Hypermobility and Music Lessons: How to Reduce the Pain of Playing

 

kelly-sikkema-jrFNMM6K0VI-unsplash.jpgMost kids want to learn how to play an instrument in grade school.  Most parents encourage some form of musical training for the benefits of musical training: social, coordination, attention and focus, even the suggested connection between math skills and musical ability.  Hypermobile kids can struggle with the physical demands of playing an instrument sooner and more severely than a typically developing child.

There are ways to make it easier and less painful, right from the start.

  • Steer them into the right instrument for their physical abilities.  Heavy instruments are a questionable choice for kids that have back and shoulder issues, as they will be moving their instrument around a lot.  Children with very hypermobile wrists could find the positions for violin or guitar much more challenging than the positions for piano or clarinet.  There will still be a lot of fingering, but it occurs in a different plane of movement.
  • Understand that as hypermobility changes, so may the type of instrument that best fits your child.  This is a tough thing for kids to accept, but if they are experiencing repeated strains and injuries or an increasing amount of pain, they may have to switch to an instrument that is less risky.  Remember:  hypermobility syndromes don’t disappear, and most hypermobile children will not become professional musicians.  This isn’t life-or-death, no matter what.  Injuries that affect the ability to attend school and eventually affect working…that is something to avoid.
  • Positioning matters.  Just as with sitting at a desk or a table, hypermobile kids need to use the best possible postural control with the least amount of effort.  Children playing the piano may need a chair with low back support rather than a piano bench.  Seats may need to have cushions that give more support and seats should definitely provide solid foot placement on the floor at all times.  Some kids may need the support of a brace or braces.  Back, shoulder, wrist, and even finger splints aren’t slowing them down; they are supporting performance.  The biggest problem will be resistance from the artist.  Children rarely want to wear these devices, and if they aren’t well designed and fitted, you will hear about it.  Ask their OT or PT for direct assistance or find one that can do a consultation.  And don’t wait until an injury happens.  Get in front of this one.
  • Musical skills require practice, but hypermobile kids may need to break up their practice or do targeted practice to shorten the total amount of time spent and reduce the physical strain.  Targeted practice requires that their instructor knows which types of practice are the most likely to build skills, rather than just adding minutes to a practice session.  Breaks are important, and most kids don’t have the ability to know when and how to take them.  They need to be taught, and the little ones need to be supervised on breaks.

 

Looking for more information on raising a child with hypermobility?

My next e-book, The JointSmart Child:  Living and Thriving With Hypermobility  Volume Two:  The School Years is coming out in March 2020!  It will have more information about kids 6-12, including sports and the hypermobile child, improving communication with your child’s teachers and coaches, and how to address handwriting and keyboarding problems.  It will have more forms and checklists than the first book, but still cover all the self-care issues like toileting and how to make your home safer for your child.

Look for it on Amazon.com and YourTherapySource.com soon!

 

clark-young-tq7RtEvezSY-unsplash.jpg

 

Sensory Processing and Colds: Nothing to Sneeze At!

joel-overbeck-552597

Here in the US, it is cold and flu season.  Most of my day is spend with kids recovering from some upper respiratory virus.  A few seem to have a continuous runny nose and cough.  They also have an increase in their sensory processing issues.  Is this connected, and if so, what can be done?

  1. Anything that affects health will make sensory processing harder.  Anyone, at any age, will struggle more when they don’t feel well.  If a child is super-sensitive, feeling ill will make them edgier and more avoidant.  If a child is a sensory seeker, that funny feeling in their head that changes when they flip upside down will probably make them do it more.  If a child is a poor modulator, and goes from 0-60 mph easily, they will have more difficulty staying in their seat and staying calm.
  2. Colds often create fluid in the ears.  This is a problem for hearing.  This is often a problem for speech and mealtimes.  It is also a problem for vestibular processing.  Fluid in the ear means that children are hearing you as if they are underwater.  Their speech may be directly affected.  They probably realize that biting and chewing open the eustacian tubes from the mouth to the ear, so they may want to chew more.  On everything.  They may also be unable to handle car rides without throwing up.  They may refuse to do any vestibular activities in therapy.
  3. Children sleep poorly when ill.  Anyone with sensory processing issues will struggle more when they are tired.  Young children cannot get the sleep they need and don’t understand why they feel the way they do.  Enough said.
  4. Spatial processing problems will get worse.  Being unable to use hearing to orient to the space and the people and objects in the room, children will roam around more, touch things more, startle more, stand still and look disoriented, and may refuse to go into spaces that are hard to process, like gyms or big box stores.  Uh-oh.

So what can you do as a parent or a therapist?

  • Understand that this is happening.  It is real.  It may not be a personality issue, a deterioration in their ABA program, or a problem with therapy.
  • Ask your pediatrician for more help.  There are nasal sprays and inhaled medications that can help, and some, like steroids, that can create more behavioral issues.  If your child needs steroids, you need to understand what effects they can have.  Saline sprays, cold mist humidifiers, soups and honey for coughs, if your pediatrician approves, are low-tech ways to help a child suffer less.
  • Alter your daily routine if needed.  Making less appointments, fewer challenges, and more rest could help.  Kids can be over-scheduled and under-rested.  Therapy sessions may have to be adjusted to both be less stressful and more helpful.
  • Your child may benefit from vestibular movement if they do not have an untreated ear infection.  Your OT can help you craft a sensory diet that moves fluid, but not if there is an infection.

caroline-hernandez-698708-unsplash

 

Young Children, Sensory Modulation, and the Automatic “NO!”

taylor-smith-Mw9TO8Wbz8A-unsplash

Kids as young as 18 months can express their sensory processing issues with one word: “NO!!”  What appears to be a budding attitude issue or even oppositional defiant disorder can be a sensory modulation issue instead.

How could you possibly tell?

Well, if your child has already been diagnosed with sensory sensitivity or sensory modulation problems, you know that they won’t just make it harder to wear clothes with seams or touch Play-Doh.  These issues affect all aspects of daily living and create emotional regulation and biological over-activation issues as well.  Young children are learning how to express their opinions and separate physically and emotionally from their caregivers.  Saying “NO!” isn’t unusual for young kids (and a lot of older ones too!).  But refusals that make no sense can have a different origin.

So what is the giveaway?

When a child has an almost immediate “NO”, perhaps even before you have finished your sentence, and the reaction is to something you know they have liked or almost certainly would like, you have to suspect that sensory modulation is at play.  You should know when your child is trying to get your attention or get you activated.  This should feel different.

What do I do next?

You also need to respond in a specific way to test your theory.  Your response should be as vocally neutral and emotionally curious as you can manage.   “Oh, really….you said no…” is a good template.  Whether it is “no” to their fave food, show, toy or activity.  You remove all criticism and encouragement from your voice.  You don’t want to fuel the refusal fire; you want to shut it off and see what is left in the embers of “NO”.

Now you need to wait for them to neurologically calm down.  Little brains are like old computers.  They take a while to reboot.  Look at the floor, wipe your hands, etc and wait a minimum of 15 seconds, probably 30, to ask again if they want a cookie, to go out, to play, to eat, or whatever.  The child who needed their primitive part of the brain that responds defensively to go offline and then use their frontal lobes may ask for what they just refused, or respond to your exactly identical request with a cheery “YES”.

Please try to have compassion for them.

It can seem maddening to do this all day long, and in truth, if you are, you need to learn how to work with an OTR to learn sensory treatment strategies that have some power to rewire the brain and get out of this pattern.  But your child isn’t jerking your chain when their behavior fits this pattern.  They are almost a captive of their brain wiring.   Don’t let yourself react as if they are intentionally being difficult.  That day will come…..

valeria-zoncoll-AVGc87j_vNA-unsplash

What To Say When Your Child Cries After Losing a Game

kiana-bosman--8j5FpnLmQk-unsplash

Whether it is a board game or a soccer game, once children are old enough to wrap their minds around winning, they cannot handle losing.  Their grief leads parents to “throw” every game so that their child wins every time, or they make up games where everyone is a winner (I will admit to doing this one).  But inevitably, a child has to learn to accept that this time, in this game, they didn’t prevail.

What makes them learn to handle this without doing a “John McEnroe” and throwing the game board all over the room, or screaming in the car on the way home from the field?

  1. Model the emotions of losing, not just the noble way to lose.  Kids need to know that it is normal to feel bad about losing, just not behaving badly and not feeling devastated.  Seeing and especially hearing someone say how they feel helps children learn about their own emotions.  Play a game with your partner as well as your child, run a relay race, etc.  Just talking about it isn’t enough for young children.  They want to see the drama unfold.  If you showboat around the living room, you might want to reconsider that one.
  2. While we are speaking about showboating, you can comment to your older children on the behavior of sports figures.  Older kids can comprehend why that isn’t admirable behavior, and they need to hear why you think that.
  3. Tell children why adults don’t cry when they lose (most of the time).  It is very simple:  we know we will get another chance to win the next time we play.  We are still sad, because everyone wants to win.  They need to know that is true as well.  We also know that the best part of the game is playing, or else it isn’t really fun.
  4. If your partner/spouse doesn’t display the same equanimity about losing, you have a conversation in front of you.  Raging and bad behavior on the field or the rink has become dangerous, and you want no part of it.  Some adults were never taught these things, and some people have such limited lives that games really are that important in them.  They need help to grow up and reach for greater things.

robert-collins-333411-unsplash

How Using Dr. Karp’s Fast Food Rule Transforms Kids With Special Needs

wout-vanacker-497472

Yes, I said the word transform.  I know that hyperbole isn’t always appropriate when you are a therapist (we try to hedge our bets with predictions), but I am willing to go out on a limb in this instance and say that learning this single Happiest Toddler on the Block technique will make a difference with any child with special needs that functions with over a 12-15 month cognitive level.  Will it work with older children?  Absolutely.  Done right, it will also work on spouses and co-workers!

What is the Fast Food Rule?  You can read more about it here Help Your Child Develop Self-Regulation With Happiest Toddler On The Block but the simplest way to explain it is that when you have an upset person, they get to express themselves first, then the adult paraphrases the upset person’s expression with about 1/3 of the emotion that was used.  The paraphrasing is done at the level of comprehension of the upset person.  This means that someone who has a very low language level and is very upset may only hear “You say NO NO NO”.  Remember that any degree of agitation immediately lowers language comprehension IN EVERYONE.  Even you.

That’s it.  The phrase may have to be repeated a few times until the adult observes signs that the upset person’s agitation is decreasing (not necessarily over).  What are those signs?  A decrease in screaming volume or intensity, more eye contact, stillness of the body, turning to the adult rather than turning away, etc.  If the problem isn’t clear, altering the phrase is OK.  No harm done if you get it wrong; try again to state what their problem is.

ONLY WHEN THE UPSET PERSON HAS DECREASED THEIR AGITATION IS IT PERMISSIBLE TO OFFER A SOLUTION, OR EVEN CONSOLATION.

Why?  Because until the upset person REGISTERS that the adult understands the nature and the degree of stress, they will continue to protest to make their point.  It doesn’t matter if the point is pointless.  All the better.  Being understood is more important than being corrected.  Always.

Because young children’s brains are immature, their agitation may start up again after the problem is solved.  This is neurological, not psychological.  Rinse and repeat the FFR, and come out on the other side calmer.

Why does this transform the life of a special needs child?

Kids with special needs often need to be more regulated than the average child.  They can be unsteady, difficult to understand even when calm, have medical issues that get worse when they are agitated, and fatigue rapidly on a good day.  Being upset makes safety, endurance, sensitivity and sensory seeking worse.  Sometimes much worse.

If your child or your client has any of these issues (and I have yet to work with a child with special needs that doesn’t have ONE or more of them), then you need to learn the FFR today and use it consistently.

  • Kids with cerebral palsy can move with better safety awareness and expend less energy.
  • Kids with hyper mobility are also safer, less fatigued and can focus on movement quality.
  • Children with sensory processing issues are more modulated, less aversive or sensory seeking.
  • Kids with ASD do less self-stimulation and have less aggressive behaviors.

 

The biggest obstacle for me?  Using Dr. Karp’s Toddler-See language strategy and fearing that I sounded like an idiot in front of parents who were paying me a lot of money to treat their child.  It turns out that not being able to calm a child makes me look like an idiot, and effectively getting a child calm and focused makes me look like a skilled professional.

beatriz-perez-moya-rYvj17pefXs-unsplash

Should the PARENTS of Kids With Sensory Issues Use Quickshifts?

juliane-liebermann-542688-unsplash

My clients and my blog readers know that I started using a therapeutic sound treatment called Quckshifts earlier this year Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation.  I haven’t lost my enthusiasm for this treatment.  It has made easy sessions more effective, and difficult sessions workable.  Kids that are struggling get a boost, and kids that needed a lot of preparatory sensory activity to regulate and engage rapidly find their footing.

Could this be useful for parents too?

There is no age limit on the use of Quickshifts, and the creators at Vital Links write and speak about treating adults using this program in their training materials.  But thus far I haven’t heard them talk about the use of Quickshifts with the parents of their clients.  I wonder why.

If you have a child with sensory issues, even one who attends mainstreamed programs and is doing fairly well in social activities, your days have a certain level of stress in them.  Sensory diets work, but they also take work to use and monitor.  Children aren’t crockpots, so you are actively administering or at least setting up the activities the comprise a sensory diet.  Kids reach bumps in the road, and kids with sensory issues can have bigger meltdowns over smaller bumps.  Parents have to help them manage things that other kids shrug off.  And parents always are thinking ahead, wondering what effect a new summer camp or new school with have on their child.  Even when things are going well, parents can feel some stress about all of these things.

It is well known that if you are a therapist treating children with sensory processing issues, at least one parent could say to you “Wow; I used to have the same problems, and everyone told me I was just being difficult/stubborn/picky, etc.”  Treatment options picked up in the early 90s, so we do hear this less and less.  But not in every community  or school system.  And if a parent’s parents refused to “believe” in sensory treatment, then these kids got nothing.  Or perhaps they were sent to a psychologist.  When I describe their child’s experiences using sensory processing terms, some parents recognize that their responses are very similar.  They have been told, or they have assumed, that they are reacting psychologically to events or stimuli.  They now are thinking differently about themselves as well as their children.

Finally, in this era of #MeToo, there is growing awareness that many of the parents of the children we work with bring their own trauma with them into parenting  Are You a Trauma Survivor AND the Parent of a Special Needs Child?.  I just did a presentation in FL (Feb2020) on using sensory processing treatment to help adults with traumatic dissociation.  The dysregulation that accompanies trauma doesn’t disappear after delivering a child.  At times, having a child can bring past traumas up to the surface and create problems that seems to have been handled or forgotten.  These parents need our support and assistance.

Which brings us to the question:  Should the parents of kids with sensory processing issues, especially the parents that have problems with self-regulation, use Quickshifts as well?

My strong opinion is that since there isn’t a downside, they should give the Regulation albums a try, and see how they navigate a typical day after listening.  The changes in adults are more subtle because their lives are more complex.  Parents need to know what changes to look for: usually the ability to remain calm with transitions, to focus on a task or to think a process through more easily.

Parents with more anxious tendencies might use Gentle Focus successfully, and parents that need to up-regulate would love Synching Up or Rockin’ Surf.  The decision to use Quickshifts and how to select albums really is easier when you consult an OT.  Wasting money and time buying and using the wrong album is unnecessary!  I love working with adults that have regulation issues or sensory sensitivities.  The relief in their faces tells me that they are getting the help they need to be their best.

 

mike-arney-9r-_2gzP37k-unsplash

Can Harvey Karp’s HTOTB Strategies Help Kids AND Adults with Regulation Issues?

jose-antonio-gallego-vazquez-690049-unsplash

Many child psychologists and psychotherapists are focusing on attachment theory and the problems of poor emotional regulation in children.  The rise of self-harm behaviors in teens and aggression in children as young as 3 can be related to difficulties handling emotions and experiences that increase arousal levels but never get resolved.

Not every child who throws their book down in frustration or slams their bedroom door needs to see a therapist.  But I do wonder how many of those teens that cut themselves, starve themselves or get suspended for putting their hands on a teacher or fellow student, actually needed Dr. Karp’s techniques when they were 3 or 4.  Maybe, just maybe, if they had been helped with Patience Stretching when they wanted that toy, or if someone had used the Fast Food Rule with them when they had a tantrum Use The Fast Food Rule For Better Attunement With Your Child, maybe they would be in better shape at 13.

Why?

Because these techniques don’t just work on the child.  They work on the adult using them as well.  And adults who can self-regulate raise kids who learn to do it too.

When I use Patience Stretching Stretch Your Toddler’s Patience, Starting Today!with a toddler that wants one toy while I want them to work a bit longer on a therapy task, I am actually receiving the benefits of the technique as well.  I am both teaching and experiencing the reduction in frustration and the decrease in agitation as this strategy calms down the whole situation.  Oxytocin gets released when we calm down with a child, and adults need that hit as much as children do.  If we “go there” with an agitated child, we feel worse, even if we think we won because we have the power to deny or punish.  It doesn’t feel good to do either, but it also doesn’t feel good to give into a screaming child.  Not really.  Even the most permissive adult will say no to something dangerous, and then the child who is unfamiliar with hearing “no” will really explode.

The good news is that you don’t have to get an advanced degree to use Dr. Karp’s strategies.  You have to practice them so that your delivery is flexible and confident, but anyone can do it, not just therapists.  In fact, if these techniques don’t work well once you improve your delivery, that could be one way to decide that you need to consult a child specialist.

mike-arney-9r-_2gzP37k-unsplash