Monthly Archives: January 2018

How Parents Can Teach Healthy Body Boundaries To Young Children

 

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One of the greatest horrors of the Larry Nasser story is that parents were often mere feet away from these girls while they were being molested.  The people most invested in a child’s safety had no idea that anything violent was occurring, and these girls did not reveal their discomfort at the time.  These parents are beyond distraught now, and often filled with guilt.  I do not blame them for what happened.  They were deceived by Nasser and their children weren’t able to communicate their distress or confusion.

Parents who read these news reports are wondering how they would react; would they recognize abuse?  And they are wondering what to say and do to prevent this from ever happening to their own children.

My strong belief is that there will always be people like Larry Nasser in the world, and that children who have experience with being touched with respect could be more likely to recognize and report abusive touch, even when it comes from an authority or a family member.

I would like to share my best suggestions to teach children the difference between healthy touch and invasive touch, drawn from my practice as a pediatric occupational therapist who treats children with ASD and sensory processing disorders.  I would also like to say very clearly that there is never any reason for any occupational therapist to make contact with a child’s genital area.  Ever.  But since parents and caregivers perform diaper changes, dress children, and provide bathroom assistance, it is important to me to teach the following strategies for respectful contact in therapy so that children have a sense of what type of touch is unacceptable:

With non-verbal children of any age, I use a combination of observation, use of my own body language before I begin physical contact in therapy.  If children can make eye contact, I use visual regard to establish a connection, and I do not initiate physical contact quickly.  If they cannot meet my gaze, I read their cues, and often wait for them to come closer to me and reach out.  I use intermittent touch that avoids hands, face and feet initially.   Deep pressure is less alerting to the nervous system than light touch, so my contact is stable, slow and steady.  I will describe what I am doing therapeutically, in simple statements with calm tones, even if I am not sure that they will understand me.   I remove my contact when I see any indication of agitation, and before a child protests strongly.  What I am communicating is “I get you.  I see you and I respect you.  I will not force you, but I will invite you to engage with me”.

With children that can communicate verbally, I do all of the above strategies, and I ask permission.  Not always in complete sentences, and not always using the word “touch”.  I constantly tell them what I am going to do or what movement I am going to help them to accomplish.  It doesn’t matter if they fully comprehend my words; they can read the tone in my voice.  If they protest, I will voice their protest without criticism “You want no more _______; no more __________.  OK.”  I reconsider my approach, adjust, and either begin contact again or shift activities to build more tolerance and trust.

With slightly older children that can understand my question and can respond clearly, I will teach them that they have a choice about greetings.  I teach “Handshake, Hug or High-Five?“.  Children get to choose what kind of physical contact they wish to have when greeting me or other adults.  I must agree to their choice.  I encourage parents to teach their family members to offer this choice and to never force a child to kiss/hug or accept a kiss or a hug from anyone.  Children need to feel that they have agency over their bodies without criticism.

Anyone who remembers enduring a sloppy smooch or a crushing hug from a relative can relate.  You may or may not have actively protested.  It doesn’t matter.  Allowing an adult to have this form of contact with a child is not just an irritating experience for them.  It is a serious message that children of all genders are given:  The people that are in power have the right to do things to your body that you don’t like, and you have no right to complain.

Is this the message that parents intend?  Of course not, but that doesn’t make it any less a clear communication.  Larry Nasser and his kind depend on a combination of authority, status and compliance to perpetrate abuse, even if the child’s parents are in the room.  I believe that children who know that any uncomfortable touch from any adult, even those closest to them, can be refused, they are more likely to recognize and report abuse. They will be believed and they will not be shamed.

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Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome?

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My posts on proprioception and hypermobility have been popular lately, leading me to think that parents (and therapists) want more information on the sensory basis for their children’s struggles, and that often their treatments don’t include addressing their sensory processing issues. The Ehles-Danlos Syndromes (yes, there are more variants than just vascular and hypermobile!) are somewhat rare connective tissue disorders that can create generalized joint hypermobility.   Kids with EDS are often diagnosed as having a coordination disorder before they get the EDS diagnosis, and their families describe them as “clumsy” or even “lazy”.  I see them as having sensory processing issues as well as neuromuscular and orthopedic issues.   Take a look at Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior and Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children for more on this subject.

There are some caveats in using techniques from sensory integration protocols with this population.  This doesn’t mean “no”; it means think about it first.  The use of the Wilbarger Protocol is one that requires some thought before initiating with EDS kids.

The Wilbarger Protocol:

For those of you who are unfamiliar with the Wilbarger Protocol, it is a common treatment approach for children with sensory sensitivity, sensory discrimination issues and poor sensory modulation.  Created by Patricia Wilbarger, a terrifically talented OTR  who directly trained me as a young therapist, it is a neurologically-informed treatment that can be used quickly for both immediate improvement in sensory processing and it can make long-term alterations in the brain’s ability to use sensory input for movement and state control.  The Wilbarger Protocol involves skin brushing and joint compression in a carefully administered method that uses the “gate theory” of sensory processing to assist the nervous system in regulating awareness and arousal.

There have been other protocols for regulation developed over the years, and adaptations to the Wilbarger Protocol have occurred since it’s creation.  But daily and repeated use of brushing the skin and use of joint compression to deliver deep pressure input (to inhibit light touch registration and enhance proprioceptive discrimination) are the cornerstones of treatment delivery.

Adapting the Protocol for Ehlers-Danlos Syndrome

Since the Wilbarger Protocol was not created to treat EDS, I am recommending that therapists and parents consider adapting it to protect the joints and skin of children with EDS while still gaining benefit from this technique:

  • Reconsider using the brush.  Although the dual-treatment of brushing and joint compression makes this technique a powerful approach, kids with EDS often have skin that is more fragile than average.  It can bruise and tear more easily, especially with the vascular or classic EDS subtypes.  Small children will be brushed repeatedly over the same skin area, increasing the risk of shear, abrasion and bruising.  Children (and adults) with EDS will have skin reactions far in excess of the amount of pressure applied.  This is related to the assumption that the connective tissue that makes up skin and blood vessels is either weaker or thinner than typical children.  My advice: go with the joint compression component alone, and see if you get a clinically valid result without the risk of skin damage.
  • Make sure that you are well-trained in the positioning and administration of joint compression.  I have taken joint mobilization training courses, as well as having dual licenses in massage therapy and occupational therapy.  Being able to feel correct joint position and alignment is absolutely key when children have loose joints, so use this technique with care.  Avoid painful joints and limit repetition to the shortest amount needed to see a clinically meaningful response.
  •  Train parents extremely well before recommending home use.  Most parents can learn this technique with the right explanation and some practice.   If a parent seems unable to perform joint compression correctly, reconsider the use of a home program.  This has only happened once in my career.  A mom was truly unable to perceive the amount of force she was using.  She admitted that this had been an issue for her since childhood, and I suspected that she had her own sensory processing issues.  We moved on to other treatment choices.  There is never a reason to stick with a treatment that causes a risk to a child or makes a parent feel like they are a failure.  Ever.

The true skill of a therapist is the ability to offer the just-right challenge to each child, based on a therapist’s observations, assessment and knowledge base.  I believe that there are many kids with EDS that could benefit from the Wilbarger Protocol when it is effectively adapted to their needs.

Looking for more than blog posts?  Visit my website tranquil babies and purchase a phone/video session to discuss your concerns and learn about what occupational therapy has to offer your child!

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Teach Utensil Grasp and Control…Without the Food!

Therapro has just published my latest guest post! There are some situations that almost require occupational therapists to separate mealtime from utensil manipulation, at least at the earliest stages.  Check out my post Teaching Utensil Use Outside of the Mealtime Experience to find out if your child or client would benefit from this approach!

If you haven’t already read this very popular post I wrote earlier, make learning to use utensils an opportunity to bond emotionally,  take the pressure of self-feeding off the table and help an avoidant child engage in food play with Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

Therapro has been one of my go-to sources for quality therapy equipment for years.  Take the time to review their catalog online and explore their unique bowls, plates and utensils that can help children with developmental delays achieve independence in self-feeding.

Why Gifted Preschoolers Should Be Taught Handwriting Early (And With The Best Strategies!)

 

 

guillaume-de-germain-329206Gifted children are identified by their asynchronous development.   The three year-old that can read, the two year-old that can play a song on the piano after hearing it once at music class, the four year-old that can complete his sister’s math homework…from second grade! These children have one or more advanced areas of skill that classify them as gifted.  One of the skills that rarely emerges early in the gifted population is handwriting.  More often, gifted children have problems with handwriting. Some are just sloppy, some produce illegible products even after trying their best.

A few theories exist to explain this phenomenon:  gifted children are more concerned with expression and ignore handwriting lessons, their typical motor development doesn’t keep up with their advanced cognitive skill progression and they give up, or perhaps a gifted student with poor handwriting has an undiagnosed motor and learning disabilities.

I am going to suggest an additional explanation:  gifted children are not given effective early pre-writing instruction and are often taught to write using strategies that create confusion, boredom or frustration, turning a fast learner into an underachiever.  Gifted kids like novelty, complexity and intensity.  Tracing a dotted-line “A” over and over isn’t any of those things.  Gifted children often remain so focused on their passions that it is easier to let them go and shine in their chosen areas than to make handwriting fun and appealing.

Yes, it is true that children with advanced cognitive skills could have average or below-average motor skills that don’t allow them to independently write a complex original story.  Writing details down may take too long for their quick minds, or they need to use letters they don’t yet have the skills to execute.  A child with an amazing imagination and vocabulary may find standard writing drills dull in comparison to the creative process.  Gifted children may even be averse to the unavoidable failure inherent in practice that leads to mastery.

What can be done?

  • Good pre-writing instruction is essential to build the foundational motor control and spatial skills.  This includes teaching grasp rather than waiting for it to develop, purposely building two-handed coordination and drawing into play,  and using other pre-writing tasks such as mazes, puzzles and tracing/dot-to-dot (not for letters, for drawing).  See Why Dot-To-Dot Letter Practice Slows Down Writing Speed and Legibility to understand why dots aren’t a great strategy for any child.  Learning to draw balloons, birthday cakes and Christmas trees is fun.  It is also a great way to practice writing the curves and intersecting angles that letters require.
  • Use multi-sensory, multi-media methods to develop pre-writing and handwriting skills.  Many gifted children love sensory-based experiences.  Their natural drive for intensity and complexity can be satisfied when letters are made from pretzel sticks or Play-Dough.
  • Create a fun, open environment for learning, in which challenge is expected and success is both celebrated and beside the point.  If children are taught that they are expected to know all the answers since they are gifted, exploration can be suppressed.  If they learn that failure is anticipated and shame-free, it allows them to try again and invent solutions to the problems they face.
  • Harness the skills a gifted child possesses to advance their handwriting development.  Children that have great spatial awareness notice letter formation similarities and proportion rules.  They transform an “F” into an “E” and chop two vertical lines in half to make an “H”.  Children in love with language can use fun mnemonic devices or little “stories” that help them form letters correctly.  When the letter “S” starts as a mini “C” and then “turns around and goes back home” they remember the formation of this tricky letter more easily than copying or tracing alone.

As an occupational therapist, I use the Learning Without Tears program (formerly known as Handwriting Without Tears).  The materials are high-quality, the learning progression is developmental and builds one skill on top of the previous skill, and the early levels are more sensory-based than most writing programs.  See Can HWT’s Flip Crayons Transform Pencil Grasp in Preschoolers? and Why Do You Start (Uppercase) Letters at the Top? Speed and Accuracy for some HWT strategies that really work.  Gifted kids usually want to be creative and expansive when learning, so take a look at Have More Fun When You Use Drawing To Develop Pre-Writing Skills to make teaching a gifted child   easier.

If you are the parent of a gifted child, or if you teach gifted preschoolers, please share your best strategies to support handwriting here!!!  If you are wondering if you should tell your child that their advanced skills have a name, “gifted”, check out Should You Tell Your Gifted Child About Their Giftedness? for some good reasons why they need to know and how to approach this issue with them.

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