Is Your Child Jumpy, Distracted, Or Controlling? Sound Sensitivity Could Be The Problem

 

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M.E. couldn’t pay attention to her homework.  The landscapers had arrived, and the muffled sounds of their equipment had her looking around and running to the window every few minutes.  Her brother sat on the floor with his LEGOs, oblivious to it all.  He was four years younger, but his behavior was easier to manage than hers.

T.F. wouldn’t let his brother play video games unless he was upstairs in his room.  He said that it was “too loud” even then, but the rest of the family could barely hear anything but a low rumble.  If the sound wasn’t exactly as he wished, he would scream and throw toys until the volume was turned down.  Thunderstorms were the worst.  He was inconsolable.

The child that holds his hands over his ears is NOT the only child that is sensitive to sound.  Kids who have to keep looking around and behind their chair, but deny that they are fearful or suspicious.  Kids who try to control the conversation at a meal, and are the loudest member of the family.  And kids who run from the vacuum, blender, or hairdryer as if it is attacking them, but have no problem playing their video games at high volume.

Defensive reactions to sound aren’t one-size-fits-all.  They tend to be particularly strong at low frequencies, related to their difficulty in identifying exactly where the sound is coming from.  They also tend to be strong at higher frequencies, and can affect the ability to perceive sounds like “f” , “s”, and “th”.  When a defensive reaction occurs, muscles in the inner ear contract and reduce the ability to discriminate sound.  This contributes to the appearance that a child has hearing loss.  The inconsistency of this response should suggest another causation, but often that is explained by saying that a child is being manipulative.

And manipulated is how many parents feel.  Children with auditory defensiveness can be controlling and oppositional as they try to avoid the sounds that startle them or increase their sense of threat.  They often tend to strongly dislike large cavernous spaces such as gyms, rail stations, and even large churches.  The architecture of such spaces “suck out ” the helpful sound frequencies that humans use to orient themselves in a space.  A child that has difficulty interpreting sound in other environments will find that they feel incredibly unsafe when they have less sensory information available.

What can be done to turn this ship around?

Occupational therapists use therapeutically-altered sound as treatment.  When combined with physical activities that improve visual and vestibular performance, many children (and adults) gain greater comfort with a wide range of sounds, and feel that their behavior is no longer considered being “bad”.

For more information, read Spatial Awareness and Sound: “Hearing” The Space Around You and  Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation

Diaper Sticker Shock? Train ‘Em Now!

The pandemic has created gaps in consumer staples and rising prices for everyday items.  One of those staples is…diapers!  Well, when things get harder, it is time to think out of the (diaper) box.

If your child is over 18 months of age and has typical motor and cognitive development, there is a fair chance that they have the neurological abilities needed for toilet training.  They have to have a dry diaper for a few hours during the day, and it would be even more encouraging if they wake up dry from a nap every once in a while.  They are able to follow your directions to sit down and stand up, and they are trying to help you get some of their clothes on.  

Yup.  That is all you need.  

In fact, if you start pre-training early enough, you avoid the stage at which any and all of your statements are met with “NOOOOOOO!”.

Waiting too long for training is as big a mistake as expecting an infant to master the potty.  I regularly get hired to teach 4 year-old with no medical issues (or any other problem) that have decided that they simply won’t train.  Usually this child is failure-averse, and things go well in a matter of sessions.  In every instance, there wasn’t a perfect time to train or their early resistance allowed abandonment of any type of training.  And there you are, with someone who is ready to learn to read, but not to poop in the potty!

Pre-training often is so successful that it is obvious that real training needs to start.

Pre-training includes:

  • The child gathering the need wipes, fresh diaper, and creme, and bringing it to the bathroom, not the family room.  Elimination happens in one location in the house now.
  • Talking about body parts and body functions during diaper changes, not chatting about other plans or watching videos.  This is learning time, not fun time.
  • Watching videos and reading books about toilet training.  Talking about your own toilet needs.  Allowing your child to see you or your partner eliminate.  
  • Talking up the positives about future success.  Communicating that they can and will be successful, and that it is a good thing to be potty trained.  We talk up college, driver’s licenses, and going to kindergarten.  We need to talk up potty training.

For kids that have low muscle tone, there is a book parents can use to solve the complex challenges they face along the way to success.  Filled with useful strategies, not theories, it guides parents through all the stages, and all the skills, right into using the potty in public.  No child or parent should struggle when there are things they can do right now to make toilet training easier and faster:

The Practical Guide to Toilet Training Your Child With Low Muscle Tone is available as an e-book on amazon.com

Why Using a Chair Correctly is SO Difficult for Hypermobile Kids and Adults

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I spend a fair amount of time teaching hypermobile people of all ages how their sitting position affects their ability to write, keyboard, or do just about anything.  And of course, we want hypermobile people to have a stronger core while sitting.  But their chair can help them.  It is not a crutch.

Yup.  Use the chair.  Correctly.

Understanding how to use the back support of the chair correctly is fairly simple, but really hard for hypermobile people to do.  The reason it is so challenging has very little to do with being obstinate, forgetful, or in denial.

It has a lot to do with sensory processing and old habits (even for kids).

  • Hypermobility reduces sensory feedback from joints and muscles.  This makes it harder to pay attention to posture while sitting.  It is the equivalent of writing while wearing mittens.
  • Less sensory feedback frequently results in unconscious strategies to boost feedback.  Wrapping legs around the chair’s legs.  Leaning forward and resting the head on the palms.  Folding one leg under the body while sitting.  They do increase proprioception.  They also put the spine out of alignment and reduce the use of core stabilizers.
  • From the moment a hypermobile person is born, they come up with compensatory strategies.  Leaning.  Twisting.  Slumping.  Getting up for no good reason, over and over.  This means habits are formed before they know how to walk.  By the time they get to school, they are simply “The way I am”.  And hard to break.

If you or your child are hypermobile, there are a few hacks that work:

  1. Practice.  Even for a few minutes.
  2. Write a note on the table or screen in front of you.
  3. Make sure the chair is a good one.
  4. Accept that fatigue destroys the best intentions.  Allow movement breaks.
  5. Get rid of the old idea that depending on the chair indicates poor postural control.  Use the chair to perform the task.  You can exercise later.  This is not the time to exercise.

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Toddler Whining, Not Playing? Try Showing Them a Good Time

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Toddlers are notorious for requesting a toy and then fussing about it.  They aren’t being manipulative.  They are being toddlers.  Sometimes they can’t decide what to do with the toy (build a tower, build a house, etc.) and sometimes they find receiving a toy isn’t instant joy, but they expected it anyway (toddlers are rather like movie stars that way…)

Assuming that whining means they don’t want that toy, many parents become short-order playmates, dragging out everything but the kitchen sink to see if it pleases majesty.  This almost always increases, not decreases, whining.  For an explanation, see the above paragraph.

What can a parent do when their toddler gets what they want and then begins to whine?

Well, if your child isn’t hungry, in need of a diaper, exhausted, or ill…..

Start playing with it yourself.

That’s right.  DO NOT INVITE THE CHILD TO JOIN YOU.  NOT YET.

Play happily, but not with crazy abandon.  No need to go nuts.  But play with the toy in the manner in which you would expect your child to be able to play.  This means build a tower, not a replica of London Bridge.  Feed the baby doll, don’t teach it Spanish verbs.  Squish the Play-Doh, don’t make a coiled pot.

Very young children often jump right in, now that they have a clearer idea of what to do, and someone to do it with.  Wait for them to indicate that they are interested, and offer the toy without a lot of words.  If the toy gets tossed and a big grin spreads over your toddler’s face, you know they are baiting you.  They are drawing a line in the sand.  But if they play nicely, respond with smiles and even a hug.  This is the fun part of parenting, and you just hit a home run!

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Teaching Kids To Cut With Scissors? Don’t Use Cheap Paper

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As a pediatric occupational therapist, I would guess that every third IEP I have seen for preschool children includes some version of being able to cut with scissors. Understanding anatomy and neurology certainly help therapists understand why a child struggles. But when teaching a motor skill, it also helps to know what tools make a difference.

The type of paper offered to children can make such a huge difference that I am devoting an entire blog post to it.

Here is the simplest suggestions that I can make:

  • The younger or more challenged the child, the more important paper selection will be.
  • Moderately stiff paper will be most successful for almost all children.
  • Cheap printer paper is the equivalent of an adult cutting out a trapezoid from a facial tissue.
  • The younger the child, the smaller the paper should be, down to 4 or 5 inches square. Paper smaller than this size requires greater grasp control. Paper sized 8.5×11 inches is more difficult for almost all children under 5 to control.
  • Slightly textured drawing paper provides some tactile input for children that struggle with sensory registration.
  • Every part of a high-quality piece of paper can be used. Paper strips can be made, scraps can become collages, etc. There is no need to waste paper.

To learn why I only use one type of safety scissors, read:

Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler

How To Write Numbers And Letters To Avoid Confusing Young Children

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One of the common questions children will ask me when I am working with them on handwriting is “Why is your “6” different from my book’s “6”? , or why is your ” M” different from my book’s “M” ?

This is an EXCELLENT question.

Here is the answer: because a computer made those numbers and letters, not a person’s hand. We don’t write the same way a computer does.

If you understand the development of hand control skills, and you understand the development of cognition and visual-motor skills, you will realize that using the fonts on books is a foolish way to teach handwriting. A good example is the “K” in the above photo. This is a more challenging letter to write, as the writer needs to be able to start the second diagonal stroke at exactly the right location and at the correct angle, while still connecting the stroke to the baseline.

My private clients know that I strongly prefer Handwriting Without Tears to teach young children. The simple style and the developmental progression of the teaching sequence make learning easy, and therefore, make my job easy.

HWT teaches something they call an “easy 6”. It begins with a vertical stroke, not a curve. This is because the earliest and easiest stroke a child can execute is a vertical stroke. What about the more mature method of writing a “6”? It comes naturally to most kids, as they develop better pencil control and greater desire to copy the style of their older siblings and adults.

The same happens with the HWT “M”. It has vertical and diagonal lines that extend all the way to the baseline, to assist kids in learning to touch the baseline and develop symmetry. See the “M” in the photo above. The D’Nealian “M” has two diagonal lines that extend partially to the baseline. If a child can execute this letter with control, I will not stop them. But few young children can do so.

There is no reason to make learning to write difficult. None.

School administrators rarely know how to select a handwriting program, and they often choose as if they were playing darts. I know a local district where they homes start in the low 1M range. They use one program for kindergarten, then switch to another for 1st and up. Insane. Great for my private practice, but absolutely nuts.

Like The Cube Chair? Here Is a Table and Chairs Set For Younger Toddlers!

My post on the classic Cube Chair The Cube Chair: Your Special Needs Toddler’s New Favorite Seat!  has been popular, but it isn’t always a great choice for the smaller toddler that was a preemie (they tend to stay smaller in size).  So…enter the next choice for toddlers that need some back support and need to have their feet on the floor for good postural control: the Costzon Table and Chairs set!

This set that can morph into a table/chair/bench/desk isn’t for bigger kids.  The Cube Chair, rotated to the higher seat height may be the better choice for kids that have a wider hip width or leg length.  But we all know that there will come a point at which a toddler resists sitting in their high chair for play, but needs more lateral (side) support than a standard chair provides.

Why do they need this support?  Usually they need more sensory input due to hypermobility and/or low muscle tone.  Some kids with sensory aversions like the cocooning experience of a chair with more support.  And of course, kids with mild cerebral palsy or other motor issues may need a bit more assistance for sitting, but don’t need an adaptive chair.  

The back of the chair isn’t as tall as the Cube chair, so kids that go into trunk extension may not do well with this chair.  The larger piece turned into the bench setup is tall, but probably won’t accommodate kids with significant postural issues.  I like that piece better as a wider desk or table anyway.

This set has safe rounded edges, but it is made of wood, so it has more weight than the Cube chair.  That can make it a little more stable for those kids that like to tip their chair over a bit for input.  It can also reduce the desire to push it around for fun.  The rounded edges of the table encourage things to slide off, so I would recommend using Dycem The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem or my fave cheap hack, a silicone baking sheet, as a topper.  The carrying cut-outs are handy for adults, but I will warn you that toddlers are gonna want to see how many crayons they can slide through that opening.  Step carefully!

 

Why A Circular Scribble ISN’T a Circle

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I spend a lot of time in telehealth with toddlers and young preschoolers doing pre-writing.  It requires few tools, it is easy to demonstrate, and it is fun.  But when parents tell their two year-old that they drew a circle after they scribbled in a circular pattern, I stop them.

Why?

After all, copying a circular scribble is a 2.5 year-old skill, and a very important one.  Control of a curved stroke is huge for pre-writing.

Because what you say to a child who is learning pre-writing strokes matters.  A lot.

  • A circular scribble doesn’t have an optimal starting location, nor does it have a sequence.  It can be more oval, it can be more round.  It can be 3 revolutions, or 30.
  • A CIRCLE starts at the top (of the page, of the section of paper, etc) and rotates to the left.  It connects to the beginning point of the stroke.  Once.
  • Confusing the two risks making early writing harder.  I get paid a considerable amount to remediate errors like starting letters at the baseline and writing too slowly to copy from the white board.  It starts here, with inconsistent and incorrect instruction at a vulnerable period in learning.

Teaching a child that there is a difference doesn’t mean criticism.  At all.  I celebrate every circular scribble, and I demonstrate a circle when kids are ready to learn, or when I want them to scribble ON TOP OF MY CIRCLE.  Or draw a face on my circle.  You get the idea.

I want a child to notice that there is a difference, and learn what those differences are, without judgement.  This will help them understand how to execute the correct start and sequence to draw a circle when they are cognitively and motorically ready.

Doing Quickshifts? Modulated Music? Therapeutic Listening? Get These Affordable, Comfortable, Kid-Size Bluetooth Headphones From PURO!

Wirecutter, owned by the New York Times, just did a piece on great gifts. The PURO BT2200 models were featured because they are child-sized NOISE-LIMITING headphones with a BUILT-IN MIC, which is great for virtual school participation.

I am recommending them because they will not destroy your child’s hearing. They max out at 85 decibels. No matter what your kid does with the volume bar on your iPhone, these headphones will save their hearing. You can stream from your iPhone wirelessly from 30 feet. That means it will work with Quickshifts and Modulated auditory/sensory processing treatment programs.

Readers know how effective I believe therapeutic listening can be for kids Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation , but using speakers isn’t ideal. Finding headphones that your kid will keep on their head isn’t easy, and nobody wants a fight during a pandemic (or any other time, to be honest).

The new over-ear ear cups are big and soft, making longer listening times easier. They only fit the NEW headphones though, so if you want them, you will have to buy the current model of the BT2200. The new BT2200’s are $85, so you can give the old model to your other kid(s) and use the new one for your kid doing therapeutic listening. The large ear cups are $15. This is a really affordable buy-in for high-quality headphones for sensory treatment at home in the middle of a pandemic. For kids who cannot get in-person treatment, this is one way to make a big difference in their sensory processing without direct contact.

They come with an extended warranty, and since kids throw things, I do recommend buying it. The one-year warranty is good, but the extra coverage means you can breathe a little.

Book Review By An OTR: Life, Disrupted; Getting Real About Chronic Illness in Your Twenties and Thirties

Although I work in pediatrics now, I spent the first 10 years of my career in adult ortho-neuro rehab. This means that I worked with many young adults facing issues from RA, MS, Lupus, spinal cord injuries, and more. They were just getting started with jobs, raising children, and making an adult life, but they had to deal with chronic disorders that impacted every part of daily living. And their needs were different in some ways from the older patients, who developed issues in their 60’s and 70’s or beyond. THEIR children were grown, their careers were often over, they had saved for retirement, etc.

Why am I writing a review on a book about ADULTS? First, many of the kids I treat will grow up to be adults with chronic issues. Their parents may or may not acknowledge this at 3 a.m., when they think about their child’s future with some fear in their hearts. Second, the PARENTS of some of my clients have their own issues. Sometimes the same ones, but sometimes lightning does strike twice, and the child has a different issue or issues from the parent’s own concerns. Either way, people want ideas and the feeling that they aren’t the only ones dealing with these issues.

This book is written by Laurie Edwards, who faces a chronic respiratory illness with a combination of determination and honesty that other adults with chronic illness will find refreshing. She isn’t shy about describing how it has affected her relationships or her ability to look at her future. But the book includes many other stories. Within the book you will meet a college student with Ehlers-Danlos syndrome, a young mother with another respiratory illness, and others with common and uncommon diagnoses.

Chronic disorders or illnesses can make immediate decisions harder, but they make plans for the future harder as well. I have felt strongly that teens with chronic illnesses need to plan their careers based on more than their talents. The realities of living in the US mean that having health insurance isn’t a given. Having the ability to take paid leave isn’t either. The “gig economy” isn’t kind to people with chronic disorders, and until our country decides to change this, it is important to choose education and training that will allow a person with a chronic illness to obtain good care. It really can be a “life or death” decision.

Ms. Edwards also takes on the decision to bear and/or raise children. Although there aren’t any specific strategies offered, she walks the reader through her process, and the decision-making of other people with chronic illnesses and conditions. One of the great gaps in care, IMHO, is care for mothers with chronic disorders. Raising children is hard work. Hard physical work, hard mental work, hard emotional work. Lots of joy, but lots, and lots, of work. Protecting their health when faced with their child’s needs often means that women sacrifice themselves and do not realize that there are options that reduce risk while being the great moms they want to be.

The lack of useful information from the therapy community is just astounding. We know a great deal that could make life easier, but there isn’t anything available to parents unless they are lucky enough to have generous health care coverage that provides them with therapy sessions. I have found YouTube videos on lifting and carrying kids when you have physical disabilities…none by therapists. We know so much about this topic, but parents seem to have to figure even this simple thing out for themselves. When understanding the principles and their own abilities could make them empowered to plan for each situation as it comes along.

For more information, read Career Planning for Teens with JRA, EDS, and Other Chronic Health Issues and Parents With Disabilities Need The Happiest Toddler on the Block Techniques . To read posts about children that have relevance for adults as well, read Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection Strategies and When Writing Hurts: The Hypermobile Hand .

Book Review From an OTR: Easy For You To Say Q and A’s for Teens Living with Chronic Illness or Disability

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If you are a teen with JRA, Ehlers-Danlos syndrome, MD, paraplegia, or any of the many conditions that create daily challenges in your life, you need to read this book.

If you are the parent of a teen or tween with these medical conditions, you REALLY need to read this book.

Dr. Miriam Kaufman wrote the first edition of this book 25 years ago.  It has been updated and improved, IMHO.  It is honest and direct about issues that matter to teens.  She is specific about drug use, sex, intimate and social relationships, and the challenges of having these problems when you are still learning who you are and what you want in life.  Young adults would probably get a lot out of this book as well.  Sometimes illness and disability make launching yourself as an adult a slow and disconnected process.

What is inside?

Chapters 1 and 2 focus on family life and managing medicine and medical doctors.  Teens are trying to separate but still need and (sometimes) want family involvement as much as they want to grow into the amazing adults they are meant to be.

Chapters 3 and 4 talk about friends, dating, school, and work.  

Chapter 5 addresses alcohol, drugs, and medications.  She isn’t judge-y, and she knows that experimentation is likely with or without information.  She just wants teens to think things through so that they make choices based on more than rumor or whispered stories.

Chapter 6 discusses sexuality.  The teen I have treated care more about this topic than they care about almost any other, except dating and friendships.  Dr. Kaufman is honest, explicit without being insensitive, and hopeful.  No teen wants to hear that a satisfying sex life isn’t possible.  

Chapter 7 addresses recreation, and Chapter 8 discussed transitions into adulthood, including taking responsibility for your own healthcare.

Wait.  There is more.  Much more.

Pages 299-315 are appendices that offer you charts so that you can understand which drugs are known to cause acne, hairiness, decreased sexual desire, erectile problems, gynecomastia, affect birth control pills, and then there are pages and pages of explanations of how street drugs interact with therapeutic drugs.  

If you are a teen male and want to know why you have boobs now, or acne, or why sex is no longer the focus of every other thought…it is in here.  If you want to know how to talk to your parents or your doctor about your unwanted facial hair, or the hair “down there”…it is in here.

If you are a parent, and have no idea what yo say about drug use except “don’t”…this book has your back.

Is this book perfect?  No.  Dr. Kaufman doesn’t know some of the strategies and equipment that rehab therapists can suggest to make the physical aspects of sex easier or more pleasurable, or how to deal with getting around the halls and sitting/walking at school, a job, or in your own bathroom, and the chapter on school and work isn’t detailed enough for me as an OTR.  But she has provided a book that is more helpful than others I have seen, with more details than I knew about drug interactions (both legal and illegal usage) and how some drugs affect the effectiveness of birth control pills.  For her extensive appendices alone, this is a book to read and own.

Should You Use White Noise With Toddlers?

I teach The Happiest Baby on the Block techniques to calm newborns because it is based in science.  The science of neurology and early development.  But babies grow.  The 5 S’s, used all together, really don’t work much past 12 weeks of age.  Nobody is swaddling a 6-month old, or jiggling an 8-month old.

But you can use some of the principles of The Happiest Baby on the Block well past that 12-week mark to make life, and sleep, better for everyone. White noise is one of the S’s that is helpful for toddlers.

I wrote a popular post on white noise Are Babies Addicted to White Noise? Yes….and No  and I haven’t seen any reason to change a word. White noise both triggers the brain to think “time to sleep” and alters the level of alertness in a young children so they can drop into sleep.

For toddlers, white noise has an even more important role:  it muffles the sounds of family activity and scary household sounds.  Toddlers want to stay up to hang out with their parents and siblings.  They are old enough to understand that they go to sleep ALONE, that the party is over until morning.  Toddlers that are exceptionally social find this the hardest.  The other group that struggles is the children who are in daycare and only see their parents and siblings in the later afternoon and evenings.  A few hours of meals and bath simply aren’t enough for them, but they are tired and cranky.  Let the screaming begin….

Toddlers are also old enough to develop some fears.  Noises that they cannot identify may scare them.  Things like closing a squeaky door or running the dryer.  As adults, we don’t find these noises alarming.  Toddlers can and do get scared since their brains are able to conjure up fears from emerging imaginations.  White noise can block them all.

But you have to use the right type of white noise, and at the right volume.  Some toddlers need a stronger sound, not bubbling water in a brook.  They need a hairdryer sound.  Some need the heartbeat sound, but louder. Once a child is asleep, you can always switch to a lower, less intense sound.  Dr. Karp’s white noise album on iTunes has a variety of sounds that can be put on in sequence, or on repeat, to deliver that “just right” level of sensory input.

Think you should use music with singing instead?  Not for sleep.  Just like us, toddlers pay attention to the lyrics.  You might find lullabies that soothe, but they might be too stimulating to keep your toddler sleeping.  We go through sleep cycles, and leaving music on during the light sleep stage could wake them rather than send them back to sleep.

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The Three Stages of Color Recognition in Toddlers and Preschoolers

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Although this is not officially an OT issue, I field questions about when and how to teach color recognition to young children.  Like many of my other posts, I am writing this one so that I have something I can send parents; they can read about the concepts we discuss.  There is so much going on in a session that it is hard for the average parent to retain everything I “throw” out in a 30-45 minute session!

Color recognition doesn’t usually emerge before 14-16 months, and typical children can be struggling to match primary colors for months after that age.  But the progression, delayed or on-time, follows a fairly standard pattern.   Expecting stage 3 responses when your child is still at stage 1 is simply asking for frustration from your child, and creates unnecessary concern for parents.  These stages aren’t seamless, meaning that one day a child will consistently be at stage 2, and the next, they are functioning at stage 1.  This is also normal, because a young child that is ill, tired, distracted, upset or even hungry cannot perform skills consistently.

Color identification generally happens with primary colors first, and progresses to secondary and tertiary colors.  This  means that a child often can distinguish red and blue  before they know purple and gray.  There are children over three that are totally confused about brown, gray and beige…..that is completely normal.

Stage 1:  Your child is able to match colors shown to them without being able to respond to a request for a specific color or to name the color.  You hold up a blue block, and ask your child to give you another block that is the same color.  You may even find one and say “HERE it is!  The same! I found another block!”  Your child clearly looks at a few blocks, and hands you the blue one.

Stage 2:  Your child is able to respond to a request to find a block of a specific color.  You say to your child “Please give me a BLUE block”, and without showing them which block is blue, they find one and give it to you.  This requires receptive language, as a child interprets your words and assigns labels to the objects they are seeing.

Stage 3:  Your child is able to correctly answer the question “What color is this block?”  This level of skill means that they know the names of colors and can state them on demand.  This requires expressive language, and anyone who has learned another language will know the internal Rolodex as you search for the right name for the color you are viewing.

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How The Pandemic is Affecting A Toddler’s Learning

The New York Times ran a ridiculous piece today about the effects of the pandemic on early learning.  It had quotes from staff at programs for music class about the amazing motor and cognitive benefits of clapping in time to a song and imitating animal sounds.  It had quotes from parents in wealthy NY suburbs, concerned that not learning turn-taking and social skills in class would affect their children’s performance at preschool.  And of course, it showed stills of music class on Zoom, with toddlers looking at a split screen with the adult singing and the other children visible in little boxes.

Do not fear:  very young children aren’t losing out.  Their social skills won’t be permanently crippled by being at home with their parents.

The parents of typically-developing very young children are the original and best source of socialization and language skills.  There is no substitute.  Parents are MORE than capable of providing the right stuff.

Parents might be missing the benefits of having someone to share the long hours of childcare, and the opportunity to connect with other parents, but very young children under 3 without any developmental delays are able to do just fine without their movement or activity class, AS LONG AS THE ADULT(S) CARING FOR THEM ARE WARM, INTERACTIVE, RESPONSIVE, AND FOCUSED ON THEIR NEEDS.

As a therapist working in Early Intervention programs, my job has been to instruct parents in how to promote development, and how to manage behaviors that arise from delayed development or disabilities.  But it also has been about teaching some parents how to play with children under 3, how to pick out toys that match their current skills, and how to deal with the typical tantrums and defiance that come with the territory.

 Many parents have no idea what to do, and a few, frankly, really don’t want to deal with the sometimes boring and tedious job of caring for and playing with very young children.  I see a fair amount of outsourcing parenting when people can afford to do so.    And I understand it rather than condemn it.  This is real work, and not everyone wants to do it.  For generations, the wealthy have hired people to raise their children, because they could.  Why vilify middle class modern parents for the same thing?  But don’t think that a very young child is missing out on important social skills when they can’t go to music class.  The owners of the class are missing their income.  The babies will be just fine.

Very young children are wonderful, but they require a tremendous amount of energy.    It can be draining, in a way that getting out a project update is not.  Raising children is work.  Hard work.  There aren’t that many professionals willing to state the obvious:  young children take much more than they can give in those very early years.  They can’t converse.  They can’t joke.   They can adore you, but they can’t reciprocate cognitively or socially in the way an adult needs.  Regardless of how much you adore them, it is work.  Rewarding and important work, but hard work.  Done alone in a pandemic, while a partner is focused on earning a living, it can be isolating and exhausting.

Enter infant music classes and Mommy-and-Me groups.

These are terrific for breaking up the long days of childcare and getting adults together, but most 14-month olds don’t socialize with peers.  They don’t have the mental ability to do so.  The adults do.  This has real value for adult mental health, but please don’t lie about who is getting the most out of the class.  Accept that raising very young children is hard work, and make sure that caretaking parents are able to take care of their own needs.

But do not buy the idea that without going to music class, a young toddler is risking a loss of social, emotional, motor, or cognitive skills.  But their parent might be.

Is Your Child Bright or Gifted? Spot the Differences

 

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One of my posts, Why Gifted Children Aren’t Their Teacher’s Favorite Students….  gets a lot of interest.  Parents are surprised that having a gifted child doesn’t reap enthusiasm from the average educator.  The general characteristics of a gifted person (intensity, drive, and complexity) can be downright disruptive in a general classroom.

 It often isn’t any easier at home.

So if you are wondering if your child is gifted, and you haven’t started searching for a psychologist to perform the WISC-R yet….here are a few differences between the bright kids and the gifted kids:

  1. Bright kids learn quickly.  Gifted kids can learn lightening fast.  Show a bright kid something new and after 5-8 repetitions, they have it down.  A gifted kid can have it down in 1-2 demonstrations.  They learn new words after hearing you use it once.  They make connections without being shown, because they can process information so well, rather than just remember it.  Think Shirley Temple.  They could teach her a dance routine by simply showing her the steps once.  That is a gifted dancer.
  2. Bright kids are great listeners.  They sit and wait for you to finish.  Then they answer you.  Gifted kids will interrupt with questions, argue points you never saw coming, and have a strong need to examine the materials that you are holding.  They almost want to inhale your props to learn more about them.  They are good guessers, because they make inferences without you having to spell things out.
  3. Bright kids make friends easily.  Gifted kids can struggle to find true peers, and often prefer to be alone so that they can pursue their interests and control the outcome of their play.  A gifted athlete may be competing with children much older, leading to difficulties knowing how to behave with them, and a child that is able to expertly play an instrument or read at an advanced level has to find common ground with peers while having uncommon skills.  The developmental asynchrony of gifted kids often means that they struggle more with social interaction even though their sensitivity and sense of justice makes them very connected to how others are feeling.
  4. Bright kids really ARE a joy to teach.  They have great memories, know how to fill in the blanks, and follow your instructions.  Gifted kids have their own strong passions, and rarely have enough space on a worksheet to fill in their complex answer to a simple question.  They want to express their unique viewpoints, and they see many sides to a situation, so “yes/no” responses don’t really work for them.  Take a gifted kid on vacation, and you could have someone who has no interest at all in going to the beach, or someone who won’t leave the beach because there is still so much more to see.  
  5. Bright kids win awards, get elected for school offices, and are often group leaders.  Gifted kids may or may not accomplish these things.  Their performance may be driven by their desire to explore rather than excel, so they may be accused of not living up to their potential.  Gifted kids will not always be found in the top reading group or in the honor classes.  They aren’t driven by other’s agendas.  Their own internal sense of drive and mastery will prevail.  The perpetually daydreaming or laser-focused gifted child may have an agenda that hides their gifts.  Gifted children can be interested in and talented in many things, and have difficulty staying with one passion long enough for mastery, and they may not care about mastery anyway.  Their passion is the journey.  

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Is It Sensory Treatment…Or Sensory Stimulation? How To Know The Difference

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I have spent the first part of my career in pediatrics convincing parents, teachers, and other therapists that sensory processing is important for development, and that sensory processing disorders are a real “thing”.  I am spending the latter part of my career trying to explain to the same groups that using a sensory-based activity does not constitute sensory treatment.

Why?

Results.  You will not get good results to any treatment if the underlying principles aren’t understood and used correctly.  This requires more than a therapy ball and a brush.  A local school district uses general sensory activities for the whole class, rather than sensory-based treatment for kids with sensory processing disorders.  I get a lot of private practice referrals from this neighborhood.  The district’s refusal to address children’s needs in the classroom, while telling parents that they are “sensory-aware”, is frustrating to everyone, including the therapists in the district.  They don’t seem to stick around…..

Therapy for sensory processing disorders requires an evaluation.  Assessing the problem and identifying a rationale for the related behaviors or functional deficits is essential.  Tossing out a sensory-based activity because it is fun, easy, or has worked for another child is the hallmark of a well-meaning provider that wants to help a child but doesn’t have the training of a licensed therapist.

A good example would be to offer teething toys to a child that chews their shirt.  Sounds like a solid plan:  oral seeking equals oral stimulation.  But wait! What if the child is using oral seeking to address severe sound sensitivity?  Isn’t it better to deal with the cause of the problem rather than the end-point behavior?  You would need an evaluation to know that their greater problem is poor modulation and sensitivity.

Treatment techniques follow a pattern that is based on the brain’s neurological response to sensory input.  I didn’t take courses in neuroscience because I liked looking at brain sections.  I took those courses so that I could understand the structure and function of the brain!

The right intervention (movement, pressure, etc.) uses intensity, duration, specificity of sensory input, location of contact/input, frequency, and timing to achieve results.  This sounds like a lot to consider, and….it is!  The way OTs create a sensory diet isn’t by looking at what worked for another child.  We look at what we observe, what we assess, and what the child’s performance demands are.  Only then can we identify what should be used, how and when it should be used, and how to determine our next steps in treatment.

What about the child selecting the activity that they “sense” they need?

Well, if that were therapy, we would all simply set up equipment and let the child play.  We are THERAPISTS, and we know that seeking input isn’t the same as treating dysregulation, aversion, or poor postural activation.  Of course, we want and need kids to have a say in their sessions.  But the idea that a child’s nervous system knows what it needs?  That is like saying that since I like Doritos, then my body is telling me that I need more fat, processed carbs, and salt.  Not.

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A great treatment that isn’t used at the correct level of frequency or used when it is most needed is going to fail.  So will the right frequency of treatment used vigorously rather than with skilled observation.  Non-therapists can be taught a treatment intervention, but it takes training and experience to create a treatment program.  This is no different from any other type of therapy.  Psychotherapists aren’t just talking to you. Speech therapists aren’t simply teaching you how to pronounce the “r” sound.  If it was that easy, we wouldn’t need licensure, or even a degree.

It would be a lot more fun.  We make it look easy, and that is the art of OT.

I have just explained (some of) the science.

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How to Help Toddlers Prepare to Write

Ian, Lila, and Tom aren’t writing. They are drawing!

Contrary to the ideas of some preschool teachers, most three year olds don’t write their names.  In truth, most young fours don’t either.  I refuse to count the kids who “draw” their names like the photo above.  That isn’t writing.  That is drawing, the same as if I copied my name in Mandarin.  I would be drawing the characters, not writing.  Writing requires that I know the correct start and sequence of strokes.

So…What can you do to help late twos and the threes prepare to write?

The mom of a toddler brother of a private client asked me, and I know this child uses his fist to hold a crayon.  Improving his grasping skills should be one big goal, and there are a bunch of fun toys that can support this.  Read Water Wow: Summer Pre-writing Fun on the Road  and read LEGO Duplo My First Car Creations: Putting Together Cars, Building Hand Coordination for two great toys that kids in this age group will love.

 Another way to prepare a young child for handwriting is to build a child’s skilled use of spoons and forks for self-feeding.  I wrote a post on this  How Using Utensils To Eat Prepares Your Child To Write  , and I don’t think parents always fully understand that offering finger foods isn’t going to build hand skills after age 2, unless your child is very physically delayed.  Once they can pop a chicken nugget into their mouth, finger feeding isn’t building hand control.  It certainly isn’t enhancing grasp!  Getting a child the right utensils seems to be an issue in many homes.  Pre-pandemic, I did live EI sessions, and regularly asked parents to throw out those infant feeding spoons (they have a tiny bowl and a super-long handle) because they DO NOT HELP YOUR CHILD SELF-FEED.  THEY MAKE IT HARDER.  Read Which Spoon Is Best To Teach Grown-Up Grasp?  and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child   to find good utensils that support hand control.

The use of a vertical easel, the kind found in any preschool classroom, can build hand control and prevent the development of an awkward crayon grasp.  Stabilize the paper with clips or tape, because young children will not hold loose paper while coloring.  Using a screen stylus builds finger strength and makes drag-and-drop screen time into a hand exercise.  

Crayola’s PipSqueak markers and their My First Crayons are great choices for pre-writing.  ColorWonder paper and markers will not make a mess.  They will save your MIL’s couch at the same time!

Enhancing bilateral assembly skills will prepare a child for the visual-perceptual and midline awareness needed for handwriting.  I love MagnaTiles and DUPLO blocks, but there are other ways to build.  A great variety of building materials will support a typically-developing child.  Sitting passively in front of a screen will not.  Safety scissors should be offered.  The kind that really work: Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler

Finally, young children need to see adults and older siblings drawing and writing.  If your older kids are addicted to screens, you will have to be the one coloring and drawing.  During stressful times, this might help you relax as well.

Remote Learning Strategies for Special Needs Students

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Remote learning isn’t easy.  Helping a special needs student navigate it isn’t easy either. Here are some strategies to improve outcomes and reduce everyone’s stress about it:

  • If your child’s OT has created a sensory diet for them, this is the time to use it.  A sensory diet is a series of activities and actions that support the brain’s ability to regulate alertness and emotional arousal. How To Remember to Do A Sensory Diet With Your Child If there every WAS a time to get serious about a sensory diet, it is now.  Your child needs every advantage to stay calm and focus.  If you never drilled down and tried it, ask for a review of the techniques, and don’t be shy about admitting that you don’t use it as often as recommended.  We know you are overwhelmed.  We are too!
  • Your learning environment matters.  Take a look around, and remove distractions.  Remove things that don’t distract you, but could distract your learner.  This may mean that you put up a tension rod and a drape that blocks a window, another room where a sibling is learning, or even the view to the snack cabinet.  It may mean that cheerful signs go down.  It may mean that the room you are using is the wrong room because it is too bright, too warm, too noisy, etc.  Kids with learning differences don’t get motivated by lots of decorations; they get distracted.  Teachers get enthusiastic about decorating their classrooms, but they don’t have sensory processing or learning issues.  Don’t make things harder for your child.
  • Positioning matters.  The chair height and desk/table height will affect your comfort and attention span, so you have to think about how it affects your child.  If your OT is virtual, you can send photos and videos of your set-up and get feedback.  This may not require a purchase.  We can help you use the materials in your home to make your equipment work better.
  • How much sleep is your child getting, and how much rest, play, and fun?  Some kids are way over scheduled, even with COVID, and some aren’t getting a chance to be creative.  Make sure that you have puzzles, art supplies, crafts, and other ways for your child to explore.  You might find that you can throw off some stress by painting or crafting as well.
  • Consider therapeutic listening.  I am using Quickshifts Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activationwith almost all my private clients, and it is helping them focus on Zoom sessions.  Even parents that were skeptical of this treatment have come on board.  They see the difference it makes!

Why Your Kid Still Needs To Be Able to Write With A Pencil

I just watched a Google tech guy try to explain why digital education is so great. Maybe it is, for older kids and college students, and kids in rural parts of the world.

But for the youngest children, and for kids with special needs of all types, digital instruction has proven to be lacking in so many ways. One of the ways digital instruction is failing kids is that children 2-5 still need to see live demonstration of pre-writing and handwriting. Live, as in a person sitting next to them, not on a screen. At the very least, the adult helping them with their Zoom lesson needs to be demonstrating how to write and draw.

This isn’t because these children have deficits. Learning to write has it’s own natural progression, and when you leave out one of the steps, you risk losing some kids completely. Every time I saw a “writing corner” in a preschool, with a few handouts and a few markers left available, I would cringe. Add in some kids with learning differences, and you have a recipe for…hiring me privately in a couple of years when the child cannot keep up in school or hates writing so much that they refuse all together.

Why?

Because intuition is no way to learn to form letters and numbers. There is a stroke sequence that is based on hand anatomy, which creates letters formed with the least amount of time and effort and with the greatest ease. NO PRESCHOOL CHILD WILL INVENT THIS SEQUENCE BY LOOKING AT A COMPLETED LETTER OR NUMBER.

Children learn to write from observing an adult holding a writing tool, copying their movements, and hearing the verbal cues that teach the sequence and skills that reduce reversals and errors like overstrokes and poor proportion.

Only after this phase can they progress to copying a finished sample and then move on to the most advanced level: independent writing without any sample at all.

By 3.5 years, a child should be able to copy a circle and a vertical cross. These skills prepare them to write beginning letters like “L” , “O”, and “H” at 4- 4.5 years of age. Expecting a 3 year-old to trace lowercase letters, or expecting a 4 year-old to write a sentence is seen when parents expect teachers to know the expected age for pre-writing skills to emerge, and how to develop them.

Thank goodness there are occupational therapists that can help out. The current preschool programs have teachers that aren’t taught anything about hand development, visual-motor development, or how to teach handwriting, and eagerly let struggling kids move onto the next class, in the hope that they will pick up some skills along the way. With hybrid education due to COVID-19, there will be some kids that never learn to write with any skill, unless administrators decide to get OTs as consultants and turn this doomed ship around.

How To Remember to Do A Sensory Diet With Your Child

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A “sensory diet” is the cornerstone of managing a child’s sensory processing issues.  Every therapist knows that without a good home program that only addressing a child’s needs in a session, we aren’t going to see much progress.  Treatment sessions are spent half playing catch-up:  trying to increase postural activation, calming them down, or waking them up to participate .  When a child’s nervous system has the right input, their performance and how great they feel inside…it can blossom.  You can see what their potential really is, and their life gets better.

COVID-19 has halted many children from attending treatment in clinics.  Parents are now trying to do activities through telehealth, and their success is determined by many factors.  As therapists, we know that if we cannot see your child live, the sensory diet becomes even more important.

Sensory diet activities don’t always run smoothly.  Kids are busy, parents are stressed, caregivers aren’t around as much or as often.  Parents are asking “How do I remember to do these activities when I have so much else to do during the day?”

The answer is to build a routine that makes sense and that your child will use without a fight.  

  • Find the right time of day, when your child needs this imput.  Using the same things at the same times each day make them more familiar.  More familiar can mean less of a fight.
  • Find the right place, where you aren’t fighting their desire to see the TV or see kids outside playing.  Use a space that supports, not competes, with your goals.  Some kids don’t do well in bright lights, big spaces, or with competing sensory input.
  • Find the right sequence, in which a challenging activity is preceded by one that helps your child focus and get in a positive state of mind.  Ask your OT if there is a way to put activities in an order than makes sense for modulation.
  • Find the right toy, book, person, or food that makes a sensory diet activity a chance to play with something or someone special.  This may mean enlisting the other parent, a sibling or someone else in your pandemic pod.  It takes a village.

The perfect sensory diet is the one that you will do and your child will use.  Your therapist might suggest an amazing activity, but if you cannot do it, your child resists it, or you don’t have the time for it….it isn’t an amazing activity.  It is a burden, and a chance for you to feel like a failure and your child to act up.

Don’t let that happen.

If you cannot manage the current sensory diet with enough ease, ask for advice.  Ask for new activities, new toy recommendations.  Ask for more of a demonstration, even if you think you risk seeming less than perfect.  We like parents who show interest, and we don’t mind repeating our instructions.

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