Category Archives: behavior issues

How to Get Children to Wash Their Hands

 

phil-goodwin-TxP44VIqlA8-unsplashThis season’s flu and viruses have parents and teachers wondering how to raise their game regarding infection control.  Washing your hands is one of the most important things anyone at any age can do to protect their health.  But small children aren’t always cooperative.  Getting them to wash their hands can be tough.

The families I work with know that I will not begin a session in their home, and especially that I won’t touch their child, without washing my hands first.  Not only is this to protect them, it is to model good practice for the kids.  Some children will ask me why I am washing my hands.  I always answer them by naming two things familiar to them.   I tell them that when I touch the outside of my car, my hands get dirty, and I don’t want to put dirt on our toys.

Cars and toys.  Most kids over 2 know what those two things are, and they know that one is not so clean, and the other one shouldn’t have dirt on it.  They get it.

But only a few parents insist that their child wash their hands before they begin working with me.  Some children want to share my sanitizer spray, and if a parent agrees, I will show them how to use it.

Now that we are facing both a serious flu season and a new virus, it seems like a good idea to provide suggestions to help parents out with hand washing:

  1.   Model good hand washing practices with a bit of drama.  You have to be a bit of a ham, and remember that kids need simple but dramatic explanations for information to sink in.  Something along the lines of “Oops, I FORGOT to wash my hands!  I will be RIGHT back as soon as I find some soap and water.  Do you know where it is?  Raise your vocal inflection, and use some gestures like stretching out your fingers.  Now say “That is SOOOOO much better.  My hands feel good and clean”.  Interrupt lots of things you are doing with a calm departure to wash your hands.  But make sure they hear you say where you are going and why.
  2. Get soap that they like.  Whether it smells good to them, has a character they love on the bottle, or is foamy or even tinted, soap they like is soap they will use.  Liquid soap is so much easier for young children to handle than bar soap.
  3. Make it easy.  They should be able to reach the water by using a spout extension, and possibly help you get the soap on their hands.  Paper towels that pop out of their holder ready to dry hands are easy to hold and the best way to avoid spreading germs.  Unless a cloth towel is changed very very frequently, it isn’t the cleanest choice. I treat a child whose mom is a cardio-thoracic surgeon.  There is a hands-free soap dispenser and a box of pop-up towels in her main floor powder room.  Enough said.
  4. Ask your partner and other people in the house if they have washed their hands when your child is paying attention to you and watching them respond.  Young children don’t take notice of these practices of others unless you point them out.  Hearing about who washed their hands, and hearing their enthusiastic replies, sends home the message that everyone washes their hands.  It is what we ALL do.
  5. Spin it positively.  Some children really become frightened if you message things about getting sick.  The message is to stay healthy.  Keep it that way.
  6. Make a habit of it.  Infection control staff know that making actions into habits is the best way to ensure safety.  Create new rules about washing hands throughout the day, and gently insist on them.  They will become habits.  Good ones.

lubomirkin-XKpPsuuGE_Q-unsplash

Sensory Processing and Colds: Nothing to Sneeze At!

joel-overbeck-552597

Here in the US, it is cold and flu season.  Most of my day is spend with kids recovering from some upper respiratory virus.  A few seem to have a continuous runny nose and cough.  They also have an increase in their sensory processing issues.  Is this connected, and if so, what can be done?

  1. Anything that affects health will make sensory processing harder.  Anyone, at any age, will struggle more when they don’t feel well.  If a child is super-sensitive, feeling ill will make them edgier and more avoidant.  If a child is a sensory seeker, that funny feeling in their head that changes when they flip upside down will probably make them do it more.  If a child is a poor modulator, and goes from 0-60 mph easily, they will have more difficulty staying in their seat and staying calm.
  2. Colds often create fluid in the ears.  This is a problem for hearing.  This is often a problem for speech and mealtimes.  It is also a problem for vestibular processing.  Fluid in the ear means that children are hearing you as if they are underwater.  Their speech may be directly affected.  They probably realize that biting and chewing open the eustacian tubes from the mouth to the ear, so they may want to chew more.  On everything.  They may also be unable to handle car rides without throwing up.  They may refuse to do any vestibular activities in therapy.
  3. Children sleep poorly when ill.  Anyone with sensory processing issues will struggle more when they are tired.  Young children cannot get the sleep they need and don’t understand why they feel the way they do.  Enough said.
  4. Spatial processing problems will get worse.  Being unable to use hearing to orient to the space and the people and objects in the room, children will roam around more, touch things more, startle more, stand still and look disoriented, and may refuse to go into spaces that are hard to process, like gyms or big box stores.  Uh-oh.

So what can you do as a parent or a therapist?

  • Understand that this is happening.  It is real.  It may not be a personality issue, a deterioration in their ABA program, or a problem with therapy.
  • Ask your pediatrician for more help.  There are nasal sprays and inhaled medications that can help, and some, like steroids, that can create more behavioral issues.  If your child needs steroids, you need to understand what effects they can have.  Saline sprays, cold mist humidifiers, soups and honey for coughs, if your pediatrician approves, are low-tech ways to help a child suffer less.
  • Alter your daily routine if needed.  Making less appointments, fewer challenges, and more rest could help.  Kids can be over-scheduled and under-rested.  Therapy sessions may have to be adjusted to both be less stressful and more helpful.
  • Your child may benefit from vestibular movement if they do not have an untreated ear infection.  Your OT can help you craft a sensory diet that moves fluid, but not if there is an infection.

Read more about sensory processing here: Does Your Child Hate Big Spaces? There is a Sensory-Based Explanation and Spatial Awareness and Sound: “Hearing” The Space Around You

caroline-hernandez-698708-unsplash

 

Young Children, Sensory Modulation, and the Automatic “NO!”

taylor-smith-Mw9TO8Wbz8A-unsplash

Kids as young as 18 months can express their sensory processing issues with one word: “NO!!”  What appears to be a budding attitude issue or even oppositional defiant disorder can be a sensory modulation issue instead.

How could you possibly tell?

Well, if your child has already been diagnosed with sensory sensitivity or sensory modulation problems, you know that these issues won’t just make it harder to wear clothes with seams or touch Play-Doh.  These issues affect all aspects of daily living and create emotional regulation and biological over-activation issues as well.  Young children are learning how to express their opinions and separate physically and emotionally from their caregivers.  Saying “NO!” isn’t unusual for young kids (and a lot of older ones too!).  But refusals that make no sense can have a different origin.

So what is the giveaway?

When a child has an almost immediate “NO”, perhaps even before you have finished your sentence, and the reaction is to something you know they have liked or almost certainly would like, you have to suspect that sensory modulation is at play.  You should know when your child is trying to get your attention or get you activated.  This should feel different.

What do I do next?

You also need to respond in a specific way to test your theory that sensory issues are the root of the ‘tude.  Your response should be as vocally neutral and emotionally curious as you can manage.   “Oh, really….you said no…” is a good template.  Whether it is “no” to their fave food, show, toy or an activity.  You remove all criticism and encouragement from your voice.  You don’t want to fuel the refusal fire; you want to shut it off and see what is left in the embers of “NO”.

Now you need to wait for them to neurologically calm down.  Little brains are like old computers.  They take a while to reboot.  Look at the floor, wipe your hands, etc and wait a minimum of 15 seconds, probably 30, then ask again if they want a cookie, want to go out, want to play, to eat, or whatever.  The child who needed the primitive defensive part of their brain to go offline to allow them to use their budding frontal lobes may sweetly ask for what they just refused, or respond to your exactly identical request with a cheery “YES”.

Please try to have compassion for them.

It can seem maddening to do this all day long, and in truth, if you are, you need to learn how to work with an occupational therapist in order to learn powerful sensory treatment strategies that can get your child out of this pattern.  But your child isn’t jerking your chain when their behavior fits this pattern.  They are more likely a captive of their brain wiring.   Don’t let yourself react as if they are intentionally being difficult.  That day will come…..13 is just around the corner!

valeria-zoncoll-AVGc87j_vNA-unsplash

What To Say When Your Child Cries After Losing a Game

kiana-bosman--8j5FpnLmQk-unsplash

Whether it is a board game or a soccer game, once children are old enough to wrap their minds around winning, they cannot handle losing.  Their grief leads parents to “throw” every game so that their child wins every time, or they make up games where everyone is a winner (I will admit to doing this one).  But inevitably, a child has to learn to accept that this time, in this game, they didn’t prevail.

What makes them learn to handle this without doing a “John McEnroe” and throwing the game board all over the room, or screaming in the car on the way home from the field?

  1. Model the emotions of losing, not just the noble way to lose.  Kids need to know that it is normal to feel bad about losing, just not behaving badly and not feeling devastated.  Seeing and especially hearing someone say how they feel helps children learn about their own emotions.  Play a game with your partner as well as your child, run a relay race, etc.  Just talking about it isn’t enough for young children.  They want to see the drama unfold.  If you showboat around the living room, you might want to reconsider that one.
  2. While we are speaking about showboating, you can comment to your older children on the behavior of sports figures.  Older kids can comprehend why that isn’t admirable behavior, and they need to hear why you think that.
  3. Tell children why adults don’t cry when they lose (most of the time).  It is very simple:  we know we will get another chance to win the next time we play.  We are still sad, because everyone wants to win.  They need to know that is true as well.  We also know that the best part of the game is playing, or else it isn’t really fun.
  4. If your partner/spouse doesn’t display the same equanimity about losing, you have a conversation in front of you.  Raging and bad behavior on the field or the rink has become dangerous, and you want no part of it.  Some adults were never taught these things, and some people have such limited lives that games really are that important in them.  They need help to grow up and reach for greater things.

robert-collins-333411-unsplash

How Using Dr. Karp’s Fast Food Rule Transforms Kids With Special Needs

wout-vanacker-497472

Yes, I said the word transform.  I know that hyperbole isn’t always appropriate when you are a therapist (we try to hedge our bets with predictions), but I am willing to go out on a limb in this instance and say that learning this single Happiest Toddler on the Block technique will make a difference with any child with special needs that functions with over a 12-15 month cognitive level.  Will it work with older children?  Absolutely.  Done right, it will also work on spouses and co-workers!

What is the Fast Food Rule?  You can read more about it here Help Your Child Develop Self-Regulation With Happiest Toddler On The Block but the simplest way to explain it is that when you have an upset person, they get to express themselves first, then the adult paraphrases the upset person’s expression with about 1/3 of the emotion that was used.  The paraphrasing is done at the level of comprehension of the upset person.  This means that someone who has a very low language level and is very upset may only hear “You say NO NO NO”.  Remember that any degree of agitation immediately lowers language comprehension IN EVERYONE.  Even you.

That’s it.  The phrase may have to be repeated a few times until the adult observes signs that the upset person’s agitation is decreasing (not necessarily over).  What are those signs?  A decrease in screaming volume or intensity, more eye contact, stillness of the body, turning to the adult rather than turning away, etc.  If the problem isn’t clear, altering the phrase is OK.  No harm done if you get it wrong; try again to state what their problem is.

ONLY WHEN THE UPSET PERSON HAS DECREASED THEIR AGITATION IS IT PERMISSIBLE TO OFFER A SOLUTION, OR EVEN CONSOLATION.

Why?  Because until the upset person REGISTERS that the adult understands the nature and the degree of stress, they will continue to protest to make their point.  It doesn’t matter if the point is pointless.  All the better.  Being understood is more important than being corrected.  Always.

Because young children’s brains are immature, their agitation may start up again after the problem is solved.  This is neurological, not psychological.  Rinse and repeat the FFR, and come out on the other side calmer.

Why does this transform the life of a special needs child?

Kids with special needs often need to be more regulated than the average child.  They can be unsteady, difficult to understand even when calm, have medical issues that get worse when they are agitated, and fatigue rapidly on a good day.  Being upset makes safety, endurance, sensitivity and sensory seeking worse.  Sometimes much worse.

If your child or your client has any of these issues (and I have yet to work with a child with special needs that doesn’t have ONE or more of them), then you need to learn the FFR today and use it consistently.

  • Kids with cerebral palsy can move with better safety awareness and expend less energy.
  • Kids with hyper mobility are also safer, less fatigued and can focus on movement quality.
  • Children with sensory processing issues are more modulated, less aversive or sensory seeking.
  • Kids with ASD do less self-stimulation and have less aggressive behaviors.

 

The biggest obstacle for me?  Fear of using Dr. Karp’s Toddler- Ese language strategy, which sounds infantile to the ears of an adult, because I thought that I sounded like an idiot in front of parents (who were paying me a lot of money to treat their child).  It turns out that not being able to calm a child makes me look much more like an idiot, and effectively getting a child calm and focused makes me look like a skilled professional.

beatriz-perez-moya-rYvj17pefXs-unsplash

How Dr. Harvey Karp Helps Kids AND Adults with Regulation Issues

jose-antonio-gallego-vazquez-690049-unsplash

Can you do DBT with toddlers?  Well, Marsha Linehan probably would say no, but the Fast Food Rule and Patience Stretching come as close as you ever could!

Many child psychologists and psychotherapists are focusing on attachment theory and the problems of poor emotional regulation in children.  The rise of self-harm behaviors in teens and aggression in children as young as 3 can be related to difficulties handling emotions and experiences that increase arousal levels but never get resolved.

Not every child who throws their book down in frustration or slams their bedroom door needs to see a therapist.  But I do wonder how many of those teens that cut themselves, starve themselves or get suspended for putting their hands on a teacher or fellow student, actually needed Dr. Karp’s techniques when they were 3 or 4.  Maybe, just maybe, if they had been helped with Patience Stretching when they wanted that toy, or if someone had used the Fast Food Rule with them when they had a tantrum Use The Fast Food Rule For Better Attunement With Your Child, maybe they would be in better shape at 13.

Why?

Because these techniques don’t just work on the child.  They work on the adult using them as well.  And adults who can self-regulate raise kids who learn to do it too.

When I use Patience Stretching( Stretch Your Toddler’s Patience, Starting Today! ) with a toddler that wants one toy while I want them to work a bit longer on a therapy task, I am actually receiving the benefits of the technique as well.  I am both teaching and experiencing the reduction in frustration and the decrease in agitation as this strategy calms down the whole situation.  Oxytocin gets released when we calm down with a child, and adults need that hit as much as children do.  If we “go there” with an agitated child, we feel worse, even if we think we won because we have the power to deny or punish.  It doesn’t feel good to do either, but it also doesn’t feel good to give into a screaming child.  Not really.  Even the most permissive adult will say no to something dangerous, and then the child who is unfamiliar with hearing “no” will really explode.

The good news is that you don’t have to get an advanced degree to use Dr. Karp’s strategies.  You have to practice them so that your delivery is flexible and confident, but anyone can do it, not just therapists.  In fact, if these techniques don’t work well once you improve your delivery, that could be one way to decide that you need to consult a child specialist.

mike-arney-9r-_2gzP37k-unsplash

Secrets to Teaching Young Children to Share

 

beatriz-perez-moya-rYvj17pefXs-unsplash

It is the rare toddler that eagerly gives up a desired toy or snack to share with another child.  Yup; your child isn’t any different from the great majority of kids out there.

You may even have witnessed the “grab-and-go” move, where they take a toy from another child and then quickly escape to a corner of the room.  I know it doesn’t feel great when the thief is your child, but it also doesn’t mean they are destined to be selfish or live a life of crime.  It is normal for young children to behave selfishly; they haven’t fully developed the cognitive abilities that provide them with awareness of another’s perspective, nor do they fully appreciate social norms.

So, what can you do to teach your child to share?

Well, here are a few things that don’t work:

  1. Shaming.  Telling your child that they are selfish and bad because they don’t want to share isn’t going to build empathy.  It may have the exact opposite effect.   And they may try to hide or deny their behavior from you.
  2. Bribing.  Paying off for good behavior has been scientifically proven to backfire.  Paying kids for good grades, paying employees to exercise or lose weight, etc.  It won’t create a more empathetic child, but it could create a scheming child who parlays their desire for something else into a little show for you.
  3. Begging.  Pleading with your child makes you look powerless and puts your child in an awkward-but-intoxicating position.  It won’t make you more credible when you deny them something or try to teach another civic lesson.
  4. Playing the “Your behavior makes Mommy sad” card.  Children desire love and will do almost anything for it, but making it appear that they have crushed your heart because they followed theirs?  This is a slippery slope, and shouldn’t be taken unless you think long and hard about what you are teaching.

So what ELSE could you do or say that might elicit sharing?

  • You can demonstrate sharing YOUR items, and be very clear about how you made the decision and how you feel.  Make sure that you admit that sometimes you want all of your snack for yourself, but then you remember how good it makes you feel when you share and see how happy the other person is.
  • You can also have another person say how they feel when you share with them.  Children really don’t always pick up on the subtle feelings of others, and they need to hear it out loud.
  • When your child does share, be crystal clear about how good it makes you feel when they do.  This is different from telling them how bad you feel when they don’t, and different from bribing them to share.
  • Read some age-appropriate books on sharing, and try to discuss how the characters felt in the story.  Some kids prefer to talk about characters and not about their own feelings.

Your child may still shrug and refuse to share, or they may want to try sharing, now that they know so much more about it!

How To Stop Your Toddler From Hitting You and Use The Fast Food Rule For Better Attunement With Your Child are two of my popular posts that also help you help your child manage their feelings without crushing their spirit!

caroline-hernandez-698708-unsplash