Category Archives: sensory processing issues

Is is Sensory Or Is It Behavior? Before 3, The Answer Is Usually “Yes!”

If I had a dollar for every parent that asked me if head banging when frustrated means their child has a sensory processing disorder...well, I would be writing this post from a suite in Tahiti.  Modulation of arousal is the most common sensory processing concern for the parents that I see as a pediatric occupational therapist.  Their children struggle to transition, don’t handle change well, and can’t shift gears easily.  But hold on.  A lot of this behavior in children  under 3 is developmental in nature.  Not all, but a lot.  Parsing it out and addressing it takes a paradigm shift.  Not every annoying or difficult behavior is atypical for age and temperament.

Everyone knows that you can’t expect your infant to self-regulate.  Nobody tells their baby “Just wait a little; why can’t you be like your brother and sit quietly for a minute?”  But why do adults assume that once a child can speak and walk a bit that they can handle frustration, wait patiently, and calm down quickly?

I know parents WANT that to be the case.  Toddlers are a handful on a good day.  Adorable silliness can melt your heart, but getting smacked by an angry child that was just given a consequence for trying to put your cell phone in the toilet to see if it would float?  Nah, that isn’t going to put a smile on your face.  Parents tell me “If they could only understand that when I say “wait”, I mean that you will get what you want, just not immediately.”  But no.  The toddler brain grows very slowly, and even the super-bright children who read at 3 cannot make their emotional brain grow any faster.  Sorry.  Really.   This brain thing means years of developing communication and regulation skills.

Here is the good news:  Even young children with clear sensory-based behaviors do better when your responses to their behaviors help them self-calm.  The recipe is simple to describe.  You give limits based on age, use familiar routines, teach emotional language and responses by modeling, and communicate effectively.  The Happiest Toddler strategies have transformed my work because children feel listened to but I don’t give in to toddler terrorists.  Everybody wins.

Here is the bad news:  You have to change your behavior in order to help them.  And you have to do it consistently and with loving acceptance of their limitations.  “Behavior” isn’t just their problem.  It is both of yours.  Take a look at my posts on Happiest Toddler techniques that really work for the little ones, and see if your suspicions of a sensory processing disorder wane or even evaporate as you and your child learn some valuable communication and self-calming skills.  The posts that can alter things today might be Nip Toddler Biting in the BudToddlers Too Young For Time Out Can Get Simple Consequences and Kind Ignoring, and How To Get Your Toddler To Wait For Anything (Hint: They hear “Wait” as “No”)

Good luck, and let me know what works for you!

 

Can Hypermobility Cause Speech Problems?

 

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As a pediatric OT, many of my clients have speech and feeding problems that are attributed to low muscle tone.  Very often, that is where assessment ends.  Perhaps it shouldn’t.  Joint hypermobility can create issues such as dysarthria, disfluency and poor voice control.  It isn’t only about muscles and muscle coordination.  Being able to identify all the causes of speech delays and difficulties means better treatment and better results.

I have had the privilege to know a handful of master speech pathologists whose manual evaluation skills are amazing.  These clinicians are capable of identifying joint laxity and poor tissue integrity (which contribute to injury, weakness and instability) as well as identifying low muscle tone, sensory processing issues and dyspraxia.  They can assess whole-body stability and control instead of ending their assessment at the neck.

It is more difficult to clearly differentiate low muscle tone from hypermobile joints in young children.  Assessing the youngest clients that cannot be interviewed and do not follow instructions carefully (or at all!)  is a challenge.  Many times we are forced to rely on observation and history as much as we use responses from direct interaction with a child.  In truth, laxity and low tone often co-exist.  Lax joints create overstretched or poorly aligned muscles that don’t contract effectively.  Low muscle tone doesn’t support joints effectively to achieve and maintain stability, creating a risk for overstretching ligaments and injuring both tendons and joint capsules.  A vicious cycle ensues, creating more weakness, instability and more difficulties with motor control.

Some children that are diagnosed with flaccid dysarthria, poor suck/swallow/breathe synchrony, phonological issues and poor respiratory control may be diagnosed later in life (sometimes decades later) as having Ehlers-Danlos Syndrome or generalized benign joint hypermobility syndrome.   They often drop the final sounds in a word, or their voice fades away at the end of a sentence when they are younger. These kids might avoid reading or speaking front of the class when older.  This isn’t social anxiety or an attitude problem.  They are struggling to achieve and maintain the carefully graded control needed for these speech skills.

You may notice a breathy-ness to their voice that makes them sound more like their grandparents than their peers.  Children that avoid running in sports like soccer or hockey aren’t always unable to continue because they are globally fatigued or in pain.    Being unable to stabilize their trunk results in inefficient muscular recruitment and limited grading of breath.  Ask any runner or singer and they will tell you what that means: game over.

If your child is struggling with these issues and isn’t receiving speech therapy, now may be the time to explore it.  You and your child may be relieved to learn that there is effective therapy out there!

 

 

Problems With Handwriting? You Need The Best Eraser

 

 

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A good eraser can make a frustrated child more willing to fix writing errors.  A bad eraser confirms their failure as a writer.

Occupational therapists in some schools hand out HWT pencils and a variety of pencil grips like candy, but many forget about how important it is for kids to erase mistakes successfully in order for their work to be truly legible.  The Pentel Hi-Polymer eraser is the one that gets the job done.

I will confess that I did not discover this eraser on my own.  A smart parent turned me onto this amazing school tool, and I am over the moon about how much it helps children complete their writing assignments.   It would be almost criminal to let kids go back to school this fall with those nasty pink erasers that leave more of a mess than they remove!

Here is an example of how well this eraser works.  I used my fave mechanical pencil for younger children, the one I blogged about in Great Mechanical Pencils Can Improve Your Child’s Handwriting Skills , and wrote a few numbers in the darkly shaded boxes of a Handwriting Without Tears sheet.  Notice that the shading wasn’t removed along with the pencil marks:

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Numbers 5 and 6 have been erased so well that tracing-over the original mistake is impossible!

Here are a few reasons to add this eraser to your back-to-school list:

  • While large enough for small hands to use, it is not so big that it is difficult for children to control.  Think erasing isn’t a real skill?  Take a look at Teach Your Kindergartener How To Erase Like a Big Kid
  • It is latex-free, a necessity for children with latex sensitivity.
  • There are fewer eraser “crumbs” created during use, so less mess (for parents) to clean up, and less visual and tactile distractions for kids with ADHD, SPD and ASD.
  • This eraser doesn’t require substantial pressure to remove marks.   Great for kids with Ehlers-Danlos, JRA, and all the other conditions where strength and endurance are concerns for handwriting.
  • Because of it’s softness and effectiveness, it rarely tears paper, even the thin paper commonly used for school worksheets and workbooks.

Pentel Hi-Polymer erasers are very affordable, and commonly come in packs of three. This is helpful when you know in your heart that the first two will be lost before the week is over, never to be seen again.  When your child realizes that this eraser helps them finish their homework a bit faster (you might want to mention this if they don’t notice it right away), they will work harder to hold onto that last one!

Taping The Paper To The Table For Your Child? Stop!

Many young children between 2 and 5, especially children with low muscle tone or postural instability, will struggle with bilateral control.  In preschool, one way to notice this is to see the paper sliding around the table while a child colors.  The common response of teachers (and parents) is to tape the paper down.  Oops!  This  eliminates any demand for both hands to work together.  Bilateral control only develops if it is needed and practiced.

The better approach, the one that makes the brain work and builds a child’s skills, is to make it even more slippery while making the activity more fun.

Why?  This child,’s brain, as described, needs more information about what is going wrong with the activity.  You can use heavier paper, stickers in a book that need accurate placement, or fun glittery markers.  Really, anything that makes a child care more about placing marks accurately.   I select the smoothest table surface available.  Glass coffee tables are a fave at home.  The alternate choice is a bumpy surface, something that will be slightly uneven and make the paper move more with each stroke.

I have some older kids that really struggle but can use a visual cue.  I make a mark on their paper and tell them to put their “helper hand” – the one not coloring- on this mark.  This is sometimes helpful, but it is limiting the extent that this hand is providing optimal postural support.

Yup, support.  The hand that holds the paper is also performing another function.  It is stabilizing the child’s body so that the dominant hand can execute a skilled movement.

So….no more tape on that paper, OK?

Gifted at Preschool: How to Support The Young Gifted Child In Class

Gifted children often cannot wait to go to preschool.  They may follow an older sibling into their classroom and cry when they have to leave.  After all, look at all those books, art supplies, and science stations to explore!   Things can go right off the rails, however, if the teacher and the classroom aren’t prepared for everything a gifted child brings with them.  And I don’t mean the lunchbox or the fidget spinner!

Gifted children are more intense, use more complex thinking, and more driven than other children.  Even at the preschool level.  This is a child who may teach himself to read, tells wonderful stories, creates wonderful multi-media art, and practices kicking a soccer ball into a goal until it is too dark to see the ball.  At 3.  It can also make a child argue about school routines,  insist on changing the rules of every game, and constantly discuss and examine every item in the room.  Imagine the average teacher’s reaction when a gifted toddler wants to grab the story book from the teacher at circle time to determine exactly which type of dinosaur is displayed.  Is that a T-Rex, a brontosaurus, or a brachiosaurus?  She can pronounce their names and knows the difference at 2, and she wants to figure this out, while her classmates are making growling sounds or picking their noses!

Here are some suggestions for teachers to understand and manage the behavior of their gifted students without crushing their spirits or allowing them to run the classroom:

  • Learn about the child’s gifts.  Knowing who you have, who you really have in your classroom: it will help you make a plan.  What they like, what they love, and what frustrates them.  This doesn’t mean that you focus the class on them, but you know that a module on space will elicit a lot of interest, and a module on the color red will not.  Unless you talk about the red planet, Jupiter.
  • Learn about the multiple sensitivities of gifted individuals.  They are not limited to intellectual gifts.  They can include physical sensitivity, emotional sensitivity, and even spiritual sensitivity.  Some will be easier to deal with than others.  But you want to teach the whole child, right?  That way, you see a three year-old’s intense need for movement throughout the day or wanting to have a formal ceremony for the recently deceased goldfish as normal, not perverse.
  • Explain the rules, negotiate the deal when possible, and acknowledge the frustration of things that seem unfair or arbitrary.  Helping gifted individuals fit into a society that says it loves giftedness but really supports conformity, without crushing their spirit, is tricky.  You can help.  Bring their awareness to the fact that controlling the game and telling people what to do and how to do it makes other children less likely to want to play.  This is real teaching.  Even if their new rules for Candyland are truly innovative.
  • Offer real enrichment, not busywork or babysitting.  I have heard stories from parents of teachers who tell gifted children to read to their classmates, or tell them to “teach” their friends about shapes.  This alters the relationships between classmates and is not a good idea.  These kids are going to be singled out soon enough as different.  Build friendships, not mentorships.  More worksheets that they can race through isn’t better.  Find worksheets that challenge them, even if you have to look at kindergarten or first grade materials.  Better yet, make your own, following their interests.  You will be rewarded by a child that loves school and knows they are truly seen as an individual!

 

The Difference Between Special Needs and Typical Potty Training Approaches: Address Sensory/Behavioral Issues and Use Consistent Routines

tai-jyun-chang-270109.jpgAfter writing The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have been asked what was different about my book. There must be 100 books on potty training special needs kids. What did I do differently? Simple. I am an occupational therapist, so I have no choice but to use my 360 degree viewpoint to target all the skills needed to do the job. Seeing the path to independence in this way was second nature to me, but not to parents of kids with special needs. Time to offer some support!

The books I reviewed before I started writing were great, but every one lacked at least one important feature. If the authors were psychologists and teachers, they weren’t fully comprehending or directly addressing the sensory and motor aspects of a very physical skill. Oops.

OTs are always aware of the cognitive and social/behavioral components of activities of daily living, but we also have a solid background in physiology and neurology as well. That makes us your go-to folks for skills like toilet training. And that is a major reason why The Practical Guide is so helpful to the frustrated parents of children with SPD,autism, Down Syndrome, Ehlers-Danlos Syndrome, and a host of other diagnoses that result in delays or difficulties with muscle tone and potty training independence. It explains in detail how low tone creates sensory, motor, and social/behavioral problems, and how to address them. Knowledge is power, and knowledge leads to independence.

The other huge difference is that developing consistent sensory-motor-behavioral routines matter more for these kids. Tone isn’t a constant, as anyone with a child that has low tone knows all too well. Fatigue, illness, even a very warm day; these all make kids less stable and can even reduce their safety. Having a really solid routine makes movements easier to execute and more controlled when situations aren’t perfect. Kids with normal muscle tone can shift their behavior on the fly. They can quickly adjust and adapt movement in ways that children with low tone simply cannot. It isn’t a matter of being stubborn or lazy. Kids with low tone aren’t going to get the sensory feedback fast enough to adjust their motor output.

Good motor planning on a “bad day” occurs for these kids when they have well-practiced routines that support safe and smoothly executed movements. What makes the difference isn’t intelligence or attention. It is recalling a super-safe routine effortlessly. This is completely attainable for kids who have speech or cognitive issues as well as issue with low tone and instability. It may take them longer to learn the routine, but it pays them back with fewer accidents and fewer tears.

To learn more about my book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, visit my website, tranquil babies.com, or view it on Amazon.com!ferris-wheeltai-jyun-chang-270109

Sensitivity and Gifted Children: The Mind That Floods With Feeling

Gifted children are often the most emotional and empathic toddlers in the room.  They are the kids who cry when the ASPCA runs those tearjerker commercials.   They are the teens who want to develop an NGO to provide clean water in developing countries.  Gifted children don’t do this to get a boost on a college application, but because it physically hurts them to think of another’s suffering.  Your gifted child’s mind cannot help but to feel strongly and care deeply.  

How can you help your child navigate these feelings without crushing their altruism and energy? The first step in helping these children to handle their sensitive social and emotional nature starts with adults understanding that this isn’t a personality quirk; it’s a neurological bias that accompanies an impressively active and intense brain that doesn’t “turn off”.

Sensory Sensitivity, Autism, and Gifted Sensitivity
When OTs usually refer to sensitivity, we usually speak about the physical sensitivity that our clients may experience.  We know that sensory sensitivity can lead to avoidance of sensory input and poor modulation of arousal.  The poor modulator is the child who has a hard time staying in an optimal state of calm, struggling to focus attention on accomplishing their daily activities.  This can be true with gifted children, but is not always a feature of giftedness.

We also know that children with ASD find it difficult to connect with another’s emotional experience due to their neurological wiring.  It is not that they choose to misinterpret other’s emotions.  They may long to know what others are thinking and what to do and say in interpersonal relationships.  Temple Grandin and John Elder Robison have written about their difficulties and discomfort in understanding how friends and family feel.

The gifted client is swimming at the other end of this pool:  they have profound emotional connections to people (and sometimes feelings for objects as well!),  even strong connections with the imagined emotional experiences of strangers!  Again, this is not just their temperament or their personality; the emotional flood is coming from their brain wiring that generates deep connections between profound concepts and expansive comprehension of situations. Gifted kids see very clearly how the human race is all one, how affecting a part results in affecting the whole, etc. It can be overwhelming for them to know this at 4. Or 14. Gifted children are not little adults, even when testing indicates amazingly advanced mental abilities. Their asynchronous development means that they may understand concepts but still cry when they lose a game. They are still children.

There is some science behind the idea that gifted children are emotionally advanced as well as academically advanced.  Researchers on giftedness are eager to display their fMRI views of the gifted brain as it thinks, showing it humming along at warp speed, lighting up like a Christmas tree in areas that are mostly quiet for other people.  I would guess that those mirror neurons (proposed to support empathy and interpersonal skills) that seem inactive in ASD are probably switched on 24/7 in gifted individuals.  

Parents get their first taste of this quality when they see how attuned their baby is to their speech and their movements.  “She would just watch our faces all day long!” is a familiar report when asked about early development.  Toddlers begin to be aware of their own emotions and the emotions of others, and the gifted toddler can be quite a handful as she sorts this out. The gifted child may want to volunteer, may become upset when reading news stories, and may insist that the family participate in activities for social causes. On the other hand, a gifted child may become sad and overwhelmed by situations that other children are unable to comprehend. It can lead to feelings of powerlessness and anger when the adults in their world don’t respond in kind or disregard their concerns.

My message to parents and teachers of gifted children, and those who work with children showing strong emotions and advanced skills without a gifted label is to consider that the strong reactions that you see may be a brain effect, not a personality defect. Your next step: supporting a child to handle the flood of emotion, and help them channel their feelings into productive actions and interactions that build social skills, not isolation and a negative self-image.
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