Category Archives: autism

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!

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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 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), 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.  That line of cars is part of their environmental adaptation for security and stability; it’s not actually play at all.  There isn’t a sense of playfulness about changing things around.

A lack of developmentally appropriate play skills is 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 you.
  • no response when her name is called, or looking toward people when the name of family members 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.

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!

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!