Monthly Archives: February 2017

Why Dot-To-Dot Letter Practice Slows Down Writing Speed and Legibility

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These beach umbrellas look like a dot-to-dot picture!

Most workbooks feature dot-to-dot practice for writing letters.  They shouldn’t.  Why?  The answer is obvious if you know how to teach handwriting.  The biggest problem is that so few people understand how children learn to write, and what gets in their way.

There are 3 stages of learning:  imitating an adult, copying printed materials, and independently writing a letter.  When the first stage of instruction is too short, poorly attended to (imagine a distracting preschool room) or nonexistent (“go practice at the writing table during your free period”), children end up drawing their letters, unaware of how letters are correctly constructed.  Dot-to-dot worksheets encourage drawing letters. They do a very poor job of teaching correct formation and a good job of encouraging bad habits in handwriting.

These worksheets, even the ones with a starting dot or arrow, cannot be followed correctly by most very young children.  They look at the letter “a” in the same way I look at a Chinese character or a hieroglyph.  I could probably copy it, but I have no idea which lines make a single stroke, which to write first, second and third, and no sense that it should be similar to other characters.  Children really don’t follow a tiny arrow or understand that numbering the strokes means that a tiny number two at the top means “This is your second stroke”.  Older children do, but they aren’t the ones laboring over the dot-to-dot letter pages.  There is a better way.

To make my point clear, look at the letters that Handwriting Without Tears calls the “magic c letters”:  c, o, a, d, and g.  By the way, are you wondering why “q” isn’t in the group, since it is formed in a similar manner?  They add “q” later in instruction, due to the potential confusion with “g”,which is a more commonly used letter in English.  I have seen a single child write the letter “c” made starting at the baseline and curving up, then make the letter “o” correctly by first writing a “c”, and then write letters “a”, “g” and “d”  by drawing circles and adding straight or curved lines.

This method of letter formation never looks neat once children have to write full sentences with some speed.  It can’t look good, as the pencil control required to write well with these strategies is too challenging for young children once they have to write more than a few letters.  Ooops! Where did they come up with all those different methods of writing letters that should be made by starting with the letter “c” and then continuing to form the specific letter?   They figured it out for themselves, since no one was watching!

The “Magic C” approach is brilliant because it is simple to recall and it creates control and automaticity, two hallmarks of legible handwriting.  Dot-to-dot writing leads children down a path riddled with possible bad habits.

So are dot-to-dot pictures a terrible idea?  Not at all.  I love the way children have to control pencil strokes and visually scan the page.  They are great visual-motor fun.   There are complex dot-to-dot pictures with over 200 dots that really challenge kindergarteners who can count.  Just don’t teach letters this way!

Strengthening A Child’s Pencil Grasp: Three Easy Methods That Work

 

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Dreaming of summer fun!

When a child makes fast progress from a fisted grasp to a mature pencil grasp in therapy, parents notice.  This isn’t easy to accomplish, but it is possible.  I spent the first decade of my pediatric OT career thinking that finger exercises were the answer.  Nope.   Here are my three favorite strategies to see quick improvements in children ages 3-5:

  1. Crayons.  Yes, I suggest you go old-school and use crayons, not markers, for scribbling and drawing.  The tackiness of wax on paper  creates slight resistance that builds strength.  Feel free to provide paper with a bit of texture, such as watercolor paper; it is worth the investment!  Just like when you go to the gym, all muscles will respond to resistance by recruiting more fibers and building more strength.  Yeah!
  2. Easels.  Every pediatric OT recommends an easel, and there is a good reason why.  Easels work.  I take if further, and make sure that the paper doesn’t slip at all, and that the target for a child’s scribbling is in the middle 1/3 of the easel surface.  Why?  Unless a child is very tall or very tiny, this will result in a more effective shoulder and wrist angle that allows a mature pencil grasp.  How do I ensure that a child uses the target area?  I color in the top  and bottom 1/3’s, creating either good demos of shapes/designs, or just scribbling away, having fun.  What I draw depends on the child’s needs at the moment.
  3. Tablet Stylus.  I am well aware that some therapists are recoiling in horror at the thought of using a tablet.  They might have to reconsider their stance after reading what I have to say.  Children are using them daily in their homes, many have their own, and sport a newer model than I drag around for work!  Tablets aren’t going away, so use them to your advantage.  Using a stylus (my fave is the iCreate stylus)  produces the tacky resistance that we like about crayons, but on a touchscreen.  When children have to drag-and-drop objects, they are using more muscle strength and better control to maintain a stable yet mobile grasp.  A few years ago, I worked with a very weak child who was dealing with a life-threatening illness.   No one was going to force him to do anything, and all he wanted to do was play on a tablet.  He was told to use the stylus while playing, and 6 weeks later he was eagerly coloring with crayons on paper.  His improved pencil grip was amazing!  As always, my apps are educational as well as fun, and tablet use in therapy is neither a reward nor the focus of my sessions.  I make it clear that lots of fun can be had without it.

As with any therapeutic exercise, I monitor fatigue and adapt my set-up and activities to maximize use of a mature grasp with minimal compensation.  The rule is:  if it looks like a bad grip, it probably is!  If your child insists on using a fisted grasp even with these strategies, you need to use some behavioral motivational tools in addition to good equipment.  Your OT can help you with that!

If your therapists have mentioned that your child has low muscle tone or ligament laxity (loose joints) take a look at Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility? for some clarity on addressing pencil grasp with these issues.

Sensory Sensitivity In Toddlers: Why Responding Differently to “Yucky!” Will Help Your Child

Sensory sensitivity and aversive behaviors are among the most common reasons families seek occupational therapy in Early Intervention.  Their kids are crying and clinging through meals, dressing, bathing and more.  What parents often don’t see is that they can help their child by being both empathic and educating them throughout the course of the day.

My clinical approach has matured over the years from the standard OT treatments to a whole-child and whole-family strategy.  One important part of my approach is to alter how adults react to their children.  It isn’t complex, but it is a shift away from thinking about the problem as being exclusively “my child’s issues with sensory processing”.  Once adults understand the experience a child is having from the child’s point of view, they can learn to respond more effectively to a child, and get results right away.

I recently did a therapy session with a toddler and her mom.  When the child became overwhelmed by her dog barking and rushed to her mom to be picked up, I warmly and clearly said “You want up?” twice while using explicit body language to convey calmness, while the mom looked at her child but didn’t scoop her up right away.  The child turned to look at me, stopped whining and dropped her shoulders.   She relaxed at least 50%, stuck her thumb in her mouth for about 30 seconds, then started to play quite happily.  What I know is that this short interaction affected her body’s level of neuro-hormonal arousal, her thinking about how adults handle sensory events, and her memory of how she feels when she is overstimulated changed. I believe that those differences physically change the wiring of her brain in a small but meaningful way.

I cannot take full credit for this strategy; I used the Fast Food Rule from Dr. Harvey Karp  Use The Fast Food Rule to Help ASD Toddlers Handle Change.  I am using it for therapeutic means, but it the same tantrum-defusing method he developed.   I responded with loving calmness to her over-the-top reaction, acknowledging her request while not granting it. She was “heard” and accepted.   I gave her a moment to come up with an alternate response (quick thumb-suck and then search for fun a fun toy).

This little girl has a habitual reaction to sensory input that puts her into a fear-flight pattern on a regular basis.  Cuddling her works for the short-term, but it leaves her seeking adult assistance for any fears, and it doesn’t give her any skills to handle things or suggest that she could handle situations differently.  Shifting her habitual reactions to  these benign events is essential to make progress, and telling her that it was “just the dog barking” doesn’t work.

Why?  Because Dr. Karp will tell you himself that toddlers hear you saying”just” as if you were telling them “you are wrong”.   They protest more to make you exactly see how upset they are.  Explaining things rationally doesn’t help a little person in the throes of emotion.  Modeling calmness while acknowledging their feelings is what helps them learn and grow.

Your child is wiring his brain every moment of every day. Your sensitive child is assessing all of your reactions to learn about what is a danger and what is not.  His brain, not his hands, are interpreting the world as irritating or frightening.  Your reactions to events and to his responses will help to hardwire his brain to believe something is scary, or challenge him to adapt and change that automatic pattern of response.  It isn’t all psychological, it is neurobiological as well.  Most researchers don’t differentiate between the two any longer.  They know that biology drives thought and that thought can alter biology.  The rubber meets the road right here, right now, in your own home!

OTs working with sensory processing disorders generally believe that an aversive response to a benign stimulus (hysteria when touching lotion or oatmeal) is not a skin issue or a mental health issue, but a brain interpretation gone wrong.  There are many reasons why this would happen, but most of us believe that experience and exposure, done well, can change the brain.  Some exposure is done with programs like the Wilbarger Protocol, the use of weighted or pressure garments, and many other great therapeutic techniques.  Changing adults’ responses hasn’t been researched nearly as much, but my clinical experience tells me it probably should be.  I know that teaching parents how to shift their behavior has made a difference for my clients almost immediately.

Good therapy can diminish a child’s aversions substantially, and even create exploration and excitement.  It is wonderful to see a formerly anxious child move through her day exploring and enjoying the world around her!

Does your sensitive toddler struggle with toilet training?

 The Practical Guide to Toilet Training Your Child With Low Muscle Tone is my new e-book (hard copies can be obtained by contacting me directly) that may help you tonight!  Sensory-based strategies can really help children with sensitivity, and good instruction minimizes all the multi-sensory mess that training can become when you don’t know what to do.  Your child doesn’t need to have severe issues with low tone.  Many children have both sensory sensitivity and low muscle tone.

Visit my website tranquil babies, and click “e-book” on the top ribbon to learn more about this unique book!

Avoiding Letter Reversals In Preschool

Are letter reversals in preschool normal?  Yes.  Can you avoid them, and thus speed up the accuracy and automaticity that are hallmarks of successful handwriting?  Sure!  This post will explain why reversals are slowing kids down unnecessarily and how to limit letter and number reversals right from the start.

Writing letters backward is very common in preschool, and is not considered abnormal if a few letters or numbers are reversed if a child is under the age of 8.  So why bother even thinking about how to teach letter formation without reversals?  Common Core, PARC, and all the other achievement tests have contributed to less classroom time made available to focus on handwriting, while demanding independent writing skills earlier and earlier.  Teachers in grades 1 and up expect that learning to write letters and numbers has been accomplished, and now it’s all about content.  That means that preschool and kindergarten teachers need to spend time on writing instruction, and they need to choose the most effective methods to do so.

That sounds so simple, but understanding how to avoid reversals without doing constant drilling is hard.  That is how your grandma’s learned to write: kids practiced daily and knew that good “penmanship” was a thing, a thing that mattered.  Today’s preschool teachers generally don’t have much (or any) instruction in how to teach handwriting, and certainly don’t review research on how to teach it the most efficiently for the fastest results.  They are asked to teach kids with learning differences, some of which make it difficulty for kids to perceive that they have reversed a letter, even when it is pointed out to them.  Their budget includes glue and posters, not training programs on something as targeted as writing instruction.  For some teachers, the best they get is a thick packet and some worksheets from their director.  That’s it.

Handwriting Without Tears does a terrific job of attacking reversals where they begin, with the start and the sequence of strokes.  To simplify it:  They start letter instruction with the letters that are easy to write and begin in the same manner without risk of reversals, use a style of writing that is less easily reversed, and they have great beginner tools which replicate the same cues throughout the program.  Their smiley-face icon for orientation while writing is a good example.  The repetition on workbooks and writing materials remind children where to start so many letters supports correct orientation right from the beginning.  They also use meaningful but simple directions.  No tree line, no worm line and no dangly tails that could go either way.  Letters such as “S”, “J”, and “Z” have specific cues to help children prevent reversals.  They are also among the last letters taught.

Kids have lots of practice with start and sequence before they hit the harder letters.  The kids with perceptual issues learn a motor plan that is so automatic that they may write a letter perfectly even if they struggle with object manipulation.  Their hands are telling them how the letter is made, not their eyes!  Should they still get practice with these skills?  Yes, but they need to be successful writers now.

In my opinion, the push for increasing demands in early grades is here to stay.  The smartest thing teachers and parents can do is to pick materials that fast-track kids toward handwriting independence and then use them consistently.  It is also the kindest thing to do.  Kids don’t need more pressure, they need more success!

 

Hypermobility in Young Children: When Flexibility Isn’t Functional

Your grandma would have called it being ” double jointed”.   Your mom might mention that she was the most flexible person in every yoga class she attended.  But when extra joint motion reduces your child’s performance or creates pain, parents get concerned.  Sometimes pediatricians and orthopedists do not.

Why would that happen?  A measure of flexibility is considered medically within the norm for children and teens.  Doctors often have no experience with rehab professionals, so they can’t share other resources with parents.  This can mask some significant issues with mild to moderate hypermobility in children.  Parents leave the doctor’s office without a diagnosis or advice, even in the face of their child’s discomfort or their struggles with handwriting or recurrent sports injuries.  Who takes hypermobility seriously?  Your child’s OT and PT.

Therapists are the specialists who analyze functional performance and create effective strategies to improve stability and independence.  I will give a shout-out to orthotists, physiatrists and osteopaths for solutions such as splints and prolotherapy.  Their role is essential but limited, especially with younger children. Nobody is going to issue a hand splint or inject the ligaments of a child under 5 unless a child’s condition is becoming very poor very quickly.  Adaptations, movement education and physical treatments are better tolerated and result in more functional gains for most middle and moderately involved hypermobile children.  Take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children to understand more about what an OT can do to help your child.

Low tech doesn’t mean low quality or low results.  I have done short consults with children that involve only adaptations to sitting and pencil choice for handwriting, with a little ergonomic advice and education of healthy pacing of tasks thrown in.  All together, we manage to extend the amount of time a child can write without pain.  Going full-tilt paperless is possible when pain is extreme, but it involves getting the teachers and the district involved.  Not only is that time-consuming and difficult to coordinate, it is overkill for those mildly involved kids who don’t want to stand out.  Almost nothing is worse in middle school than appearing “different”.  A good OT and a good PT can help a child prevent future problems, make current ones evaporate, or minimize a child’s dependence and pain.

Hypermobile kids are often bright and resourceful, and once they learn basic principles of ergonomics and joint protection, the older children can solve some of their own problems.  For every child that is determined to force their body to comply with their will to compete without adaptation, I meet many kids that understand that well-planned movements are smarter and give them less pain with more capability.  But they have to have the knowledge in order to use it.  Therapists give them that power.

Parents:  please feel free to comment and share all your great solutions for your child with hypermobility, so that we all can learn from YOU!

Is your hypermobile child also struggling with toilet training or incontinence?  Check out Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty  to gain an understanding of how motor and sensory issues contribute to this problem, and how you can help your child today!

Your Gifted Child: More Than An Amazing Intellect

 

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The characteristic that convinces a parent that their child is gifted is often an impressive vocabulary or mathematical ability.  This is the criteria that will get them into the “G and T” program in school, and is often a source of pride for both parents and children.  Wait!  There are other characteristics of giftedness that aren’t always so well received.  Making the most of a powerful brain will sometimes mean addressing all the effects of giftedness on behavior, emotional reactions, social interaction and even physiology.

My primary point in writing this post is to mention that giftedness brings with it a host of abilities, and managing all them effectively will be your child’s lifelong challenge.  Poorly managed, a child can struggle internally or fail to use their gifts with joy.  Success starts with parental awareness and support.

Your gifted child, from toddlerhood onward, may demonstrate common patterns of behavior or thinking that can be challenging for parents:

  • intense feelings and reactions
  • high sensitivity to other’s feelings
  • idealism and a sense of justice, intolerance of rigid rules at school or home
  • daydreaming or preoccupation with own thoughts
  • intense focus on specific tasks or topics, ignores other’s interests
  • unusual sense of humor and playing with objects in atypical ways
  • vivid imaginations, including imaginary playmates
  • difficulty tolerating classroom routines and simple games
  • less interest in playing with peers; seeks out older children or adults
  • worries or becomes fearful of anticipated events or things they don’t understand

When children are assessed by a psychologist and found to have asynchrony in their development (a fancy term that describes a chart of testing scores that look like the Alps:  high in some areas, average or below average in others), this can add to the frustration of living as a gifted child.  Preschoolers with advanced cognition but poor articulation of speech cannot express themselves but are thinking amazing thoughts.  This is so frustrating for them!  Super-sensitive children may pick up on a teacher’s stress over her home life just by her posture and her energy level.  They know that something bad is going on, and wonder if they should be concerned.  Children with sensory sensitivity complain about scratchy shirts, irritating lights and can have difficulty with typical levels of noise, scents or movement.

Gifted kids can be incredible negotiators, remember every promise you make and hold to to them,  develop sarcasm to control people, or try to influence every game so that it reflects their strong interests.  They can be overwhelmed by commercials requesting donations for animals or children, and become upset when they listen to adults discuss political issues.  All at 6 years of age or less!

What can parents do to help their gifted children, right from the start?  Notice which characteristics seem to be most difficult for your child to handle.  Some kids are irritated by stimulation from the physical world, some are under stimulated or simply lonely for sure peers at school, and some are overwhelmed by emotions.  They are like snowflakes; each one is different.

Support your gifted child where she needs it most.  Energetic kids need lots to do, and ways to calm down.  Sensitive kids need to learn ways to manage the world without being overstimulated.  Children who wear their hearts on their sleeves can take action to help others and understand how many adults are working for the same purpose as we speak.

Gifted children who learn to manage all the characteristics of giftedness are the leaders of the future, the innovators, and the people that will bring us forward.  With the right support and understanding, they can use their abilities freely and joyously!

Overwhelmed With Your Toddler’s Demands? How To Cut Tantrums in Half!

 

Do I have your attention?  Good, because to achieve this amazing feat you will need to learn some new techniques, and understand your toddler’s perspective more clearly.  Take a look at two of my popular posts on toddler behavior, then practice a bit until your new communication skills shine.  The posts that will teach you some new ways of responding are Stretch Your Toddler’s Patience, Starting Today!  and  Taming Toddler Tantrums Using Sympathetic Reframing.  They give you easy strategies to use two of the best Happiest Toddler on the Block techniques.  These moves build listening skills and enhance cooperation in little people who are prone to big reactions.  Tantrums happen less often when toddlers feel heard and feel powerful.  You still are the parent.  Set limits and create consequences, but start here to get your toddler calm first.

Why change yourself in order to change your toddler?  Because they are waiting for you to show them how to behave, and waiting for you to reward them for their great progress.  You are teaching them skills, and so you have to model them.  Trust me, this isn’t that hard to learn.  Once you see a potential tantrum dissipate into the air, you will want to practice these techniques all the time!

You need to know a few things about the toddler mind.  It isn’t the same as the kindergartner mind, and certainly not the elementary school mind.  It’s an immature brain, running on very little frontal lobe power and a lot of amygdala and hippocampus use, all in a frenzy.  Add sugar, some taunting from an older brother, shake gently, and watch the “fun” erupt!  But that is life, so accept that your toddler is who he is, and teach him some skills to manage his reactions.

I will mention that these techniques will come in handy in about 10 years, when you have an emotional teen standing in front of you!

Here are some highlights that you should know about the toddler mind while you practice:

  • They haven’t mastered language, so talking more isn’t helpful.  Pare down the amount of words you use, and use more expressions/ gestures to express yourself.
  • They always react emotionally, not logically.  Your responses have to acknowledge their feelings, rational or not, or you are going to increase tantrums, not stop them.
  • Brains grow slowly, like trees.  Don’t expect that success once or twice means you can stop using these techniques.

Yes, I am really promising you an actual 50% reduction in tantrums .  Maybe not today, since it does take some time to become really good at the Fast Food Rule and Patience Stretching.  And maybe not when you are in the nightmare trifecta of a very tired child who is also feeling ill and is changing schools or caregivers.  That is a super-stressed child!  All bets are off then, but I think you will be able to diminish even these tantrums.  But all those other tantrums over broken cookies and not being allowed to stand on the table?  The Happiest Toddler methods can help you stop those before they even start.

The other great Happiest Toddler on the Block techniques such as Gossiping and Playing the Boob ( Dr. Karp, I wish you would rename that one!) support a warm and loving relationship with your toddler, and they will give you another 10-15% reduction in tantrum severity, depending on how much your toddler needs a more positive connection with you right now.  But just these two techniques from Dr. Harvey Karp will give you more smiles and less whining, all day long!