Recognizing and Parenting Sensitive/Anxious Children

You’ve probably observed families in which one of the kids is super resilient and easy-going while the other is super sensitive and anxious. Same family, same parents, but two extremely different children. What gives?

My guest today says that some kids are like robust dandelions, while others are like fragile orchids. And while the fragility of orchid children might seem like a liability, in the right circumstances, these kids can actually thrive to an even greater extent than their dandelion peers. His name is W. Thomas Boyce, and he’s a developmental pediatrician and professor of pediatrics, as well as the author of the book The Orchid and the Dandelion: Why Some Children Struggle and How All Can Thrive. We begin our conversation discussing the respective attributes of dandelion and orchid children and how the increased reactivity of the latter influences their health, emotional well-being, and development. Tom then explains how orchid children can be both the healthiest and sickest of children, depending on the environment in which they’re raised. We then discuss the theories as to what causes orchid children to be orchid children, including genetics and environmental factors. We end our conversation with tips for parents of sensitive children on how to help them thrive and succeed.

Show Highlights

What does a dandelion kid look like? What does an orchid kid look like?
How to know your child’s “reactivity” or “sensitivity” levels
Is there a relationship between this orchid sensitivity and autism?
Why orchid children tend to have either the best or worst outcomes depending on context
The interplay of environment and genes on high reactivity children
The advantages of being highly sensitive
Why no two children are raised in the same family
The roles of a child’s peers in their thriving or not
What can parents do to help highly reactive children?
What happens to these reactive children when they grow up?

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Read the Transcript

Brett McKay: Brett McKay here, and welcome to another edition of the Art of Manliness podcast. You’ve probably observed families in which one of the kids is super resilient and easygoing while the other is super sensitive and anxious. Same family, same parents, but two extremely different children. What gives? My guest today says that some kids are like robust dandelions while others are like fragile orchids. While the fragility of orchid children might seem like a liability, in the right circumstances, these kids can actually thrive to an even greater extent than their dandelion peers.

His name is W. Thomas Boyce. He’s a developmental pediatrician, professor of pediatrics, as well as the author of the book, The Orchid and the Dandelion: Why Some Children Struggle and How All Can Thrive. We begin our conversation discussing the respective attributes of dandelion and orchid children and how the increased reactivity of the latter influences their health, emotional wellbeing, and development. Tom then explains how orchid children can be both the healthiest and sickest of children depending on the environment in which they were raised.

We then discuss the theories as to what causes orchid children to be orchid children, including genetics and environmental factors, and we end our conversation with tips for parents of sensitive children, how to help them thrive and succeed. After the show’s over, check out our show notes at aom.is/orchid. Tom joins me now via clearcast.io. All right, Dr. Tom Boyce, welcome to the show.

Tom Boyce: Thank you very much. Glad to be here.

Brett McKay: You are a professor of pediatrics who studied children’s development, and you’ve postulated that there’s a spectrum that kids reside on where on one end of the spectrum, they are what you call the dandelion kids, and on the other end of the spectrum, you have what are called orchid kids. Can you describe what you’re talking about? What is the dandelion kid, what do they look like, and what does an orchid kid look like?

Tom Boyce: We began years ago trying to understand why there was such variation in children’s health responses to the adversities and stressors that they encounter in their lives. We decided that one way of indexing this would be to bring them into a laboratory circumstance where we would sit them down in front of a previously unknown examiner, and we would ask them to carry out a series of mildly stressful tasks, things like repeating a series of numbers that the examiner says to them or asking them to watch an emotion evoking video clip or having them take a drop of lemon juice on their tongue.

We found that when we monitored the stress response systems that are characteristic of the human body that there were tremendous differences between children in their responsivity, their reactivity within those systems to these various stressors. When we began to then study patterns of illness and development within these populations of children that we were studying, we found that the most reactive children in the laboratory in real life had either the best or the worst of the healthy outcomes depending upon the kinds of social settings that they were living in, their families, their communities, their schools. We began calling these highly-reactive, highly-sensitive children orchid children, and then called the children who were really the majority of those that we tested in the lab that had very little in the way of response to these minor stressors, we started calling them dandelion children.

Brett McKay: Dandelions, like a dandelion, these kids, doesn’t matter what environment they find themselves in, they’re going to do okay. The orchid kid needs something… like orchids are delicate. They need a certain type of environment to prosper.

Tom Boyce: That’s right. That’s the idea. The terms actually come from a Swedish word, maskros barn, which means dandelion child, and what the Swedes mean by that is a child that can, like the dandelion thrive in any environment that it encounters. We coined the second term orchid child to reflect the opposite of that, which is children who are very sensitive and responsive to the kinds of environments they encounter.

Brett McKay: When you talk about reactivity or sensitivity to stress in an orchid child, what does that look like? I mean, how do you know that a child is reacting or is highly sensitive to stress?

Tom Boyce: Well, in the laboratory, we monitored these two principles stress response systems, which are the cortisol system. Cortisol, of course, being a major stress hormone that’s secreted by the adrenal glands signaled from the brain. We monitored cortisol levels, and we also looked at the autonomic nervous system, which is the fight or flight system that causes sweaty palms and dilated pupils and increased heart rate. We had those two stress response systems in the lab that we could monitor that would tell us whether the child was reacting vigorously or minimally over the course of these minor stressors. That’s how we find those children in the laboratory.

Now, in clinical work, finding those kids, obviously, we’re not going to be testing every child that walks through the door of a clinic. We find that the kids who are the orchid children tend to be shyer. They are kids who are typically shy. They tend to withdraw from novel situations, so going to a birthday party where they don’t know many of the kids would be an example of a novel situation that an orchid child might be more sensitive to and withdraw from. These orchid children also seem to have more in the way of sensory sensitivities. They have, in all of the various senses, smell, taste, touch, and so on. they seem to have greater sensitivity than do the dandelion children.

Brett McKay: Now, listening to this, we’ve had guests on the show talking about autism. Some of these things sounds similar to autism. Is there a relation at all between this sensitivity and autism?

Tom Boyce: Well, orchid and dandelion are not, they are not diagnoses. They’re not diagnoses in the psychiatric sense of being a definable mental health disorder, but they do overlap in certain ways with some of the traditional psychiatric diagnoses. The one that you’ve point out is a good example. Sometimes children who are somewhere on the autism spectrum do have the same kind of hypersensitivities and the sensory modalities that do these children who we find in the laboratory are orchid children.

Brett McKay: Okay. That makes sense. That’s a good point to make. This is not, like this idea of like an orchid dandelion child is not… you can’t go to your child’s psychologist and be like, “Hey, is my kid an orchid child?” They’re going to be like, “That’s not a clinical diagnosis.”

Tom Boyce: That’s right.

Brett McKay: Okay. You mentioned something earlier though that’s interesting. As you describe as hyperreactivity to stress that orchid children have, people hear that and think, “Well, that’s not good. You’d be better to be a dandelion child,” but in your research you’ve done on orchid children, orchid children, in some cases, do the best in certain situations. Can you talk about this paradox where orchid children can either, depending on their circumstance, do either really well both in health, wellbeing, et cetera, or poorly.

Tom Boyce: Yes. This was the part of our early findings that had been sustained both in our laboratory and other laboratories around the world that was truly surprising. We had expected that the children who showed biological high reactivity in the laboratory would be kids that, when encountering nature adversities in their real life, out in real social circumstances, would have the highest rates of illness and injury and behavioral disorders and so on.

Sure enough, that was true. The kids who are high in reactivity in the lab and who experienced lots of adversity in their normal everyday lives, those were the kids who were the least well, had the most developmental and behavioral problems. But what we hadn’t anticipated, and what really took us by surprise and has been replicated now over and over, is that these same kids who are high in reactivity in the laboratory, the so-called orchid children, when they’re growing up in very nurturant, supportive, predictable conditions, they don’t just have average levels of health. They have the best health of all of the children in our samples. These seem to be children who have either the best outcomes or the worst outcomes, depending upon the character or the kind of social context in which they find themselves.

Brett McKay: Orchid children tend to get sicker more in the wrong environment, but they can be the healthiest kid in the right environment. This dichotomous outcome isn’t just about health. You also see it in behavioral outcomes, so in the wrong environment, an orchid child could be the most anxious, most stressed out, but in the right environment, they can be the happiest, most thriving kid there is in a group.

Tom Boyce: That’s right, and that really is kind of the hidden good news in all of this. It is that the kids that we sometimes worry about as parents or as physicians, teachers, the kids that we worry about most in certain circumstances can actually be the healthiest and have the least developmental and behavioral issues of any of the children that we contend with.

Brett McKay: This connection to health or getting sick, that relates to the stress response because I think what happens when you get stressed out a lot, your body’s immune system sort of diminishes, so I can see how an orchid child would get sicker more often because they’re highly sensitive to stress. Their immune system is going to take a beating.

Tom Boyce: That’s right. Both of these systems that we measured in the laboratory, both the cortisol system and the fight or flight system, both of those systems have really profound effects on immune competence, and they can alter the ability of the child to resist pathogens like viruses and bacteria.

Brett McKay: I thought the interesting thing about that related bacteria was about cavities. It’s not just eating sweets that causes cavities. It’s the sweets plus bacteria plus stress that causes increase in cavities.

Tom Boyce: One of the studies that we did was to examine caries in children, and we did this by asking them to donate to us the baby teeth that fall out at about grade one. We paid them $10 a tooth, which was far above the going rate in their family homes. They gladly gave us these teeth, and we were able to study both the teeth that were still in their mouths and look at the level of caries that the children had experienced, but also look at the microstructure of those deciduous teeth that had fallen out. We were able to show that the kids who had more in the way of caries were the kids who had greater stressors in their lives and who had greater sensitivity of those teeth by virtue of exposures to cortisol and other kinds of biological factors.

Brett McKay: How soon can you and your researchers tell if a child is going to be on that orchid spectrum? Is it at birth, or do you have to wait a little bit before you start seeing that?

Tom Boyce: Our studies have primarily been in four to eight-year-old children, so sort of middle childhood, but one of my primary colleagues, Dr. Abbey Alkon, who’s a professor of nursing at UCSF has, along with Dr. Brenda Eskenazi, has studied children in farm worker families and has begun to look at reactivity and stress responses on down into infancy. Those studies show what I think most parents and pediatricians would have suspected that right from birth, there are differences in the infant’s reactivity and responsivity to the changes in perturbations in the environment. There actually are children that we think we can identify very early in life that have these predispositions to high reactivity.

Brett McKay: You can tell that with that Apgar test. I remember my kids, as soon as they’re born, they’re swept away, and they do that Apgar test to figure out that sort of thing. They sort of test the response of the infant.

Tom Boyce: Yeah. The interesting thing about the Apgar score is that most of the signs or signals that are used to score the Apgar are signals that are mediated by the stress response system. It’s things like respiratory effort and heart rate and circulation. Many of those things are actually influenced by these stress response systems. We think that the Apgar score may in fact be a kind of index or indicator of a stress response even in the first moments following delivery.

Brett McKay: If you can see this, if the research is suggesting you can see this high reactivity at birth and suggest there’s like a biological genetic component to it, but that can lead you down the path of genetic determinisms, like, “Well, that’s your genes. There’s nothing you can do about it,” Is there more going on? Is the environment and genes working together to determine whether this high reactivity is displayed?

Tom Boyce: Yes. That’s exactly right. You may ask, “Well, if there are differences in reactivity, even in the first moments of postnatal life, where does the experience part come in?” But what we’re learning more and more is that there are experiences that the fetus has during intrauterine life just as surely as an infant does during the first six to nine months postnatal life. We think that the development of these patterns of orchid or dandelion responses actually begin post-conception, and they involve not just biological factors like genetic variation, that they also involve experience and exposures that children have both during intrauterine life and then in postnatal life as they go into infancy. It’s a matter of gene by environment interaction, not simply an effect of genes or an effect of environments in isolation.

Brett McKay: That’s the epigenetics where the environment influences what genes are expressed.

Tom Boyce: That’s right. Epigenetics, of course, means, “epi” means on top of, so the epigenome is the part of our genome that lies on top of our actual DNA sequence. Those marks that lie on top of the genome are the things that govern whether a given gene is expressed or not expressed and have a lot to do we think with the development of these orchid or dandelion phenotypes.

Brett McKay: That can explain… so let’s say the mother experiences a lot of stress while she’s carrying a child. That could turn on some genes in the fetus saying, “Okay, the environment out there is really stressful. You need to get ready for that, so we’re going to help you be highly sensitive to stress so you can notice it when you see it.”

Tom Boyce: Yes, that’s what we think is going on now. We’re in the very early days of studying stress experiences during pregnancy, during fetal life, but the early evidence is that there may be these epigenetic differences that determine orchid or dandelion phenotypes based on experiences during fetal life and genetic variation that the fetus inherits from his mom and his dad.

Brett McKay: This could get really interesting because I’ve read some stuff about epigenetics where some researchers postulate or theorize that even grandparents can influence grandkids based on the stress they experience. I think they talked about Holocaust survivors, and the grandchildren of Holocaust survivors, they tend to be more highly reacted to stress. I think that’s what it is, but this is an interesting world that it opens up with epigenetics.

Tom Boyce: It really is. we’ve known for a long time that both differences in genes and differences in environments affect child health and wellbeing, but up until just in recent decades in the last 20, 30 years, we’ve now begun to actually be able to identify the physical locus where genes and environments come together, and that is this epigenome, these epigenetic marks that lie on top of the genome.

Brett McKay: In one part of the book, you talk about the epigenetics of orchid children is sort of nature’s way of hedging bets and allows them to survive in a stressful environment. I mean, we think of this sort of like being highly reacted to stress would be maladaptive, but in a weird way, it’s kind of adaptive. Can you talk about that?

Tom Boyce: Well, it’s adaptive in the sense that if you’re growing in really comfortable, supportive, nurturing conditions, it actually is an advantage to be highly sensitive because then you’re, if you will, sort of able to take in more of the goodness that that environment provides for you. You could argue that both the best of environments and the worst of environments would be affected by this sensitivity that some children have to those social contexts.

We also can think about environments of evolutionary adaptiveness. Back thousands of years ago when children were part of hominid troops that wandered various continents, those kids, you can see how children who were highly reactive and highly sensitive might’ve had bad outcomes under conditions of predation and danger. But on the other hand, it may have been helpful actually to a troupe of early hominids to have individuals who are highly sensitive to the stressors and the dangers that may have been out there. On the other hand, during periods of quiet and peaceful existence, those same individuals might have thrived, that provides us with a kind of evolutionary account of why these phenotypes might’ve persisted in those ancient environments.

Brett McKay: There’s a biological component, a genetic component, but as we’ve been talking about, the social environment plays a huge role, and the first social environment that most children are put into as a family, but yet the chapter where you discuss family and the interaction with orchid children, you say, “No two children are raised in the same family.” What do you mean by that, and what are the implications for orchid children?

Tom Boyce: What I mean by that is that the differences in gender, in birth order, in personality, children in certain ways create the environments of their family. It’s pretty clear that the experience of one child in a given family is not the same as the experience of another child, so a sort of shorthand way of thinking about that is to say that really, actually, no two children are raised in the same family in the sense that their experiences of their parents, of their sibship, and so on, are very different one to the other.

The implications of that are that children growing up in the same family can have very, very different health outcomes and developmental outcomes from one sibling to another. It’s a common experience of pediatricians that a family comes in for primary pediatric care, and a parent will say, maybe they have three children, that these two kids are healthy all the time, but this one, that one is sick most of the time or has problems of one kind or another. We think that that may come from these differences in the experience of the family environment that different children have.

Brett McKay: Right, and it also, when I read that, I started thinking about my own experience or watching other families. I mean, if a child’s born at a certain stage in, say, the parent’s career development, that can influence how the parents behave and whether they’re stressed out or not stressed out at home. When they’re younger, there’s a difference between if a parent’s older and they have a child. I thought it was interesting because you talk about the story of you and your sister as an example of same family but different outcomes because it wasn’t the same family. She was more sensitive, and she experienced some hard times with your family that you didn’t experience. That affected her and influenced her the rest of her life, and she even ended up taking her own life in adulthood.

Tom Boyce: Yeah, that’s right. Of course, I think there were, there were major differences between my sister and myself in our sensitivities to the adversities that we experienced within our family. I believe in retrospect that my sister was a classical orchid child, and I believe that I was mostly a dandelion child, so our differences in sensitivity to the experiences within our family were probably profound.

Brett McKay: Another social context that have a big influence on children is school, when they go off to school. What role do peers play in whether an orchid thrives or struggles?

Tom Boyce: Oh, I think they play a major role. First of all, there is the issue of bullying, which is way too prevalent in our schools today. We’re gradually becoming aware of it of how children treat each other. But those experiences that probably are pretty universally experienced among kids in primary school age groups, those experiences are very different depending upon whether you’re an orchid child or a dandelion child.

We also know that there are social hierarchies that are set up within groups of school children. Any kindergarten teacher can tell you this, that within a couple of weeks after 20 or 30 five-year-olds are brought together in a novel social group that is a new kindergarten classroom, that those children set up the pecking order, with some children at the top of that order that are the dominant children and those at the bottom that are the more subordinate children. There are these experiences of hierarchical position and bullying and coercion and so on that very much affect the wellbeing and the experience of one child versus another. Teachers also can dramatically influence those experiences.

Brett McKay: Right, so those highly stressful situations like that could cause an orchid child to flounder, but if they were in a better environment, they could actually thrive do well in a school.

Tom Boyce: That’s right. We actually have found out in some of our studies that were done in Berkeley, California primary schools, kindergarten classrooms, our research assistants kept coming back into the lab and saying, “This class is very different from that other class,” and describing to us these profound differences in the way that, in the cultures that the teachers set up. We began seeing that some teachers almost cynically use the social hierarchies that kids set up as a means of behavior control within their classrooms while other teachers go out of their way to be sure that the kids that are at the bottom of those hierarchies are having positive, beneficial experiences as well, doing things like showing to the class the special capabilities of those children that are in the subordinate positions. The sensitivities and abilities of school teachers turn out to be very crucial to the outcomes that children experience in school settings.

Brett McKay: What about parents? What if there’s a parent who’s listening, they got a hunch that their kid is highly reactive to stress. They’ve noticed some of those things, their novel social situation, they’re shy, they hide, things like that, so they think, “Well, maybe my kid’s an orchid kid on the sort of orchid side of the spectrum.” Any advice for those parents who have sensitive children?

Tom Boyce: Yeah. In the book, there’s one chapter that deals with strategies that seem to be helpful that parents use to help children with these high sensitivities. Interestingly enough, they’re the same strategies that very sensitive good teachers use to help children with those same kinds of hypersensitivities. We talk about six strategies, which have the happy coincidence of forming the mnemonic orchid or O-R-C-H-I-D, and those are beginning at the top with O, own true self, the way in which the parent recognizes and honors the expression of the child’s own true self. I think one of the highest responsibilities that we have as parents is to allow each child to come forth and express who that child is in honest and open ways.

The R stands for routines. We’ve also found that orchid children seem to thrive in conditions that are and routine, even monotonous at times. That seems to be something that is helpful to orchid children. The C stands for caritas, the Latin word that means a steadfast love. We all strive as parents to love all of our children, but this kind of steadfast support and love provided to orchid children seems to have especially profound effects on them. The H is for human differences. Some families try to obscure or blur the differences between children. The families that are the most helpful to orchid children are those where human differences are celebrated and expressed openly.

The I is for imaginative play. Some people think of play as kind of trivial child activity. It is not. It’s really profoundly important in the lives of children, and having the opportunities to have this kind of imaginative play seems especially important to orchids. Finally, the D is for danger. One of the most difficult things to do as a parent of an orchid child is to decide when to push the child into situations that feel dangerous to the child versus allowing them to withdraw from those experiences.

It’s things like if a… I mentioned earlier going to a birthday party where a child doesn’t know many of the children. Parents have to make a decision with orchid children in those circumstances about whether this is a circumstance where we want to push that child, nudge them forward into experiencing a victory over that concern or fearfulness, or is this a circumstance where we want to allow that child to withdraw. Those are six kind of strategies that parents seem to use that seem to be helpful to all children, but are especially important to orchid children.

Brett McKay: Yeah, I think it works for all children because as I was listening to that, it made me think, another key point of that, recognizing differences between your kids. Oftentimes, I think parents think, “Well, it worked for this first kid. It’s going to work for kid number two.” Probably not, so you have to adapt on the fly. I’m curious, have you guys done research on what a development for an orchid child looks like in adulthood? What happens to these highly sensitive kids as they get into their 20s and 30s?

Tom Boyce: Well, if we study it at the level of stress reactivity, those biological responses that we talked about earlier, if anything, it appears that one’s position on the spectrum of reactivity tends to become even more committed in the transition from childhood to adulthood. Children who are highly reactive tend to be even more solidly high reactivity as they get into adolescence, and even more so in the transition into adulthood.

Now, in adulthood, we also begin to develop coping mechanisms and approaches to dealing with stress and adversity that may be profoundly helpful to us and may make an orchid individual far more adapted than that individual might’ve been during childhood, but we think that the profile, at least biologically of being an orchid or a dandelion on that spectrum of reactivity, that tends to become even deeper and more committed as individuals go into adult life, but with the proviso that these ways of coping and dealing with stress become evermore elaborate and effective as we get to be adults.

Brett McKay: What do those positive coping mechanisms look like?

Tom Boyce: Well, I think in certain ways, they are the same strategies that parents use, but we gradually begin to learn over time as orchid individuals that those same strategies we can use on ourselves. For example, feeling open to recognizing and affirming who you are as a person, allowing those differences to be expressed and not suppressed, having a relatively routine life where things are predictable from one week to the next, from one day to the next so that these routines that are effective and helpful in orchid children can also be instituted by an orchid adult, taking care of and finding the kind of support and love that an individual needs within an individual life, all of these kinds of things that parents provide early in life, we begin to learn to provide to ourselves later in life.

Brett McKay: I imagine a person who’s on that orchid side of the spectrum, they would probably choose a route job that has pretty stable routine. They want to have a stable family life because that’ll provide that sort of stability that they thrive in. I imagine orchids, there’s maladaptive ways to cope with stress, things like alcohol or drugs or things like that, and that would just be even worse for an orchid adult.

Tom Boyce: That’s right. That’s exactly right.

Brett McKay: Well, Tom, this has been a great conversation. Where can people go to learn more about the book and your work?

Tom Boyce: Well, the book was published in January 2019 by Knopf. It is out there and available. That’s probably the best summary of the work. The book also includes a listing of the scientific papers on which the book is based, both my own and that of other investigators. I would say the book and the papers and perspectives that are referenced in the book would be the best place to begin.

Brett McKay: Fantastic. Well, Tom Boyce, thanks for your time. It’s been a pleasure.

Tom Boyce: Thank you. Pleasure on this end as well. Thank you, Brett.

Brett McKay: My guest today was W. Thomas Boyce. He’s the author of the book, The Orchid and the Dandelion. It’s available on amazon.com and bookstores everywhere. Be sure to check out our show notes at aom.is/orchid where you find links to resources where you delve deeper into this topic.

Well, that wraps up another edition of the AoM podcast. Check out our website artofmanliness.com where you find our podcast archives. There’s over 550 episodes there and also thousands of articles we’ve written over the years about parenting, how to be a better husband, better father, physical fitness, personal finance. You name it, we got it. Also, while you’re there, make sure you sign up for daily or weekly newsletters so you never miss a new article. If you’d like to enjoy ad-free episodes of the AoM podcast, you can do so in Stitcher premium. Head over to stitcherpremium.com, sign up, use code MANLINESS for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS, and you can start enjoying new episodes of the AoM podcast ad-free.

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