Monthly Archives: January 2017

Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help

 

 

rockybeachI work with two amazing children that could be diagnosed as “twice exceptional”.  Both boys, they have amazing intellectual gifts (one verbal, one in math) but they work with me on their handwriting and their behavior.  Neither can write a simple sentence without significant errors in letter placement or formation.  But both can shock me with their mental abilities.  They are very familiar with what happens when your mom gets a note from the teacher.  It usually isn’t because of their giftedness.  Helping them to succeed in school shouldn’t be that difficult if you look at their test scores.  But it is.

Both kids feel that they are failures in school.  They get in trouble more often than their peers, their homework comes back with lots of red-lined comments, and they have no idea why people alternately compliment them on their skills and then make it clear that they are a problem in some way.  Their minds generate lots of ideas; many of them are clever ways to decrease the amount or level of challenge I throw at them in our sessions.

What is going on?  I think that the whole child has to be seen to be understood.  The gifted brain is different, not just high-powered.  Some kids have  wonderful ideas and thoughts they cannot get on paper fast enough.  Some have struggled with emotional or physical sensitivity.  They freeze or run (mentally) almost before they have written anything.  Some were not paying attention to handwriting in preschool, or figured out that the teacher would accept any effort, so they ignored the class instruction in letter formation and placement.  The other children glowed with pride to write their names neatly.  These children were gazing at the stars, quite literally!

Many, many gifted children struggle with motor skill development, and many more just don’t have the patience for practice.  The incidence of learning issues such as dyslexia in the gifted population is not insignificant.  Their cumulative test scores on their achievement tests mask the learning disability too often.  On paper, these kids look average.  They are nothing of the kind.  Look for striking subtest score disparities to identify them.  But then you have to help them.

Occupational therapists are the secret weapon for the twice exceptional student.  OT has a lot to offer these kids.  We can help self-regulation issues, we can adapt seating, listening, and learning environments for these kids.  We have skills to help them deal with anxiety and the performance issues that arise, and we have handwriting instruction and remediation strategies that work well and work fast with bright students.   Twice exceptional kids often don’t get services because they can “game” the evaluations.  Their great visual-perceptual or cognitive skills allow them to get an average score, but if their approach is carefully observed, the OT can see that happening.  The narrative in the evaluation has to highlight the issues, and the parents have to advocate for treatment.

Working with twice exceptional kids is a joy for me.  They are just as deserving of good therapy as the globally delayed children I treat.  I just have to pay attention to issues of global significance and make sure that I can keep up with the conversations they initiate!

Does your twice exceptional child have a stubborn streak a mile wide?  If so, read Is Your Gifted Child Also Your Most Strong Willed Child As Well? for my perspective on why someone so clever can also get stuck defending a position that makes no sense!

Young Children With Dysgraphia Need Better Handwriting Instruction, Not Just Technology.

The diagnosis of dysgraphia is so vague that I almost hesitate to write about it.  The reason I am dipping a toe into these messy waters?  Almost every psychologist that gives a child this diagnosis recommends abandoning handwriting in favor of tablets and speech recognition programs.  I feel strongly that this does young children a huge disservice.  They will still need to write to survive at school and in life.  There are ways to help them accomplish this without sending the message that writing is hopeless.

When I meet dysgraphic children that clearly have difficulties with the control and placement aspects of handwriting, I know two things:  they are likely to need instruction in posture/paper positioning, and they probably did not have handwriting instruction in a developmental order.  Control (lines that don’t connect, overshoot, get re-written, etc.) can be fixed with some of Handwriting Without Tears’ best materials, including the magic of gray block paper.

Older kids, those in second or third grade, sometimes balk at being asked to write capital letters in those little boxes.  They don’t realize that the box borders and the uniformity they provide will automatically help them grade their control and build uniform sizing.  Really.

Adding some work on learning the  correct start/stop sequence with frequently used letters such as “e”, “a”, and “t” can make a big difference right away.  The number of children that have no idea that an “a” isn’t made with a circle and a short line is almost unreal.  Give them directions that don’t confuse them, use double-lined paper, and see progress occur.  Not a cure, but it can make a paragraph legible for the first time in years.

Many kids with dysgraphia also have issues with postural control, body awareness, and dyspraxia.  They do not sit in a position that gives them optimal pencil and paper control.  And they have never been taught that it matters.  Their teachers may not know the importance of posture/placement, or they assume that these children should have learned about it in preschool or kindergarten.  Not.  Being direct about the how and the why, and firm about not writing until they are physically ready to write can make a huge difference with dysgraphic kids.

A word about mastery.  A diagnosis of dysgraphia tells me that a child has been struggling with writing for a while.  When a dysgraphic child makes progress, they need to experience it fully and take joy in it.  Their peers felt this in preschool and kindergarten.  Give them the same chance.

Being successful hasn’t been emphasized enough in OT.  Mastery is a wonderful feeling, and sometimes we move kids to the next level before they have fully received the blessings of mastery.  Even if activities move forward, always keep a mastery task on board.  Start the session with it, use it on an “off day”, when a child really needs the chance to feel good, or end a session on a high note.  I never let the opportunity for a mastery moment slip by.  Ever!

 

How Do You Teach Word Spacing?

Kindergarteners need to learn to space their words correctly.  But how exactly do you do that?  Most teachers are using the “put your index finger next to your last word as a spacer” strategy.  This isn’t a terrible idea, but many children can grasp the true spacing measure.  Here is why you should attempt to explain it to young children.

First, children are often smarter than we think.  Secondly, they like to know what adults know.  And finally, picking up your “helper hand” off the paper to space words will often result in paper shifts or postural shifts that result in the next word being written incorrectly.  Out of the pan, into the fire!

As children progress from kindergarten through elementary school, they are likely to have less and less handwriting instruction.  Quite frankly, I am seeing even kindergarten classrooms trying to race to language arts, while their students are still unsure of how to write lowercase letters.  That is going to create some interesting substitutions and compensations.  Children know that they are expected to produce written materials, and will substitute uppercase letters in the place of the harder-to-form lowercase letters, or search for a different word with letters that they recall.  What they won’t do is ask for more instruction.  They are kids!

OK, here is the skinny on spacing.  Regardless of the size of the letter, the correct amount of space between words is the width of a lowercase “o”.

That’s it.  Large or small, cursive or print.  One of my sharp students asked why I had left more space than this between the sample words on her homework.  Easy answer:  beginning writers often write larger than the sample, or they make errors.  If I used standard spacing, when she copied my sample and wrote a few of her letters too large, it would be harder for her to fit in her writing directly below my sample.  Her letters would extend past my sample.  Having to move her eyes up and on an angle to see the sample makes it even harder for an early writer to do a good job.

Achieving correct spacing is really not expected until late kindergarten.  Well, it isn’t expected by OT’s that understand the developmental progression of handwriting.  If a teacher asks me to work on spacing at the beginning of the year, I tell them that we have some other things to work on first.  Have they already assessed whether the child knows how to write all 56 letters?   First things first…..!

Improve Your Child’s Coordination, Beginning With Fun Finger Awareness Play

Children with low muscle tone, children with spasticity, and children with dyspraxia all struggle with using their hands effectively and efficiently.  Therapy can be super boring, but it doesn’t have to be!  Here are four simple and fun ways to build your child’s awareness of their fingers that will support grasp, pinch and more!

  1. Gentle hand and finger massage.  This is not the same as what your manicurist does when you get all decked out for a night on the town. (remember what that’s like?)  You will be gently massaging each finger from the knuckle to the fingertip.  I like to place my thumb on top of a child’s finger, and the side of my index finger underneath.  The stroke is firm but not hard, and as smooth as you can manage it.  Children tend to move about more than adults during massage.  You may be aware that I am also a licensed massage therapist.  There is nothing I like better than incorporating massage into OT when it is appropriate!
  2. Name each finger during massage, and during play.  Exaggerate finger movements to help them remember the names and pay attention to your description.  I weave finger awareness into every session I do with some children.  I will name their fingers as well.  I describe what they are doing right ” You have your pointer finger right on top; that’s just the right place to….” and why things aren’t working out for them “I think that when you moved your thumb off your pencil, you pushed so hard that your crayon broke”
  3. I especially like talking about what I did wrong.  Children feel a sense of equality and fairness when adults admit to, and even elaborate on, their mistakes.  It takes some of the pressure off of them as young learners.  I will clearly describe to a child what I think I did wrong, and what I am going to do differently the next time.  That allows me to model persistence, one of the traits that help children with delays and disabilities thrive.
  4. Use “Where is Thumbkin?” and other finger plays.  These are not just for preschool.  They are fun for parents too.  Your child may not have been able to keep up with the faster version at school, so this is a great opportunity to practice with an adult that can slow it down and repeat the movements until he gets it just right!

How Occupational Therapy Can Help Gifted Children (And Their Exhausted Parents!)

rockybeachGifted children have abilities that make them more sensitive to their bodies, their world and the people in it.  They notice sensations, emotional states and the interplay between the physical and the non-physical world in ways that non-gifted people do not.  Exquisite sensitivity often comes at a price for gifted children and their parents.

Think about this in the same way an electrical device cannot support additional volts of current.   A parent’s pride in her child’s amazing abilities can be overshadowed at times by the fatigue and frustration in dealing with tantrums, rigidity, sensitivity, and a child’s seemingly inexhaustible energy.  Occupational therapy can help manage the current and “keep the lights on” without power surges destroying the functioning of the computer.

Particularly in the early years, gifted children can become easily overwhelmed when their emotions, their impulses and their perceptions exceed their ability to process everything they experience.  They may feel clothing or food as intensely strong sensations.  They may want to swing for an hour, then cry when it is time to leave the playground. They might be aware of a parent’s sadness or another child’s frustration more acutely, but have no idea what is happening or what to do.  They really “get” the plight of the polar bears on the disappearing ice sheets.  After all, they can read the New York Times at 5!    They just don’t know what to do with all these feelings, thoughts, desires and sensations.

Some abilities in gifted children are advanced by years, such as reading or math.  The ability to share with a sibling?  Not advanced at all!  This “asynchronous development” can cause internal conflict and may result in more frequent and more intense outbursts, refusal to participate in school or playdates, sleep issues and more.

OT’s with a strong sensory processing background can help gifted children and their families navigate the complex sensory-motor, cognitive and emotional/social overload that happens when brainpower exceeds management capacity.  What unique skills does an OT bring to the table?  The ability to assess and implement a whole-person approach.    Talking about behavior, making a rewards chart, and cognitively understanding where all that energy comes from is simply not enough to make the days and the weeks easier for a gifted child.  The occupational therapist’s toolbox is deeper and wider, and includes physical interventions that look like play, social/emotional mastery experiences (not just talk), and sensory-based activities that support self-regulation as a child grows into their amazing abilities.  Take a look at Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help if your child is gifted but dealing with issues such as sensory processing, ADD, learning issues or ASD.

Occupational therapists do use cognitive strategies such as the “How Does Your Engine Run?” program by Williams and  Shellenbarger.  A cognitively gifted 4 year-old may be fully capable of engaging in this useful program.  A sensory diet, one of the core concepts of most sensory processing treatment programs, can help children discharge and manage sensitivity and excitement throughout the day.

Parents that know how to help their child regulate their arousal feel empowered, not defeated, when their child becomes overwhelmed.  Children learn that their parents “get” them, and that they can turn to them for support instead of criticism.  Feeling understood and feeling capable is the bedrock of self-confidence and self-esteem.  Gifted individuals need to know that they are more than their stratospheric IQ, and this is where it begins.

Dr. Harvey Karp’s Happiest Toddler on the Block program is amazingly effective at teaching children how to handle the strong emotions of early childhood, and teaching parents how to support their children without crushing their spirit.  I use his incredible techniques with every gifted client I see.  Children with ASD respond, children with SPD respond, and gifted children respond.  Dr. Karp’s strategies allow children to learn how to express their feelings without judgement, and teach parents to set limits and place consequences on behavior without crushing a child’s spirit.  Isn’t that what we all want for our children?  Check out Stretch Your Toddler’s Patience, Starting Today! even if your child is not a toddler.  It turns out that Dr. Karp’s easy technique for handling demands works on impatient people at almost any age.  You just alter your presentation to fit their emotional state and communication level!

Research suggests that the way a gifted brain functions is always going to be different than the typical child.  I believe that therapy for gifted children effects change in a very similar manner to therapy for the autistic child; therapy can make daily life easier, and it can help a child learn to handle their thoughts and experiences with greater comfort and ease.  Brain function changes as it learns to adapt and make better connections, but the structure remains unique.  Occupational therapists support gifted children and their families in exactly the same way we support people in the special needs community:  without judgement or dismissing problems that arise in living.

If you are the parent of a gifted child, and you would like more support, take a look at some of my previous posts on The Happiest Toddler strategies such as  Is Your Gifted Child Also Your Most Strong Willed Child As Well?Your Bossy Baby or Toddler May Be Gifted. Really. Here Are The Signs You Are Missing! and on sensory sensitivity Dressing Without Tears: Sensory-Sensitive Strategies That Work.  You can use these concepts today to help your gifted child!

Want more personalized support?  Visit my website tranquil babies and purchase a phone consultation.  You will have a chance to ask questions and get answers that directly give you more calm and more joy in your home…today! 

Why is Staying Dry at Night So Challenging For Some Children?

I have received a few questions on this subject since publishing my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Parents are wondering how to expand daytime success through the night.  Here is what I know about getting through the night high and dry:  it is as much a physical milestone as a behavioral accomplishment.  The pituitary gland is involved in hormonal secretions to diminish urine production, and the nerves for sphincter control may not be fully developed in younger children.  The bladder has to expand to hold a quantity of urine at night, so tiny children really cannot accomplish this feat, regardless of motivation.

Typical children who are dry all day can need another 2-4 years (yes, years!) to stay dry at night and/or wake themselves and use the potty independently.  The child who is a “potty master”, getting there on time and managing all the skills at school, may still need a pull-up style training pant as an insurance policy.

What can you do to improve the odds of dryness at night?

  • Limit drinks right before bed.  As you know from my book, children will generate enough urine to “go” about 45 minutes after a big drink.  The kidneys are also responding to hormone and salt levels in the blood, so some urine will be generated at night, even if nothing has been taken in by mouth for 2 hours before bed.  Deny that late night sippy cup or that last swig of juice, and come up with a better bedtime routine in it’s place.
  • Insist on the bathroom being a last stop before bedtime.  Empty that bladder, even if your child insists that they don’t feel that they need to “go”.
  • Make sure your child is well hydrated during the day.  A thirsty child is going to beg for that drink, and then fail to stay dry.  The bladder gets it’s exercise during the day, as it fills and empties.  Constantly running to the bathroom, or never making it to the bathroom can both contribute to late preschool bedwetting.  Be encouraging but firm with children that tend to dry out during the day.  They don’t realize the part their refusal plays in bedwetting, they just feel like a failure, and maybe worry that they are a failure in your eyes as well.
  • Recognize the role of constipation can play in bedwetting.  The pressure of stool on a bladder can be enough to create problems.  My book has many ideas to address constipation, and this is another reason to address this problem instead of hoping it will go away.
  • Accept that brain maturation is a key driver of night dryness.  A child with brain differences, from ASD to ADHD to SPD, may need more time to achieve this milestone.  Criticism and harshness isn’t going to make that brain develop any faster.
  • Ask your pediatrician’s advice if your typical child isn’t dry at night by 7, or if you suspect that there is another issue.  Never ignore your gut feelings about your child.  You know more than you think!

Take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about my e-book and how it can help you toilet train your child!  Visit my website tranquil babies to purchase the book and buy a phone consultation to get your specific questions answered personally!

Is Your Sensitive Child Gifted As Well?

Happy New Year!  The topic of sensitivity (in all it’s expressions) in young children isn’t new to this blog, but the correlation with giftedness hasn’t been a part of my other posts.  It is today.

Sensitivity is common in gifted toddlers and preschoolers, and sensitivity is ubiquitous in young children with diagnoses such as ASD and SPD.  Could you have both?  Sure.  Could you have neither, and just have a very sensitive little soul who avoids socks with seams and still can’t spell their name at 5?  Sure.  Seeing the pattern of sensitivity that gifted children can express isn’t that easy, but it can make dealing with a young child so much easier when you understand the source and know how to support them.

Gifted children make mental and emotional connections that other children their age do not.  They see and feel the world differently.  They are still young children, without fully developed emotional regulation, and they bear the weight of all that they perceive.  It can  accumulate throughout the day and over time, and overtake them.  You can see more outbursts, more episodes of being overwhelmed, and more crushing waves of emotion.  Strong emotions are common with the gifted populations, and they can be more challenging during the toddler years.  Remember: not every aspect of brain development is advanced at the same level in gifted children.  In many ways, your 3 year-old who reads chapter books is still just 3!

Our brains do not have barriers, so emotional and cognitive floods will create sensory floods as well.  This is something that every adult can understand:  if you have had a fight with your partner, it is more likely that the bright sunshine will bother you a bit more, the TV will seem too loud, and the people in line at a store are crowding you a bit more than you’d like.  You are an adult, so you can take action to reduce your sensitivity (sunglasses, remote control, choosing a shorter line or leaving) but children cannot.  They do not even know what is making them uncomfortable.  And they often cannot put feelings into words, even if they can tell you all about every dinosaur or how tornadoes affect the planet.  Emotional maturity and expression is not always developing at the same amazing pace as cognitive skills in gifted toddlers and preschoolers.

What can you do to help a gifted and sensitive child?  The general methods to address  sensory sensitivity will be helpful for these children.  OT’s use a wide range of physical and behavioral strategies effectively, about which I will write about in more detail later this week.  Verbally gifted children may be able to comprehend an explanation of why they explode the way that they do, and they may even be able to help you create a plan to help themselves.  Loving your child isn’t enough, but accepting the entirety of who they are can go a long way to making life easier with your sensitive gifted young child.

I will be writing more about this topic in 2017, and hoping to expand my posts to an e- book and a few local lectures.  Please comment here, and let me know if there are specific issues with sensitivity and the gifted child that you would like to see posted!