few more comments.
First, your child is probably not an HSC if he is sensitive about only one thing, or only about something that would be expected for his age. For example, most children develop a fear of strangers in the second half of the first year, and become fussy about how things are done when they are two. Most young children are bothered by very loud noises and separations from their parents. They almost all have some nightmares.
Your child is also probably not an HSC if there was no sensitivity or fearful reactions until a big stress or change in the child’s life—a new sibling, move, divorce, or change of caregivers, for example. If your child’s personality has undergone a sudden, persistent, disturbing change—such as becoming withdrawn, refusing to eat, developing obsessive fears, picking fights constantly, or developing a sudden, very negative self-image or sense of hopelessness—that needs to be checked by a professional team, which usually includes at least a child psychologist, child psychiatrist, and pediatrician. An HSC’s reactions are fairly consistent from birth, not a sudden change, and not purely negative.
HSCs have responses that are more pronounced than those of a non-HSC, but they are within the normal range for HSCs, and the normal range on most other behaviors. They start to talk and walk at about normal times, although slight delays are common in toilet training or giving up a pacifier. They are responsive to people as well as to their environment, and eager to communicate with those they know well. And while young HSCs may refuse to talk at school at first, they should be talking at home and with close friends—that is, they should be relaxed in familiar surroundings.
HSCs and ADD
I am always asked about the relationship between the trait of sensitivity and attention deficit disorder (ADD). On the surface, there are similarities, and some professionals think many HSCs are misdiagnosed as having ADD. And, I suppose, it is possible for HSCs to have ADD. But the two are not the same at all, and in some ways are, in fact, opposites. For example, there is more blood flow to the right side of the brain in most HSCs, more to the left in those with ADD. Children with ADD probably have very active go-for-it systems and relatively inactive pause-to-check systems.
Why are the two confused? Like children with ADD, HSCs can be easily distracted because they notice so much (although at times they are so deep in thought they notice very little). But ADD is a disorder because it indicates a general lack of adequate “executive functions,” such as decision making, focusing, and reflecting on outcomes. HSCs are usually good at all of this, at least when they are in a calm, familiar environment. For whatever reason (the cause is not known), children with ADD find it very difficult to learn to prioritize, to return their attention to what they are doing once they have glanced outside or know the teacher is not talking to them personally.
Again, HSCs can generally tune out distractions when they want to or must, at least for a while. But it requires mental energy. Thus another reason HSCs can be misdiagnosed as having ADD is because, if the distractions are numerous or prolonged, or they are emotionally upset and thus overstimulated already from within, they may very well become overwhelmed by outer distractions and behave as if agitated or “spacey.” They may tire midway through a long, noisy school day because they have to make a greater effort than others to screen out distractions. Also, if they fear they will perform worse in a given situation because of overarousal and distractions—for example, during an important exam—they very often do become overaroused and therefore notice some distraction they could ordinarily tune out.
Teachers may suggest that an HSC has ADD because there is usually money for treating ADD, so the student who is thus diagnosed will receive special help—as discussed, high sensitivity is a less familiar explanation for unusual behavior. (There is also considerable controversy among those who study temperament about whether much of ADD is simply normal temperament variation that is, like sensitivity, misunderstood. For an interesting cultural discussion of ADD, with much to say to highly sensitive people as well, take a look at Ritalin Nation by Richard DeGrandpre.)
Autism and Asperger’s Syndrome
Usually, when a child has a serious problem, such as autism or Asperger’s disorder, the parents or pediatrician have spotted it early on. Autistic infants do not smile, imitate facial expressions, follow a pointing finger with their eyes, or mouth the syllables of language. At two or three they have little interest in others or responses to others’ needs and feelings. They apparently do not wish to communicate and do not engage in imaginary play, as far as we know. This is all very different from the behavior of an HSC, who is eager to communicate except when very overstimulated. High sensitivity is found in about 20 percent of the population; autism affects two to four children in ten thousand, and three quarters of them are boys. One is a normal variation, the other is a true disorder.
Asperger’s syndrome affects about one in five hundred children and is five times more common in boys. Such children often exhibit motor problems, such as strange postures, gestures not matching their speed, awkwardness, poor rhythm, and unreadable handwriting. An HSC during the stress of an examination might show poor coordination but not the other symptoms. Children with Asperger’s do seem to wish to communicate, but do so very poorly because they apparently lack an intuitive understanding of how to listen and when to talk. They cannot take hints, understand irony, keep secrets, or decipher facial expressions. They often talk monotonously on a subject no one else is interested in. None of this is true of a normal HSC.
The reason there is sometimes confusion here is that children with autism or Asperger’s are usually very highly sensitive to sensory input. But again, they are not sensitive to social input, or at least not in an adaptive way, which makes them very, very different from HSCs. I do not believe that HSCs are on some normal end of an “autistic spectrum,” although that argument has been made. A better description of children on the more normal end of the autistic spectrum would be those who are socially “odd”—eccentric, pedantic, or emotionally remote.
Again, normal children, HSCs included, are born ready and eager to relate; they are programmed for it. As we will see in Chapter 6, they are probably already emotionally responsive to their mother even in the womb; children with these other disorders are not.
What to Do If You Are Not Sure
If in doubt, have a team of professionals evaluate your child. Start by getting the name of a highly respected professional who takes a team approach, then get the names of the other professionals with whom he or she works. This may be costly, but problems caught early can usually be changed and with far less expense. You need a team because a pediatrician alone may emphasize physical symptoms or solutions. A psychiatrist will be looking for mental disorders that might be helped with medication. A psychologist will want to teach new behaviors but may miss a physical problem. Occupational therapists will emphasize sensorimotor problems and solutions; speech therapists will attend to verbal skills; a social worker will examine the family, school, and community environment. Together, they are great. Indeed, there may be some problem in each area that needs attention. (In my opinion, medication alone is never a sufficient treatment for a behavioral problem in a child, who should be learning how to cope with whatever problem she has.)
A thorough evaluation will take weeks, not hours. Those involved should want reports from you, your child’s teachers or child-care providers, and any professionals who have already seen your child. They should ask for your family’s medical records and history, and someone should observe your child and possibly you and your child together. Above all, they should talk about temperament as part of the total picture and sound knowledgeable on the subject. Unfortunately, many professionals are not, and they can make serious mistakes with an HSC. (See Resources at the end of the book for names of temperament counselors.)
Finally,
