Category Archives: autism

Universal Design For Parents of Special Needs Kids: It’s Important for You Too!

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Stunning, but how many potential safety problems can YOU spot?

I just finished the coursework for my CAPS certification (certified aging-in-place specialist)!  Amazing instructor and loads of valuable information about construction and renovation that only the National Association of Home Builders could impart.   And not just for aging-in-place; the concepts of accessibility make homes more visitable for family and friends, and more livable and adaptable for the future.   Now I have to decide how to add this knowledge to my practice to help families make their lives easier and better….might as well start blogging about it now!

Universal design is more visible in public places.  Hotels are installing features that make showers more accessible and banks are providing variable-height counters to fill out deposit slips.   But most of us don’t think that we need universal or accessible design in our own homes as non-disabled adults.  Wrong.

Universal design allows your great-grandmother more ease when she wants to meet your baby in your own home.  It helps your neighbor with multiple sclerosis come over and water your plants when you take the kids to Disney.  And it allows you to carry a kid, carry a bag and pull the dog into the house without dropping one of them.  Universal design also allows your husband, who tore his achilles tendon during a pickup basketball game, to get into the shower by himself while he decides if he can admit he’s not 25 anymore.

 But for parents of kids with special needs, the need is two-fold: universal design helps them do a demanding physical job, but it also allows their children more independence earlier. These parents are lifting and carrying heavier children than they might otherwise.  In and out of the car, the crib, the stroller and more.  There is a big difference between lifting a 20-pound toddler and a 47-pound preschool child wearing heavy AFOs.  Parents are hauling around equipment like therapeutic strollers, standers and medical equipment every day.  I have written a bit about positioning your child How To Get Your Special Needs Child To Sit Safely In The Tub and Kids With Low Muscle Tone: The Hidden Problems With Strollers , but now I will be addressing design beyond equipment.

Universal design’s principles of low physical effort and adequate size/space for approach and use will give enough room at a landing for the stroller, and the parent, and the dog.  It will make it possible for your child to open the door for himself and to reach the sink without being held up to the water.   Universal design’s principles of equitable and flexible use will allow children more access with less assistance as they build skills.  The principles of simple and intuitive use, tolerance for error and perceptible information reduces confusion and safety risk to children.  A good example would be faucets with both temperature control valves to prevent scalding and handles marked with red/blue codes instead of H/C.  No reading interpretation is required once your child knows “red is hot” or “red is stop”.  That happens easier and earlier than reading skills.

I don’t hear a lot of parents complain about the wear-and-tear on their bodies as they care for their children, but I see it.  Parents: don’t think that because you don’t say anything that your occupational therapist isn’t aware that your back is giving out.  That is a shame, because OTs could be helpful to parents in this situation.  Not in telling them to hire help, but in teaching them how to move with more ease and how to select and use equipment based on universal design principles to make life better for everyone.

Maybe after this post, I will be hearing from all those parents who go to bed tired and wondering how they will be able to keep up with the physical demands of special needs parenting over the years to come.

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Teach Your Child To Catch and Throw a Gertie Ball

 

71rwmnHGrHL._SL1500_These balls aren’t new, but they don’t get the recognition that they should.  The ability to catch a ball is a developmental milestone.  For kids with low muscle tone, sensory processing disorder (SPD) or ASD, it can be a difficult goal to achieve.  The Gertie ball is often the easiest for them to handle.  Here’s why:

  1. It is lightweight.  An inflatable ball is often easier to lift and catch.  The heavier plastic balls can be too heavy and create surprisingly substantial fatigue after a few tries.
  2. Gertie balls are textured.  Some have the original leathery touch, and some have raised bumps.  Nothing irritating, but all varieties provided helpful tactile input that supports grasp.  It is much easier to hold onto a ball that isn’t super-smooth.
  3. It can be under-inflated, making it slower to roll to and away from a young child.  Balls that roll away too fast are frustrating to children with slow motor or visual processing.  Balls that roll to quickly toward a child don’t give kids enough time to coordinate visual and motor responses.
  4. They have less impact when accidentally hitting a child or an object.  Kids get scared when a hard ball hits them.  And special needs kids often throw off the mark, making it more likely to hit something or someone else.  Keep things safer with a Gertie ball.

The biggest downside for Gertie balls is that they have a stem as a stopper, and curious older kids can remove it.  If you think that your child will be able to remove the stem, creating a choking hazard, only allow supervised playtime.

Looking for more information about sports and gross motor play?  Check out Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility and Should Your Hypermobile Child Play Sports?.  You could also take a look at What’s Really Missing When Kids Don’t Cross Midline?.

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Halloween is Coming: For Children Who Get Spooked Easily, It’s No Celebration

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I wonder what the little girl with the sparkler is really thinking?

I love Halloween, but not everyone does.  Kids with sensory sensitivity top THAT list!  The strange transformation of their classrooms, homes and yards aren’t exciting; they are disorienting.  The masks and loose costumes?  Pure Hell.  But at least here in America, it often seems like it is almost unpatriotic to shun this holiday unless you have a religious objection.  What can you do?

I am re-blogging this post since I think it is worth another look: Have More Halloween Fun When Kids Don’t or Can’t Trick-Or-Treat , and because even if you DO take your child out for treats, the ideas could help them handle things more easily.

In this climate of diversity challenge, I sincerely hope that there is room for all of the people, young and old, who don’t really have fun with Halloween in it’s traditional forms.  I would like to think that holidays could be what you make them.

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Just because the squash on the left aren’t orange, that shouldn’t mean they aren’t great symbols of the season!

Tub Safety For Special Needs Children

Bathtime is usually a fun experience for young children.  Toys, splashing, bubbles.  But it’s not always fun for parents.  If your child has issues with sensory sensitivity, sensory seeking or hypermobility, you can feel like a one-armed paperhanger; juggling toys, washcloth and child!

One solution is to use a bath seat.  A word of common sense first:  never leave a child unattended in any type of bath seat.  Just because these devices improve stability, they don’t remove all the risks of bathing in a tub.  Young children need to be supervised at all times.  But a tub seat does help a special needs child remain sitting and stable, and that can really help parents during bathing.  Here are the positive effects of using a bath seat or tub insert:

Kids with sensory seeking or sensory sensitivity can find the expanse of the standard tub overstimulating, and in response, they may become agitated or fearful.  The youngest kids can’t tell you how this feels.  They just act up.  Using a bath seat or a tub insert can allow these children to stay in the tub long enough to be washed, and help them stay calm and relaxed.  Since bath time is usually before bedtime, that is a big plus!

For kids with instability, the bath seat or insert can prevent them from injuring themselves if they tip or lean too much.  They could even build their ability to sit up if the seat is well-chosen for their needs.  These kids need to acquire a sense of independence, and if they are given the right support, they can start to sit without an adult holding them.  They may be able to use both hands more freely, developing coordination for learning to wash themselves and confidence in their independence.

Selecting the correct equipment can be easy or challenging.  After determining what level of assistance your child needs, figure out if your child fits well in the seat you are looking at.  Some seats are made for very small children.  If your child is older or larger, keep looking until you find equipment for them.  Therapy catalogs and sites have equipment for children with significant difficulties in holding their head up or maintaining a sitting position.  These are more expensive than mass-market items, but they are often adaptable and you can remove parts as your child builds their sitting skills and safety.

For more information about self-care and the special needs child, check out Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course StrategyImproving Daily Life Skills for Kids With Special Needs, and OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues.

Are you toilet training your special needs child?  Do you worry that it may never happen?  I wrote the e-book for you!  The Practical Guide To Toilet Training Your Child With Low Muscle Tone is filled with readiness tips, techniques to find the best potty seat, and techniques to make learning faster and easier for both of you!  It is available on my website tranquil babies, and on Amazon and Your Therapy Source )a terrific site for parents and therapists).  Read more about this unique guide here: The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

 

Not Making It To the Potty In Time? Three Reasons Why Special Needs Kids Have Accidents

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If your special needs child isn’t experiencing a medical reason for incontinence (infection, blockage, neurological impairment) then you might be facing one of these three common roadblocks to total training success:

  1. Your child has limited or incomplete interoceptive awareness.  What is interoception?  It is the ability to sense and interpret internal cues.  The distention of the bladder, the fullness of the colon, etc are all internal cues that should send them to the potty.  Unfortunately, just as poor proprioception can hinder a child’s ability to move smoothly, poor interception can result in potty accidents, among other things.  Working with them to become more aware of those feelings can include monitoring their intake and elimination routines.  You will know when they should have more sensory input, and can educate them about what that means.  Listen to how they describe internal feelings.  Kids don’t always know the right words, so use their words or give them a new vocabulary to help them communicate.
  2. Your child’s clothing is difficult to manage, or their dressing skills aren’t up to the task.  They run out of time before nature calls.  Tops that are hard to roll up, pants that have tricky fasteners, even fabrics that are hard to grasp and manipulate.  All of these can make it a few seconds too long once they get into the bathroom.  If you are not in there with them, you may have to ask them to do a “dry run” so you can see what is going on and what you can change to make undressing faster.  In my e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, I teach parents the best ways to teach dressing skills and the easiest clothing choices for training and beyond.  If you have ever had to “go” while in a formal gown or a holiday costume, you know how clothing choices can make it a huge challenge to using the toilet!
  3. Your child is too far from the bathroom when they get the “urge”.  Children  with mobility problems or planning problems may not think that they are in trouble right away.  They might be able to get to the bathroom in time in their own home.  When they are out in public or at school, the distance they have to cover can be significant, and barriers such as stairs or elevators can be an issue.  Even kids playing outside in their own yards might not be able to come inside in time.  If you can’t alter where they are, teach them to use the potty before they go outside or when they are near the bathroom, instead of waiting.  Taking the time to empty a half-full bladder is better than an accident.

Looking for more information on toilet training?  Read How To Teach Your Child To Wipe “Back There” and Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty.  and of course, my e-book is available for more extensive assistance The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Spatial Awareness and Sound: “Hearing” The Space Around You

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Just floating along in a big ocean……..

I hear a lot about kids who aren’t comfortable in big spaces: cafeterias, churches, gyms. Many parents, and even some therapists, attribute it to lack of familiarity: these are places they use inconsistently and are filled with more strangers.  Or they mention noise intolerance:  to music, to shouting, and to sounds like balls bouncing or people clapping.

But how about spatial issues?  We use our hearing to know where we are in a space, and to monitor our position in relation to people and objects as we move through space.  Kids who are poor at orientation to sound (I hear it, and I know where it is coming from) are usually also fair to poor at discriminating sound (I know what that sound is like and what it is or could be).  They may have a diagnosable hearing issue, or they may have a processing issue with no organ limitation.  Or they have both.

As sounds bounce off surfaces, we hear them and determine, like RADAR, how close we are to that surface.  We might turn our heads slightly, but we can hear in both ears, giving us stereo comparisons that tell us about what is behind us, above us and even below us.

In large spaces, sounds are “swallowed up” and give us less information.  This is part of the design of gothic cathedrals; you have a different sense inside them, a sense of being a bit “lost”, of how small you are in the face of the almighty. Not just luck.  Our ancestors understood the effect of altering spatial awareness on our sense of safety and stability.  But for people with spatial issues, they feel uncomfortably lost, very off kilter in environments that make them struggle to get a sense of their position in these types of locations.  For kids with poor sensory processing, it can happen in a grocery store or a new classroom.

What other sense is involved in spatial awareness?  Vision.  Vision is only helpful for about the 180 degrees in front of us, and not all of that vision is acute.  Our peripheral vision is fuzzy but still gives us some information about things going on to our extreme right and left.

The kids with poor auditory skills will use their vision excessively, and the kids with poor vision will try to use their auditory skills to shore up what they can’t see.  What does this look like?  Kids who are turning their heads constantly as they move, trying to get a sense of their location as they move, when their auditory system should be telling them about the distance between them and the boundaries of the room and it’s contents.  Kids who seem to hear everything, and yet not your voice telling them not to step on their brother’s LEGO car, which they don’t seem to see on the floor.

Poor spatial awareness often makes kids anxious.  This can sometimes be interpreted as a psychological issue, but CBT and drugs will never make it better.  That is a hint that perhaps it is a sensory issue.  Spatial issues can also make kids rigid about where they will go.  They may refuse unfamiliar parks, pools, playgrounds and new classrooms.

What can you do to help kids?  Work on auditory and visual skills, and always use vestibular and proprioceptive input as modulators and regulators.  I especially like the Therapeutic Listening Spatial series.   Spatial skills are important, and they can be improved!

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Teaching Safety Awareness To Special Needs Toddlers

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Parents anxiously wait for their special needs infants to sit up, crawl and walk.  That last skill can take extra months or years.  Everyone, and I mean everyone, uses walking as a benchmark for maturity and independence.

They shouldn’t.  A child with poor safety awareness isn’t safer when they acquire mobility skills.  Sometimes they are much less safe.  Yes, they may be able to move without your help, but they may need to be more highly monitored and given more assistance to learn how to be safe.  They are exploring their environment and their new skills that took them a long time to develop.  They have been wanting to climb on the couch for months.  Now they can.  Getting down the “safe” way isn’t as important to them, and maybe not as easy as sliding or rolling off.  Oops.

What can parents do to help their child be a safer (notice I didn’t say “safe”) ambulator, crawler, cruiser, etc?  

  1. Talk about safety before they are independent.  Will they understand what it means?  Probably not, but your tone and your insistence on how movement is done says that you value safety and you want them to do the same.  Kids learn from all of our actions.  Make this one familiar to them by being very obvious and explicit.
  2. Take your physical therapist seriously when she or he teaches you how to work on core strength and balance skills.  Yes, I still maintain that safety is more than a sensory-motor skill, but having the best possible sensory and motor skills is important.  Having good safety awareness and safety behaviors without these skills will make a child more vulnerable to falls and injuries.
  3. The same goes for sensory processing activities.  If your child cannot perceive the movement of falling, the tactile and proprioceptive change as they crawl or step on something, or tolerate multiple sensory inputs at once, they are much less safe, even with good strength and coordination.  Really.
  4. Know your child’s cognitive and social/emotional skills.  Impulsive children are less safe overall.  Children that cannot process your instructions or recall them without you are less safe.  Children that enjoy defying you more than they want to avoid falling are less safe.  If you know any of these things, you can gauge safety and react more appropriately.  You will be less frustrated and more helpful to them.
  5. Reward safe execution and do not reward unsafe behavior.   My favorite way to avoid punishment but also to send my safety message home?  Not providing eye contact or much at all in the way of conversation as I stop unsafe actions, and either removing a child from an unsafe situation or assisting them in using the safe method to execute their move.  They get no satisfaction from seeing me react strongly, and they get the message that I am not accepting anything but their best safety skills as they move.
  6. Stop a child that is moving in an unsafe way, and see if they can recall and initiate the safe choice before assisting.  You don’t want to teach them that only you will make them safe and they need someone to be safe out there. They have to learn how to assess, react and respond, and all children can build their skills.  Some need more teaching, and some need more motivation to begin to take responsibility for their safety.  Give them both.

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