329. Q&A: Is my child anxious or just sensitive? Or could it be both?

Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:44):

Hey, Rebecca Hershberg is here to answer some listener questions. How are you?

Dr. Rebecca (00:48):

I’m well, thanks. How are you doing?

Dr. Sarah (00:50):

I’m doing well. You ready for this question? What I was going to say, what have we got today? What have we got? I got a question from a listener. Okay. They write. Hi Dr. Bren. I’m hoping you can help me make sense of something I’ve been noticing with my 6-year-old lately. I’ve been wondering if some of her behaviors is anxiety or if it could be sensory related. She gets really overwhelmed in noisy or crowded places, sometimes cover her ears and certain clothes really bother her like socks or tags. But she also worries a lot about things going just right and gets really upset when plans change. I’m feeling confused and unsure of what’s going on. Could this be anxiety, sensory sensitivity, or maybe both? How do I even start figuring this out and when should I consider getting help? Thank you so much. I love the podcast. It’s been so helpful to our family. I know. Thank you. That’s great. I love when that happens and not the sensory issue.

Dr. Rebecca (01:49):

But the liking the podcast.

Dr. Sarah (01:52):

The podcast being helpful to your family. So thank you.

Dr. Rebecca (01:56):

I think this question, and I so get it, but part of me feels like it’s the product of just having too much information available on Instagram because I think it’s a little bit of a distinction without a difference. This is a kid who maybe they’re anxious about sensory input, maybe they’re sensory sensitivity because of anxiety, but these things are so often highly correlated and the goal is the same, which is that we have to help kids learn to get through the day, either presumably by avoiding some things like cutting out tags, but also increasing their distress tolerance, whether it’s for sensory overwhelm and or anxiety. And so to me, what I hear a hundred percent, understandably as a parent is this parent’s overwhelm at, what do I call this? What do I call this and how do I address it? And that’s not your job as a parent in a good way.

(03:06):

There are ways that we do start to make distinctions for the purpose of treatment recommendations. However, right now, I mean not to say the thing I always say, but you want to look at distress and impairment. How much is this getting in the way of your day-to-day life? How much distress is it causing your child and your family? And if those things feel high, then absolutely seek some help. And I would, you could go the OT route or the parenting clinical psychologist route, and we could talk about those, although I think you do that on another episode. But I don’t know that if I were this parent, no, let me put it this way, if I were this parent, I would absolutely probably be obsessing about this. And my advice would be that I don’t actually think that’s a great use of your own thoughts spinning that your child is clearly someone who’s really sensitive and you can be sensitive to thoughts and ideas and things not going well and to sensory input. And if it’s causing a great deal of distress to her, to your family, then absolutely let’s get some help. Because help certainly isn’t going to hurt.

Dr. Sarah (04:18):

And I do think there are certain types of diagnoses where the differential could really change the course of treatment if we’re saying, is this a DHD or is it autism? Things like that. But when we’re looking at something like anxiety and sensory sensitivity, which, and not reasonably, not most parents necessarily know that these things are co-occurring and sometimes so interconnected that they’re not actually different. I can understand why a parent would be like, I have two possible things we need to figure out and separate them, and so we know which one we’re treating. But frankly, both of these would be treated in really similar ways. So that’s a good thing. It also reduces the need to get it a hundred percent accurate and which one it is, which is chicken, which is egg probably, what’s the word I’m looking for? There’s probably a feedback loop between the two of them anyway.

Dr. Rebecca (05:17):

I was going to say they’re cycling.

Dr. Sarah (05:18):

Yeah. You have to remember with anxiety and with sensory sensitivities, we’re talking about nervous system. We’re talking about how easily does my child’s nervous system get overstimulated and move into some sense of fight or flight, some sense of hyper arousal and what helps my child to come back down to baseline. If I have a child who’s highly anxious or who’s very sensitive to sensory sensitivities or just sensory input, then they’re going to move into fight or flight more easily and it might take them longer to move back to baseline. So a lot of what I tend to do with kids who have this profile is, yeah, I’ll do a couple, I’ll double check on some very specific symptoms and stuff, but we’re really probably going to treat it in a very similar way. And it’s also about helping the child build regulation, nervous system regulation strategies, and also help them figure out what their sensory preferences and sensory sensitivities are so that we can help give them tools to navigate their environment and use the things that help them calm down to their advantage. And if they are able to independently avoid the things that are overstimulating to them, that’s also okay. And not over avoiding because we’re afraid, but if I know that it’s really loud, I am very sensitive to loud noises, then Im also going to be mindful, I want to build skills in my child so that my child can be mindful of advocating for their own needs or seeking out spaces that are quieter when if they have to be contending with noise, that’s just sort of building coping strategies that help them navigate the world.

Dr. Rebecca (07:32):

It’s like there are people who will never leave their home without their sunglasses, even when it’s pouring rain and you’re like, why do you even have your sunglasses? It’s like because the second it gets the tiniest bit bright that you may not even be able to perceive my eyes are sensitive to. Right? Learning how to manage, how you personally take in sensory input is a skill. And understanding that if you are someone who’s particularly sensitive to sensory input, of course you’re going to feel anxious because it makes the world a more uncomfortable and unpredictable place, which we know contributes to anxiety. So again, instead of kind of parsing, which it’s about focusing on coping, focusing on learning the skills, focusing and you can link to your various space episodes, but focusing on not accommodating too much as parents, which is of course difficult. Again, there’s a difference between helping our kid learn how to advocate for themselves and learning coping skills versus accommodating. And again, that can be covered in another episode, but I think that the parsing here of what’s, what is a distraction from she’s struggling, let’s help her learn some skills, whether that’s something that you can do at home or you need a professional for, which probably depends on, again, just how much distress and impairment there is.

Dr. Sarah (08:56):

And she was saying too, when should I start consider getting help? And I think that speaks directly to that point, Rebecca is like, how much is this impairing this child’s day-to-day functioning and joy? Is it causing them so much distress that they want to start not going to birthday parties because it’s too loud and chaotic? Or is it that they want to go to the birthday parties, but they need a couple strategies to bring with them so that when it gets really loud or when they sing happy birthday or whatever, you’ve got a plan for that.

Dr. Rebecca (09:36):

But it’s child distress or family distress, because you might have a child who’s doing fine because mom is up till 3:00 AM every night cutting out every tag on every outfit and researching what brands have. You know what I mean? So I’ve definitely seen that where at this point, a kid distress is pretty low, but it’s because the family has completely, you know…

Dr. Sarah (09:58):

Revolved their life around managing that anxiety. Yeah, exactly. So I would say help would be a good thing to consider if either your child is very distressed and it’s getting in the way of them enjoying day-to-day like activities or even just interest in participating. If their world’s getting smaller, that’s a good time to consider some interventions. If you are really distressed or engaging in a lot of accommodating to the point where your world is getting smaller, that would be a good time to just pull in some resources, pull in some supports that could look like getting an evaluation. It could be an occupational therapy evaluation, it could be a therapy, a psychologist or a pediatrician even could do a developmental pediatrician.

(11:02):

I think though that would be where I’d start. And usually there’s lots of ways in, you don’t have to do, you could go ot, you could go therapy, you could go parenting support. And I think all three of those things could touch this and perhaps help. So I would not throw the book at it, do one thing, see how it goes, learn from that, and then iterate. But you don’t need all three of those things. Start small and then increase interventions only as needed. I’m a big fan of what’s the least intrusive level of intervention necessary. Start there.

Dr. Rebecca (11:47):

Absolutely. And in this case it might be, which I know we both parenting guidance,

Dr. Sarah (11:52):

Yes, would be a place space supportive parenting for anxious childhood emotions. Again, it’s designed for anxiety and OCD, but the sensory sensitivity would work just as well for a kid who has a lot of sensory sensitivities, in which case the family is accommodating tremendously and it’s not working for the family. That’s where space really helps, because space specifically works with the parents to reduce accommodations for anxious or sort of compulsive obsessive rituals and also for avoiding discomfort. So that piece, if parents are engaging in a lot of accommodation to help a child avoid discomfort, then space would be a pretty good place to start because it is time limited. It’s just the parents. The kid doesn’t have to really be involved. I mean, they kind of are a recipient of the changes, but they don’t have to come and do the therapy at all. It’s really all about, it’s very much, it lives inside of the parent world, so I find it to be one of the lightest lifts.

Dr. Rebecca (13:08):

Yeah, absolutely. And it may be also that this parent doesn’t need, depending on the distress and impairment, there’s people who offer, you could do a couple sessions, you wouldn’t have to do a full course of space. You could learn some general concepts and techniques because even sometimes space, although it’s time limited, it’s still a full whatever it is, 12 sessions. And so you would want someone who could potentially give you a quick and dirty version.

Dr. Sarah (13:35):

Yeah, shameless plug. My group practice runs space groups that are four weeks long, and you just do the first kind of first round of it. And most parents just kind of have enough after that to just go and run with it on their own. Especially for a sort of straightforward situation like this. I’ll put the link to our space group in the show notes at up your brand psychology group. But a lot of places do these groups also. And so it’s a resource for people all over the country. You can find if you go to, I think it’s space treatment.net, they have a directory of all their providers that are trained in this modality and lots of places run groups. So that’s another even lighter lift. Start there and see if that gives you what you need.

Dr. Rebecca (14:22):

And thank you for saying the podcast is helpful because that fills our bucket.

Dr. Sarah (14:27):

It does. It makes us feel good. We love compliments, so please.

Dr. Rebecca (14:31):

Keep them coming.

Dr. Sarah (14:33):

Just keep validating us.

Dr. Rebecca (14:34):

Yeah, exactly. Accommodate us. Accommodate us, please.

Dr. Sarah (14:38):

Yes, accommodate us, your kids. Oh, it’s good talking with you. Thank you so much, Rebecca. We’ll have you fill us with your knowledge again soon.

Dr. Rebecca (14:49):

Oh, anytime. Great to see you.

Dr. Sarah (14:50):

Alright, bye.

(14:54):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.