Flexibility in thinking and doing
In this page …
- Fitting in with the world around – being flexible
- Getting ‘stuck’ on one thing/Can’t seem to stop doing one thing/Talking about one thing
- Favourite things
- Worrying about things
- Doing the same things all the time
- Answering questions/Responding to things
- Finds new things difficult or upsetting/Gets angry or upset when plans change
- Being upset/angry
Fitting in with the world around – being flexible
As children get older they become more aware of the world around them. They can think more clearly about how what they want fits in with:
- What is happening now.
- What might happen later.
- What other people want or feel.
- What is possible or practical.
Children learn how to use what they know to solve problems. Problems can be practical or social. In many situations there can be more than one way to act e.g. to grab a toy that is wanted or to say ‘please’. Young children often need help making the ‘right’ choices about how to behave.
As children grow they learn that to act on their first whim or desire is not always the right thing to do. They learn to be more flexible in how and when they do things, even when it’s something they really want. A child or young person with hydrocephalus may find this very difficult. Instead they may seem to get caught up in their thoughts and actions without being able to change or ‘adapt’ them.
It might be tempting to think that they are being ‘selfish’, ‘stubborn’ or just naughty. In fact they may not be able to see the situation in the same way as others. They may not be able to work out what they are doing ‘wrong’ or how to change it.
Getting ‘stuck’ on one thing/Can’t seem to stop doing one thing/Talking about one thing
Inflexibility in thinking and acting is often seen as repetitive (perseverative) behaviours: doing or saying the same things over and over again. This can be worrying, upsetting or just irritating for others. But, it can also get in the way of doing other things. A child or young person who can’t get a thought out of their mind will also have difficulty focusing on their school work, for example. Non-stop talking or repeated questioning will stop a child from listening.
When repetitive (perseverative) behaviours get in the way we need to find things or methods that will ‘break’ the cycle. This is not always easy. It is likely to be more difficult for a behaviour that’s been around for a long time. Replacing the repetitive behaviour with something else is likely to be more successful than just trying to make something stop.
Charlie, aged 10, wanted to talk about his favourite computer game all the time: at meal times; in the car; with his teacher; with friends; at bath time … it seemed endless. Sometimes the game changed but the way Charlie wanted to talk about it was always the same. Apart from being irritating, it was sometimes difficult to get Charlie to stop and do the things he was meant to.
Charlie’s parents tried some different techniques and found a few things that work well for Charlie.
- They decided that the walk to and from school is Charlie’s ‘computer game talk time’.
- This is shown on his visual timetable so that his parents or teacher can point to this as a reminder.
- If Charlie tries to talk about his games at other times, he is reminded (with his schedule) and the subject is changed. Charlie can still be involved in a chat but not about his computer games.
- At the weekends Charlie meets with a friend who enjoys the same games. This is also on his visual timetable.
Using Charlie’s schedule is a really useful way of keeping Charlie’s ‘computer game talk time’ within limits that make it easier to work around. It means he can get involved in other family activities and concentrate better at school.
Worrying about things
Every time Sam, aged 9, had a dentist appointment he would start to ask his Mum the same set of questions over and over again. If Sam noticed the appointment on the calendar the questions could start days before. Sam’s Mum realised he was worried (anxious) about going to the dentist. Mum stopped putting dentist appointments on the calendar – there was no point in Sam worrying about it for days. It just caused upset and disruption.
If Sam gets anxious when she tells him about the dentist (usually the morning of the appointment) Mum tries different things to try and help him with his anxiety like: using visual signs to tell him to take deep breaths, or squeeze a ‘stress ball’ 50 times. This sometimes works but if it doesn’t Sam can sometimes be distracted with his favourite comic or by listening to some music. Sam’s Mum has also found he copes better if she has her teeth looked at in the same appointment. Sam can watch what she does and see that the dentist doesn’t cause his Mum any anxiety.
Previous trips to the dentist had actually gone smoothly once Sam was in the chair. So, Sam’s Mum reminded him that it was never as bad as he thought. This also gave Sam’s Mum a chance to praise him for coping so well in the past.
Visual timetables and visual signals are good ways of reminding or distracting your child. If they are stuck in talking about something (in a verbal mode) they may not hear or understand what is being said to them. A visual signal may be a more useful way of ‘breaking’ the repetitive behaviour.
Doing the same things all the time
Sometimes a child or young person with hydrocephalus repeats or will not stop a game. Perhaps they watch the same cartoon over and over again for example. It may be useful to ‘timetable’ the things your child likes doing. Allow time for these things and remind them when they will happen. It might also be useful to use an actual timer that ‘beeps’ when the playing or cartoon time is up or give them five minutes notice before the time is up.
Answering questions/Responding to things
Sometimes a child or young person with hydrocephalus will make a mistake in the way they answer a question, or the way they act (their behaviour) may look odd. Even if they are told they have said or done something wrong, they may keep going (persevere) with the answer or action.
Hydrocephalus causes changes in the brain that may make it difficult to find and choose between different ways of responding to a situation. Even when the wrong option has been put into action, the brain may struggle to see the mistake and put it right. The person will carry on saying or doing the wrong thing.
Laura, aged 9, was doing well at reading and writing. She managed most of her class work but seemed to get a bit stuck when it came to answering written maths questions. This puzzled her teacher because when he talked to Laura about different things she seemed to show fairly good knowledge and understanding.
After doing a couple of different maths tests, Laura’s teacher realised that she often tried to use the same calculation method over and over again. Laura didn’t always seem to know when to switch to a different method.
Laura’s teacher realised that when she wasn’t sure what method to use, she sometimes got stuck. Together they worked out a ‘how to solve’ plan. It gives Laura some questions to think about every time she looks at a maths problem like:
- What words or symbols give clues about how to solve it?
- What information are you given?
- What do you need to find out?
Laura had to practice using the plan a lot before she got the hang of it. It doesn’t always work but it has helped. Laura gets a bit of extra time during tests too. This has stopped her worrying too much because she knows she has time to use her ‘how to solve’ plan.
Sometimes it is difficult for someone with hydrocephalus to spot the right clues that usually help the brain find an answer. Finding ways of making these more obvious to someone with hydrocephalus may be very helpful.
Finds new things difficult or upsetting/Gets angry or upset when plans change
We often think that a day out or something special for a meal will be a nice treat. It can be perplexing and hurtful when a child refuses or seems to be upset with their ‘treat’. For someone with hydrocephalus familiar things are often comforting. Doing the same things and eating the same foods are things they understand: they know what needs to be done (this is a routine that has been learnt). If something new comes along, the thoughts and actions that are usually useful suddenly won’t work. This can be upsetting or confusing for the child or young person. Someone with hydrocephalus may find it difficult to solve the problem.
Josh was generally a happy boy. He liked being with his family and seemed to enjoy being at the dinner table with them. His Mum and Dad couldn’t understand why he always had a full blown temper tantrum every time they suggested going out for dinner, even on birthdays. This made it really difficult for the rest of the family because they really wanted to go but most of the time, they found it easier to stay at home.
Mum had a special birthday coming up and she really wanted to go out with the whole family. She didn’t want Josh to be upset as she knew this would upset her too. Months before, they started having ‘restaurant night’ at home. Bit by bit they added things you would find in a restaurant and talked and joked with Josh about it. They used things he liked:
- Josh and his sister designed a menu with Josh’s favourite food on it.
- They laid the table together.
- They played Josh’s favourite music in the background.
- Dad pretended to be a silly waiter and made everyone laugh.
Each time they kept most things the same but changed or added one or two things. The family talked a lot about how this was like a real restaurant. They talked about how it was fun. Josh’s sister started looking at pictures of real restaurants with Josh and they talked a lot about how happy people looked.
Eventually, they got Josh involved in choosing a restaurant and they went out for a quick and simple meal (Josh’s favourite). Josh was a bit nervous and asked lots of questions but they reminded him of all the things they’d done at home and how this was the same. Josh got involved in planning Mum’s special Birthday. On the big day, Mum was so happy and so pleased with Josh that he actually seemed to forget his nerves and enjoyed himself.
All children get upset or angry at times. There are phases in a child’s life when they are more likely to show more anger and frustration, eg toddlers and teens (see ages and stages). Someone with hydrocephalus can become anxious, angry or upset like anyone else. But, sometimes they may be unable to let go of these feelings and appear to get ‘stuck’ in ‘tantrum’ like behaviour. This can be embarrassing and upsetting but the best thing to do is try to stay calm.
Anger and upset may be a sign that the young person is struggling to cope with something. It may be that they are aware of a mistake but can’t put it right, or it may be that things aren’t going as they expected. Helping a child to learn how to behave in routine situations may help avoid upset. Having some tricks up your sleeve to distract and re-direct unexpected upset is also useful (see above).