LD Made Easy

Autistic Teens: the Driving Dilemma

2012-01-27T13:20:00.001-08:00

Depending upon where you live in the United States, thedecision to let your HFASD (High Functioning Autistic Syndrome Disorder) childdrive could rest solely on the shoulders of parents.

If you are lucky enough to live in a state such as Pennsylvania,then all teens applying for a driver’s permit must have a physician sign off ontheir potential driving abilities. Andif you live in Michigan, Montana or Illinois (for example) then all teens also need proof having a GraduatedDriving License certificate.

That teens are impulsive, at times irrational, and oftenunpredictable is common knowledge. Thesecharacteristics are often even more pronounced in HFASD children.

In addition, a child with HFASD often has issues withcommunication, motor regulation, and social skills, all of which are factorsthat can impact driving skills. Very fewstudies have been done on these teens to access their abilities and thepotential issues regarding their safety and the safety of others on the road.

It is a statistical fact that the incidence of teen deathsand automobile accidents are closely linked. Some place automobile crashes as the number one cause of teendeaths. The Center for Disease Controlreports that in 2009 8 teens ages 16-19 died everyday from motor vehicleinjuries. The report goes on the statethat per mile driven, “teen drivers ages 16-19 are four times more likely thanolder drivers to crash”. Therefore,investigating how teens learn to drive and specifically how HFASD teens learnis a significant safety issue.

Occupational therapists often teach driving to adults whohave had injuries that change the way they drive: spinal cord injuries forexample. With the exponential increaseof those being diagnosed with Autism, the role of the OT in teaching andassessing driving abilities should be a essential part of therapeuticinterventions when addressing the functional capacities of teenagers intreatment.

Whilenot all teens with autism will become drivers, it is important to note thatmany will. Patty Huang, MD, adevelopmental pediatrician at the Children’s Hospital of Philadelphia (CHOP),as devised a list of predictive factors of HFASD teens who will want to and whoare most likely to become drivers. Thislist includes but is not limited to:

· At least 17 years old

· Enrollment in full-time regular education

· Planning to attend college

· Having held a paid job outside the home

· Having a parent who has taught another teen to drive

· Inclusion of driving-related goals in his or herindividualized education plan (IEP)—this is where OT’s can have a lot of input!

Occupational therapy, whilecommon with the elementary school aged child, is less so with the high schoolteen. The OT’s role in the IEP Planwould be to assess and set the driving related goals.

Research supports that teensthat have participated in Graduated Drivers Licensing (GDL) programs are38%-40% less likely to have accidents than teens that were taught by familymembers or by other individuals. With aGLD rights and privileges for operating a vehicle are slowly graduallygraduated into a program that eventually leads to fully independent driving.

It is during that periodthat the occupational therapist can work on increasing rate of motor responsespeed, visual scanning, peripheral visual awareness, midline issues (turningthe steering wheel with both hands), integrating the concept of attentionconcerns (radio/tape player/friends, etc.) and reciprocal motor movements bothupper and lower extremities.

Creating a pre-drivingcompetency checklist may be helpful for starting such a program in yourstate. Be sure add specific laws thatare essential for the driver to know, processand understand.

Dr. Vanessa M. Dazio, OTD,OTR has a checklist for aging drivers that I slightly altered for the teendriver. You can read more from Dr. Dazio at: http://www.safeaging.com/information/SkillsDriving

Driving is multi-tasking taken to an “artform”. Driving engages the total person:physically, mentally and emotionally. Being able to not only be aware of yourself, but everything around yourequires practice as well a patience while learning to coordinate multipletasks with multiple skills.

Suggested Checklist for the Teen Driver:

Physical Skills

· Focus constantly on the task of driving even in the presence of minordistractions

· Twist and turn bodyquickly (to see motorists or pedestrians coming from the far right and far  left

· Move the head and neckside to side, up and down, back and forth and use visual scanning techniques 

· Good joint range of motion and coordination are needed to:  hold, control and turn wheel reach and manipulate knobs/buttons/controls use turn signals and wipers  adjustmirrors  quickly move the foot from the accelerator to the brake

Visual Skills

• Good distance vision for checking intersections, highway changes,signs determine distances needed for merging into lanes, making turns, lanechanging look at highway and even weather conditions look for other approachingcars observe and scan far ahead for potential safety threats or hazards observeroad conditions watch for pedestrians

• Close vision is needed to: Judge the closeness of other cars, pedestrians,walkways distinguish curbs, ramps, roadways, etc. distinguish details read roadsigns, maps, inside car features

• Fluid peripheral vision is needed to see a moving object (like a personstepping off a curb) Hearing is used to detect:

• Determine closeness of approaching cars (by the sound of tires andengines) inside car sounds for "empty gas tank" or "checkoil". odd engine sounds suggesting maintenance problems outside sounds oflife: such as children playing, distracted pedestrians outside warning soundssuch as car horns, trains, ambulances, sirens, screams threatening weatherconditions, etc.

• Touch: The awareness of touch is needed to gage how hard to tap thebrakes or press the accelerator. It is also important to be aware of grippingthe steering wheel. Fluid use of palmarand pincer grasp with and without associated reaching.

Mental/emotional Skills

• The brain is "Central Control". It directs the body to doeverything when driving. Driving requires a clear and alert mind. The newdriver should not have the radio/tape player or other auditory distractor onwhen driving

• Quickly and correctly choose the best options in constantly changingsituations quickly and correctly react to prevent or reduce accidents orinjuries. To be able to  quickly makethe best decisions given the set of circumstances  quickly recall and applydriving rules and regulations at all times.

Teens, inclusive of those with HFASD, and thedesire to drive are most probably inevitable. The current statistical rate of teen automobile fatalities does not haveto be. OT’s can make an impact here andthe sooner the better!!

Additional references:

· Centers for Disease Control andPrevention. Web-based Injury Statistics Query and ReportingSystem (WISQARS) [Online]. (2010). National Center for InjuryPrevention and Control, Centers for Disease Control and Prevention (producer).[Cited 2010 Oct 18].

· NHTSA[2009]. Fatality Analysis Reporting System (FARS), 2009. Washington, DC: U.S.Department of Transportation, National Highway Traffic Safety Administration,National Center for Statistics and Analysis.

· Finkelstein EA, Corso PS, Miller TR,Associates. Incidence and Economic Burden of Injuries in the United States. NewYork: Oxford University Press; 2006.

· Insurance Institute for HighwaySafety (IIHS). Fatality facts: teenagers 2008. Arlington (VA): TheInstitute; 2009 [cited 2009 Nov 3].

· Chen L, Baker SP, Braver ER, Li G.Carrying passengers as a risk factor for crashes fatal to 16- and 17-year olddrivers. JAMA 2000;283(12):1578–82.

· Jonah BA, Dawson NE. Youth and risk:age differences in risky driving, risk perception, and risk utility. Alcohol,Drugs and Driving 1987;3:13–29.

· Simons-Morton B, Lerner N, Singer J.The observed effects of teenage passengers on the risky driving behavior ofteenage drivers. Accident Analysis and Prevention

· National Highway Traffic SafetyAdministration (NHTSA), Dept. of Transportation (US). Washington (DC): NHTSA;2000a [cited 2009 Nov 6].

· National Highway Traffic SafetyAdministration (NHTSA), Dept. of Transportation (US). Washington (DC): NHTSA;2008b [cited 2009 Nov 6 ].

· Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2007[Online]. (2009). National Center for Chronic Disease Prevention andHealth Promotion (producer). [Cited 2009 Nov 6 ].

Keeping “it” a secret!! Dumping the Guilt!! Helping our families

2012-01-17T12:00:00.000-08:00

No parent wants their child labeled, made fun of by peers,or ostracized in any way. But when does“protection” go too far? When is“keeping the secret” more harmful than helpful?

Being an occupational therapist is a commitment to life-longlearning. So in my 35+ years of practiceI had not encountered a child with XXX Syndrome until December 2011. I had to get a handle on what it was,prognosis, treatment and life consequences.

I have chosen this scenario because it was new to me, andperhaps is to my readers as well.

So what is it? It is a chromosomal variation that puts anextra X chromosome in each cell of the human female. It is not inherited and is caused by an errorin cell division in utero. Generallyspeaking, these children are usually within normal IQ but may be lower thantheir genetic siblings, have speech delays and/or poor language skills, andhave delayed motor skills with specific coordination and generalized clumsiness. There are also some slight physicaldifferences but nothing too pronounced that would set them remarkably apartfrom their peers.

So here I am working with a parent who wants “all of thiskept quiet’; not allowed to share with the teachers or the head of school, I amin a therapeutic communication no-man’s land.

During the evaluation, when trying to help the mother feelless anxious, I said “as one parent to another, our children are who they areand what they are we cannot take blame or credit”. At this she promptly replied, “oh but it ismy fault, it was my egg that did not split right, this is all my fault”. Stunned and incredibly saddened all I could do is take her hand.

How many parents are in this situation? How many parents live the with misplacedburden of blame (about their children)? How often do we (as therapists, teachers, etc.) get so caught up helping the child that we miss what isgoing on inside the parent that lives daily with these overwhelmingfeelings?

As parents, and particularly moms, we (myself included) arein charge of “making it right”, “fixing it” and “kissing away the hurts”. When hurts just cannot be made right orkissed away, when the diagnosis is devastating, when the earth starts movingunder their feet, parents become our patients too.

How your chosen professional deals with you and your family is as important asmaking sure that your child is achieving developmental gains.

Sometimes the health situation is something parents cannot “just get over”; it is aseismic life shift that impacts them, their child, and their otherchildren. Below is a list of ideas thatmy be helpful for the family and that can easily be incorporated into OTsessions and/or therapy.

1. Including siblings during some of the therapy sessions

2. Cooking cookies during a session with siblingsand then having a “party/snack” together—letting the child in TX be the“leader”

3. Helping families structure homework or quiettime (if not homework, drawing, reading, etc.)

4. Talk about it, and then talk some more, there isno monster in the closet it is a fact that just is—keeping it natural makes itOK.

5. If needed suggest a support group for theparents/family if there is not one, contact a psychologist or a counselor andwith respecting privacy, ask for resources

6. Former client’s families that have been throughsimilar situations are often a great resource for both information and support.

7. Encourage the parents to share confidentiallywith the school, so that accommodations and modifications can be offered andlearning stresses decreased.

8. Celebrate each other: make a “WOW Board” and each week each personin the family gets to post at least one thing that they are really proud of.

Keep sharing with the family all the wonderful things theirchild can do. Shine “light” onthe achievements. If they haven’t sharedthe child’s issues with grandparents, or a close trusted extended family memberor friend, encourage them to do so. Sharing this information allow the parent to not be alone and createsfor them a caring community of support.

So, shhh no more, and shoo away the guilt—my daughter (now34 years old) wrote a song when she was in 7^th grade; the refrainwas: “Kids don’t come with instructionbooks, and they don’t come with guarantees, I’d like to thank you Mom and Dadfor taking care of me”.

So, remember Mom and Dad, take careof your child and YOURSELF too!!.

Back to School Coping Skills and Frequently Asked Questions

2011-09-14T13:34:00.000-07:00

BACK TO SCHOOL COPING SKILLS

Howto spot academic issues early.

Isyour child is some way “different” from his/her peers and does that differencebother you? If you have a "feeling" seek an assessment or screening by a registered occupational therapist. HOW your child does something can be even MORE important than what they are doing!

Howto request services.

Simplygo into the principal’s office and ask…it is your RIGHT to ask forservices. There is a process, butyou can initiate it.

Whatto ask for and when if you think your child is having concerns.

Youcan ask for a psycho-educational evaluation. In fact parents have a lot of power, it is just that the schools are often not very forthcoming about this.

Keep in mind that reports from the "Student Support Team" are not a legal document. It is basically a "promise" that your child will be given "consideration as to possible needs".

Only an IEP or a 504 Form bind the school to specific actions.

Whatis the difference between and Occupational Therapy Evaluation and PsychologicalEvaluation?

Apsychological gives an IQ score and assess what the child has learned. An OTevaluation looks at the way a child learns: visual/sensory/motor processing.

Handwritingmatters--the answer why it does.

Handwritingis graphic motor skill that uses every sensory/motor pathway in the brain. WSJarticle 2011: “Handwriting Trains the Brain”. The WIN™ Write Incredibly NOW™ Program is sensory based and non-repetitive as so many of the standard programs are. (WIN™ is a registered trademark of Children's Special Services, LLC. The WIN™ Program is available through YourTHERAPYSource.com).

Homeworkstrategies AVOID power struggles

“HomeworkBox” it organizes the “monster” and cleans out the book-bag!~~Ideas from "Learning Re-Enabled" , Elsevier/Mosby Books

Behavior--it'snot just about the kids.

Thinkhow are YOU responding to the ups and downs of your child’s school day? Parents of kids grade 3 andup beware!—relationships turn on a dime—remember to let your kids work things out—coachfrom a distance.

If you feel your child is "not working up to his potential".

Keep in mind that what you see 1-1 when you are working with your child may be VERY different than what he can do in a class of 20+ children. The pressures are different. But if you feel that the teacher is letting your child "slide by" then you may want to think about the following.

Start a "MY BEST" portfolio. In it DO NOT put HOMEWORK or previous class assignments. Put a drawing and/or a poem, a picture that shows a special interest. Let your child work on this over time. Let him (her) know that you want to show the teacher how wonderful they are.

And HIS optimum at school under peer and teacher stress may not be what you see when you are with him at home. But this is the goal he can reach for because it is not a teacher expectation, but something he is already capable of.

Sometimesyou need to talk to the teacher--how to handle that.

Gowith something written down, think this through at home first. Speak slowly andrespectfully, ASK Questions. Do not go in like gang-busters. But if you do not talk to the teacherfirst, the principal will not talk to you unless you do. (State procedures--in most states)

And sometimes the teacher and/or the principal IS NOT RIGHT. Be tactful but clear. (No, his IEP does say...."...."helium and nitrogen do not make a compound"....."You did get a note today. I handed it to you about....."

Report card responses--the child and you.

The Homework Box (see "Learning Re-Enabled") should take the surprises out and preventReport Card Shock. But teachershave email now and you can set up at the start of the year that you want toknow immediately if your child is not keeping up, not turning assignments,etc., RIGHT AWAY!!

Most of all this is a temporary marriage between you, your child and the school so hone your negotiating skills, all of life is always give and take and keep your focus on where you want your child to be at the END of this school year.

©Children'sSpecial Services, LLC 2011 AllRights Reserved May not copy without

Is LIFE stressing your child out??~~Using Media to Quell the Madness

2011-08-27T15:33:00.000-07:00

Trying to get your child up in the morning can be a challenge. Trying to get your health challenged child up in the morning can feel almost impossible. You wake up 5 minutes before her alarm, and brace yourself for another morning of tears, perhaps yelling, and sibling chaos.

It can be so very troubling when your child who you KNOW wants to be sweet and can be faces every school morning with a loss of control.

Here is a tip that I suggested to a family with whom I work and I wanted to share it with you. To do this you will need a video recorder and a private place with just you and your child without the sibling “audience”.

Tips on Making a Wake Up Video: Sally to Sally “The Interview”

Ask Sally to make a video in private with just you and your husband and it could be just her on the screen and it could be her "wake up video". Make it no more than 2-4 minutes in length and let her "write the script" --yelling doesn't feel good for her or anyone else. But when she is calm maybe she could "greet herself" each morning when she gets out of bed Play it on a computer, DVD player, etc. but in her room before she does anything else--

For example it could go something like--

Hi Sally this is Sally

We both know you HATE mornings

And it is your bugaboo time

We both know that you are really mad about being rushed

It makes "us" nervous and we feel like everything is falling around us

We HATE to be rushed

Breathe deeply--com'on let's hear it really deep now!!

Listen and Hear me say 3 wonderful things about you (us) 1._________2.__________3._________(creative, brave, tries hard for example)

Now close your eyes as I count to 10 breathe in and out

Picture something really fun or pretty

Now

Open your eyes and have a great day!!

Before she talks, before she brushes her teeth she gets to tell herself that the chaos is inside her—it is manageable and all that she has to do is all do-able!

It is the time limits and organization that I believe is stressing your child out. Other tips include:

§ Setting out clothes the night before

§ Putting the toothbrush out with the toothpaste

§ Shower/bathe at night

§ Put book bag by the door ready to pick up on the way out

§ Set the cereal out the night before so the breakfast choices are made

§ Make lunch the night before and put it in the refrigerator ready to pack

§ Make a checklist that “Sally” can mark off so she gets reinforcement that she is on “track”.

§ Keep morning instructions to a minimum let the routine “do the talking”.

For help with those “Homework Wars” great pointers can be found in “Learning Re-Enabled” 2^nd Edition (Elsevier Books).

But most of all, remember that this is not at you it is in her—step back, breathe deeply, and you both will feel better!!

Selective Mutism: what does this mean how does this happen?

2011-08-25T09:18:00.000-07:00

Selective mutism affects less than 1% of the preschool/early grade children (Selective Mutism foundation website). Most of the children impacted are female. Although it is hard to diagnose, antidotal reports suggest that the actual numbers are somewhat higher.

This is a psychiatric disorder characterized by a persistent failure to speak in select settings. These children are usually within normal limits academically, and make their needs known by gestures, nodding their head, pointing, or remaining motionless and expressionless while waiting until someone guesses what they want. The condition is usually not obvious until the child begins school, because at home they are talking to parents, grandparents, etc. Importantly, time not speaking is paramount in predicting the success of interventions. By the time school starts, if life without speech has become a “way of life” many of these children find it harder and harder to speak at all outside of specific and distinct situations.

Immediate intervention is crucial. The longer the child is allowed to remain in the non-verbal mode the harder it will be to remediate. The younger the child, the better prognosis for recovery since the time in specific settings without speech is shorter. The impact on school and other social situations is also lessened with early interventions. Some primary research suggests that without treatment the disorder can become irreversible.

In that regard, Dr. E. Steven Summit III an advisory board member of the Selective Mutism Foundation states that he has, “…yet to hear of a case …(preschool onset and persistence past the first few months of school) where the disorder remitted spontaneously, i.e. the child “outgrew it” without treatment.”

Description of the Disorder

Selective Mutism is thought to be an anxiety disorder and published research reports much success has been achieved with the use of medications such as Prozac in combination with other behavioral therapies. The effectiveness of the medication/therapy protocol usually takes 3-6 months to begin to take effect. The success rate in young children (preschool/kindergarten through first grade) is reported to be as high as 80-90%. This rate of remission steadily and considerably decreases, as remediation is delayed.

It is important to note that this is not a language disorder, as children can speak fluently and coherently when they are comfortable and in what they perceive to be anxiety-free situations. Speech disorders are not limited to specific situations (as Selective Mutism is) and are observed globally as the child communicates.

According to the DSM-IV (Diagnostic and Statistical Manual of  Mental Disorders— DSM) the definition of Selective Mutism is: "the persistent failure to speak in specific social situations, (e.g. school, with playmates) where speaking is expected, despite speaking in other situations."

Secondary characteristics may include: excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, excessive crying, compulsive traits, temper tantrums or other controlling or oppositional behaviors (these may be more prevalent at home or in school/social situations).

Occupational Therapy Treatment Protocol

It is also highly recommended that the treatment protocol be inclusive of families, psychologists, teachers, and related social and behavioral interventions. Progress is usually slow and incremental; patience and understanding are needed for children to overcome this disorder.

Occupational Therapy is valuable here to provide the child with multiple sensory-motor experiences that will increase their self-esteem as well as increase their ability to create expanding realms of confidence and competence. Such therapy should incorporate play-based situations where the child can lead and increase achievement levels within task demand situations. Specifically, having the child make and then “speak through” a hand puppet and/or other projective experiences can help with verbalizations.

It is essential to address this condition early as it can interfere with academic, social and/or occupational successes. Therapy should utilize puzzles, board games, sign language, rhymes, music/songs, within both fine and gross motor activities that can facilitate spontaneous responses. Slowly introducing eye contact and alternating between whispers and “funny voices” can allow the child to interact in and at the same time feel emotionally safe.

Other techniques that can be incorporated into an occupational therapy treatment session are:

Teach the child to sub-vocalize and talk themselves through a sequential task
Acknowledge the anxiety (sadness and/or anger) and help the child deal with it*—do not deny it (*you cannot kid a kid!)
Increase physical activities
Increase creative experiences (arts and crafts, music etc.)
Increase positive self-talk (one idea is to make a “Positive Tree” and put leaves on the tree each time a skill is achieved)
Help the child anticipate situations that may be stressful and to role play them in advance
Promote the decrease of “startle” (Moro) reflexive responses and other neuro-sensory-motor responses that persist beyond their developmental age criteria.

Research by Sally Goddard, Director of the Institute of Neuro-Physiological Psychology (author “Reflexes, Learning and Behavior”, Fern Ridge Press, 2005) relates Selective Mutism to primitive neuro-reflexes that should have developmentally self-extinguished but have not. She provides what she calls a “roadmap” of the brain and relates “the inability to speak” to a retained fear paralysis reflex. This is an early reflex that exists in utero. It is eventually transformed into the Moro reflex, but never fully disappears. When we are faced with a sudden shocking situation we may freeze… totally unable to move. (I refer to it as the "frightened deer" reaction. When you come across deer they won’t just run away, they stand there, completely still. It’s not that they are brave … they can’t move. It’s a protective mechanism, because an immobile target is harder to see for a predator.) Also included here in addition to the Moro Reflex, is a sustained symmetrical tonic neck reflex that can posturally place a child so close to the desk (or other writing surface) that no other stimuli can be acknowledged and thus all stimuli becomes “unexpected” eliciting a startle response.

This research has primary implications for treatment within occupational therapy. By facilitating the child to move and react we are increasing her ability to “defrost” from what Goddard refers to as frozen neuro-developmentally delayed responses. She goes on to explain that these children cannot speak because they are in constant overload from ferreting out stimuli that other children readily ignore (i.e., unexpected sounds, movements or situations).

Conclusions

The OTR, by careful application of activity can help these children whose physiological and psychological systems are impeding them from fully participating in the process of growing up. Occupational Therapy teaches the “art” of living, and verbal expression is an essential element of that art.

What Principals Do NOT Want YOU to Know

2011-08-23T19:20:00.000-07:00

This is going to be short, but I really have to share.

With approval from the main office and support of the PTA my neighborhood elementary school was going to let me rent space for ONE hour to have a meeting for parents and professionals. Titled ..."Back to School Coping Skills".

The flyer read.....

BACK to SCHOOL coping skills for parents, teachers, Occupational Therapists, Psychologists, Resources Teachers and related support professionals!!

How to spot academic issues early.
How to request services.
What to ask for and when--
if you think your child is having concerns.
What is an Occupational Therapy Evaluation?
What is psychological how are the 2 different?
AND THE BASICS
Handwriting matters--the answer why it does.
Homework strategies.
Behavior--it's not just about the kids.
Sometimes you need to talk to the teacher--
how to handle that.
Report card responses--the child and you.

And more.................

What this principal took offense to was "the list of topics". To quote, "...I do not want someone in speaking at my school telling parents information that is not approved by the county." In other words parents should not get information that can help them help their children.

I was floored!! Not wanting parents to have information is a contradiction to the Parental Rights each school is obligated to share with any parent who asks, and must be shared at all IEP Meetings.

Of course it is in size "5" font and is in a trifold brochure, and at the moment a parent is handed "their rights" leaves little to no time to read them.

Not all parents have sat on the other "side" of the table like I have, professionally. So when it came time to advocate for my own children I knew what to do. But still I was intimidated. Are these people going to be mean if I push the issues? ETC.

But when I was told to "just trust them" I flipped off the fear and said .."that in 10 years I will not remember their names but in 10 years I will still know my child. So trust aside, let's get to the purpose of this meeting which is to create a happy and successful learner!"

So it is threatening to give this information to families??

Parents, BEFORE you have an IEP, 504 or any meeting with your child's school READ your parental rights in advance. http://www.parentalrights.org is a good place to start, and also look them up for your specific state.

Has protection of educational domain replaced the mission of education? At least it seems at my local elementary school it has.

The law is on the side of the child and the parent--invoking it appears to be at the discretion of the principals, take back the power you were given no one will protect your child like you will.

Cycles of conversation the role of Social Skills Groups with young children

2011-07-14T14:52:00.000-07:00

“Talk to me: Practicing the art of conversation -- what preschool experts call "cycles of conversation" -- is another goal for the year. Taking turns to talk is about a growing sense of respect for others -- an important piece of the school-preparation puzzle. Same goes for asking for permission before taking that red crayon.” (www.brainhealthandpuzzles.com/preschool_brain_development.html)

In the clinic setting I often encounter children who sad to say seem, to have a sense of entitlement. “I see it, I want it, I’ll take it” without regard to who might be using the item or the consequences of what taking the said item might produce.

These kids come from “good homes” and go to “good schools”. What is the issue? Why haven’t they learned the basic concepts of respect for self and others?

It would be too easy to say that indulgence is the answer but it is certainly part of the answer. The other is that we have in many cases allowed for technology to speak to our children more than we do.

Nothing can replace human touch and interaction for teaching. It is important to learn through experimenting what is appropriate and binding and what is coarse and rejecting in our daily interactions. Speaking to our children is primary source of how children learn to speak to others.

And they learn by observing. If one parent is routinely putting another parent “down” verbally, than the child may naturally assume that it is OK to talk to the chastised parent in the same manner. This is often although not always translated into the way and manner that child interacts with other adults such as teacher, caregivers, etc.

On the other hand, allowing the child to “explain himself away” instead of owning his or her behavior is just as detrimental to the development of positive social skills. Teaching a child to accept “no” as answer is a life skill that will stand well in both home and school situations.

When a child sees aggression as power and he sees him or herself as not so powerful, the urge to mimic the bossy behaviors seen in close adults (such as parents) can result in what is seen as aggressive or bullying behaviors in children by teachers etc.

A child learns respect for others by seeing the significant adults in his or her life showing respect for each other. A child learns self-respect by living in a culture of respect and feeling secure in the limits of his immediate world (home and school).

Difficulties seem to arise when there is more than one message being delivered. When children get to be the unwilling shuttle puck in a game of “who is the better parent”? Or “listen to me not __(mom/dad)__”; or any other similar ying yang game that leave the child making the choice of who to listen to and when. These children then go to school and the rules are so confusing that they often unwittingly get into trouble for not following rules they saw as “optional”.

Young children learn respect by what they see. Respecting self comes form respecting others first. Respecting self in young children is manifested by effort in school work, pride in the results, polite responses to not only adults but peers and intuitively understanding that “first’ and “best” are not interchangeable terms.

If a child is getting into repeated trouble in peer situations, favors one parent over another (with the exception of abuse cases), is modeling adult behaviors not appropriate for young children, then clearly this child is in social difficulty. He or she is obviously trying to create behavioral patterns that he sees as working for “__dad/mom__” and is confused as to why it is not working for them.

This goes back to the structure and boundaries discussed earlier. Clearly adults are not children, children are not adults. The differences create different behavioral expectations. It is not a “one size fits all”.

While “do it because I say so” is not the universal best option sometimes it is necessary. At other times negotiations and or expanded explanations are needed. But these explanations are not “owed” they are “offered” to explain a circumstance and it is incumbent upon the child to accept without confrontation these situations especially those with parents and teachers.

So the ART of Conversation is a cycle of give and take, talk and listen, taking turns, respecting others and ultimately maturing into a healthy respect of self.

Finding the best way to be the best parent …is it possible?

2011-04-30T07:04:00.001-07:00

First off let’s start by saying that there is no such thing as the best method, the best protocol, the best book to read on how to be the best parent. Whether or not your child has special needs or not, there just simply isn’t a method that is the one to use.

Every snowflake is different and so is every child. Every family is different too. So those “experts” who espouse to know just how YOU should be doing something as important as raising your child are way off the mark!!

Now that is not to say that there are not real theories and ideas out there about how to handle specific situations—the oppositional child, the one who refuses to eat, the overly shy child, etc. Yes, there are suggestions out there on how to handle these situations, but remember that is what they are suggestions, not dogma. (And I say this as an author of book about special needs children!)

All too often I have seen well meaning parents read a book, go to a lecture or seminar and come back and “swallow the system whole”. They structure their lives around doing the “recipe” totally unaware that there is no tried and true path for raising children.

However there are a few things that can help:

Start with common sense
What you do has to fit in with your family and ALL the family members
Mom and Dad MUST be on the same page and be a team together
Do not try to be your child’s friend—you are the parent
Parent is both a noun and a verb
Your real job is to become obsolete—not needed—eventually
Children only really need three things:

Love
Structure/security
Boundaries

There are a lot of “cookbooks” out there. The advice overflow can be confusing and overwhelming. Starting the with gold standard of Dr. Spock, all of them promise that if you follow their method you will have the happiest, most well behaved, adjusted children ever.

If it were only that easy, first there would be only ONE book everyone used, and second it would imply that we are all the same. But, alas we are not all the same and the plethora of books substantiates that.

What does happen when parents “marry” a system is that is stymies the parents’ creativity. If “Jimmy” is acting out and he is not stopped because the “book” says to let him “figure it out” that may work at home, but at school when the teacher says “stop” she means “stop and now”. Not used to that “Jimmy” can be unjustly labeled a “trouble-maker” when in truth he is only doing what is acceptable at home.

If you “Google” parenting you come up with 1,000+ entries and if you try “best parenting” you get even more!

When my daughter, now 36, was graduating high school she wrote a song who’s opening lines were….”Kids don’t come with instruction books and they don’t come with guarantees, I’d like to thank you Mom and Dad for taking care of me…”

I saw a greeting card recently that listed the “Top 10 Reasons” someone was the ‘best parent and #1 was “ You Love Me”. Forget about being embarrassing, you will be; being “hated”, absolutely but only temporarily; not being “cool”, hardly ever and the list goes on.

Don’t be afraid to parent your child. Your child wants you to be the parent. They have peers at school. They need you to be the steady force that guides them—reliable, constant and loving.

Saying no is part of the program—boundaries are everywhere and they might as well learn that starting at home. We live with red lights, schedules to meet, and behavioral constraints. Children need to learn that boundaries can also be guiding and protective.

Letting a child learn from “natural consequences” may be OK some of the time, but left solely to a world of “consequences” without limitations other than those self-imposed can lead to chaos and confusion.

Because something “worked” at your friend’s home with “Jill” does not mean it will work with your “John”. Because something looks good in a book, does not mean it will work in your home. Because the video at the seminar was motivating, does not mean that you can reproduce that within your family.

Use COMMON SENSE, and just provide love, security, structure, boundaries and patience—for both you and your child.

Feeding Issues and Sensory-Motor and Emotional Development

2011-03-19T12:24:00.001-07:00

Tommy is 4-years old and he won’t eat. He can eat. He can swallow. He can chew. He just refuses. It is difficult at home during mealtimes, and it is impossible to go to restaurants.

Sound familiar? If it does, read on.

Children with feeding issues often present with a complex array of issues that impact the entire developmental scheme. It involves physical, emotional, sensory, social and cognitive skills.

In many cases, by the time the child enters therapy, the problem has been on going for many years. Therapy often requires an intensive multi-disciplinary approach in order to accomplish long-term goals and long lasting changes.

Before treatment begins with occupational and speech therapists, it is essential to rule out any associated medical problems such as reflux, slow stomach emptying, constipation, respiratory or cardiac issues, etc.

Left untreated feeding issues can have far reaching impacts on the child well into adulthood, giving rise to physical, mental and behavioral concerns.

Eating is basically a suck-swallow-breathe pattern that is repeated over and over. Most children learn this automatically, but for some it must be taught. For this a speech therapist is often engaged to treat this along with any other oral motor associated concerns.

Behavioral issues with feeding are sometimes referred to as “conditioned dysphagia”. Conditioned dysphagia is a learned disorder that holds onto a “habit” long after the physiological need for such a behavior has ceased to be needed.

All feeding programs should have as its primary and most important goal nutrition.

Justine Joan Sheppard, SLP from Columbia University suggests that mealtime be the place to present the child with foods that they are already successful with instead of unfamiliar new experiences. However Heather K. Adams, in an article from the North Dakota Newspaper suggests a compromise. Have the child’s preferred foods, but then have a “tasting spot” at the table with new foods. The child can then try small tastes, does not have to have them on his/her plate but has had the opportunity to sample something new. The child should not be pressured, and should be allowed to reject a food after a small taste has been made.

The Kennedy Kreiger Institute has a program for children with food aversions that focus on weight gain, food by mouth intake, mealtime appropriate behaviors and self-feeding abilities. Their multi-disciplinary program is part of a continual assessment and re-assessment of measurable goals that both the child and the family can work on together.

Irene Chatoor of the Children’s National Medical Center specifically notes these issues as “Sensory Food Aversions”. She states that children have aversions to particular tastes, smells, textures, and temperatures of foods. She goes on to state that these children often have other sensory issues as well.

There is a difference between “picky eaters” and children with real food aversions. In an article by Dovey, Staples, Halford and Gibson (2007), “picky eaters” are defined as children who “consume an inadequate variety of foods through rejection of substantial amounts of foods that are familiar (and/or unfamiliar) to them. “Food neophobia” on the other hand is the avoidance of new foods. While the “picky eater” and the “food neophobic” are related, but have theoretical and behavioral differences. These authors saw that “Food Neophobia” was part of picky/fussy eating but without many of the associated behaviors.

Within these (above) categories are the “selective eater” who will only eat certain foods, and the “choosy eaters” who generally show a disinterest in eating. Sensory food aversions generally appear about age three when children are being transitioned to self-feeding. At this age children are expected to become more autonomous and less dependent. This transition for some children maybe more traumatic and therefore food issues sometimes arise.

In order to successfully address these concerns it is imperative to distinguish between children with minor food aversions and those with more serious concerns where their reluctance to eat can evolve into serious eating problems.

Treatment generally follows a basic three-step system:

Acquisition—the child learns a new behavior relating to food i.e., chewing, orienting to food, etc.
Fluency –the child practices the behavior to become faster at it and for it to be automatic
Generalization—the child utilizes the learned behavior with different items in different settings.

Imbedded into these steps is the reinforcement of appropriate mealtime behaviors and the extinguishing of non-appropriate ones. This can include a reward system where an activity is offered that the child would not have access to otherwise, etc.

§ So if your child only eats burgers and pizza, try some of these suggestions:**
Introduce a grilled cheese sandwich

§ Let them use their fingers—try introducing edamame!! (full of protein!)

§ If texture is a problem puree foods to start and slowly increase the consistency

§ Use toast as it has texture and cannot easily be lost as a bolus in their mouths

§ Use dips—toast into tomato soup for example

§ Disguise protein as a dip—put it in familiar sauces and mix it in your food processor

§ Tempt them with foods they love and let them know that you want a meal the whole family can love

§ Serve veggies with ketchup—green beans can become “green fries” with ketchup

§ Teach fine motor skills with “chop sticks” using pealed carrot sticks instead of the wooden ones—if they bite down they get some nourishment instead of splinters!!

§ Gross-em-OUT—works great for some little boys—one mother reports that her son wouldn’t eat beans until she told him they made him fart!!

§ Create a “Tasting Spot” with the rule that the picky eater has to at least try a little; if they like it they can finish it, if not they can leave it.

**from various Internet sources

And remember

§ DO NOT get into power plays this is NOT about the caregiver it is about Nutrition

§ Children use food in many cases as a stress “reactor” so adding stress is counter-productive

§ Food aversions are often associated with co-existing diagnoses such as Autism, Depression, reactions to life situations, etc.

§ The goal of diet therapy is to gradually increase in-take

§ Progress is slow

§ There are often set backs

§ Eating is a major social event –it is “family time” and not being able to participate may impact the child’s self-esteem

Occupational therapy with its extensive training and research into the area of sensory integration, and speech therapy with its focus on oral motor development are ideal interventions to help the child address these sensory concerns as well as helping the family construct a positive home program.

And lastly, avoid labeling. If asked, simply respond “Tommy is not eating now, but he is trying and we are working on it with him.” Things are so much easier when done with an understanding friend. And a child’s best friend is often found in the family.

Susan N. Schriber Orloff, OTR/L, is the author of the book Learning RE-Enabled, a guide for parents, teachers, and therapists (and a National Education Association featured book), and the Handwriting on the Wall Program. Children's Special Services, LLC is the exclusive provider of P.O.P.tm Personal Options and Preferences, tm social skills programs. She was the 2006 Georgia OT of the Year and the CEO/executive director of Children’s Special Services, LLC, which provides occupational therapy services for children with developmental and learning delays in Atlanta. She can be reached through her Web site at www.childrens-services.com or at susanorloff@childrens-services.com.

Sensory Interventions with the Autistic Child

2011-03-03T18:09:00.000-08:00

Many of the characteristics of a child with autism also mirror those of a child with sensory processing disorder. Autism as a sensory issue is very tricky, so many things over lap and intertwine. The classic indicators seem to almost be the same. However, it is important to differentiate between the two. The following lists help to illustrate the similarities and the differences between the two conditions.

Sensory Integrative issues may be characterized by:*

1. Either be in constant motion or fatigue easily or go back and forth between the two.

2. Withdraws when being touched.

3. Refuse to eat certain foods because of how the foods feel when chewed.

4. Be oversensitive to odors.

5. Be hypersensitive to certain fabrics and only wear clothes that are soft or those they find pleasing.

6. Dislikes getting his or her hands dirty.

7. Is uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator.

8. Have difficulty calming him or her after exercise or after becoming upset.

9. Jumps, swings, spins excessively.

10. Appears clumsy, trips easily, poor balance; odd posture

11. Social skill issues/authority issues.

12. Tantrums

13. Overly sensitive to criticism

14. Either always on the go or very sedentary

15. Memory difficulties and/or problems following directions

16. Has difficulty with buttons or snaps.

17. Is overly sensitive to sound. Vacuum cleaners, lawn mowers, leaf blowers, or sirens, etc.

Lacks creativity/variety in play; plays with the same toys in the same manner over and over etc.

While Autism and or PDD issues may be characterized by:

1. Insistence on sameness; resistance to change

2. Difficulty in expressing needs; uses gestures or pointing instead of words

3. Repeating words or phrases in place of normal, responsive language

4. Laughing, crying, showing distress for reasons not apparent to others

5. Prefers to be alone; aloof manner

6. Tantrums

7. Difficulty interacting with others

8. May not want to cuddle or be cuddled

9. Little or no eye contact

10. Unresponsive to normal teaching methods

11. Sustained odd play

12. Spins objects

13. Inappropriate attachments to objects

14. Apparent over-sensitivity or under-sensitivity to pain

15. No fear of danger

16. Noticeable physical over-activity or extreme under-activity

17. Uneven gross/fine motor skills

Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

(*complied from various sources)

Not every child on the spectrum will exhibit all of these issues. However there will be areas of relatedness and it is in these similarities an understanding of unique interventions can be found.

For example let’s look at “Patrick”:

Five-year old Patrick is always on the 'go'. His teachers do not know what to do about him. He has few friends and those he makes he cannot keep. He cannot sit in circle time. Lining up to go out to recess is unpredictable. And even worse, he talks about not liking himself and how he hates everyone and "everyone" hates him.

He has his favorite toys and his favorite clothes and that is what he plays with and wears, with little to no deviation.

School is a challenge. He seems to either escalate or get so lethargic that he cannot move. He seems unable to “reset” himself, he stays “on guard” and anxious. He does not like to go to PE or to lunch because he says that the other kids "pick on him and hit him”. On the playground he plays mainly with girls, and the boys seem to ignore him. When he runs he does so with abandon bumping into people and things and barely noticing. His gait is awkward and when he runs his arms are up and sometimes he runs on his tip toes. He does not seem to respond to facial expressions or to be able to register empathy for others. He complains that things "hurt" him even when there is no evidence of that.

Making eye contact and following a slow moving object is impossible for him without accompanied very cues. Hyper sensitive to smells, he complains about odors in art class, the lunchroom and on the school bus.

Recall of academic information is difficult and varied repetition seems to be the best learning path at this time.

Easily upset and emotionally labile, he seems uncomfortable in his own "skin".

Children on the spectrum often have pronounced sensory issues. To understand Johnny’s primary areas of concern, how therapy helps, and what can parents do at home, please refer to the following chart.

Presenting Issue	Behavioral Manifestation	Sensory Processing Concern	Treatment Approach*	Anticipated Outcomes
Auditory Concerns: Easily startled by unexpected noises Easily Distracted	Screams and yells and has temper tantrums	Not hearing sounds with auditory figure ground discrimination or with sound/activity relationships Attention floats and does not stay on topic	The Listening Program ™ Games that incorporate unexpected noises with the “warnings” of noises decreasing as tolerance increases	Increased noise tolerance Increase attention to task with diminishing supports
Visual Concerns: Does not seem to see objects in his immediate visual field	Bumps into people and things and falls a lot	Visual figure ground and visual constancy issues Does not use visual motor ideation to plan movements	Obstacle courses Use of weight appropriate free weights during gross motor games to increase sense of body in space	Increased motor planning in familiar situations—translating this into less familiar tasks as tolerated
Movement: Always on the go Takes risks during play Seeks movement	Does not know how to slow self down and he just builds momentum until outside forces slow him (teacher, etc.)	Perseverative quality to his movements Skewed motor planning Depressed vestibular processing	Quick change activities where increasingly the sequence or order of things changes and he has to make movement, planning and/or postural adjustments	Slow it down! Have the child make a “plan” keep it to a maximum of 4 things—1^st do____ 2^nd , 3^rd and 4^th ___ stick to the plan and make choices for the next time
Tactile: Habituates wearing the same clothes Expresses discomfort when touched Demonstrates exaggerated responses to touch	Tantrums if “right” clothes not available Will not try to put on anything new even if pre-washed Gets into fights when he is trying to make friends	Tactile defensive behaviors This causes adverse emotional reactions both in school and home	Timed trials for adjusting to new fabrics: i.e. “you only have to wear this for 3 minutes” or only while you are brushing your teeth and increase time tolerances Provide “expected” unexpected touch and rate with child the reactions	Increased ability to tolerate new fabrics and to try new pieces of clothing Modulated reactions to touch
Olfactory/taste: Smell in lunchroom, art class, etc. are noxious to him	Nutrition issues and he becomes lethargic in the afternoons due to lack of food and this impacts his school work	Textures in mouth may be a negative trigger and over-sensitivity to smell is operating here	Make a dinner “Tapas” bar where he gets to eat whatever he usually chooses but must also take a taste and intentionally smell a new food	Increase repertoire of tolerated foods Will eat in the lunchroom with support—first place him near the door and then slowly move him into the room
Emotional: Easily upset Difficult for him to self-regulate Labile mood swings Few friends Hard for him to enter into group play Uncomfortable with who he is	Unpredictable behaviors make it hard to anticipate his needs Peers see him as “weird” so he is often not asked to play and when he asks he is often rejected Isolated from others in classroom group time due to behaviors	Almost absent self-regulation skills Chaotic responses not always fitting the circumstance Social isolation Organizational deficits	Make a game together where he is in charge of making the rules (but you are in charge of making it reasonable) and “rig” it so (gently) he is not always “winning”. Warn him of this in advance and talk about reactions and choices make a “reaction box”©***	Use gross motor games to create simulated social and motor planning actions and activities and get him into a new comfort zone!

*Treatment Approaches are suggested ones there are many ways to address these issues

**The Listening Program ™--available commercially

***The “reaction box”—exclusive to Children's Special Services, LLC Get a heavy cardboard man’s shoe box; decorate it with paint, contact paper, etc. put in it on separate slips of paper good behavior choices ONLY. When he is upset let him pound on the box for a while and then he picks a choice out of the box and you help him achieve that “choice”.

So what do you treat first? Everything! That is Occupational Therapy, changing the context in which one lives so that life can be lived with greater ease.

Quirky Kids: Sensory Driven--what makes the TICK what makes them TICKED

2011-03-01T09:43:00.000-08:00

The story of two children:

Johnny:

Five-year old Johnny is a mess. His teachers float between anger and frustration about him. He has few friends and those he makes he cannot keep. His parents walk on eggshells around him never knowing how he will react in a given situation. And even worse, he talks about not liking himself and how he hates “everyone”.

In school he can be great, but then the fire alarm can go off and he is a “lost cause” for the rest of the day. Unable to “reset” himself, he stays “on guard” and anxious. He does not like to stand in line to go to lunch because he says that the other kids “hit him”. On the playground he is a “wild-man” running with abandon bumping into people and things and barely noticing. His gait is awkward and he cannot reasonably participate in team sports. He habituates wearing the same clothes so Mom has several of the same outfits ready for him each day. He does not eat in school because the smells in the lunchroom “make him sick”.

Brent:

Brent is 6 years old. He is smart, both his parents and his teachers agree on that. At home he is interactive and plays well with his older brother Max aged 8. Mostly he plays with Max’s friends and they generally include him.

At school the children are friendly to him, but he rarely gets invited for play dates, and during recess he seems to be a loner or randomly hangs with the same 1-2 classmates.

While he is not the athletic “star” he is not the worst either, but he is at the lower end of physical performances. Academically bright, he nonetheless is very forgetful and turning in homework is a problem.

He insists on wearing long sleeves even in the summer and will not go into the water at the beach without a full body suit or at minimum a long sleeve t-shirt.

Although congenial and generally obedient, he does seem to be always in a “fog” needing guidance and redirection.

What is going on with these children? Are they lazy? Defiant? Uncaring? The answer is most probably an unequivocal NO.

Both Brent and Johnny are having processing issues. Obviously Johnny is much more overtly involved than Brent, but both are displaying developmental “red flags”.

Taking a sensory processing view of these behaviors, several issues come clear. Breaking observed behaviors into auditory, visual, tactile, movement, body awareness (muscle/bone/joint), olfactory/taste, and emotional categories it is easy to see the patterns of a skewed sensory processing impacting all of the above areas.

Johnny needs sensory “calming” while Brent needs sensory stimulation. Both are having sensory processing issues but at opposite extremes. Johnny needs to learn how to slow it down, and Brent needs to learn how to be more fluid.

Brent needs to learn to be more assertive and to learn to try new things. Johnny needs to learn how to be more discriminating and make better activity and behavioral choices. Brent is probably harder to identify than the “squeaky wheel” Johnny. But clearly they both need help developing skill sets that are more in line with their life demands.

So how do we know when to seek outside help, and when to not? Although there are many developmental checklists online, I caution readers to use them sparingly and in conjunction with input from an occupational therapist or other related professional. One concern does not make an “issue”. However, there are some questions you can ask yourself as a guide to whether or not you should look deeper.

You may want to ask:

Does your child_____________

§ Seem to need more “protection” than other children

§ Excessively fidgets or appears “on the go” most of the time

§ Seem to be unusually forgetful

§ School is a struggle

§ Refuse certain foods

§ Reject certain textures in clothing and/or habituates wearing the same clothes over and over

§ Motor skills are intimidating

§ Resist combing his hair/getting it cut

§ Seem to have “weak” muscles; tires easily

§ Has a difficult time calming down when upset

§ Has difficulty accepting criticisms

§ Social issues dominate school concerns

§ Doesn’t want to go to school

§ Depression* (*anger, “show off,” hypochondria, bossy behaviors, to name a few)

If your “quirky” kid has a reasonable number of friends, gets good grades, is generally an easy member of the family, has age-appropriate interests, is able to transition and go with flow, etc., then just love his quirks.

If however, any of the above-mentioned items are a concern to you, then I suggest you

consider consulting a developmental pediatrician. They usually provide a lot of much needed answers. It is important to note that there is a huge difference between a developmental pediatrician and a general pediatrician. The one most families go to is trained to look at developmental milestones, wellness and the absence of illness. The developmental pediatrician looks at neurological, emotional, physical and motor/cognitive development. They look at the “nitty-gritty” of development and can discern if there are ambiguities that need to be addressed. They are one-stop shopping in the discovery process of how and why your child is performing the way he/she is.

To quote Mel Levine, MD author of “One Mind at a Time”; “Children do not outgrow anything but their clothes.” So do not wait for your child to “grow out of it” or to “mature”. Specific issues evolve but they do not go away, and research clearly supports the benefits of early intervention.

Bullies and the Bullied

2011-02-24T20:39:00.001-08:00

What about the Bully? The OT’s role in facilitating a sense of self—

So much has been written about the impact that being bullied has on children, but what about the bully?

No doubt that bullying is a huge issue. The National Association of School Psychologists report that about one in seven school children (about 5 million children) have either been a bully or has been bullied! The report goes on to state …“children who experience persistent bullying may become depressed or fearful. They may even loose interest in going to school or other activities.”

Adults rush to the aid of the child being bullied and punish the child doing the bullying.

At first glace this seems right, but is it? Particularly when it comes to children, shouldn’t both children –the bully and bullied—be helped?

David Nelson and Clyde Robinson of BYU in an article from the Journal of Early Education and Development conducted a study linking relational aggression and social status in preschoolers. Previously thought to be a condition seen primarily in adolescents, relational aggression, meanness, bullying, etc. is now being observed in very young children. Between 17 and 20 percent of preschool girls, according to Nelson and Robinson, display such behaviors with the numbers being less with boys.

What is bullying all about? It is about POWER.

Someone having to make someone else less so they can feel bigger.

So if someone needs to make others smaller, what are they really feeling themselves? And what are some crucial issues that should be noted in formulating an effective program for helping both the perpetrator and the victim?

Some important factors to note are:

Non-physical bullies should be confronted
Girls are often more verbally abusive than boys (with boys being more phsycial)
Bullying has long term negative repercussions
Girls as young as 3 or 4 years of age have mastered manipulation and peer pressure to get what they want
There are many “warning signs” of children who may become bullies:

§ Temper and mood swings

§ Loner

§ Poor socialization skills

§ Tend to single out children who appear passive, anxious, sensitive, quiet or stand out in some way

§ Poor school performances

Bullying is an aggressive behavior.
Teasing is a form of bullying—there is not such thing as “just in fun”
Bullied children are more likely to suffer depression, use drugs and alcohol
Bullying is more than “kids being kids”
Classroom activities that let the children “perform as usual” and then having the teacher and/or facilitator confront and point out the positive and negative behaviors (sometimes through role-playing or puppet shows, etc.) is an excellent way to help the children recognize and then practice alternative response patterns.
When organizing groups, do not allow children to choose their “partners” or groups, let them be assigned at random and/or with protagonists and antagonists combined.
Teachers, facilitators, etc., need to be very observant as to the body language of the children in the various groups. (It will be easy to detect who is comfortable, and who is not.)
A carefully orchestrated peer review of behaviors allows for the whole class to decide on what is acceptable behaviors and what is not.

The following happened as I was conducting a P.O.P.™ Social Skills Program (Personal Options and Preferences™ a registered trademark program of Children's Special Services, LLC) the following happened—

Matty* is a six-year old boy who is large for his age. His parents come from the near East, and he “looks different” from his more “American” classmates. Although born here, he has not transitioned well from his small nurturing preschool setting to the larger arena of Kindergarten at the neighborhood elementary school.

During the first session Matty was busy telling everyone where to sit, when to listen and was the self-appointed “watchman” ready to tell the OT or the teacher when someone was not following directions. He clearly had a problem with personal space, often getting in someone’s face to talk to them, etc. He also was ready to take offense if anyone said anything to him, even asking if they were asking him to stop what he was doing. His reaction was to hit and/or (or both) talk sharply and point out something negative about the other child.

These behaviors led to hurt feelings and the OTR having to talk to Matty away from the group to talk about behavior that hurts others. This did not help.

Later on during the program (of several sessions), Matty confided that “no one likes him”, “everyone says he is dumb” and “he has no friends”. Clearly Matty lives in a “strike or be struck” mode of action and reaction. And as much as we needed to be mindful of the feelings of all the group members (8 children), there was a marked shift in the group from “he thinks he’s better than us” to “poor Matty” and this opened for both Matty and the group, discussions about how all of us have felt dumb and unaccepted at various times. The group helped make of list of what to do and it wasn’t just for Matty, but with him, and everyone was benefiting.

*Matty not his real name

So while we are teaching the art of daily living, and social skills is an art, occupational therapists need to keep in mind that treating the group can be as powerful as treating the individual, and often when it comes to re-channeling bullying behavior that may be the most effective route.

When formulating a social skills group occupational therapists should consider the following topics to be discussed:

Teaching of self-respect
Expression of anger or dissatisfaction—blowing off steam appropriately can be a life ling skill
Stress the importance of body language
Encourage friendships
Teach children to express themselves clearly, yet diplomatically
Judge when and when not to assert themselves
Teach humor as a way to deflect a verbal “attack” (examples: teasing, swearing, put downs, gossiping, twisting your words around, judging gone unfairly, passing blame, bossing, embarrassing one in front of others, making someone cry, confusing you on purpose, etc.)
Avoid bullies whenever possible—suggest ways to do this
Do NOT be ashamed to ask for help
Help the bully feel successful for who he/she is
Have the bully “walk in the other child’s shoes” (role playing)
Make it clear to all that bullying will not be tolerated and has negative consequences for ALL

Former President Teddy Roosevelt’s favorite expression was “Bully” which he used for noting his approval. Maybe that is what today’s bullies are lacking—approval, self-esteem and a strong healthy sense of self.

For additional reading “Taking the Bully By the Horns” is a children’s book by Kathy Noll (available from the author directly $12.95 plus $2 S/H to Kathy Noll 3300 Chestnut Street, Reading PA 19605).

And one last thought:

"Keep away from people who try to belittle your

ambitions. Small people always do that, but the

really great make you feel that you, too, can

become great."

Mark Twain

Susan N. Schriber Orloff, OTR/L, is the author of Learning Re-enabled, a guide for parents, teachers and therapists. The book is featured by the National Education Association. She also writes “Ask the Therapist,” a column in Exceptional Parent magazine, and is CEO and executive director of Children’s Special Services, LLC, an occupational therapy service for children with developmental and learning delays in Atlanta, GA. WIN™ Write Incredibly NOW™ is a US Trademarked handwriting program for children pre-K through teen. She can be reached on the Web at www.childrens-services.com or at sorloffotr@aol.com.

Therapy "vacations" are generally NOT a good idea

2010-12-24T14:33:00.000-08:00

As this is time off time, I want you all to think about yourself and medication.

Would you take time off from blood pressure medication just because you have time off of work?

Would you stop a specialized diet for diabetes just because this time of year there are too many goodies to resist?

If you are logical, the answer would be "of course not"!

Well the same goes for your child.

A sensory skewed child, one with learning challenges, behavior issues, may find that time out from school is the IDEAL time to have therapy. No homework to compete with, no after school programs, no tutoring to go to--just a down time with a purpose.

An extended therapy time may be just the thing for your child to stay on track and be on track when school starts back up again. I am not saying everyday, but 1-2 times during the vacation can be an ideal time to address sensitive areas of competence at a stress-free time.

For those children with social issues, you might ask if they could bring a friend to work on a project in OT together, getting in fine motor, task design and social skills!!

Instead of therapy being something to take a vacation from, think of OT during vacations as something to enhance and enrich the time off!!

Should a teacher diagnose your child!!---NO!!

2010-12-24T14:23:00.001-08:00

Too often I hear that “…Tommy’s 2^nd grade teacher told me he has ADD so I went to the pediatrician and he prescribed_______”….. HOLD the phone!!~

Stop the presses!!! Freeze and do not defrost!!

Teachers cannot diagnose!! And too many are taking the “squirmy kid” and giving him or her a label!

And shame on the pediatrician who goes on the teachers’ say so!

ADD can be seen on a PET or MRI of the brain. It can also be diagnosed through comparative checklists filled out by parents, teachers, and others who interact with the child. These checklists are them interpreted by a developmental pediatrician or and psychologist. NOT a TEACHER.

I have nothing against teachers; I was one years ago before becoming an OTR. But nothing I learned in a top 25-education college ever taught me about brain function. And ADD/ADHD is a disregulation of brain functional capacities. It can be treated both chemically and with occupational therapy teaching the child strategies for coping and self-calming, etc.

So before you head down that path think about where the information comes from. ADD/ADHD can look like an attention problem when it is really a sensory integration issue. Sensory information not processed correctly can throw off a child’s ability to know where their body is in space (so the wander), make touch uncomfortable (squirmy in their clothes), or make reactions to sound extreme, to mention only a few of the issues that may present in the “inattentive child”.

Sensory issues can present as under-reactive (low affect, slow to respond, sluggish child), over-reactive (highly emotional, always on the go, poor adaptability to changes, etc.) or that it looks like ADD but is not.

And then there is the sensory seeking child. Ants in the pants, always touching, cannot keep his/her hands off of anything, has no fear, and is moving too fast to easily respond and or react to verbal directions. They need lots of repetition to learn new tasks. NOT because they are not paying attention, but because their mind is moving like a firefly and cannot land long enough in a “comfort zone” to relax to learn.

These children generally do not respond to medication. So the “give him a pill” knee jerk of too many unqualified individuals is often to the detriment of the child.

So before you walk that path, talk to a pediatric occupational therapist for a full evaluation, a developmental pediatrician and interface that with information from the teacher. It really does take a “village” to diagnose a child properly.

LD Made Easy: Sensory Assessments As Part of a Unified Early Lea...

2010-11-12T13:26:00.000-08:00

LD Made Easy: Sensory Assessments As Part of a Unified Early Lea...: "School based screenings for young children are common, but what do they test, and are they enough? They are usually generalized for fine a..."

Autism/PDD or a Sensory Issue: suggestions for making a clinical decision

2010-11-11T20:37:00.001-08:00

Autism as a sensory issue is very tricky, so many things over lap and intertwine. The classic indicators seem to almost be the same.

In fact, I really hold to the opinion, that the two diagnoses are irrevocably meshed.

Having said that , however, there nonetheless remains a need to differentiate between these two distinct issues.

The two lists offered here are to help illustrate just how careful we need to be in suggesting parents further investigate clinically observed behaviors. I also suggest that clinicians use these lists as informal checklists as part of their parent in-take process or in the course of therapy as needed. I advise making this into one list but keeping the items separated, and then note which items from the two categories are most noted.

The suggested items* for each issue is listed below: (*complied from various sources)

Sensory Integrative issues may be characterized by:

1. Either be in constant motion or fatigue easily or go back and forth between the two.

2. Withdraw when being touched.

3. Refuse to eat certain foods because of how the foods feel when chewed.

4. Be oversensitive to odors.

5. Be hypersensitive to certain fabrics and only wear clothes that are soft or those they find pleasing.

6. Dislike getting his or her hands dirty.

7. Be uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator.

8. Have difficulty calming him or her after exercise or after becoming upset.

9. Jump, swing, and spin excessively.

10. Appear clumsy, trip easily, or have poor balance; odd posture

11. Social skill issues/authority issues.

12. Tantrums

13. Overly sensitive to criticism

14. Either always on the go or very sedentary

15. Memory difficulties and/or problems following directions

16. Have difficulty handling small objects such as buttons or snaps.

17. Be overly sensitive to sound. Vacuum cleaners, lawn mowers, hair dryers, leaf blowers, or sirens may upset your child.

Lack creativity and variety in play. For instance, your child may play with the same toys in the same manner over and over or prefer only to watch TV or videos.

While Autism and or PDD issues may be characterized by:

1. Insistence on sameness; resistance to change

2. Difficulty in expressing needs; uses gestures or pointing instead of words

3. Repeating words or phrases in place of normal, responsive language

4. Laughing, crying, showing distress for reasons not apparent to others

5. Prefers to be alone; aloof manner

6. Tantrums

7. Difficulty in mixing with others

8. May not want to cuddle or be cuddled

9. Little or no eye contact

10. Unresponsive to normal teaching methods

11. Sustained odd play

12. Spins objects

13. Inappropriate attachments to objects

14. Apparent over-sensitivity or under-sensitivity to pain

15. No real fears of danger

16. Noticeable physical over-activity or extreme under-activity

17. Uneven gross/fine motor skills

Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

And, as illustrated here, it is easy to see, especially in very young child (ages 2-6) how these behaviors can be dismissed as “they’re young, they’ll grow out of it.” And making broad statements, suggestions of referrals to other sources, etc., may be very frightening to parents, especially if they have been trying to tell themselves that the nagging feelings they have been experiencing is due to being an “over-protective mother”.

A psychologist who refers to my practice once counseled me about informing parents of issues with their children. She said, “…the first person to tell them gets shot, the second shoved and the third gets listened to. Try to be number 3.”

In our position as occupational therapists, we are often put in the role of being “number one”. Being the resource person in the schools, the first referral source of pediatrician, the person known in the community for what we do, etc. puts us in the precarious position of saying first to a parent, “there is something that needs to be investigated”. I hope that the use of these lists when converted into a check- list will help guide both our families and us in the quest to provide empathic quality care.

Susan N. Schriber Orloff, OTR/L is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA. She can be reached through her website at www.childrens-services.com or at sorloffotr@aol.com.

Doodling..is GOOD for your Brain!!

2010-11-11T19:24:00.000-08:00

Doodling: bane to teachers—a boost to the brain

I went to “teacher school”; even was one for a while. And I have to say unequivocally that there was no information about how a child learns—just what they should learn.

I guess that is why I became an occupational therapist. I needed to know what was going on “inside” not just the outside—looks as they say, can be deceiving.

And so it is the case of “doodlers”. Admonished for “not paying attention” they are often made to feel belittled and self-conscious about something they really do on “auto-pilot”.

Recent research has shown that doodling actually helps learning!! The child may not look like he or she is paying attention but science says otherwise. In findings published in Applied Cognitive Psychology (2009) test subjects who doodled while listening to recorded messages had a 29% better recall than those who didn’t.

The article goes no to state that, "If someone is doing a boring task, like listening to a dull telephone conversation, they may start to daydream," study researcher Professor Jackie Andrade, of the School of Psychology at the University of Plymouth, said in a news release issued by the journal's publisher. "Daydreaming distracts them from the task, resulting in poorer performance. A simple task, like doodling, may be sufficient to stop daydreaming without affecting performance on the main task."

Various articles on associative memory contend that doodling can boost retention up to 50% for immediate recall. In other articles there is information that doodling actually helps the learner “opt-IN” to discussions by enhancing recall invigorating multiple neural pathways.

Science is giving a new slant on doodlers, fidgeters, and, Heaven forbid—whisperers!! Reprimands from teachers (and even bosses) may soon be a thing of shame to them NOT to the “culprit”. “Pay attention”, “Are you listening, I will not repeat myself” and “Am I bothering you?” and similar phrases are more than inappropriate, demeaning and harsh—they scientifically wrong.

TIME Magazine (Feb. 2009) states a study that defines the benefits of doodling very simply. It prevents daydreaming. Daydreaming tends to trigger the brain to recruit other networks that shift your attention to other things so you cannot focus on the tasks at hand. Doodling does just the opposite; it keeps the motor running so the brain can focus. And historically we have had some rather impressive doodlers: Winston Churchill, John F. Kennedy, Franklin D Roosevelt, John Keats and Bill Gates to name a few.

Other studies support that doodlers tend to be more organized than their non-doodler counterparts. Doodling, it is reported, actually helps clear the mind by relieving stress and aiding in relaxation. So what is the problem? Obviously with the people that doodling seems to upset. (Teachers??) “Paying attention” in class usually means sitting up straight, feet on the floor, not touching anyone else and eyes on your work or the teacher.

Research has a different slant on doodling. Similar to the analysis of dreams, the inspection of doodles can actually create a better understanding of how a mind works. It is the connection between the conscious and unconscious and that is where we learn. Rather than a distraction, doodling can assist in triggering many major routes for us to store information into long-term memory.

Margaret Livingstone, a Harvard University neurophysiologist writes in her book, “Vision and Art: the Biology of Seeing” that art is a “spin-off” of our brains visual system and this connection cues neurons. Not only does it help us pay attention, it also helps our mind wander into unimagined areas stimulating associative thinking aiding in symbolic expression.

What is known about doodling is that it increases arousal in the brain and forces it to use up just enough energy to STOP it from daydreaming. Doodling seems to stimulate the right side of the brain that mediates visualizations (reading and writing) leaving the left side (information gathering) to relax and absorb information more readily. Both sides together allow the person to synthesize the total concept being presented.

Encouraging doodling may be a route to increasing attention in class. Wouldn’t it be amazing if “Increase doodling while listening” became an IEP goal?

Susan N. Schriber Orloff, OTR/L, is the author of Learning Re-enabled, a guide for parents, teachers and therapists and Write Incredibly Now™ 12 hours to better handwriting. She is the Executive Director of Children’s Special Services, LLC, in Atlanta, GA. She can be reached on the Web at www.childrens-services.com Her WIN™ program is available through YourTherapySource.com.

How to pick a preschool and why

2010-11-07T17:53:00.000-08:00

For some very young children, preschool is NOT the answer. Some kids just belong at home a little longer.

Now as an "always" working mother, I more than "get" that you have to go to work and the kids have to be somewhere and not everyone can afford in-home care.

But keep in mind that the early learning experience can have long-range impact on the young child. Because this is often the first time that they have been away from home without a parent, finding the right experience is crucial.

Choices for this are often chosen for reasons ranging from: geographical convenience, social (this is where my friends take their children), religious, cost, physical appearance.

While all of these issues are important the list needs to also include:

Experience of the teachers
School certifications
Philosophy of the school
Size of the classrooms
Number of classes per age group (are there smaller classes for children that might need modifications in the general program)
On-going continuing education for the teachers
Frame of reference for age/class specific curriculums
Structure of the school (level of classroom structure and flexibility, is it experiential, etc.)
Classroom facilities
Extra-curricular experiences available (foreign language)
Outside consultants (OT/Speech, Nutritionist, psychologist)
Accommodations and modifications for the child with early learning needs

These issues become even more important when you are selecting a school for a child with special learning concerns. This is where the occupational therapist is often engaged to help the parent make specific decisions that are essential for a successful early learning experience.

Helping find the right place is two-fold: it must fit the child and it must fit the parents.

Evaluating the home philosophy is as important as the evaluation of the child. A child from a family that is "democratic" may not do well in a structured school. And conversely a child from a very structured home may be lost in a loosely defined atmosphere.

If your child has been asked to leave a preschool setting the first impulse is to be defensive. But step back a minute and think, "was this really a good match?" Usually the answer will be "no". Figure out why before picking the next setting.

Maybe some testing might help you get to the right decision. Or maybe an alternative setting might be just the "ticket". For more information log onto "The Modified Developmental Preschool" at www.childrens-services.com

Sensory Assessments As Part of a Unified Early Learning Testing Protocol

2010-10-03T16:14:00.001-07:00

School based screenings for young children are common, but what do they test, and are they enough? They are usually generalized for fine and gross motor, basic perception and social/emotional development.

All of this information is important and very valuable, but for some children essential insights into the quality of a specific performance are not addressed in what “TOTEMS”* used to call “quick and dirty” overviews. (TOTEMS and AOTA program Training Occupational Therapists for Educational Management Systems).

Some children just seem to be missing the ability to “stay with the group”. (That is what I hear a lot of when parents call about their young children.) Discovering “why” often falls to the OT doing a specialized assessment.

Many preschool and lower school directors respond to these children by suggesting facilitators who stay with the child during school. While in many cases these individuals do an excellent job, they are also expensive and make the child “stand out” from their peers within the classroom.

Screening for developmental issues can help both the parent and the school administrator decide on the best placement for the child. While the majority of early learners do very well in traditional typical programs, the ones that do not suffer in the same situation. That is when seeking an alternative modified program may be advised.

Learning should never hurt, and early learning should be joyous. For the child with sensory developmental issues school can be a scary place. Try to think about going to the same place everyday but not being able to recognize it as familiar. Think about going to a familiar place but finding noise, smells or light noxious. Put yourself in the “shoes” of a child with postural instability and asking them to sit a table for any length of time.

Knowing these things before the child enters the classroom can make the difference success or failure for these young learners. It is also good information for both parents and teachers to have on all children. Therefore a unified assessment process should include a parent checklist and an admissions or early in the school year assessment.

The parent checklist should include items that address self-care, family participation, self-calming and interests as well as the standard motor/task areas. A sample of such a checklist is offered below.

Dear Parent: Your child ________________________has been referred for an occupational therapy assessment/screening. As part of this process, you are being asked to please fill out this checklist and return it to the school prior to the screening. Thank you.

________________________________OTR/L._________________________date

SELF CARE __Problems taking on/off coat __Cannot tie shoes __Cannot manipulate buttons, snaps, zippers __Unkempt __Rejects going to the bathroom __Cannot use utensils easily __Spills drink often	__Needs reminders to keep track of belongings __Rejects certain fabrics __Resists toilet training __Messy eater __Picky eater (explain) __Always wears socks, long sleeves even in warm weather __Habituates wearing 1-2 specific outfits __Other__________________________
MOTOR SKILLS __Poor motor learning (new skills) __Mixed and/or no hand preference __Does not attempt to initiate writing first name __Does not like to (or never liked to) scribble __Does not like to draw/write __Frustrated with fine motor tasks __Difficulty when trying to copy simple shapes __Poor gross motor (Running, jumping, skipping) __Looses place when looking at a book that is being read to him/her	__Walked early did not spend a lot of time crawling __Poor grasp (awkward use of pencil/crayon) __Poor writing pressure __Motor performances seem unusually slow __Cannot color inside the lines as needed __Poor reproduction of shapes/forms/ designs __Poor cutting skills __Shows no preference for his/her right and left handedness __Holds back with gross motor games __Rejects tasks that have multiple parts (figure-ground perception) __Other__________________________
TASK BEHAVIORS __Difficulty staying focused __Disorganized __Over-organized __Overly dependent on teacher/parent __Does not seem to hear when instructions are given __Poor (task) sequencing skills __Sloppy work areas __Easily distracted	__Difficulty initiating tasks __Difficulty transitioning from one skill/task to another __Needs instructions repeated __Gets confused easily __Cannot sit easily in “circle time” __Restless when riding in a car __Work pace is much slower than peers __Difficulty with instructions that are more than 1-2 familiar steps __Other__________________________
SOCIAL __Not many or few friends __Complains that “someone hit” them __Difficulty with cooperative tasks __Multiple somatic (physical) complaints __Poor eye contact when speaking to peers, adults, new acquaintances (circle one) __Seems fearful of new situations/places __Argumentative __Difficulty with self-calming when upset __Hangs of people or things __Cannot tolerate things out of “place” __Difficulty demonstrating affection	__Wants to but is hesitant to interact with peers __Prefers to play alone rather than with peers __Difficulty discerning personal space __Poor verbal expression of thought, ideas, and feelings __Overly sensitive to corrective remarks (criticisms) __Avoids talking out in class, and/or participating in discussions __Easily frustrated in social situations __Not understand jokes __Difficulty reading body language or facial expressions __Uses oral language that is less mature than peers __Does not wait to ask for help if an adult is talking __Other_________________________

The teacher would also be asked to fill out this checklist and the results compared. It is important to (gently) explain to the parent that life on “Planet Home” is very different than life on “Planet School”*. It is often hard for parent to get that they have been “trained” by their children to anticipate areas that may be stressful for them and thus circumventing challenging situations. This is particularly difficult if the child in question is number one! (*From Learning Re-Enabled, Mosby/Elsevier Books)

Parents of young children are often focused on are they “having fun” and are they “happy”, while teachers are focused on the physical, intellectual, emotional and the neurological actions and reactions impacting learning. Unfairly, teachers are often deemed “unfriendly” by parents or having a “personality conflict” when issues are revealed.

The Occupational Therapist can play a pivotal role in the assessment and learning environment by explaining development to the parent and the teacher so that increased understanding can be attained. The OT can also help explain the crucial importance of early intervention and discouraging the “wait and see” attitude many parents may choose if they do not fully understand the issues.

And we all can be reminded of the famous quote by Mel Levine, MD author of One Mind at a Time, “children do not outgrow anything but their clothes.”

As Occupational Therapists one of our many roles with children is to make sure they grow with their clothes.

You and Your Willful Toddler

2010-09-21T22:12:00.000-07:00

Your little one just won’t listen.

She gets upset at changes.

She will not follow routines.

It feels like she is sabotaging you and the whole family.

Everything revolves around her and her potential to explode.

You are just plain worn out, and you are beginning to not like you. You should love and adore this child, and somehow it has become an adversarial relationship; not at all the one you envisioned with her when she was a baby.

Well, you do love and adore her. But daily routine has become more about control than nurturing and you both have to get back on track.

What could possibly be the matter? How to spin what seems like a negative spiral into a positive trajectory?

Toddlers are by nature defiant. So first off, DO NOT TAKE IT PERSONALLY.

Think how you would feel, if you knew what you wanted but could not say it right, could not move as quickly as you wanted and felt constantly frustrated. How would you act?

Mmmmm….bet not too different. Early on it is best to let your "budding" individuals “own” their own feelings and behaviors.

Natural consequences seem to be an automatic teacher, but so do consistent limits and boundaries. Those boundaries when consistently applied provide the structure that gives rise to feelings of both security and safety.

Nothing trumps love, attention, praise and ROUTINE. So first off if you say you are counting to 3 and then the toy disappears for example, then it disappears. Not doing so teaches the child that crying gets the toy back. By going back on the limit you set, you are just letting yourself in for a more forceful exhibition the next time.

The Mayo Clinic stresses love and acceptance and structure that is constant is key for helping toddlers mature. However their research does address tantrums and behaviors that may indicate developmental issues.

“….Sometimes, however, temper tantrums can indicate an underlying issue, such as:

Developmental delay

Attention-deficit/hyperactivity disorder (ADHD)

Rarely, temper tantrums may indicate a more serious condition, such as Asperger's syndrome.

To determine whether your son's temper tantrums are cause for concern or simply an age-appropriate response to frustration, ask yourself these questions:

How often and in what settings do the temper tantrums occur?

Is your son's speech development on track?

Are your son's motor abilities and curiosity normal for his age?

Are you able to manage the tantrums?

Has your son ever injured himself or others during a tantrum?....”

Here are some parenting tips for raising toddlers:

Love and accept your child for who she or he is
Limit rules at first and keep it to those that are for protection and safety and then add others later.
Childproof your home and try to remove temptations
A strong willed child has perseverance, give the child challenging toys, let them learn problem solving but not to the point of frustration.
Understand your child’s limits and as much as possible do not push it.
Make sure your child understands what you asking him or her to do and be sure they can do it. Asking them to do something beyond their skills is a fodder for an outburst due to frustration.
Do not command but use a friendly tone.
Do not over-react when your toddler says “no”—just repeat the request—friendly but firmly.
PICK YOUR BATTLES—say no because you have to –do not make it a power play, toddlers do not think about that, they just want what they want when they want it. It is not about you.
Do not make “deals” it teaches your child that there are ways they can break rules and that is not what you want.
Stick to schedules and pre-set—known—limits –“no you may not run in the parking lot –ever”
Offer choices when possible, if helps with the child learning self-control and decision making skills. Keep the choices to 2, not an array of items. i.e. the blue or the green pajamas?
Try to find “alone time” when it is just the two of you and let your toddler plan the time—we have a whole afternoon, what should we do first?
Encourage using words, baby talk is cute but it can be a real deterrent to effective communication.
Enforce consequences—neither you or your child is a “saint” and sometimes rules get broken and limits must be enforced. So if it is a time out, withholding privileges, etc. follow through on that consequence.
After the consequence has been given engage your child in a positive activity and reinforce that he is “good” but the choice was not.

Nobody said parenting was easy, however, my willful daughter now 36 called me long-distance the other day to complain about her ‘adorable son’ who just would not listen and was being totally ‘contrary’. “This parenting thing is harder than it looks”, she said.

“Mmmmmmm”, I said, smiling.

When it comes to challenges..especially with handwriting tasks listen to your child's complaints...carefully

2010-08-14T20:04:00.000-07:00

Sense-able feelings—when learning new skills

In addition to individual therapy, I also provide therapy camps and groups. These groups help children with sensory processing (Play YOUR Way to Sensory-motor Success), handwriting (Write Incredibly Now WIN™) and social skills (Personal Options and Preferences POP™) in a supportive peer/task environment.

And inevitably every now and then there is at least one or two kids who drop out because (as reported by mom), ‘their feelings got hurt’.

On a closer look these were the kids that really needed the groups! The ones that cracked at even minor frustrations, were over-sensitive to unintentional “slights” by the other children, who had difficulty following a one-step direction in a 1-1 setting and/or whose short term memory was almost non-existent.

As therapists we are doing our job when we challenge a child to make choices that change old, non-productive patterns. The disconnect happens when the child complains (often tearfully) to the parent that “everyone is mean to me in the ___________group”.

I have thought long and hard about how to circumvent this and I think I have a solution I want to share. By providing parents a before group syllabus and letting them know what we are doing in advance they can support the child at home and ask the appropriate questions to counter the complaints. I use the following chart form.

Using handwriting as a sample (from my WIN™ program)* I offer this example:

What activities

Purpose

Anticipated (child) Responses* (all activities are new to the children and have never been tried before)

Functional Goal

Sliding a straw between three fingers

In hand translation skills

Awkward motor skills-some frustration

Increased in hand fluency

Paper cup button catch

Visual tracking

Timing

Competition with peers

Some possible frustration

Increase in-hand timing and visual tracking

Paper cup shell game

Visual memory

Visual tracking

Visual spatial organization

Acting silly

Reluctant to try (some)

Peer helpers

Increased visual skills with constancy and movement

Water bottle rock turning

Increase palmar “apple hand” position

Increase finger individuation

Increase wrist stability

Fun to make

Hands get tired

Decrease wrist rotation

Hard to keep wrist steady

My fingers won’t move “right”

Making choices

Estimating skills (when bottle is “heavy enough”

Prepositional understandings with movement

Increase isolated finger movements

Wikki-Stix relief rubbing

Increase tactile awareness

Increase kinesthetic skills

Automatic pride in being able to make a complex form

Learning shapes automatically without vision a foundation skill of automatic writing

Workbook

To systematically introduce formation and fluency

Hesitant at first

May rush through to get it done

May not want to correct self

Learning that to do it right is more important than to do it fast

Pride in a job well done

Self-measure progress

*This is only a partial list

Now that the parent is aware of what is going on in the class, it is also important to let the parent know when all this is going to happen. A timeline of what to expect can be very helpful for the parent to help the child through frustrations and expectations. Using the WIN™ program again as an example, I often tell parents that this is a 12-hour program offered (usually in 4 3-hour days) so here is what you can expect:

§ Day One—NO writing we will spend the whole day playing with our hands and bodies and learning how they move and how we can be “in charge of them” instead of them being in charge of us!

§ Day Two—tracing, nonsense shape making, chalkboard activities, blindfolded “writing”, gross and fine motor fluency activities, and initial workbook activities.

§ Day Three—All of the above and new games and crafts to put in our end of session take-home bags, putting our bodies together games using fine and gross motor patterns within one activity, continue in our workbook

§ Day Four—finish the workbook, and do Mad-Glad-Grab Sentences to learn about writing paragraphs with the T-E-C System (Topic Embellishers and Conclusions)—both trademarks of the WIN™ handwriting system.

Now the parent knows what and when and has some really useful tools when talking to their child about their feelings about writing, making new friends or tolerating unfamiliar situations.

But that still leaves us with the issue of how to help the emotionally fragile child. This is the child for whom everything is upsetting. The very act of walking into an unfamiliar place can be so upsetting that they need what I call a “first day shadow”, or a special “transition toy” that they can have with them the whole time. For these children creating trust is often synonymous with safety and both must be in place before learning can occur.

Even with all this in place, there will often be that “one child” for whom group therapy settings are just too much. The chaos of the group, the noise level, the stimulation of people moving, the inability to know how to ask for help, etc. can all be influences that impact a child’s ability to benefit from a given program.

So above all else, make sure that the parent knows that you are available to them by phone, email, written note, whatever works for the both of you. And YOU want to know how their child is reacting before they take action to remove him from the group. Letting the parent know that their child’s success is your only objective puts you both focused on the same goal—a happier more functionally secure child.

School is starting...translation...worksheets and homework!!

2010-08-09T15:53:00.000-07:00

Handwriting: Why is something so "simple" so hard?

The controversy over handwriting is clear evidence that computers have not “killed” it.

Handwriting is more than pen to paper. The lack of the ability to write has a diagnosis: dysgraphia. Dysgraphia is “…a learning disability resulting from the difficulty in expressing thoughts in writing and graphing. It generally refers to extremely poor handwriting.” (Medical Dictionary definition)

Keith E. Berry, Ph.D., author of the Developmental Test of Visual-Motor Integration, known as the VMI, is a “gold-standard” standardized test often used by psychologists, occupational therapists and other professionals to evaluate educational abilities. He addresses the issue of handwriting, citing that is a “natural vehicle for teaching” and that it is “frequently an indicator of children’s mental and social foundations.” This visible, graphic, tangible illustration of performance is a powerful reinforcement that can be either positive or negative.

Dr. Berry writes, “Because it is so visible (in contrast to spoken language), poor handwriting often operates as a self-fulling prophesy. If a child is allowed to continuously portray his mental and social inadequacies graphically, he may come to increasingly believe that he is an inferior person and to behave accordingly.”

Concurring with Dr. Berry, Jeanette Farmer, and pediatric handwriting expert in Denver, Colorado states that “handwriting is as important in the development of other intellectual faculties.”

In other words, what your child produces is how he or she sees themselves and that translates into a major influence on how he or she behaves. It is also important not to underestimate the influence of peer appraisals. The kid sitting next to your child probably has more influence over their self-esteem than you

(i.e. parent, teacher therapist) do. Pride in one’s work and feeling peer competitive is at the foundation of solid social and emotional well-being.

There are other concerns as well. Sensory-motor development is intrinsically linked to ones’ fine motor ability to being able to successfully manipulate environmental elements. Handwriting is the constant thread that links these various fine motor demands. A child can have difficulty dressing, but that happens at home, in private, no one really knows. A child has difficulty writing, that happens in school and everyone can see it. Poor handwriting cannot be hidden, ignored, or avoided. It is “in the face’ of the child for the entire school day. No wonder homework becomes a fight. They cannot fight the teacher; but Mom and Dad are easy targets for their frustrations and fears.

Learning issues are often reflected in motor performance, and the most visible school-based motor performance is handwriting. Handwriting is the task of putting something on paper. Handwriting difficulties graphically confront the child with his/her inadequate abilities. This graphic confrontation is often emotionally bruising.

Children with LD “look” like they understand, they are smart, and yet they seemingly, willfully, just don’t do their homework and if they do, it is often messy.

There are real neuro-motor reasons for handwriting difficulties that cannot be out-grown and that will not self-resolve. Understanding this neuro-motor system is key to teaching handwriting to children who find handwriting difficult and painful.

Sloppy papers are not on purpose. Addressing these issues frustrates teachers and parents; but most of all it impact the child in many negative ways. Punishment does not help. Often the (younger) student misses recess and the older student gets detention. And still, the homework remains messy, late and incomplete.

The student is subsequently labeled lazy, uncaring, willful, and the list goes on.

The child seems to be lost in a sea of unattainable expectations.

While no assisted device should be discounted, it is important to note that computers, Alphasmarts®, and the like cannot eliminate handwriting. Therefore the appropriate teaching of handwriting must be addressed for all children, and especially for the LD child experiencing developmental sensory-motor issues.

With Occupational Therapists and teachers, working closely together, can embed regular classroom tasks with simple everyday activities and techniques that can help children write more securely, getting their thoughts, ideas and feelings down on paper readily. Related handwriting skills also teach how to visually scan and copy, thus helping the student express his/her full potential and to be more peer competitive.

Resolving the homework issues is often resolved when handwriting is remediated. Knowing how to write must be paired within knowing what to write. And knowing what to write must be taught with an understanding of the obstacles to the actual task of writing.

Understanding and identifying those obstacles are essential for helping children overcome their resistance to both handwriting and homework. It often takes the trained occupational therapist to guide the child through the maze of developmental issues impacting the realm of fine motor issues.

Often children with handwriting difficulties have a real discomfort with pencil in their hand. We can see these children at a glance in the classroom, they have a “death grip”, a flimsy wobbly pencil, a wrapped hand that hides the pencil, their sitting postures are reflective of their hands, stiff, floppy, squirmy, etc.

Their issues aren’t just happening in their hands, it is happening in their physical bodies, and their emotional beings as well.

Addressing their physio-emotional issues while giving them a structure to assist with their organizational abilities helps them to become more confident in their abilities, thus able to demonstrate their actual competencies.

Those competencies: physical, emotional, neurological and intellectual interact concurrently and constantly in all of us. For children with LD, facilitating the expressions of these competencies is the essential first step to resolving the handwriting, homework and self-esteem issues.

And changing a child’s handwriting from scribble and scratch...slow and labored...to legible...Can be life-altering.

Can something that is so important really be useless? The argument that doctors have poor handwriting is invalid. They write in a fast coded shorthand for pharmacies, this is not if you ask them, representative of their personal handwritten communications.

Besides, my elementary teacher, Mrs. Buckingham of treasured memory, who insisted on precise formation and penmanship used to stress “we are what we write”. And we are so much better than sloppy papers and defensive excuses.

Handwriting matters, and school is starting....

2010-08-09T15:47:00.001-07:00

Handwriting: Why is something so "simple" so hard?

The controversy over handwriting is clear evidence that computers have not “killed” it.

Concurring with Dr. Berry, Jeanette Farmer, and pediatric handwriting expert in Denver, Colorado states that “handwriting is as important in the development of other intellectual faculties.”

(i.e. parent, teacher therapist) do. Pride in one’s work and feeling peer competitive is at the foundation of solid social and emotional well-being.

Children with LD “look” like they understand, they are smart, and yet they seemingly, willfully, just don’t do their homework and if they do, it is often messy.

The student is subsequently labeled lazy, uncaring, willful, and the list goes on.

The child seems to be lost in a sea of unattainable expectations.

Their issues aren’t just happening in their hands, it is happening in their physical bodies, and their emotional beings as well.

And changing a child’s handwriting from this:……

to this……

Can be life-altering.

You are NOT a Bad Mother!!

2010-08-04T07:12:00.001-07:00

Motherhood is tough business and I wrote this article originally for Exceptional Parent Magazine, but I wanted to share it with all of you who may not have seen it, and may benefit from it.

You are NOT a bad mother!!— Exceptional Parent 2008

Whoever said, “motherhood is not for wimps” had it right. You are loved. You are hated. You are needed. You are rejected. You are thanked. You are ignored. You cannot eat, go to the bathroom or have a conversation, that there is not an audience otherwise engaging you.

And you chose to do this (90% of the time)!!

It is not a “25-year” job, it is lifetime and it has been my experience, perhaps beyond.

It is a commitment unlike any other and it carries with a responsibility that can be, at times, overwhelming. Even all the more so when that little bundle you carried home from the hospital with such promise begins to grow and develop behaviors, or concerns that weren’t part of the “original bargain”.

“Mrs. _________, your child is acting out in class. He hits (or bites) other children. Mothers are complaining. If you don’t do something we will have to ask you to take your child out of the school.”

“Mrs. ____________, Sally just isn’t trying. She is obstinate and oppositional and you must do something about her behavior!”

These and similar comments are devastating. What are you doing wrong that every other child can function in school, but yours? The one thing you really set out to do well you are failing at. There, conspicuously out in the open for everyone to see—that, YOU ARE DOING IT WRONG.

This leaves you feeling that YOU are a bad mother. Everyone else does it better and why is it only your child who is acting out.

Well, I am here to tell you, you are not a bad mother. So “GET OVER IT”. Your child is who they were meant to be—flaws and all. No one is perfect and that is true for you as well.

The issue isn’t “is there something wrong”, but how can my child be nurtured so that they can become what they want to be?

The Silver Screen version of childhood is an illusion. It is hard work growing up. In the short span of those first five years children have to learn to eat, play, listen and get along. And if that child has a learning issue the job of growing up is all that much harder.

A child with an auditory processing disorder may not hear the world as you and I, making verbal directions may sound like static on a bad radio. Visual processing disorders may cause a child not to be able to hold a steady gaze so everything may appear as if it is on a rocking boat. Sensory motor disorders may make them more sensitive to the touch, so a “bump” may feel like a “hit”. Word retrieval issues can easily be interpreted as a child who is shy (or aloof) when in fact, they cannot find the words to say. These children are often seen as “acting out”, when in truth they are only reacting to what they perceive to be “reality”. Albeit their reality is skewed, but it is real to them.

It is essential for these children to have structured learning situations so that they can thrive and not just survive the school day.

But how do you get there, and to whom do you turn to for guidance? Seeking out occupational and speech therapists are wonderful first steps. They can help explain to both you and the teachers how your child is seeing their world. Once that vision is established understanding can evolve and accommodations can be made.

In order for children to learn, they must first know how to play and in order for children to seek to play, it must be fun. A child coping with developmental issues is not having fun. Everyday is a struggle. Every interaction is potentially threatening, holding within it the possibility of failure, ridicule and rejection.

If you felt that way how would you act? Think about that! This is not about you, Mom, and those that want to make it a reflection on your ability as a mother, are deeply misguided.

So suck it up, hold your head high, and be proud of your child and yourself. Your child is busy doing the job of becoming—and it is just harder for some children than others

Why I work with kids!!

2010-08-03T15:10:00.000-07:00

I am starting this blog because I work with kids and daily I get phone calls from parents who are confused, angry, upset, bewildered or just plain tired!!
Raising children is hard enough but when you add in the challenges that come with navigating the issues with a youngster with special needs the issues become complex and often confusing.
In a rush to fix things...isn't that what mothers are supposed to do???? I hear about a lot of money being spent on fake promises ....
   *your child will gain 6 months of skills in 6 weeks!!
   *this program is totally fool proof!!
   *we can train your child to succeed!

Golly if they can really do all those things why are they advertising??

I know as a parent I would have been camping on their doorsteps and promising the moon to help my child quickly and completely!!

But alas, after 3 kids and umpteen tutors, and a lot of money spent on testing, some helpful some not, I have found that nothing works like work.

What that work is depends on the child. But none the less it is work. It is what we as parents need to do, and what we need NOT to do. Both are equally important!!

One thing I did learn is that parents cannot be therapists, and they cannot be tutors. At least not in my case. It blurred the lines between nurturer and "demander".

It made the the relationship with one of my children one where I was more about getting "it" done --the end product--get this assignment in on time--and less about the process which is all about what learning should be.

One thing parents CAN do is be supportive, loving and structured. Let your kids know where the boundaries are. Nothing gives a kid security like knowing what is expected of them to do and not to do.

I used to say to my kids "care--share--and obey"--care about yourself and others, share things and feelings and obey the rules (mainly me).

So as a veteran mother, Occupational Therapist and advocate, I share this blog so we can grow together and perhaps I can take the fear out of different and put fun in instead.

I will be talking more!! BE Brave!! Susan N. Schriber Orloff, OTR/L