Category Archives: autism

Does Your Child Still Chew on Clothes or Toys?

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Babies love to munch on their toys.  They nibble at book bindings, chew the heck out of their loveys, and some little ones really love to chew their pacifiers.  As they grow, most children let go of this behavior.  Chewing and biting for sensory exploration and state modulation diminishes and a child’s behavior evolves into thinking, communicating, and smooth internal state regulation.

But some older kids slip their sleeve or shirt collar into their mouth whenever they can, and are left with a soggy mess by the end of the day.  They suck on their markers or the grocery store cart.  Their toys and pencils are ragged witnesses to the continuing use of oral stimulation, long past the first year or two of life.

Why do they do this?

Some kids are seeking to fill an oral cavity that is less stimulated due to low muscle tone, hypermobility and/or limited sensory discrimination.  Shoving a sleeve in there provides that sensory boost as muscles, skin and ligaments stretch.  Children that need more sensory input due to inactivity, boredom, physical limitations and illness use oral input as an always-available and independent option.  Other kids use biting and chewing to modulate their level of arousal (and open their eustachian tubes, BTW!).  While most OTs know about the modulation piece, the way biting and chewing impact hearing and even vestibular health isn’t so commonly considered.  Biting can stem nystagmus for some kids, and it can lessen dizziness or help a child move their eyes apart as they watch objects in the distance (divergence) for reading the board and for sports.  For kids that use biting well after the toddler biting phase should be over, evaluating any ocular (eye) or ENT issues can be helpful.

Exploring the level of stress in a child’s life outside the classroom or therapy clinic is another consideration.  Biting and chewing are calming proprioceptive inputs that a child can use when they are anxious or fearful, or just uncertain.  It may not be possible to impact the stress of divorce, moving to a new home, or adding a newborn to the family, but appreciating these situations as factors in behavior can improve how families, teachers and therapists respond.  Older children could be trying to modulate their level of arousal without causing trouble by running, jumping or yelling.  Chewing is less likely to be disruptive in a classroom setting.

What Can You Do Once a Chewing Habit is Established?

Once oral sensory seeking behavior takes hold, it isn’t easy to stop.  It can be very satisfying and accessible, particularly for young children.  Addressing the core cause or causes means taking things one step at a time.  Many children do well with a multi-sensory diet added to their daily activities.  More physical activity or more frequent activity breaks can help.  I find that more vestibular input in particular can be powerful.  Using whistles can be helpful when chosen well and supervised for safety and overall modulation.   Some children need to become more aware of their behaviors; older kids can use some of the “How Does Your Engine Run?” concepts to take responsibility for their behaviors and independently seek alternative sensory input.  Kids that learn mindfulness techniques can incorporate those into their program as well.

The use of chewing objects can help, but there are three concerns that have to be addressed:  hygiene, safety, and speech.  A child that sucks or chews on any object isn’t going to monitor its cleanliness, so make sure you use non-toxic soap that is carefully rinsed off.  A chewing necklace should never be worn while sleeping due to safety issues, nor can it be used when it could become snagged on branches or sports equipment.  And finally, having something in the mouth, whether it is a pacifier or a chewing toy, will minimize and alter speech if it isn’t removed for communication.  Never allow a child who is talking or learning to talk to devolve into head nods so they can keep chewing.

Looking for more information on sensory issues?  Read Sensory Sensitivity In Toddlers: Why Responding Differently to “Yucky!” Will Help Your Child and Weaning the Pacifier From An Older Child.

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Sensitive Child? Be Careful How You Deliver Praise

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Sensitive kids need encouragement as much as the next child, but they can have a paradoxical reaction when you praise them.  What do I mean?  You compliment your child by saying “GREAT job!  I knew you could do it!”, and they react by becoming angry or even arguing with you.  They may even try to destroy what they had done.  This can include being mean to a sibling or pet, or breaking something that they created.

Why?  Weren’t you supposed to support them?  All the parenting books recommend giving children accurate and immediate feedback.  You could have done everything as suggested:  you were warm, you were specific about their success, and you used words that match their age and developmental stage.  You even avoided the pitfall of praising results and instead you praised effort.  It backfired on you.

What went so wrong?

Simply put, you didn’t expect that they would think that any future performance could be seen as a failure, and this burden was more than they could bear, or the sensory input overwhelmed them.  Or both.  This reaction is more common than you would think, and happens in very young children, as young  as two!  Some very sensitive kids cannot handle the physical intensity of some methods of praise.  Your change in vocal volume and even vocal pitch may send them into physiologic alarm mode.  The longer you go on, the more upset they become.  And they don’t have a good answer when you ask why they are so upset.  They are just as eager for true appreciation as any other child, but they know that they feel bad, not good.  You weren’t intending to create pressure on them.  Kids can place it on themselves.  These are often the kids that need things to go the way they expected, or to go perfectly or it isn’t acceptable.  They are very invested in being seen in a positive light.

What can you do differently?

If you think that your child is reacting this way, dial down your response and observe how your child takes it in.  Using a lower voice and shortening your response can help.  Making a general statement rather than elaborating might be easier to hear.  “Nice work” can be more acceptable than “You did an AMAZING job; I cannot wait to show everyone what you did!”  Dr. Karp’s “gossiping” technique, whether it is gossiping to a toy or to a person in the general vicinity might be more acceptable.  Waiting a few minutes, or even waiting until the next day to deliver praise can be helpful.  It sounds great to follow the strategies listed in the parenting blogs and in magazines, but if you have a sensitive child, you have already learned that things sometimes have to be altered to fit your child’s needs.  This is just another example!

Another suggestion is to put more effort into modeling how to handle slip-ups.  Kids need to know that we make mistakes and don’t always succeed.  We look so powerful and accomplished to young children.  We know that we have our limits and faults, but kids don’t always see it that way.  Explicitly tell your child when you make a mistake, and talk about your feelings and how you make yourself feel OK with not being perfect.  This can go a long way to helping a sensitive child handle praise.

Looking for more information on helping sensitive kids?  Read What Helps Sensitive Kids Handle Haircuts? and Holidays Hints For Sensitive Kids.  Sensitivity is common in gifted kids Sensitivity and Gifted Children: The Mind That Floods With Feeling and kids with sensory processing disorder Sensory Sensitivity In Toddlers: Why Responding Differently to “Yucky!” Will Help Your Child.

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Is Your Kid With ADHD Also Gifted, or is Your Team Missing Their Giftedness?

david-clode-635942-unsplashAre you hearing that your child is a management problem at school, but is a joy at home?  Do you see them thrive when your older child’s friends include them in play?  Does your child sustain their attention and manage their behavior well when the class goes on field trips or has speakers come in, but dissolves into troubling behavior on a “regular” school schedule?  Your child may have a dual diagnosis of giftedness and ADHD, or have been misdiagnosed completely.

I know, I am not a psychologist.  But I am aware of the many kids I have treated that blossom when, instead of simplifying the environment or the activity, I expand it.  This goes against the standard treatment protocols for kids with sensory processing disorders and ADHD.  But it is exactly what gifted kids love and need.  Give a gifted kid more complex work, leave them alone to solve a challenging problem, or ask them to mine their passion more completely, and you often see better performance, not worse performance.  The kids with ADHD without giftedness often struggle more and need more help under a more complex environment.  The misdiagnosed gifted kids shine like little pennies when challenged.  Gifted kids will show ADHD behaviors in situations that restrict or frustrate their tendencies to dive deep into a subject (intensity ) and look terrific in a setting where they are stimulated and engaged.  Kids with ADHD might be happier out of school, but they struggle with the same issues of distractibility, disorganization and they show a lack of focus, not a deep absorption.

As an aside, many of the kids I treat that look like they have Asperger’s (or now high-functioning autism) are gifted, and their delays in speech or motor skills mask their gifted performance when they are between 1 and 5 years of age.  What gives them away as gifted instead of disordered?  They light up when someone wants to talk about their deep interests, and they would seek that interaction out.  Their interests may seem quirky, but they aren’t incredibly obtuse.  For example, a gifted child could be interested in ocean life, with a strong interest in squids.  If you like squids, they will talk your ear off and enjoy it tremendously if you do.  A child with Asperger’s will be interested in something so unique that they couldn’t find someone to share it with, like threshing machines, and they couldn’t care less if you share their interest.  They won’t want to convince you of the many useful things they do, they won’t want to discuss it.  Will they want to talk?  Sure, but talking to you isn’t the same as discussing it.  They may find your input annoying, in fact.

Grades, and even cognitive testing, sometimes aren’t enough to identify gifted kids.  Some of them aren’t going to try very hard.   Some will mess with the evaluator’s mind.  I have heard at least one parent report that their child deliberately gave the wrong answers to see what would happen.  This child is reading chapter books at 3.5 years old.  He really doesn’t understand that getting a low intelligence score is going to send him to special ed instead of advancing him to a higher grade or an enriched program.  Emotional maturity is one of the skills that are often not advanced in gifted kids.  To paraphrase Jack Nicholson’s character in the movie “A Few Good Men“, these kids want the truth (or the facts, or the experiences) but sometimes they can’t handle them.  Young gifted kids can fall apart when their imagination doesn’t match their execution.  Whether it is writing, building, drawing or another skill, they can display anxiety and anger when things don’t match their amazing thoughts.  This isn’t oppositional defiant disorder or an anxiety disorder, it is an asynchronous development problem.

I can’t ignore the strong bias against giftedness in our culture.  Sure, there are cultures that applaud accomplishments, especially intellectual accomplishment, but not when it is accompanied by impatience, a tendency to dominate the conversation, perfectionism and frustration with others and themselves.  Gifted people of all ages become aware that it could be easier to speak about being on the left side of the Bell curve than on the right side.  Whether you share your suspicions or your testing results is up to you, but know that you may get pushback from some unlikely sources, especially at school.

If your child is gifted, seek out support wherever you can find it, and learn how to discuss your child’s gifts with them.  There are online sites like SENG that can offer you some strategies and some resources.  You may want or need outside help to learn how to harness their overexcitabilities OT and Non-Disabled Gifted Children and handle their feelings, but a child that understands their gifts will not consider themselves impaired and will learn to accept their atypical nature with confidence.

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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  and Should You Install a Child-Sized Potty for Your Special Needs Child?, 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.  Read How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child for more information on this subject.

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.

Looking for more information on making your home safer for your child?  Read Should You Install a Child-Sized Potty for Your Special Needs Child? and How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child.  I am a CAPS as well as an OTR.  This is a natural progression, as occupational therapists are always thinking of safety and independence for their clients, all the way from infancy to end-of-life issues.

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!