Category Archives: autism

What Helps Kids Handle Haircuts?

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Depending on your child’s age and issues, getting a haircut can be anything from a chore to a dreaded event that you put off, and then put it off a bit more.  So many kids fear them:  kids with ASD, kids with sensory issues, children that have had multiple hospitalizations or procedures, children with anxiety disorders.   I have been asked by parents of children well into grade school to help them with the problem of getting their child to the barber or hairdresser without a major fight.  My strategies are informed by my training as a pediatric OTR and as a Happiest Baby on the Block educator.

My approach to improving a child’s tolerance for a haircut is based on three goals: reduce the novelty of the experience, reduce the sensory impact of the haircut, and build their overall coping strategies based on their developmental level.

  1. You can borrow techniques from “exposure therapy” to make the experience of getting a haircut more familiar.  The very first step could be making combing or brushing their hair a non-event.  Explore what tool is the most comfortable for your child, and gradually introduce combs and even hair clippers.  Let them turn the clippers on and off ( establish safety rules first) and let them hear the clippers both far away and close to their ears.  Let them comb their hair first, then allow you to do so.  Washing their hair in the bath is another experience that you can use for pretending that you are giving them a haircut.  You can also get a bit wet and allow  them to pretend to cut your hair.  I have safety scissors that don’t cut anything but paper  Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler  that work very well for this experience.  Expand grooming so that it can happen at different times of the day and in different locations in your home.  It needs to become as much of a non-issue as possible at home before a child is truly comfortable in the hair salon.
  2.  Remember that the entire experience of receiving a haircut has strong sensory components:  the salon and the sight, sound and smell of it’s other staff and customers, the tools used to cut hair, the feel of the chair and the drapes on your child.  They can all be contributors to agitation and aversion.  How can these be minimized?  Early appointments might be less crowded, there may be ways to apply water or lotions to reduce the experience of being sprayed, or children can be actively involved in saying that they are ready rather than feel attacked when they don’t expect touch.  Some kids just to be told before the event that their hair will be sprayed, or they need to feel in control of the timing.  Your child may seem too old to sit on your lap, but it could help them stay calm.  Ask if this is something they would like.  Your hairdresser is interested in doing a good job without a lot of drama.  Most of them will work with you.
  3. Many of the kids I see that struggle with haircuts also struggle handling frustration and anticipatory anxiety in general.  They are used to big dramatic exchanges when asked to do the things that are expected of them that they CAN tolerate.  These kids have often spent years developing a dance of refusal and opposition that they are now stuck in with their parents.  In my sessions, they quickly learn that I don’t engage this way; I am a no-drama girl.  I set limits and consequences, and I provide options so they feel they are working with me, not against me.  I use Dr. Harvey Karp’s Fast Food Rule methods Use The Fast Food Rule to Help ASD Toddlers Handle Change to communicate that I understand what they are thinking, regardless of it’s validity, and use all of his “Feed The Meter” strategies Turn Around Toddler Defiance Using “Feed the Meter” Strategies to build a sense of compassion and communication.  Both of these Happiest Toddler strategies work well with older children because anyone that is upset is thinking and behaving at a lower developmental level.  My best strategy is simple:  I stop a challenging task before a child has the chance to bail.  I may introduce another task that is similar and still offers challenge.  Stopping isn’t always ending the overall challenge.   The child’s experience is that they don’t have to fight to get a break, as for support or have adjustments made.  I am now their partner in learning to handle haircuts, dressing or nail cutting, not an authority making demands.

It is my belief that if you can help a child handle the daily challenges of their life with compassion, respect and skill development, that child will trust that you can help them with the other events in life that make them frightened or overwhelmed.  They have a new sense of how to manage their behavior, and believe that adults are resources for learning and partners in growth.

Looking for ideas on nail trimming or dressing as well? Read Why Cutting Nails Is Such a Challenge for Autistic and Sensory Kids and Dressing Without Tears: Sensory-Sensitive Strategies That Work

And don’t forget that my e-book on toilet training is out there to help you with this challenging skill:  The Practical Guide To Toilet Training Your Child With Low Muscle Tone isn’t just for kids with low tone; kids with ASD and sensory processing issues can use these strategies to build skills that help them make real progress quickly! You can buy my e-book on my website Tranquil Babies, at Your Therapy Source (a terrific site for OT workbooks and other products), and on Amazon.

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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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Stop The Whining With The Fast Food Rule

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Whining is a “fingernails on a chalkboard” experience for most adults.  We often give in to a whining child, just to avoid hearing that noise.  Or we explode and scare them (and ourselves) with the anger that whining can trigger.  What can you do?

What would you say if I told you that I use a technique that works more than 50% of the time, and it can work in mere seconds to halt a child in mid-whine? Well, read on and let me tell you the secrets that I learned from Dr. Harvey Karp and his Happiest Toddler on the Block book!

I spend more than 75% of my treatment day as an occupational therapist with children under the age of 6.  That can add up to a lot of whining!  Why?  Not because I am inexperienced, or because I am a pushover.  Anyone that knows me knows that neither statement is true.  It’s because young children may be able to talk, but they aren’t very good communicators.  Being able to express their feelings effectively and negotiate their desires is just beyond their pay grade at this age.  Their default is whining.

Dr. Karp’s Fast Food Rule has made my job so much easier. It makes young children see me as a friend, not just another adult telling them what to do.  This one simple strategy lets kids know that I care about how they feel, but doesn’t suggest that they will get their way with me every time.  In fact, they often find themselves following my directions without fully knowing why they have stopped crying, begging, or pleading with me.

Here is what the FFR entails:

Part 1:  Repeating what you believe is your child’s complaint or desire, using simple words, short phrases and more emotional tone and gestures/facial expression than usual.  You may not know for sure what a very young child wants, but take your best guess.  If you are wrong, you can always give it another try.  The more upset or younger the child, the simpler the wording and the more expressive the tone and gestures.  Why?  Because emotional people don’t hear you well, but they will pick up on your non-verbal cues effectively.  You are trying to convey a simple message:  I understand you.

Part 2:  Only after you see that your child has calmed a bit with the knowledge that they are understood can you then begin to comfort, negotiate, or solve their problem.  Not before. We jump in very early in the interaction to tell them “It’s OK, honey” or “I can’t hear you when you speak to me like that”.  It’s only when they know you have heard THEM that they can listen to YOU.

The importance of being understood by another when you are upset cannot be overstated.  Children need this from us more than we know.  Even young toddlers are aware that they won’t always get what they want, but they need to know that we understand their point of view.  If you do not convey this message, a child will whine, wail or scream to make it clearer to you that they are upset.  That is why telling them that things are fine seems to throw oil on the fire.  They think you don’t get it.

So, help them pull it together by stating their situation (as you perceive it) out loud and using some non-verbal messaging:  I got it.  You want more cookies.  You don’t want to leave the park.  You want Logan’s truck.  Whatever it is, tell them that you understand before you offer a solution, an alternative, or explain why they aren’t getting what they want.  I promise you, it will work more often than it does not, and sometimes it will work so well that you almost cannot believe how simple it was to calm things down.

There is a secret benefit from using the FFR:  your child will gradually become less likely to break out in a whine even when things have gone badly.  After repeated experiences of being understood and treated with respect and firmness, a child will expect that you are the source of solutions instead of a dumping ground for agitation and anger.

 

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Why Eating From a Pouch Isn’t Helping Your Child As Much As You Think

 

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Sucking food from a pouch has become a common way to funnel fruits, veggies and even protein into young children.  Few kids are eating them because they have oral motor or sensory processing problems that don’t allow them to eat solid food.  Most of the pouch kids are picky eaters or eating a pouch “on the fly” in between activities and locations.

I know very well what a food fight looks like with a picky eater.  All that whining, food flying onto the floor, and fears that your child will either starve or be nutritionally deprived.  It can get ugly.  I know.  But when pouches are more than an occasional emergency ration, they aren’t without some costs.

Here is what you risk when pouches replace solid food:

  1. Your child’s digestive system needs the physical fiber to learn how to handle it well. A colon that has very little fiber isn’t capable of dealing with regular food as well.  You risk constipation and then you have to treat that problem.  And your child feels awful when “backed up”.  Don’t let them suffer that belly pain when they are capable of eating foods with fiber.  Natural fiber.
  2. If your child is young enough to be still learning to speak (and some sounds, like “th” don’t fully emerge until 3.5-5 years old), eating, chewing and even swallowing still counts as exercise and motor learning for all the structures/movements that accomplish this amazing task.  Sucking on a nozzle doesn’t support learning anything unless you are under 6 months old.  Oops.
  3. Eating is a social activity, done over time and with other humans.  Not with tablets, not with screens.  With people that model language, social and feeding skills.  Sucking down a pouch is a one-and-done experience that sends a child off their chair and back to playing too fast to absorb much of anything.
  4. Eating is a fine motor activity, from finger feeding to spoon use with soup.  Miss out on all that work, and you might find that your child is the slowest writer or even hates to write and draw.  They haven’t spent the first 3 years of life refining finger movements in the most rewarding way possible.  Food in: successful hand use.  Food on the bib/table/floor?  Recalculate and refine finger use.

What do those pouches really provide?  An easy way to feed a child nutritious food ingredients without an argument.  The problem is that all that work for kids and parents when they eat real food with their fingers or utensils is actually an investment in current and future skills that too many children need today.

Looking for more information on building self-feeding skills?  Read Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing for some hints on how to make things easier, and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child for the most fun and easy way to practice holding a spoon.

Help Your Special Needs Toddler Make The Transition To School Routines

 

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Many developmentally delayed toddlers move their therapeutic and educational services to a toddler developmental group, A.K.A. special needs program, when they are between 18 and 30 months old.  Not all of them slide into the routine easily.  There can be a few tears and a lot of complaining about fitting into a schedule /leaving a fun activity because it is time for circle or therapy.

After speaking with a handful of clients and doing a few consultations, I thought it might help to provide some strategies to help parents make their child’s first school experience easier:

  1. Learn how teachers mark activity transitions, and commit to using them at home.  Some teachers sing the  “clean-up song”, some ring a bell or turn lights on and off.  Find out exactly how the staff help children, especially non-verbal children, anticipate and adjust to changes.
  2.  You don’t need to copy the exact transition strategy, but make it very similar and use it for activities at home that are the easy transitions.  Examples of easy transitions at home are getting into a bubbly tub, leaving the table once full and satisfied, putting on a coat to go outside and play, etc.  The transitions that are easiest are going to be the calmest, and children learn best when calm.  This positive spin makes the school’s routine more acceptable when a child isn’t completely on board with new situations.
  3. Find out how snack is served, and offer snacks in the same way at home.  If small cups are used for water or juice, practice cup drinking at home with the same sized cup.   If there are specific foods offered, then stock up.   Model your enjoyment of these snacks so that the food is familiar and has your seal of approval.

Good luck this year to all the toddlers that have made the leap to school!!

 

Halloween Fun When Kids Don’t or Can’t Trick-Or-Treat

 

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Kids big and little are anticipating Halloween, but this holiday isn’t always enjoyable for children with ASD, SPD, anxiety or motor issues.  Putting on a costume can be difficult for some kids to tolerate and nearly impossible for kids that have mobility issues.  Kids with endurance and mobility issues struggle to walk up to a front door and ring the bell, but they don’t want to be carried “like a baby”.  Even seeing other children in costume or decorations in their own home can be difficult for children that are very sensitive.

What begins as a celebration and an adventure becomes a minefield.  And yet, your child may be invited to participate in many Halloween events.  You may want to have a party in your own home.  Your child may even beg to be involved in things you know they will end up hating, not realizing the challenges ahead.  Inclusion is a murky pond for some kids.

Perhaps it doesn’t have to be so difficult.  Here are a few ideas that could make this holiday less stressful and more inclusive:

  • Costumes can be anything you want them to be.  Purchased costumes can be adapted or altered for comfort and tolerance.  If you have a child with tactile sensitivity, choosing the fabric that is less irritating is worth a trip to a brick-and-mortar store, or ordering multiple sets online with easy returns.  Instead of an eye patch for a pirate, you can use makeup to create one.  Princess skirts and Batman pants can be shortened to prevent tripping.  They can be bought larger and altered to allow for braces and for sitting in a wheelchair.  Hats and headpieces are optional, and can also be switched out for more wearable choices.  They can be purchased separately or by combining two costumes.  A comfortable costume is fun; an awkward costume will cost you in time, pain and struggle much more than you can imagine.
  • Trick-or-treat is over-rated.  Choose people your child knows, a neighborhood that has flat, accessible front steps, or even an apartment building with an elevator.  The experience of trick-or-treat doesn’t have to be a marathon to be fun: in fact, “fun” is the opposite of dragging stressed children around from house to house.  Remember that children with sensory modulation issues will start out excited and happy and become overwhelmed quickly.  Monitoring and planning for this helps both of you have fun that doesn’t end badly.
  • Many children with sensitivities need to practice wearing their costume until it becomes familiar.  They may protest and initially refuse, but some practice can really help them.  Make the run-through more fun by pairing it with something like watching a halloween movie at home or putting up decorations.  The child that refuses to wear a costume can become the child who doesn’t want to take it off!
  • Choose your home decorations with your child’s tolerance in mind.  It isn’t always about whether they are scary or not, it can be the brightness, the amount of movement or the sounds that overwhelm children.  You won’t always know what will be too much, so prepare yourself and the rest of the family that you may have to substitute/remove/repurpose things that don’t work out.
  • Do fun events that your child can handle.  Bake cookies, including the buy-and-bake-off cookies that don’t require a lot of effort or time.  The end product can be given to friends and family proudly.  Decorate a Halloween cookie house.  Put up cling-on decorations in windows and storm doors that are easy to remove if they become an issue.  Watch a fun movie at home and invite friends to dress up and come over for the show.

Holidays for kids with special needs take more thought, but they don’t have to be less fun, just a bit different.  The important concept is to consider your child’s needs and aim for the essential feelings of the holiday:  fun, and sharing the fun with others!

Lining Up Toys Doesn’t Mean Your Toddler Has Autism

After head-banging, this is the other behavior that seems to terrify parents of young children.  Seeing a row of vehicles on the carpet makes parents run to Google in fear.  Well, I want all of you to take a deep breath and then exhale.  The truth is that there are a few other behaviors that are more indicative of autism.  Here is what I think that row of tiny toys often means:

Very young children have a natural interest in order and understanding spatial relationships.  Kids like routine and familiarity way more than most adults.  Some children are just experimenting with how lines are formed or seeing how long a row of cars they can create.  Some will even match colors or sizes.  And it is OK if Lightening McQueen has to be the first in the line.  Sometimes routines have purpose.  When your child tells you that you read Goodnight Moon wrong (you just paraphrased to end it early and get him to bed), he is really saying that he likes the familiarity and the orderliness of hearing those words said in that order.  Boring to you, comforting to him.  Experts in early literacy will tell you that his fondness for hearing the same story over and over is actually a developmental milestone in phonemic awareness, the cornerstone of language mastery.

Controlling their environment and creating patterns is another reason to line up those cars.  Young children do not create complex play schemes about races or adventures.  Lining them up is developmentally correct play for very young children, and it can easily expand with a little demonstration and engagement with you.  Build a garage from Megablox and see if your child will enjoy driving each one into the garage to “sleep at night”.  (Don’t mention that in real life we all use our garages as storage units! ) Typically-developing children may even repeat your game later the same day, having learned a new way to play with their toys.

When does lining up toys become troublesome?  When it is the ONLY way that your child interacts with those toys, or with any toys. And when you try to expand their play as above, they lose their lunch because it is all about rigid routines, not object exploration.  If your child is on the spectrum, that line of cars is part of their environmental adaptation plan for security and stability; it’s not actually play at all.  There isn’t a sense of playfulness about changing things around or using these objects for imaginative play.

A lack of developmentally-appropriate play skills is certainly a concern to a child development specialist, but it still doesn’t translate into autism.  Here are a few behaviors in 1-2 year-olds that concern me much more:

  • little or no eye contact when requesting something from you.  They look at the object or the container, not at you.
  • no response when her name is called, or not looking toward people when the name of a family member is mentioned.
  • using an adult’s hand as a “tool” to obtain objects rather than gesturing, pointing or making eye contact to engage an adult for assistance.
  • a non-verbal toddler (over 18 months old) that doesn’t use gestures such as pointing to communicate needs or desires.

Always discuss your concerns with your pediatrician, and consider an evaluation through your local Early Intervention service if you continue to see behaviors that keep you up at night.  They can help you!

If you are looking for strategies to help your child handle frustration, take a look at How To Stop Your Baby From Throwing Things (Most of the Time!) and Overwhelmed With Your Toddler’s Demands? How To Cut Tantrums in Half!.  I have transformed my own reactions to toddler behavior with Dr. Harvey Karp’s Happiest Toddler on the Block methods.  To teach your child self-control skills without punishment or shaming your child, take a look at Stretch Your Toddler’s Patience, Starting Today! and Discipline and Toddlers: What Do You Say if You Don’t Want to Constantly Say “No”? .

Are you struggling with toilet training?  Does your child have low muscle tone?  Then I wrote the book for you!  The Practical Guide to Toilet Training Your Child With Low Muscle Tone is my e-book that gives you real assistance, not just “don’t rush him” or “wait until you see signs of readiness”.  I teach you how to spot and create readiness, and build your child’s skills so that they succeed! Read more about my book at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! .  You can purchase my e-book on my website Tranquil Babies or on Amazon or at Your Therapy Source , a terrific site for occupational therapy materials.