from others.
- Avoid using checklists.Checklists can convince you that your child has a serious problem because they can be so all inclusive that parents or teachers will find something on the list that applies to that child. They make you feel they are describing unusual behavior but often they are only describing things that every child will do sometimes. Checklists for ADHD can include the following questions
- Does your child forget instructions?
- Does your child have a short temper?
- Does your child fidget?
- Does your child constantly ask questions?
- Does your child leave his bedroom untidy?
- Does your child produce messy work?
Doesn’t this look like a list of the stages that all children go through and outgrow?
- Does your child know how to pay attention?Some children will seem to pay attention automatically. However, every child learns differently and for some, the ability to attend doesn’t come naturally. They need help in learning to concentrate and the good news is that concentration can be taught. For children to learn concentration, they must be given responsibility, must feel that their contribution to family life matters and must have the chance gradually to develop the skills everyone needs in order to be able to function successfully.
- Does your child only pay attention when it suits him?The reason for this may be because what he should be doing is: too difficult, too boring, too tedious or not clearly understood. The child will simply try to get out of something he doesn’t want to do or feels incapable of doing. This avoidance behavior needs investigating and a good place to start is to find out whether or not he understands how to learn or how to approach the task given. If children are not expected to learn to do things at home, they may struggle to learn at school. Setting the dining table is a good example of an age-appropriate task that can be used to teach a young child to learn. It’s a simple everyday activity but it needs a system. While busy, your child will have to keep thinking until the job is done. Having chores to do at home are good learning opportunities that have unexpected spin-offs!
What to do?
If reports from school concern you, don’t ignore them but don’t overreact either. First do your own assessment of the situation and then, if need be, find a helping professional that will look holistically at the situation. While most of the younger boys suspected of having ‘ADHD’ will not need intervention, some might well benefit from help. Unusual behaviours can have many different causes – which is why ILT practitioners are taught to consider all possibilities.
“WE’VE TRIED EVERYTHING – NOTHINGS HELPS, NOTHING MAKES THINGS BETTER”
“I JUST DON’T KNOW HOW MANY MORE MEALTIMES LIKE THIS WE CAN TAKE…”
These are real quotes from parents who felt like they had come to the end of the line in terms of finding solutions to their child’s picky eating. The internet can be a fantastic source of support for parents, but there are so many articles out there, often offering conflicting advice. It can be really hard to know what to trust, and sometimes, too much information can just feel plain overwhelming.
Recently I came across Jo Cormack who specialises in childhood eating challenges. She gave me permission to reproduce this article. I would earnestly suggest that you visit her website and take advantage of the help she and her team offer. Details are at the end of this post.
You’ve had your child’s weight and growth checked and it’s all fine. You’ve ruled out physiological causes of their eating issues, like allergies or physical problems with chewing or swallowing. Everyone tells you that they will grow out of it; that it’s only a phase! – Just put the food in front of them and wait for them to eat it, because “they won’t starve”.
But for some children who are extremely wary of unfamiliar foods – the ones who cling to their safe foods like a life raft in a stormy sea, and who really, truly need to know that the food they are offered is firmly within their comfort zone; these children need a bit more help. I call these children cautious eaters.
No amount of gentle (or forceful) persuasion, bribery, creative presentation or talk about the nutritional benefits of food will convince a genuinely cautious eater to eat something that they don’t feel comfortable with. In fact, research shows that trying to encourage children to eat can actually make their picky eating even worse.
Serving cautious eaters foods that they don’t feel okay with in the hope that they will eventually get hungry enough to relent and eat something, can end in several terrifying days where children simply don’t eat. This is deeply distressing both for them and for you. Not to mention dangerous.
It is so tough on parents when they don’t know what their next move should be. We can deal with pretty much anything if we feel that we know what we need to do, and we have the support required to do it. There is nothing worse than that feeling that you know your child needs your help, but you’ve simply run out of ideas.
I understand this anxiety and desperation: The urge to feed and nourish our children is one of the strongest instincts a parent has, and to be honest, most of the parents who reach out to me are already at a very low point with their child’s eating… sometimes things have to get to rock bottom in order to ignite a change.
Help is at hand
I want to share an incredibly valuable strategy that I use in my clinical work when I feel that a child’s picky eating is caused by a genuine fear of unfamiliar and disliked foods. It is all about laying the foundations for helping a child enjoy a varied diet, by teaching them to tolerate unfamiliarity.
Before I get into what this strategy looks like, I want to explain a little bit about how anxiety can be be at the heart of a child’s eating issues, because seeing your child’s eating through this lens can be a complete game-changer.
CHILDREN CAN BECOME ANXIOUS ABOUT FOOD FOR MANY REASONS:
- Perhaps they have sensory processing issues and their experience of eating certain food is so overwhelming to them that it is actually frightening
- Perhaps they have a naturally cautious and anxious temperament; for them, an unfamiliar food (just like an unfamiliar situation or person) can be really challenging
- Perhaps they have got into the habit of using their eating behaviours as a way of feeling in control. The idea of not being in control of their eating may be very scary as it takes a coping mechanism away from them
- Perhaps they are not used to being offered foods that they don’t know and like. If parents consistently stop offering foods at the first signs of rejection, children quickly learn to fear the unfamiliar
This is not an exhaustive list of the reasons why a child may be anxious about disliked and unfamiliar foods. But it has a common theme:cautious eaters feel safe when their food is familiar and unsafe when it is not. If they are expected to eat foods which are not on their safe list, this is extremely anxiety-provoking.
Laying the foundations for change: a 3 step approach to helping your cautious eater
1) Empathy.Before you can truly be there for your cautious eater, you need to try to understand how it feels to be in their little shoes.
It can be a bit of a shift of mindset to understand that your child’s response to food is not ‘bad behaviour’ – that it doesn’t necessarily fall into the categories of boundary testing or (developmentally normal) struggles for autonomy that run-of-the-mill picky eating can often be understood as.
Your child isn’t trying to get attention, they are simply really, really scared of foods which are not on their safe list. Especially for children with an unusually high degree of sensory sensitivity, the experience of eating foods that are challenging in terms of taste, texture, appearance or smell, is just so intense.
Many young children can’t verbalise these fears. They may act out, and express their feelings through aggression or alternatively they may withdraw. The first thing you need to do in order to help them is acknowledge that their anxiety is very real indeed and is not a choice. Research is increasingly linking anxiety in children to eating struggles. However hard it may be to imagine being scared of the wrong brand of crackers – appreciating that your child’s reactions may be anxiety-driven can be very powerful.
2) Make sure that you have a good understanding of your role in relation to feeding your child. You may well already be familiar with Ellyn Satter’s Division of Responsibility (DoR) model. If not, you can learn about it on theEllyn Satter Institute website where you will also find a very useful downloadable pdf about DoR. There are also lots of great articles written by feeding professionals about how DoR can help your family, like this article from Natalia Stasenko or this oneby Sarah Remmer, which includes a fab kitchen printable. If you are more of a book worm than a blog reader, this short, accessible bookby Katja Leccisi, provides a great overview of how to understand your feeding role.
3) Teach your child to expect variation.This is the killer strategy that will make all the difference. You are seeing things from your child’s perspective, you have educated yourself about your role in relation to feeding your child. But you are stuck, because your child will only accept a limited list of foods.
You need to begin to teach your child to accept and expect the unfamiliar, in the context of their safe foods.
Much of my work with picky eaters draws heavily on cognitive behavioural therapeutic theory. Cognitive behavioural therapy (CBT) teaches us that if we avoid something we are scared of, that fear becomes stronger. If we confront our fear and manage to do something that is outside of our comfort zone, the fact that nothing catastrophic happened – it didn’t give rise to a traumatic experience – tells our brain to produce a slightly smaller anxiety response next time that situation comes up.
A key aspect of successful exposure therapy is about making sure that you set people up to succeed and not fail. This makes sense if you thing about it; if you try something scary and find that the outcome is very upsetting because the goal was just not realistically achievable, you reinforce your urge to avoid that situation and your fear increases.
Setting your child up to succeed
You need to introduce variety in a way that will be manageable for your child and which they will not experience as intimidating. You do this by drawing up a list of their safe foods and devising teeny weeny baby changes to the foods on the list. These changes are not meant to be hidden from your child; we’re not talking about sneaky changes that they may not notice as this erodes trust and will defeat the object.
The kind of baby steps I’m thinking of, are ones that your child will both notice and cope with. For example, if your they like plain pasta, take a pasta shape that you know they usually accept and cut it in two (when it’s cooked… cutting dry pasta is no mean feat).
Combination and deconstruction
I use the twin concepts of ‘combination’ and ‘deconstruction’ as a jumping-off point for devising tiny changes to your child’s safe foods. Combination is all about pairing two safe foods in a way that is new for your child, and deconstruction is literally about taking food apart and re-presenting it in a slightly altered form.
For this strategy to work, you need to understand that you have a lot of work to do before your child is even ready to try new or disliked foods, BUT that there is plenty of room for manoeuvre within the context of their safe foods. Some children will naturally be confident eaters, but cautious eaters need to learnfood-confidence. And they need to learn it from within their comfort zone.
How this strategy works in practice
At meals, introduce a tiny change to one of your child’s safe foods. Don’t draw attention to it, just make it available to your child. Don’t praise them for eating it; this may increase pressure and fuel anxiety. Just remain focused on keeping your meals relaxed and upbeat. Perhaps initially try introducing change to their best meal of the day. For example, many picky eaters do best at breakfast – perhaps your child has toast. Cut it into fingers rather than squares. If they like raspberry jam, try sieving it before you put it on their toast so that the texture is very slightly different.
Laying the foundations for change (by helping your picky eater get used to unfamiliarity via constant tiny changes to their safe foods) will set the scene for the longer term task of introducing variety into their diet. It can take weeks – months even – for children to begin to feel comfortable with unfamiliarity. Introduce it at their pace, tune in to them and their responses.
You need to be patient, you need to be persistent and you need to be creative. Above all, you need to be in it for the long haul. But every time your child eats one of their safe foods in a new and different form, you are inching incrementally closer to giving them a positive relationship with food that will last a lifetime.
Jo does add a caveat to this advice. She says that the approach is very effective but only once your family’s mealtime dynamics are right (meaning that meals are family occasions where the conversations includes all members) and when optimum feeding practices are in place. If not, these ground rules need to be attended to first.
For parents wanting to know more about how to parent in relation to picky eating, Jo hasVisit a new membership site which you could link to: https://jocormack.lpages.co/your-feeding-team-sign-up-now/. She has a formidable, experienced team ready to help you.
Visit her website at www.jocormack.comto learn more.
This article appeared in a Science newsletter on April 2nd2019. We thought it might be of interest as so many children these days present as ‘picky’ eaters who are difficult to feed.
It was written by Sophia Komninou, The Conversation
When it comes to avoiding picky eating and meal time tantrums, parents are usually ready to try any method that promises their child will become a better and less fussy eater. This is in part why methods of giving solid food to infants have received a lot of attention in the last few years. Some think that the way babies are introduced to solids can change their attitudes to food into childhood or even for life.
The most common method used to give babies their first solids has long been to offer a puree or mash using a spoon. This helps parents make sure their babies receive adequate energy and nutrients for their development – something many are often anxious over.
More recently, however, baby-led weaning has gained popularity – and divided parents. This method sees babies selecting finger foods – such as carrot sticks, broccoli trees or other pieces of whole, baby-fist size pieces of food – and feedingthemselves. While there have been unsubstantiated claims that this method can improve a baby’s dexterity and confidence, research has associated baby-led weaning with their ability to recognise when they are full and being less fussy with their food. This makes it an appealing choice for some parents.
However, as with most things baby-related, the reality is that many parents don’t use just one method of feeding. It changes depending on the time, day or situation they are in. Which is why, for our recently published study, we wanted to compare how different styles of feeding affects a baby’s eating habits and attitudes to food.
Is baby-led weaning better?
We looked at four different categories of toddlers, whose parents introduced them to solids using either: solely baby-led weaning, mostly baby-led weaning with occasional spoon feeding, mostly spoon feeding with occasional finger foods, or just spoon feeding. We asked the parents questions about their feeding strategies and eating behaviours of their toddlers, like fussiness and food enjoyment.
Usually, in a statistical analysis, we look at whether there is a difference between groups. But what this doesn’t tell us is how big the difference actually is. To solve this problem, we looked at the size of the difference between the groups (what we call the effect size). It helps us understand whether the difference actually matters.
We found that the magnitude of difference in a toddler’s fussiness and food enjoyment is minimal across the four groups. This means that baby-led weaning, spoon-feeding or anything in between might not actually be the solution to future mealtime battlegrounds some parents hope it will be. That may seem to be in contrast with what the research shows so far, but it doesn’t negate those findings. Babies will be less picky about their food if they are fed using baby-led weaning as opposed to any of the other types of feeding, it’s just not by that much.
Socio-economics at play
When looking at the strategies parents use to feed their children, our study did show that those who follow baby-led weaning are less likely to use food as a reward or encouragement, and have less control on eating overall. This helps their toddlers learn to make eating decisions for themselves based on whether they are hungry or full. These parents are also more likely to breastfeed for longer, introduce solids after six months and eat more frequently with their toddlers.
However, the key difference here is not that the children were fed using baby-led weaning but instead the type of families who usually follow it. Our findings show that these parents are usually of a higher socio-economic status and more educated, which makes them more likely to follow a distinctly different parenting style and be able to afford to spend more time and money doing so.
Overall, our results suggest that the way a baby is introduced to solids will make very little difference to how fussy they will become, or how much they will enjoy food. It is important to remember that how children eat depend on a lot of factors, including their genetic background, their past experiences with food and their interaction with their parents.
Research findings are important when communicating complementary feeding advice to new parents, but headlines and quoted study results can often be misleading. So remember that when reports of research say there is a difference between one method over another, it’s not the whole story. The size of this difference – something that is not often communicated – matters too. The most important thing that parents can do is to try their best and introduce solids in a way that is more appropriate for their family, rather than stressing about a specific method, as research suggests might make a only a very small difference.