Sensory vs. Control issues in an almost 4 year old?

[jenmn]

We went through an evaluation for my older daughter (she'll be 4 in next month) this summer due to close family members being diagnosed as on the spectrum. We saw some signs that our older daughter was a bit atypical of other kids in her age group. After the evaluation, the OT thought we might be dealing with some sensory issues and eating issues. We are doing OT and feeding therapy on a trial basis because my daughter is "borderline" in the words of the OT.

At our appointment this week, the OT mentioned that it seems that my daughter has more "control issues" rather than "sensory issues". The OT didn't have a chance to say much else (older daughter pulling on me to read a book, younger daughter starting to cry, OT needed to go to next appt) but she said it was just something to keep an eye on.

Can anyone tell me about control issues in an almost 4 year old? What you experienced, where/how it manifests, where it comes from? Is this something that is part of sensory stuff or is it a completely different thing? Does it have anything to do with ASD?

I'm hoping to touch base with the OT and learn more from her perspective, but I'd really like to hear from other parents who have BTDT.

Thanks!

[LynnS6]

I find that comment very odd indeed.
IMO, 'control issues' stem from something else, so I'm very confused as to what the OT meant.

For my kids, 'control issues' are often anxiety issues. When they are anxious, they want to control the environment to make themselves more comfortable. For our son, who has SPD, he needed to control the sensory input.

4 year olds are developmentally somewhat contrary and hard to deal with at times. I suspect a large number of neurotypical 4 year olds have 'control issues' as well.

[APToddlerMama]

Originally Posted by LynnS6

I find that comment very odd indeed.
IMO, 'control issues' stem from something else, so I'm very confused as to what the OT meant.

For my kids, 'control issues' are often anxiety issues. When they are anxious, they want to control the environment to make themselves more comfortable. For our son, who has SPD, he needed to control the sensory input.

4 year olds are developmentally somewhat contrary and hard to deal with at times. I suspect a large number of neurotypical 4 year olds have 'control issues' as well.

Totally agree. I would take that comment with a huge grain of salt. Some kids just have a need to control their environment more than others, and I don't think that figuring out what one can and cannot control is developmentally atypical for any four year old.

I'd be a little concerned that the OT was misinterpretting my child's needs if I heard a comment like that and I'd probably look for a new OT. That is just my opinion and maybe there are some greater issues outside of sensory stuff going on, but it almost sounds like the OT is dismissing sensory needs or anxiety issues and labeling it as a personality problem. I just don't like how it sounds...

[rainbringer]

I think sensory issues, anxiety, and control all go together. Sensory sensitivity increases anxiety. Control can lessen anxiety. Kids who are often uncomfortable due to sensory processing trouble are going to try to increase their comfort level by controlling as much as they can. I would be concerned the OT does not recognize this.

[jenmn]

Thanks for the advice. I really wish I had had a chance to ask the OT about her comment at the time, but I'm still trying to follow up with her.

I'm guessing part of the reason she made the comment is that she has said that she thinks my daughter is borderline in whether she needs therapy or not. I guess I am too, depending on the day. We definitely have some sensory stuff going on, but I am not sure how much of it is "normal" 3-4 year old stuff and how much it is above average. We have also had a lot of issues with set routines for certain things and a lot of rules that my daughter wants followed, which is where the control stuff comes in.

I really do go back and forth over whether or not we should be labeling her and going to therapy or if it is just her personality and not something that needs to be addressed with therapy.

[Linda on the move]

Originally Posted by jenmn

We have also had a lot of issues with set routines for certain things and a lot of rules that my daughter wants followed, which is where the control stuff comes in.

rigid thinking is an ASD trait, and isn't the same thing as "control."

I really do go back and forth over whether or not we should be labeling her and going to therapy or if it is just her personality and not something that needs to be addressed with therapy.

It's very hard to get a clear dx for a child so young who is high functioning.

[jenmn]

Originally Posted by Linda on the move

rigid thinking is an ASD trait, and isn't the same thing as "control."



It's very hard to get a clear dx for a child so young who is high functioning.

Interesting. Could you clarify the difference between rigidity and control? I've been thinking about this and I can't seem to figure out if what my daughter does is more rigid or if she just wants to be in control. I'm guessing it is a little of both (of course, nothing is clear cut with us).

A few examples:
- A set order of things that needs to happen when she washes her hands (first the water, then the soap, this knob off, that knob off), goes to the bathroom, gets dressed (underwear, pants, shirt, socks, hair brushed), etc
- She strongly prefers to use the same color cup for water every day. Although we have gotten to the point where if it is dirty, she is now fine choosing another color. Every once in a while, she will surprise us and choose a different color.
- She loves playing pretend, especially with her dollhouse and people. But she usually has a scenario in her head of how she wants to play it. If you suggest something new, she thinks for a few seconds and decides if it is "more fun" or whatever than what she was thinking about. If it is anything destructive (like my DH introducing the dragon that comes along and knocks everything down) she gets upset and sometimes ends up screaming hysterically.
- Where everyone sits at the table is important to her. At home especially, and even when we have guests she will assign people spots. If someone has sat in one spot before, that forever becomes "their spot". Even out at someone else's house, she will have a fit or it will take a lot of coaxing if she can't sit in the same spot (like the same chair for snack and lunch).

[Linda on the move]

Originally Posted by jenmn

Interesting. Could you clarify the difference between rigidity and control?

they are similar.

"rigid thinking" is value neutral and descriptive. It's diagnostic and is something to work on gently.

"control" has negative connotations. It sounds like a discipline problem or personality issue.

I'm curious what the OT understands about autism. You'll need help and support in figuring out what works for her and how to help her, but you need professionals who understand where she is starting from.

High functioning kids on the spectrum can really throw professionals who think that only kids with profound, classic autism are on the spectrum.

[Emmeline II]

In this context I would say that "control" is pushing other people's buttons and "rigidity" is pushing her own buttons.

This is a bit of ds' OT report (I replaced ds name with child).

... a very pleasant and clearly intelligent six year old boy who demonstrates several features of Asperger Syndrome such as extreme focus on narrow range of preferred topic; differences in age appropriate processing of some sensory stimuli. Additionally, Child shows good vocabulary skills and better social skills with adults or sometimes with younger children than he does with peers. Child tends to take language very literally and is often rather inflexible with his understanding of concepts (tends to be a tattle –tale because of little flexibility about “rules” and when/ how they are applied and varying degrees of rule- breaking).

[Linda on the move]

Originally Posted by Emmeline II

In this context I would say that "control" is pushing other people's buttons and "rigidity" is pushing her own buttons.

I think that with a small child when you are first starting to try to figure this out, it can be really hard to tell what's what.

For example, my DD has issues with escalators, moving sidewalks, elevators, etc. At the age of 3, if we got near one, she would just freak out. Melt down. Scream. Hold on to me like someone was trying to kill her. This from just being near one.

Now, at age 13 with a very solid DX, a chance to work with a therapists who understands her, good verbal skills and a little self control, she can see one, take my hand, and say, "could we find the stairs?"

It was never a control issue. It's a sensory issue. Raising her as been a bit like raising a child with PSTD, except that nothing has ever happened to her.

The rigid thinking thing is different, but also can be hard to figure out. Everyone gets into habits with their thinking, believing that things have to be a certain way or else. To a certain degree, this is a normal behavior that makes life easier because we aren't re-deciding every detail of our lives every day. It can also be limiting because we get into ruts, or develop unhealthy patterns that aren't helpful to us.

For a person with "rigid thinking" in the sense of an ASD, it takes VERY little to lay down the thinking pattern, but trying to change it is like trying to convince some one that their life long religious beliefs are pointless. Combined with the lack of verbal skills and impulse control of a small child, the result is often a melt down.

Back to the "control issue" thing. My DD isn't tuned in enough to what is going on with other people to care about controlling them. She doesn't care about interacting with people and the idea of "control" doesn't make sense to her. She also isn't capable of defiance because it requires a social awareness that she lacks. Yet I've had people who don't understand her tell me that she is controlling or defiant.

<<Where everyone sits at the table is important to her. At home especially, and even when we have guests she will assign people spots. If someone has sat in one spot before, that forever becomes "their spot". Even out at someone else's house, she will have a fit or it will take a lot of coaxing if she can't sit in the same spot (like the same chair for snack and lunch). >>

This, to me, sounds like rigid thinking. It isn't that she needs to boss people around to feel OK about herself. She has tracks in her head that say that everyone being in the right spot is really important, and the right spot is exactly where they were last time. I bet sometimes she remembers details that aren't important to anyone else.

If every time you walked into the living room, the furniture had been moved, it would start to bother you after a while. We tend to put things in the same places and want things to stay put because it feels better to us. Things getting moved around at random would be disconcerting to most of us. We all have a little different threshold for this kind of thing. For some people, their threshold is set at a point where normal life is very uncomfortable.

[APToddlerMama]

I just want to throw it out there that it is totally possible that your daughter just finds comfort in routines, completely unrelated to any sort of ASD, etc. Most of us have routines related to washing, dressing, morning routines, etc. which give us order and predictability in our lives. It doesn't sounds that atypical to me. It definitely sounds like she falls on the end of the continuum where she needs a great deal of order and routine in her life, but some people just do. Perhaps much of it is sensory related as well, but if you aren't seeing other signs of ASD, I wouldn't be overly focused on that.