Category Archives: autism

The Difference Between Special Needs and Typical Potty Training Approaches: Address Sensory/Behavioral Issues and Use Consistent Routines

tai-jyun-chang-270109.jpgAfter writing The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have been asked what was different about my book. There must be 100 books on potty training special needs kids. What did I do differently? Simple. I am an occupational therapist, so I have no choice but to use my 360 degree viewpoint to target all the skills needed to do the job. Seeing the path to independence in this way was second nature to me, but not to parents of kids with special needs. Time to offer some support!

The books I reviewed before I started writing were great, but every one lacked at least one important feature. If the authors were psychologists and teachers, they weren’t fully comprehending or directly addressing the sensory and motor aspects of a very physical skill. Oops.

OTs are always aware of the cognitive and social/behavioral components of activities of daily living, but we also have a solid background in physiology and neurology as well. That makes us your go-to folks for skills like toilet training. And that is a major reason why The Practical Guide is so helpful to the frustrated parents of children with SPD,autism, Down Syndrome, Ehlers-Danlos Syndrome, and a host of other diagnoses that result in delays or difficulties with muscle tone and potty training independence. It explains in detail how low tone creates sensory, motor, and social/behavioral problems, and how to address them. Knowledge is power, and knowledge leads to independence.

The other huge difference is that developing consistent sensory-motor-behavioral routines matter more for these kids. Tone isn’t a constant, as anyone with a child that has low tone knows all too well. Fatigue, illness, even a very warm day; these all make kids less stable and can even reduce their safety. Having a really solid routine makes movements easier to execute and more controlled when situations aren’t perfect. Kids with normal muscle tone can shift their behavior on the fly. They can quickly adjust and adapt movement in ways that children with low tone simply cannot. It isn’t a matter of being stubborn or lazy. Kids with low tone aren’t going to get the sensory feedback fast enough to adjust their motor output.

Good motor planning on a “bad day” occurs for these kids when they have well-practiced routines that support safe and smoothly executed movements. What makes the difference isn’t intelligence or attention. It is recalling a super-safe routine effortlessly. This is completely attainable for kids who have speech or cognitive issues as well as issue with low tone and instability. It may take them longer to learn the routine, but it pays them back with fewer accidents and fewer tears.

To learn more about my book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, visit my website, tranquil babies.com, or view it on Amazon.com!ferris-wheeltai-jyun-chang-270109

Child Writing Too Lightly on Paper? It Might Not Be Hand Strength Holding Him Back

If your child barely makes a mark when he scribbles or writes, most adults assume that grasp is an issue. Today’s post suggests that something else could be the real reason for those faint lines.

Limitations in postural and bilateral control contribute far more to lack of pressure when writing  than most parents and teachers realize.  For every child in occupational therapy that is struggling to achieve good grasp, I see three whose poor sitting posture and inability to get a stable midline orientation are the real issues.

Think about it for a minute:  if you sat with your non-dominant (not the writing hand) hand off to the side and you shifted your body weight backward in your chair, how would you be able to use sufficient force on a pencil or a crayon?  Try this right now.  Really.  You would have to focus on pressing harder while you write and hope your paper doesn’t slip around.  That would require your awareness and some assessment of your performance.  Children don’t do “awareness and assessment” very well.  That ability comes from frontal lobe functions that aren’t fully developed in young children.  But they can learn where to place their “helper hand”, and that sitting straight and shifting forward is the correct way to sit when you scribble or write.

If a child has sensory processing or neuromuscular issues such as cerebral palsy, Ehlers-Danlos Syndrome or Down Syndrome, achieving adequate postural stability may take some effort on the part of the therapists and the teacher.  Well worth it, in my experience.  There are easy hacks that help kids; good equipment and good seating that won’t cost a fortune or inconvenience the class.  Every child can learn that posture is important for writing.  But the adults have to learn it first.  Kids take their cues from what adults appear to value, and if they figure out that they are allowed to slump or lean, they almost always will.

I am doing a lecture on pre-writing next week, and I intend to make this point, even though the emphasis of my lecture is on the use of fun drawing activities to prepare children to write and read.  Why?  Because it may be the only time these preschool teachers hear from a pediatric occupational therapist this year, and I want to make a difference.  Understanding the importance of postural control in pre-writing and handwriting could help struggling kids, and make decent writers into stars!

Is Your Gifted Child Also Your Most Strong Willed Child ?

Parents of some gifted children know that this gift comes with more than a quick intellect.  It can come with a will of iron and incredible emotional range.  Gifted children can be expansively happy one moment, and intensely sad the next.  No, it isn’t bipolar disorder, and it probably isn’t ADD (these kids are misdiagnosed at an alarming rate).  Gifted children have an emotional capacity that often matches or exceeds their intellect.  Here is why.

Their brains are different.  They are qualitatively different, meaning that they notice, synthesize, and experience information differently, not just “more” or “more like an older child” than other children.  Their brains work differently, but they are trying to comprehend how others understand it and why they behave as they do.  When they cannot or when they insist on the world working their way, things can get explosive.

Yes, the same brain that allows a 4 year-old to read chapter books to her preschool class without having been taught to read is also feeling and connecting emotional information differently from her peers as well.  She can’t “get over it” when arbitrary rules do not allow her to take materials out of the reference section of the library, or when she isn’t allowed to finish watching a documentary on sea creatures because you have to take her brother to swim practice.  Functional imaging studies have been reported to see much more diverse brain activity in gifted individuals during simple tasks.  They light up like Christmas trees because they are incredible thinkers.  All that thinking can get them in trouble with the day-to-day world of rules and behavior.

The amazing brains of gifted children are understood to have what one researcher calls “overexcitabilities”.  Only one is intellectual excitability.  The others include motor and sensory excitability.  This can lend itself to some explosive tantrums in toddlerhood and even disabling complaints of clothing or lights being far too irritating and distracting.  The same child that can explain to you how the electoral college works can be sidelined by the scratchy tag in his shirt!

Gifted children with strong wills aren’t always appreciated for their determination and their energy.  They balk at instructions, refuse assistance when they need it, and aren’t easily distracted from their desires.  I think that the first step in handling the emotional over excitability of a gifted child is to accept how difficult it is as a parent or a teacher, and then learn about how this aspect of giftedness works.  From there it is a matter of building skills in self-control and social/communication skills.  Children do not have to get their way because their IQ is in the stratosphere.  They still have to avoid aggression, including verbal aggression (something teenage gifted kids are virtual masters of).

My perspective is that gifted children need more help with social skills since they often have such disparity between their cognitive capacity and their emotional abilities.  Feeling responsible for the world’s troubles doesn’t mean that you are, and knowing that the rules are arbitrary doesn’t mean you have the authority to change them.  Parents who teach their children how to navigate these problems will give a huge gift to their children.  Children need to understand that they aren’t bad, but they are different.  And their behavior is connected to the way their brain works and always will work.  They need to navigate their path within the wider world, making friends and dealing with authorities that do not see things in the same way.  The world may not always understand gifted people, but if gifted people understand themselves, it could be a happier and calmer place for everyone.

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!

 

 

Dressing Without Tears: Sensory-Sensitive Strategies That Work

If your child has tactile (touch) sensitivity, getting them dressed can mean more than a chore.  It can mean tears.  Tags in shirts, “scratchy” jeans, and all that pulling of clothing over their face!  I know families that scheme for months to find clothes that their child will wear to a wedding or buy clothes online because trying on clothing in a store is a nightmare.

The low-hanging fruit:  soft tees and sweatpants/shorts are the most tolerated clothing for kids with sensitivity.  Even these have some caveats.  Clothing that is too loose creates movement while worn, and long cotton sleeves are a good example of irritants for sensitive kids.  Get a good fit and forget about buying things large for growth.  Comfort and compliance now is absolutely key.

Pressure garments and compression underwear:  I have never been a fan of Theratogs.  They are expensive and awkward for most kids.  When they work, they are amazing, but there are lower-tech and lower-priced possibilities.  UnderArmor underwear fits smoothly  and creates a bit of comforting pressure.  Even the lycra sunsuits that kids wear to the beach can be worn under clothing in cooler conditions.  Children who are not toilet-trained are the hardest, since you need to pop off pressure garments to change them.  This could be a great reason to begin pre-training and make your potty training plan.  Take a look at Waiting for Toilet Training Readiness? Create It Instead! for some ideas.

Don’t forget that all sensory responses have a behavioral component.  I am not saying that there isn’t a neurological reason for a child’s discomfort.  Sensory sensitivity is real.  The behavioral piece is that responses can be diminished or increased by experience.  All experiences.  Children with mild to moderate sensitivity can react less when the fear and the novelty of wearing clothes is diminished.  How is that done?  Depends on the child, but short periods of wear that happen frequently and are not forced but are rewarded can transform a child.  Having control over which button-down shirt he wears for 3 minutes, or which video he gets to watch that is only available while wearing “the shirt”, can really make a difference.  So much of tactile sensitivity is anticipatory fear and feeling trapped, that when he doesn’t feel trapped and doesn’t fear it, tolerance can develop.  Parents have to be firm and loving, and kids can expand their tolerance.

Try the Brushing/Joint Compression program.  The one I use is the Wilbarger Protocol, developed by an amazing occupational therapist, Pat Wilbarger.  It works, but it has to be done correctly and it has to be understood.  After about 10 years, I almost stopped teaching this technique because it had turned into a game of “telephone”, in which parents would show me what a previous OT had taught them.  It looked only slightly like the protocol that Pat taught me directly.  A poorly executed protocol can actually make a child more sensitive.  It was awkward to tell parents that they had been taught incorrectly.

Get it right, and make sure that your therapist can explain the neuroscience behind it.  Have your therapist explain the gating theory of sensory modulation and the reasons that you don’t brush the abdomen or do neck compressions.  That way you know you are getting the real deal.

Is your child hypermobile?  Children with ligament laxity can have difficulty dressing too.  They just don’t have the stability even if they have the strength, to pull up their clothes and fasten garments.  Read about how your therapists can help you:  Hypermobility in Young Children: When Flexibility Isn’t Functional

Comment about any great techniques you have used successfully, so that other families learn from you!

Can You Toilet Train a Non-Verbal Child?

Parents of non-verbal children often delay toilet training, assuming that these kids need more communication skills to be successful.  I disagree.  I think children and their parents need other skills more.  Here are my thoughts about what really matters for these kids:

  • Their parents need excellent observation skills.  A child that cannot easily communicate their needs and concerns is still showing you signs that they have already eliminated or that they are ready to eliminate.  Children have familiar facial and postural changes such as grimacing, grunting, and crouching.  They often go to their “poopy place”, a location in the house where they prefer to have bowel movements. Behind the sofa is a common spot.  Just like typically-developing kids, parents who know when to anticipate elimination can guide their child to the potty so that kids make the connection between sitting and successfully eliminating.  This may mean that grazing and sipping all day long is over.  If drinks and meals are served generously but not continuously, it is easier to predict when a child will have a full bladder.  The act of eating often stimulates colon activity, so bowel moments are more regular and therefore predictable as well.  This is easier when meals are larger and eating is not happening in small snacks through the day.
  • Children need familiar routines.  When non-verbal children can anticipate a toileting routine, they don’t need to rely as much on receptive or expressive language skills.   For example, ending a meal and getting dressed will remind them that they now go to the toilet.  Lack of a routine will mean that they have to work harder on communication.  Being caught out of their routine and in need of a toilet could be so stressful that they resist giving up their diaper.  Create and carefully maintain  routines that support success and calmness around elimination.
  • Families need good toileting equipment.  A child that cannot describe in detail why they are uncomfortable is going to be less cooperative with toileting.  Beyond an appropriate potty or toilet insert/footstool set-up, a non-verbal child needs clothing that is easy to manage and wet wipes that really clean them.  My strategy of “dry runs”, in which children pretend and get a chance to practice, helps everyone see if they have prepared well for toilet training.

Help has arrived!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available on my website, tranquil babies and in a clothbound hard copy by contacting me through my site.  Read   The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn how my innovative book is designed to be parent-friendly and help you move forward with toilet training today!

Does Handwriting Have An Uncertain Future in School?

I have read two reviews of Anne Trubek’s book The History and Uncertain Future of Handwriting, one of them in the New York Times The Story of How Handwriting Evolved, and May Soon Die Off.  I have not read her book yet, but since I work with young children, I spend plenty of time with “boots on the ground”, in the trenches with early writers and readers.

My first thought after reading both book reviews was “If handwriting dies off, does she predict that 4 year-olds will be typing?”.   I have not seen the amount of physical writing in early education diminish.  In fact, I am certain that kindergarteners are writing more now than we saw in first grade only 10-15 years ago.  Kids are working on tablets as well, but the flood of worksheets hasn’t slowed down at all.  If you have a child between 4 and 6, you know what I mean.  It is a lot of paper!

So much for handwriting dying out in the near future.  In fact, we are expecting kids to learn to write earlier and to learn it quickly.  That is hard enough, but no one is teaching educators how to accomplish this feat.  My local preschools change writing programs faster than they change playground schedules.  We now have large numbers of children moving into elementary education that were not taught to print correctly, and educators who want to help them but don’t know how. I will only briefly mention the children with autism and learning differences that are mainstreamed and expected to keep up under these crushing conditions.   No wonder business is booming: Sharp Rise in Occupational Therapy Cases at New York’s Schools .

Frustrating children, by not teaching them well (which often prevents full language expression) because you don’t know how to help them, is not the answer.  I spend part of each day working with children who feel bad about themselves as learners because they cannot write clearly.  They believe that the problem is theirs and theirs alone.  I help them build their skills and restore their self-esteem.  In most of my sessions I am not using extensive therapy techniques. I am teaching them to write in a developmentally-ordered, practical and logical manner.  I am observing their errors, and showing them how to succeed.

Brain research from education, psychology and neuroscience has suggested that children who physically write letters, rather than clicking them, will display greater ease of recall and improved legibility. Children with physical limitations have no choice but to write digitally, but that doesn’t make it the more desirable method for children without motor issues to learn letter recognition, spelling, and build literacy skills.  Kids with autism and learning differences deserve handwriting instruction that makes things easier and simpler if they are expected to keep up.  But is handwriting dead or dying?  Not if you are in the age group in which you still need a carseat to go away on vacation!