Category Archives: behavior issues

Safety Awareness With Your Hypermobile Child? Its Not a Big Thing, Its the Biggest Thing

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Therapists always try hard to be optimistic when discussing their pediatric client’s future.  Why not?  Kids have amazing potential, and we aren’t fortune tellers; there are so many things that can go right.

As therapists, we also should share the reality of how bad choices create unfortunate consequences.  Among them are the long-term results of falls, especially head injuries.  Kids fall, kids trip, kids walk into things.  All kids, and for much of early childhood.  The hypermobile child will have more episodes of injury, often has greater injury occurring in each episode, and frequently experiences a slower or less complete recovery from injury.  This isn’t a criticism of parents, kids, or even acute medical care.  It is the reality of living with a condition, often a syndrome, that has effects beyond just loose joints.

This can include connective tissue disorders that create weak skin, ligaments, and tendons, decreased pain registration, delayed protective reactions when falling, and cognitive or behavioral complications that make learning and controlling actions more difficult.  Hypermobile kids often spend more years in an unstable state in which they need assistance and supervision.  And more years when they are vulnerable to serious injury.  A head injury or a spine injury isn’t an “unfortunate” event.  It is frequently a life-changing event.  The course of education and employment can be forever altered.  For the worse.

In a clinic or school setting, your therapist is bound to guidelines that indemnify them and the facility. While they cannot control what happens at home, you should know what to do to make your home safer for a child with hypermobility.  It begins with your environment, then you change your responses, then your build  your child’s ability to incorporate safety awareness into their day.

  • Create a safe but accessible home.  This expands on “baby proofing” to include railings set at a height that allow your child to push up rather than hang on them.  Removal of loose rugs and adding padded floor surfaces in common areas, especially areas where they are climbing or running.  Bathrooms are the location for many injuries once children become independent in toileting or bathing.  Instead of supervising them forever, create a safe place with hidden grab bars (there are toilet paper holders and towel racks that are actually grab bars) and non-slip flooring.  Place needed items within easy reach without climbing.
  • Teach safe movement from the start.  Children that learn how to move versus children that are passively moved will have more safety awareness.  For children that still need a lot of help, narrate your moves and weave in safety messages.  It will sink in.  Finally, don’t allow unsafe moves, even if they didn’t hurt themselves.  Tell them to try it again the safe way.  Children are unable to anticipate the results of their actions.  This is why we don’t let 12 year-olds drive or let 5 year-olds cross the street alone.  Sometimes the reason they do things our way is because we said so.  Until they are old enough to understand the “why”.
  • Share your thought processes with children as soon as they can wrap their heads around things.  Even kids in preschool can follow along with the idea that too many “boo-boos” will stop them from being able to play.  Older kids can learn that the right chair helps them stave off fatigue until they finish a game.
  • Ask your therapists for specific safety advice, and then carefully think through their answers.  The truth is that some therapists are more safety-aware than others.  I have been told that I am one of the most vocal therapists on a team when regarding safety issues.  Perhaps it is because I spent 10 years working in adult rehab, treating patients for problems that started decades before I met them.  I have seen what overuse and poor design has cost people.  By then it is often too late to do much more than compensation and adaptation.  I am committed to prevention with my pediatric clients.  The cost is too high not to say something and say it loud.

For more information and ideas about helping your child with hypermobility, read Is Your Hypermobile Child Frequently In An Awkward Position? No, She Really DOESN’T Feel Any Pain From Sitting That Way and Should Your Hypermobile Child Play Sports?

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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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Are Your Other Children Resentful of Your Special Needs Child?

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This is something that is hardly ever spoken of, but it happens in many, if not most families.  The good news is that it is normal, it doesn’t predict future behavior, and you can address it without sending everyone to a psychiatrist.

The time and energy demands of a special needs child aren’t always in proportion to a child’s delays.  Surgeries or therapy intensives can pull you away for weeks.  The little things, like therapy always being at the same time as someone’s soccer games, are actually harder for siblings over time.  Even sharing lap time can be tough for a toddler who was, until recently, able to climb into your arms anytime.

Remember, toddlers naturally see the world as theirs, and assume that they and their actions are a part of everything that happens to them, good or bad.  They will not be able to fully comprehend why their sibling may take a long time to be able to play with them.  Older children may perceive that it isn’t “nice” to complain about their perceived lack of parental attention, but they feel it.

What can you do?  I believe that quality time is the answer, but only part of the answer.  When you are planning, engaging in, and reminiscing about the quality time that you spent with your child, regardless of whether they are 18 months old or 18 years old, you approach it as if you were in a long-distance love affair.

If you were dating someone across the country, you would talk about the upcoming rendezvous with excitement, you would savor every short minute of it, and you would reconnect afterward, reminding your beloved of the wonderful time you had, and what you hope will happen the next time.

The twist that I learned from Dr. Harvey Karp’s wonderful book The Happiest Toddler on the Block is to put into words exactly how you FEEL about your child and the terrific plans (or event that just passed).  Saying “I am SO, SO, looking forward to reading our special book tonight!” with a smile can mean that a child will put up with your absence at that soccer game.  Reminding a child “Remember when we went out for ice cream alone, nobody else?  That was fun!” helps them handle the fact that they are bathing with the nanny or big sister while you bathe and dress your special needs child.  Even responding with sympathy:”I know…I am sad too that I can’t go with you to your playdate because I have to take Jonah to PT” and using a tone of voice, facial expression and body language that messages real regret; this will help your child handle their feelings without becoming aggressive or shamed for their feelings.

I think this works extremely well with your special needs child’s siblings.  Kids need to hear how happy you are to be with them, that you look forward and backward with pleasure.  They know on some level, even as toddlers, that they don’t get all your attention.  But they really want and need to hear that you love being with them as much as they love being with you.  It could be an ice cream run just with them.  A game of catch just with them.  Reading a new book together.  Almost anything will work, as long as you elaborate on your feelings as well as talking about the event itself.  Mentioning your excitement or good memories during a calm time works better than wedging the comments in between correcting actions and giving consequences.  A casual mention of your future plans can smooth out a lot of feathers!

Looking for more information on parenting when you have a special needs child?  Read How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child and Universal Design For Parents of Special Needs Kids: It’s Important for You Too! and also The Cube Chair: Your Special Needs Toddler’s New Favorite Seat!

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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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How To Stop Your Toddler From Hitting You

 

patrick-fore-557736When your sweet little baby turns into a toddler that smacks you, you may be so shocked that you don’t know how to react.  The second time you get hit, or pinched, or even bitten in anger, you might feel a level of rage come up that is both surprising and horrifying.  Well, I am not going to shame you for any of that.  I want to help you get this under control and help your child handle what is (probably) a normal level of aggression.

Yes, this is likely a normal response for toddlers.  They have really limited language, hardly any understanding of their own feelings, and they live in the moment.  You probably have one of the 85% of kids who are not placidly calm most of the time.  If you have a very young child with a strongly spirited temperament (15-20% of the population) then you probably see this behavior at least a few times a week, if not daily.  It’s still normal. And you have to deal with it or you will have a bigger, stronger, and more aggressive child next year.

Here are my suggestions to deal with aggression:

  1. You are going to have to use Dr. Karp’s Fast Food Rule.  The first simple step is to state what you think your child is thinking, such as ” You say “No go inside”, in as short and simple a phrase as you can, based on age and level of emotion.  The younger and more angry your child is, the simpler the message.  Match your expression and gestures to the emotion you are stating.
  2. Wait for a shift in body language or level of screaming.  Repeat the phrase if needed, may be more than once.  Then state “No (biting, hitting, throwing)” and you say  “I don’t like it” or a “We don’t hit” if your child isn’t totally out of control.  If they are out of control, you have to wait until they can hear you.
  3. You must make it clear that YOU don’t like this behavior, not simply that it isn’t “nice”.  Why?  Because a personal message is more powerful to a toddler than stating that they broke the rules.  I even throw in “That scared me and I don’t like it” to slightly older toddlers, to come down to their level.  They might be a little surprised, but they know all about being scared.  You aren’t admitting weakness, you are telling them how they crossed a line.  As long as you are using body language that tells them you are still the adult in control, this helps them understand the seriousness of what they did.  But the 12-18 month olds don’t get that, so wait until they are older to add that one in.
  4. If you were holding your child when this happened, put him down. Nothing says confuse me like saying these phrases while cuddling.  If you were sitting next to them, move away a bit.  The message is that they have crossed a line, because they have.  They may cry about this, but that is OK.  For now.  Once they shift out of aggression, you can be more welcoming.  Get it?  Good behavior we welcome, aggression we do not.  Simple.
  5. If you see the clouds building and you can anticipate your child will hit, bit, kick or throw, you are allowed to intervene.  Pull your arm away, put them down, reach for the toy you think she will throw, or move away.  You could say “I don’t want you to kick” and then offer a solution.  This solution could be what you think your child needs, like a nap or a snack, or it could be something amusing, like looking in your purse for your keys.  Young toddlers can switch things easily.  Older toddlers sometimes commit to aggression and they won’t take the bait.  But sometimes they will.
  6. Don’t be afraid to issue consequences.  I don’t believe in physical punishment, but I have no problem with removing toys that got thrown or issuing kind time-outs.  Losing the opportunity to go do something fun because you tossed your boots at my head is just fine for me.  I never reward bad behavior.  Ever.  I have too much to lose if a child thinks that aggression will work to avoid something or receive something.  Kids can hurt themselves in the process of being aggressive, and that is always going to be my fault.  Not a chance.
  7. I always give children a chance to come back into the fold.  Maybe not to get the same thing they were being aggressive about, but a new fun thing.  You have to wait until they are calm to do this.  This isn’t coddling.  This is teaching them how I want them to behave, and that there is always a chance to do things better.

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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A Great Toilet Training Book for Neurotypical Kids: Oh Crap Potty Training!

sean-wells-471209My readers know that I wrote an e-book on potty training kids with low tone ( The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! ) but I have to admit, I learn a lot from other authors.  Jamie Glowacki  has written a terrific book that speaks clearly and directly to parents who aren’t sure they are up to the challenge of toilet training.  Oh Crap Potty Training is a funny title, but it is filled with useful ideas that help parents understand their toddler better and understand training needs so they can tackle this major life skill with humor and love.  I have to admit, I am really happy that she suggests parents of kids with developmental issues ask their OT for advice.  So few parents actually do!

Here are a few of her concepts that illustrate why I like her book so much:

  1. She gets the situation toddlers find themselves in:  using the potty is a total change in a comforting daily routine.  Jamie points out that since birth, your child has only known elimination into a diaper.  The older they are when you start training, the longer they have been using diapers.  WE are excited to move them on, but they can be afraid to sit, afraid to fail, and afraid of the certainty of the diaper always being there.  You can’t NOT get it in the diaper!  She also gets the power struggle that can be more enticing to an emerging personality after about 30 months of age.  Just saying, she gets it.
  2. Potty training success opens meaningful doors for kids, diapers keep them back.  Some great activities and some wonderful schools demand continence to attend.  By the time your child is around 3, they can feel inferior if they aren’t trained, but not be able to tell you.  They express it with anxiety or anger.  If you interpret it as not being ready, you aren’t helping them.
  3. Some kids will NEVER be ready on their own.  I know I am going to get some pushback on this one, and she already says she gets hate mail for saying it.  But there is a small subset of kids who will need your firm and loving direction to get started.   Waiting for readiness isn’t who they are.  If you are the parent of one of these kids, you know she’s right.  Your kid hasn’t been ready for any transition or change.  You have had to help them and then they were fine.  But this is who they are, and instead of waiting until the school makes you train her or your in-laws say something critical to your child, it might be OK to make things happen rather than waiting.
  4. You must believe that you are doing the right thing by training your child.  They can smell your uncertainty, and it will sink your ship.  She really sold me on her book with this one.  As a pediatric therapist, I know that my confidence is key when instructing parents in treatment techniques for a home program.  If I don’t know that I am recommending the right strategy, I know my doubt will show and nothing will go right.

If you are looking for some ideas on training kids of all stripes and needs, check out my posts  For Kids Who Don’t Know They Need to “Go”? Tell Them to Stand Up and Toilet Training For Preschool And Stuck in Neutral? Here’s Why…...  Of course, if your child has low muscle tone or hypermobility, my e-book will help you understand why things seem so much harder, and what you can do to make potty training a success!

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