A Practical Guide to Helping the Hypermobile School-Age Child Succeed

 

The Joint Smart Child.inddThe JointSmart Child series started off in 2019 with Volume One:  The Early Years.  It is finally time for the school-age child to have their needs addressed!

Volume Two:  The School Years is available now on Amazon as an e-book, filled with information to make life at home and at school easier and safer.  This book is equally at home on a parent’s or a pediatric therapist’s shelf.   Filled with clear explanations for the daily struggles hypermobile children encounter, it answers the need for a practical reference guide for daily living:

Section I reviews the basics:  understanding the many ways that hypermobility can affect motor, sensory and social/emotional development.  General principles for positioning and safety are presented in easy-to-follow language.

Section II addresses daily living skills such as dressing, bathing and mealtime.  School-age kids may not be fully independent in these areas, and they need targeted strategies to improve their skills while boosting their confidence.

Section III looks at school and recreational activities.  It covers handwriting and keyboarding, playing sports and playing musical instruments with less fatigue, less pain, and more control.  When parents and therapists know how to select the best equipment and use optimal ergonomics and safety guidelines, kids with hypermobility really can thrive!

Section IV reviews the communication skills in Volume One, and then expands them to address the more complex relationships within and outside the family.  Older children can have more complex medical needs such as pain management, and knowing how to communicate with medical professionals empowers parents.

The extensive appendix provides informational forms for parents to use with babysitters and teachers, and checklists for chairs and sports equipment such as bikes.  There is a checklist parents can use during IEP meetings to ensure that their child’s goals include issues such as optimal positioning, access, and endurance in school.  Therapists can use the same materials as part of their home program or in professional presentations to parent groups.  There are even simple recipes to use cooking as a fun activity that develops sensory and motor skills!

I believe that this e-book has so much to offer parents and therapists that have been looking for practical information, but find they have to search around the internet only to rely on other parents for guidance instead of health care professionals.  This is the book that answers so many of their questions and empowers children to reach their highest potential!

for more information on how to help your hypermobile child, read Need a Desk Chair for Your Hypermobile School-Age Child? Check out the Giantex Chair and Should Hypermobile Kids Sit On Therapy Balls For Schoolwork? plus Should Hypermobile Kids Use Backpacks?

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CPSE or CSE Review Without a Re-Eval Because of COVID-19? Here’s What You Need To Ask For

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One of my private clients just called me for some backup.  Her son, who is on the autism spectrum, may lose some of his school OT sessions due to his increased handwriting ability (thank you; we have been very working hard on it!), but no further formal testing could be done before schools were shut down due to COVID-19.  His fine motor scores were in the average range. Everyone knows he is struggling with attention and behavior in class.  Everyone.

My strategy?  I gave her the Sensory Profile for ages 3-10 (SP) to complete.  Almost all of his scores were in either the “probable difference” or “definite difference” categories.  This means that his behavior on most of over 125 different items is between one and two standard deviations from the mean.  Even without a statistics course, you can understand that this is likely to be impacting his behavior in the classroom!

Many of the modulation sections of the SP, including “modulation of visual input affecting emotional responses” and “modulation of movement affective activity level” directly relate to observed school behaviors.  Scores in “multi sensory processing” and “auditory processing” were equally low.  Think about how teaching is done in a group:  it is visual and verbal.  Kids have to sit to learn.  They have to tolerate being challenged.

This is why OT in the schools is more than how to hold a pencil.  We address the foundational skills that allow children to build executive functioning skills.  Without these skills, all the routines, prompts, reward systems and consequences aren’t going to be very effective.

School therapists cannot test your child accurately using a standardized instrument when schools are closed due to COVID-19.  But parents can respond to a questionnaire, and it can be sent and scored remotely.  The Sensory Processing Measure is another sensory processing questionnaire able to be completed remotely.  These scores will help your therapist and your district understand the importance of OT for your child.  When school does resume, related services are going to be essential services!

For more information on how to work on OT issues at home, read Using A Vertical Easel in Preschool? WHERE You Draw on it Matters! and Does Your Older Child Hate Writing? Try HWT’s Double-Lined Paper.

If your child is hypermobile, you will need my newest e-book, out on Amazon right now!

The JointSmart Child:  Living and Thriving With Hypermobility Volume Two:  The School Years, is designed to address the challenges and needs of the school-aged child 6-12.  It has plenty of add-ons in the appendix to help you at home and at school. Learn how to pick the right chair, the right spoon, the right desk and even the right bike!  It gives you ideas to build ADL skills like dressing and independent bathing, and ways to build your confidence when speaking to doctors and teachers!

My earlier book, The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years, is also available on Amazon and at  Your Therapy Source.  It addresses development from birth to age 5.  It provides parents with all the ADL strategies to build independence AND safety, plus ways to teach your family    and babysitters how to work with your child more effectively.  Parents start feeling empowered, not overwhelmed, right away!

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Is this recess in your house during the COVID crisis?

Using A Vertical Easel in Preschool? WHERE Your Child Draws on it Matters!

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There are a few equipment and toy recommendations that every home-based pediatric OTR makes to a child’s parents:  Play-Doh, puzzles, tunnels, …and a vertical easel.  Found in every preschool, children from 18 months on can build their reach and proximal (upper body) control while coloring and scribbling on a vertical surface, rather than a tabletop.

But WHERE a child is directed to aim their stroke matters.  Here is why:

  • Grasp and reach have a range of efficiency.  I tell adults to imagine that they are writing on a whiteboard for a work presentation.  Your boss is watching.  Where will your writing/drawing be the most controlled?  Everyone immediately knows.  It is between your upper ribs and your forehead, within the width of your body or a few inches to either side.  Beyond that range, you have less stability and control.  Its an anatomy thing.  If you are an OTR, you know why.  If you are a parent, ask your child’s OTR for a physiology and ergonomics lesson.
  • Visual acuity (clarity of focus) is best in the center of your visual field (the view looking directly forward with your head centered).  Looking at something placed in this range is called using your “central vision”.  Your eyes see more accurately in that location, children can see an adult’s demonstration more clearly,  and therefore they can copy models and movements more accurately.  Kids with ASD like to use their peripheral (side) vision because it is cloudy, and the distortion is interesting to them.  This is not good for accomplishing a visual-motor task or maintaining social eye contact, but they find this is a way to perform sensory self-stimulation and avoid the intensity of direct eye contact with others.
  • Young children have little self-awareness of how their environment impacts them.  Until they fail.  Then they think it is probably their fault.  The self-centeredness that is completely normal in children gets turned around, and a child can feel that they are the problem.  Telling children where to place their work on an easel gives them the chance to do their best work and feel great about it.
  • Children move on when a task is too hard, or when an adult doesn’t provide enough supportive strategies.  Telling a child to try again, or telling them that their results weren’t too bad” isn’t nearly as helpful as starting them off where they have the best chance of success.
  • Using the non-dominant hand to support the body while standing is an important part of vertical easel use.  For kids with low muscle tone or hypermobility, it is very important.  Standing to the side or draping the body on the surface to write are both poor choices that OTRs see a lot in kids with these issues.  Make the easel a piece of therapy equipment and teach a child to place their non-coloring/painting hand on the side of the easel in the “yes zone”.  Look at the picture of the older boy at the beginning of this post, then at the gentleman below.  Note each person’s posture and try to embody it.  Which posture provides  more ease, more control? 

 

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Here is a graph of where an adult should place their demonstration on a page or board for optimal vision and motor control, and where adults should encourage a child to draw.  “NO” and “YES” refer to the child’s optimal location for drawing or writing.

The exception is for height.  A very tall child will need to draw higher on the chart, and a smaller child will only reach the lowest third of the easel.  This should still allow them to use their central vision and optimal reach.  If the easel doesn’t fit the child, place paper on a wall at the correct height.

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Egg Crayons And Fingertip Crayons: When Good Marketing SLOWS DOWN Fine Motor Skill Development

411VIzKWneL._AC_SL800_.jpgNow that COVID -19 is pushing EI into telehealth, I see exactly what parents have at home when they hunt around for pre-writing tools.  These egg-shaped crayons, and crayons where the child pokes a finger inside a cone-shaped crayon, are popping out of bins and drawers like little spring flowers.  I (mostly) hate them.

Why?

Because the only kids that benefit from them are infants and kids who have such limited grasp that a cylindrical crayon isn’t a realistic choice.  For absolutely everyone else, they teach kids nothing about grasp, and they make it harder to control a stroke.  They are fun to bang together and on a table, but they are really difficult to control to make more than a poorly executed mark.  This isn’t pre-writing at all.

So why are they in the house?  That is simple:  marketing.

Parents are eager to give their toddlers and preschoolers an edge, and these are heavily promoted on sites and in stores (remember when we used to go into stores?)  They are uniquely shaped and colorful, sold with excellent packaging.  A standard box of crayons gets none of this kind of love.

Please, please: don’t believe the hype.  

Just like those spoons shaped like bulldozers, these crayons aren’t helping anyone but the people selling them.  They are gimmicks, not tools for motor development.  If your child is older than 12 months and has enough motor control to hold a spoon in a fisted grasp to eat, they are ready to hold a thick crayon and make a stroke.  Experience picking up and using a crayon, and watching an adult demonstrate how to make a stroke on a large sturdy piece of paper is so much more helpful.

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Need a Desk Chair for Your Hypermobile School-Age Child? Check out the Giantex Chair

71ASiKXBSJL._AC_SL1200_.jpgOne of my colleagues with a hypermobile third-grader told me this chair has been a great chair at school for her child.  It hits a lot of my targets for a good chair recommendation, so here it is:  The Giantex chair.

Why do I like it so much?

  • It is a bit adaptable and it is sized for kids.  No chair fits every child, but the more you can adjust a chair, the more likely you are to provide good supportive seating.  This chair is a good balance of adaptability and affordability.  My readers know I am not a fan of therapy balls as seating for homework when a child is hypermobile.  Here’s why: Should Hypermobile Kids Sit On Therapy Balls For Schoolwork?
  • It isn’t institutional.  Teachers, parents, and especially kids, get turned off by chairs that look like medical equipment.  This looks like a regular chair, but when adjusted correctly, it IS medical equipment, IMPO.
  • It’s affordable.  The child I described got it paid for by her school district to use in her classroom, but this chair is within the budget of some families.  They can have two; one at school and one at home for homework or meals.  Most kids aren’t too eager to use a Tripp Trapp chair after 6 or 7. That chair is a hit with many therapists, but it’s untraditional looks bother a lot of older children.  This chair isn’t going to turn them off as easily.
  • This chair looks like it would last through some growth.  I tell every parent that they only thing I can promise you is that your child will grow.  Even the kids with genetic disorders that affect growth will grow larger eventually.  This chair should fit kids from 8-12 years of age in most cases.  The really small ones or the really tall ones?  Maybe not, but the small ones will grow into it, and the tall kids probably fit into a smaller adult chair now, or in the near future.

For more helpful posts on hypermobile kids, read Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection StrategiesHow To Correctly Reposition Your Child’s Legs When They “W-Sit” and When Writing Hurts: The Hypermobile Hand.

And of course, if you are a parent who is frustrated with how little help you are getting from your pediatrician or your therapy team, look below to learn more about my e-book that is designed to empower you today!

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Want more information to help your older child and make life easier?  My newest book has finally arrived!

The JointSmart Child:  Living and Thriving With Hypermobility  Volume Two: The School Years is now available as a read-only download on Amazon and a printable download on Your Therapy Source .  It is filled with the practical information that parents and therapists need to make kids’ lives easier, safer, and more independent.  Your Therapy Source has created book bundles, discounting all of my books when you buy more than one, making it more affordable to get the information you need.

There are extensive forms and checklists for school and home, and strategies that make immediate improvements in a child’s life.  Learn how to buy and fill a backpack that doesn’t damage a child’s joints, how blankets can create more pain and sleep problems,  and how to help a child write and keyboard with greater control.  Read more about it here: Parents and Therapists of Hypermobile School-Age Kids Finally Have a Practical Guidebook!

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Potty Training in the COVID-19 Age

 

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Parents are staying home with their toddlers and preschoolers now.  All day.  While this can be a challenge, it can also be the right time to do potty training.

Here’s how to make it work when you want to teach your toddler how to “make” in the potty:

  1. You don’t have to wait for readiness.  What you might get instead is a child that has lost the excitement of being praised by adults, and fears failure more than seeks praise or rewards.  If that sounds like your child,  quickly read Waiting for Toilet Training Readiness? Create It Instead!
  2. Have good equipment.  If you don’t have a potty seat that fits your child or a toilet insert and a footstool that is stable and safe, now is the time to go online shopping for one.  Without good equipment, you are already in trouble.  Children should be able to get on and off easily and not be fearful of falling off the toilet.  If you are training a preschooler and not a toddler, you really need good equipment.  They are bigger and move faster.  Safety and confidence go hand in hand.
  3. Have a plan for praise and rewards.  Not every child will want a tiny candy, but nobody should expect a new toy for every time they pee in the potty.  Know your kid and know what gets them to try a new skill.  Some children don’t do well with effusive praise Sensitive Child? Be Careful How You Deliver Praise , so don’t go over the top if this is your kid.
  4. Know how to set things up for success.  If your child is typically-developing, get Oh Crap Potty Training by Jamie Glowacki, because she is the best person to tell you how to help you be successful.  She even has a chapter just on poop!  If your child has hypotonia or hypermobility, consider my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  It is inexpensive, available on Amazon and Your Therapy Source, and gives you checklists and explanations for why you need to think out-of-the-box to potty train these kids.  You don’t leave for vacation without a map.  Don’t wing this.  Just don’t.
  5. Build your ability to calm yourself first.  Exactly like on an airplane, (remember them?  We will get back on them eventually) you need to calm yourself down in the face of refusals, accidents and tantrums.  You are no good to anyone if you are upset.  Read Stress Relief in the Time of Coronavirus: Enter Quickshifts and Should the PARENTS of Kids With Sensory Issues Use Quickshifts? for some ideas.

Looking for more information on potty training?  I wrote an e-book for you!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone was my first e-book.  It is still my best seller.  There is a reason:  it helps parents and kids succeed.  This unique book explains why learning this skill is so tricky, and it gives parents and therapists detailed strategies to set kids (and parents) up for success!  Understanding that the sensory and social-emotional impacts of low muscle tone are contributing to potty training deals is crucial to making this skill easier to learn.  I include a readiness guide, strategies to pick the best equipment and clothes (yes, you can dress them so that they struggle more!), and how to move from the potty seat onto the adult toilet.

It is available on Amazon and on Your Therapy Source, a great site for materials for therapists as well as parents looking for homeschooling ideas.

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Stress Relief in the Time of Coronavirus: Enter Quickshifts

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My clients know that I use therapeutic music called Quickshifts and Gearshifters in many pediatric therapy sessions.  They use binaural beat technology (Binaural Beats and Regulation: More Than Music Therapy ) to induce an alpha brainwave state.  This is the brain’s calm-alert state.  Due to the unprecedented stress we are all under, I am using them myself.  Every day, twice a day, minimum.  Here is why:

  1. I am no good to anyone if I am vibrating with anxiety.  There is only so much breath work can do for me.  I need brain work.
  2. The calm-alert brainwave state that Quickshifts and Gearshifters rapidly induces is effortless.  Turn it on, (they can be purchased and loaded onto your phone through the free Therapeutic Listening app) wear the headphones, and it works perfectly without me doing anything else.  I do have to stay off the screen stuff, but then, I should anyway.  Mostly I take a walk (alone) or crochet.
  3. I love music.  Most of us do.  I need music.  Most of us do.  I won’t listen to some droning boring sounds if I can listen to fun music instead.  Quickshifts have children’s music, classical music and gentle techno music that isn’t aggravatingly boring.
  4. The effects of altering brainwave states boost my immunity.  And there has never been a better time for it.
  5. I can bring it with me on a walk, so I get a double dose of healthy input.
  6. It isn’t tiring or distracting.
  7. I could use it more often than 2x/day.  There is no danger or downside, unlike modulated music.  Modulated music is a workout for your brain, and using it too close to bedtime can be a challenge.   Quickshifts and Gearshifters are designed for anxiety and even trauma recovery.  This pandemic is a trauma if I ever saw one.
  8. I can use it alone at home.  No one is getting massages, going to psychotherapy, or getting acupuncture.  There is no neurofeedback machine in my house.  I couldn’t go anywhere even if I wanted to.  Enter Quickshifts.

Quickshifts and Gearshifters are best used when selected for a client by a trained OTR.  Listening to the wrong album will not damage you or your child, but it is a waste of money and time.  Two things most of us are running out of right now.  

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Think Using Dot Markers Is “Therapy” for Kids in Preschool? Think Again!

 

S495361_2I had to look twice.  A private client showed me the picture her 4 year-old made in his school OT session (not the picture above!).  A picture decorated using a dot marker.  He can copy a vertical cross and a circle using a pencil.  I showed him how to draw a triangle in less than 4 minutes during that session.  He is very risk-averse and is probably intellectually gifted.   He has lots of sensory issues and mildly limited fine motor skills.

Why was he using a dot marker for anything?

I know his therapist isn’t very experienced, and I am sure the supplies budget isn’t huge.  But neither are good excuses for using tools that don’t raise the skill level of a child that is so hesitant to be challenged.  Those markers are great for toddlers under 2 or older children with motor skills under a 24-month level, especially kids with neurological or orthopedic issues that don’t allow them to easily grasp and control crayons.  Dot markers get children excited to make a mark on paper (an 11-month fine motor skill) and can be the first step to holding a tool to develop early pre-writing.

They aren’t good at all to develop any kind of mature pencil grasp due to their large diameter and large tip.  It would be like writing your name with a broom!

The ink tends to splatter with heavy quick contact with paper (fun to make a mess, but not therapeutic!), and doesn’t dry quickly enough.  Repeated contact bleeds colors together, and it is hard to keep within the borders of a design unless the target is very large.  I can assure you that the design above was done by an adult, an adult with some art training.

Dot markers aren’t building pre-writing skills for this child I treat.  There are so many options for activities that do build skills in kids at his ability level.  Their use can discourage a risk-averse child from working on pencil grasp.  Whatever the activity it was that they were doing, unless he was swinging on his belly on a platform swing or going down a ramp on a scooter (I don’t think he was doing anything nearly that intense) while using a dot marker, there were other, better choices to make.

Read Using A Vertical Easel in Preschool? WHERE You Draw on it Matters! and Deluxe Water Wow Pads Offer More Challenge And More Fun To Preschoolers and Kindergarteners for more good ideas on fun at home that builds pre-writing skills.

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Is Your Toddler Home From School Because of COVID-19? Save Your Sanity With Fun Routines

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Many families have toddlers that are not attending daycare or preschool now.  They are at home.  All day.  They are off their schedules, and sometimes seem off their rockers!  Here are some ideas to help their parents retain their sanity:

  1. Create a routine for them.  This means that they get snacks at a certain time, outdoor play at a certain time, look at books, take a nap, listen to music, etc.  all in a predictable sequence.  Paint rocks, tear up scrap paper and glue it onto a bigger piece of paper, etc.  Crafts are fun and they can be cheap.  You don’t have to reproduce the school routine, you just have to be consistent about your home routine.  They will learn to anticipate what comes next, with all the calmness that consistency provides.
  2. Have some emergency items/activities.  Bake off some pre-made cookie dough, open up some new toy you saved for a special time.  It is special now!  Root through the back of the gift closet or the toy box and find something that is new or seems new.
  3. Turn on music and calm everyone down.  Music is powerful, and these days we need it.  Sing out and be silly.  You probably could blow off some steam too.  Consider using Quickshifts  Binaural Beats and Regulation: More Than Music Therapy if your child has sensory processing or low muscle tone.
  4. Make sure they get to move.  Every day.  Even if all you do is dance around the room, make it active.  Jump on pillows, log roll around safely, etc.  I treated kids in tiny NYC apartments, so I know it can be done.  It isn’t about having a lot of space.
  5. Reconsider the use of screens as rewards.  I know it works, but there is a price to pay after that initial quiet time.  Think carefully about what will happen when time is up, or when meals of bedtime come.  It could get ugly.  I have used screen activities in treatment, but NEVER EVER a reward, or even a consistent activity every session.  It is another fun thing we do that isn’t always available, and certainly not received by howling for it.  For apps that teach instead of entertain, read Screen Time for Preschoolers? If You Choose to Offer Screen Time, Make it Count With These Apps

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Joint Protection And Hypermobility: Investing in Your Child’s Future

 

allen-taylor-dAMvcGb8Vog-unsplash.jpgParents of hypermobile kids are taught early on not to pull on limbs while dressing them or picking them up.  It is less common to teach children how to protect their own joints.

In fact, parents may be encouraged by their child’s doctors to let them be “as active as they want to be, in order to build their strength”.  Without adding in education about  good joint protection, this is not good advice.  This post is an attempt to fill in the space between “don’t pull on their limbs” and “get them to be more active”.

Why?  Because hypermobile joints are more vulnerable to immediate injury and also to progressive damage over time.  Once joint surfaces are damaged, and tendons and ligaments are overstretched, there are very few treatments that can repair those situations.  Since young children often do not experience pain with poor joint stability, teaching good habits early is essential.  It is always preferable to prevent damage and injuries rather than have to repair damage.  Always.  And it is not as complicated as it sounds.

The basic principles of joint protection are simple.  It is the application that can become complex.  The more joints involved in a movement or that have pre-existing pain or damage, the more complex the solution.  That is why some children need to be seen by an occupational or physical therapist for guidance.  We are trained in the assessment and prescription of strategies based on clinical information, not after taking a weekend course or after reading a book.  Because hypermobile joint issues can be different from arthritic joints, read Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection Strategies  and understand the principles below that apply to almost everyone:

Some of the basics of joint protection are:

  • Joints should be positioned in anatomical alignment while at rest and as much as possible, while in use.  Knowing the correct alignment doesn’t always require a therapist.  Bending a foot on it’s side isn’t correct alignment.  Placing a wrist in a straight versus an angled position is.
  • Larger joints should execute forceful movements whenever possible.  That means that pushing a heavy door open with an arm or the side of your body is better joint protection than flattening your hand on it.  The exception is if there is damage to those larger structures.  See below.
  • Placing a joint in mid-range while moving protects joint structures.  As an example, therapists often pad and thicken handles to place finger joints in a less clenched position and allow force to dissipate through the padding.  We discourage carrying heavy loads with arms held straight down or with one arm/hand.

Remember:  once joints are damaged, if joints are painful, or the muscles are too weak to execute a movement, activity adaptations have to be considered.  There is no benefit to straining a weak or damaged joint structure.

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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.

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Hypermobility and Music Lessons: How to Reduce the Pain of Playing

 

kelly-sikkema-jrFNMM6K0VI-unsplash.jpgMost kids want to learn how to play an instrument in grade school.  Most parents encourage some form of musical training for the benefits of musical training: social, coordination, attention and focus, even the suggested connection between math skills and musical ability.  Hypermobile kids can struggle with the physical demands of playing an instrument sooner and more severely than a typically developing child.

There are ways to make it easier and less painful, right from the start.

  • Steer them into the right instrument for their physical abilities.  Heavy instruments are a questionable choice for kids that have back and shoulder issues, as they will be moving their instrument around a lot.  Children with very hypermobile wrists could find the hand positions for violin or guitar much more challenging than the positions for piano or clarinet.  There will still be a lot of fingering, but it occurs in a different plane of movement.  Read Joint Protection And Hypermobility: Investing in Your Child’s Future for some details.
  • Understand that as hypermobility changes, so may the type of instrument that best fits your child.  This is a tough thing for kids to accept, but if they are experiencing repeated strains and injuries, or an increasing amount of pain, they may have to switch to an instrument that is less risky.  Remember:  hypermobility syndromes don’t disappear, and most hypermobile children will not become professional musicians.  This isn’t life-or-death, no matter what they say about their passion.  Injuries that affect the ability to attend school and eventually affect working…THAT is something to avoid.  Cumulative trauma can result in surgeries or even ending up needing disability payments.  Don’t contribute to a less-bright future by permitting a child with recurrent overuse injuries to continue to injure their body in the present.
  • Positioning matters.  Just as with sitting at a desk or a table, hypermobile kids need to use the best possible postural control with the least amount of effort.  Children playing the piano may need a chair with low back support rather than a piano bench.  Seats for all kids may need to have cushions that give more support, and any seat should definitely provide solid foot placement on the floor at all times.  Some kids may need the support of a brace or braces.  Back, shoulder, wrist, and even finger splints aren’t slowing them down; they are supporting performance.  The biggest problem will be resistance from the musician.  Children rarely want to wear these devices, and if they aren’t well designed and fitted, you will hear about it.  Ask their OT or PT for direct assistance or find one that can do a consultation.  Ask their instructor to explain why wearing a well-chosen brace makes playing easier and better.  And don’t wait until an injury happens.  Get in front of this one.
  • Musical skills require practice, but hypermobile kids may need to break up their practice or do targeted practice to shorten the total amount of time spent and reduce the physical strain.  Targeted practice requires that their instructor knows which types of practice are the most likely to build skills, rather than just adding minutes to a practice session.  Breaks are important, and most kids don’t have the ability to know when and how to take them.  They need to be taught, and the little ones need to be supervised on breaks.

 

Looking for more information on raising a child with hypermobility?

My latest e-book, The JointSmart Child:  Living and Thriving With Hypermobility  Volume Two:  The School Years is now available on Amazon as a read-only download and on Your Therapy Source as a clickable and printable download!  It has practical information about improving independence and safety for kids 6-12, including sports and the hypermobile child, improving communication with your child’s teachers and coaches, and how to address handwriting and keyboarding problems.  It has more forms and checklists than the first book (Volume One: The Early Years), but still covers all the important self-care issues like toileting and how to make your home safer for your child while keeping it comfortable and attractive.

 

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Sensory Processing and Colds: Nothing to Sneeze At!

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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

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

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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 usually sense 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!

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What To Say When Your Child Cries After Losing a Game

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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.

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

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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.

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Should the PARENTS of Kids With Sensory Issues Use Quickshifts?

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My clients and my blog readers know that I started using a therapeutic sound treatment called Quckshifts earlier this year Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation.  I haven’t lost my enthusiasm for this treatment.  It has made easy sessions more effective, and difficult sessions workable.  Kids that are struggling get a boost, and kids that needed a lot of preparatory sensory activity to regulate and engage rapidly find their footing.

Could this be useful for parents too?

There is no age limit on the use of Quickshifts, and the creators at Vital Links write and speak about treating adults using this program in their training materials.  But thus far I haven’t heard them talk about the use of Quickshifts with the parents of their clients.  I wonder why.

If you have a child with sensory issues, even one who attends mainstreamed programs and is doing fairly well in social activities, your days have a certain level of stress in them.  Sensory diets work, but they also take work to use and monitor.  Children aren’t crockpots, so you are actively administering or at least setting up the activities the comprise a sensory diet.  Kids reach bumps in the road, and kids with sensory issues can have bigger meltdowns over smaller bumps.  Parents have to help them manage things that other kids shrug off.  And parents always are thinking ahead, wondering what effect a new summer camp or new school with have on their child.  Even when things are going well, parents can feel some stress about all of these things.

It is well known that if you are a therapist treating children with sensory processing issues, at least one parent could say to you “Wow; I used to have the same problems, and everyone told me I was just being difficult/stubborn/picky, etc.”  Treatment options picked up in the early 90s, so we do hear this less and less.  But not in every community  or school system.  And if a parent’s parents refused to “believe” in sensory treatment, then these kids got nothing.  Or perhaps they were sent to a psychologist.  When I describe their child’s experiences using sensory processing terms, some parents recognize that their responses are very similar.  They have been told, or they have assumed, that they are reacting psychologically to events or stimuli.  They now are thinking differently about themselves as well as their children.

Finally, in this era of #MeToo, there is growing awareness that many of the parents of the children we work with bring their own trauma with them into parenting  Are You a Trauma Survivor AND the Parent of a Special Needs Child?.  I just did a presentation in FL (Feb2020) on using sensory processing treatment to help adults with traumatic dissociation.  The dysregulation that accompanies trauma doesn’t disappear after delivering a child.  At times, having a child can bring past traumas up to the surface and create problems that seems to have been handled or forgotten.  These parents need our support and assistance.

Which brings us to the question:  Should the parents of kids with sensory processing issues, especially the parents that have problems with self-regulation, use Quickshifts as well?

My strong opinion is that since there isn’t a downside, they should give the Regulation albums a try, and see how they navigate a typical day after listening.  The changes in adults are more subtle because their lives are more complex.  Parents need to know what changes to look for: usually the ability to remain calm with transitions, to focus on a task or to think a process through more easily.

Parents with more anxious tendencies might use Gentle Focus successfully, and parents that need to up-regulate would love Synching Up or Rockin’ Surf.  The decision to use Quickshifts and how to select albums really is easier when you consult an OT.  Wasting money and time buying and using the wrong album is unnecessary!  I love working with adults that have regulation issues or sensory sensitivities.  The relief in their faces tells me that they are getting the help they need to be their best.

 

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

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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.

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When Should You Tell A Child NOT to Erase Their Mistake?

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I wrote a post on erasing Teach Your Kindergartener How To Erase Like a Big Kid and one on erasers Problems With Handwriting? You Need The Best Eraser , but there are a few situations in which you don’t want a child to run for the eraser.

  1. The child who stalls for time.  Some kids want to run down the clock on their therapy session or on their homework time, and realize that erasing can help them do just that.  The fun of rubbing the eraser on the paper exceeds the fun of struggling to write or struggling to answer a question.
  2. The kid that gets upset when they make a mistake.  Some children are oblivious, but some are distressed when they write poorly.  So upset that they lose some of their focus and ability to listen to your suggestions/instructions.
  3. The child who persistently traces over their original mistake.  These kids were taught with a lot of tracing in pre-K and K, and their brains have been trained to trace.  When they see the faint outline of their mistake, they have to struggle NOT to trace it.  Oops.

What SHOULD you do?

These strategies assume that an adult is helping a child directly.  You may not need to remain there for the entire homework assignment, but adult assistance is needed to get this train turned around:

  • Ask them to write the word again.  You may need to fold the paper so that their mistake is not visible, but a correct model is visible.  You may have to write a new visual model in the margins or above their work space.
  • Use Handwriting Without Tears pages.  Their workbook pages are designed to be simple but offer visual models across the page, not just at the left margin.
  • Erase the mistake yourself.  Adults can use more force and erase more effectively.
  • Make a copy (or 2) of your child’s homework so that you can ask them to start over again, but only if it is a short assignment.  No one wants to rewrite a long page.
  • Provide more instruction before they begin their word or sentence.  A reminder that certain letters are tricky or that they need to space words out How Do You Teach Word Spacing? can prevent errors.

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Are You a Trauma Survivor AND the Parent of a Special Needs Child? This Can Help Make Life Easier

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First, let me say that trauma survivors can be among the most loving and active parents I work with as a pediatric occupational therapist.

How do I know they are survivors?  Some parents share their histories openly, and some aren’t aware of what their actions and words reveal.  Occupational therapists that have worked in psychiatry are particularly attuned to patterns of behavior that suggest a history of trauma.  And after therapy has gone on for a while and the therapeutic relationship blossoms, some parents wish to share more of their personal story with me.

Trauma survivors that had complicated pregnancies Can The Parents of Pediatric Clients Have PTSD? , have children with genetic disorders, or deliver children who develop developmental delays, come in all ages and social/support situations.  Some currently have a psychotherapist for support, and some have done a tremendous amount of therapy in the past.  Others may not even recognize that what they experienced in the past was traumatic, or that there is specialized help for trauma-related issues.

What they all have in common is the (mostly) sudden stressor of having a child with special needs, the seemingly endless daily demands of care, and the constant seeking/managing of medical, educational and therapy services.  Survivors of trauma may not realize that they aren’t alone with their feelings of distress, or that their child’s therapists can help them cope.

I wrote a post on how therapists can help a child’s siblings, How an Occupational Therapist Can Help The Siblings of Special Needs Children , but parents with trauma backgrounds can ask for and receive support from their child’s therapists as well:

The simplest way therapists can help you is to validate the real demands of care and give you some perspective on what other family’s lives are really like.  We are aware that we are asking parents to do home programs and obtain equipment and toys that facilitate development.  We also know that life is messy, and it is OK if you admit that you find it hard just getting through the day.  You can ask us if other parents go through the same things that you do, and you will find out that you might be doing more than we expect.

If you are having a rough period, ask us to give you just the ONE thing that would be the easiest to incorporate into your day that would help your child this week.  We won’t be offended.  You might be surprised to find that we know what those days/weeks/months feel like too.

Some parents who are trauma survivors are less likely to ask for a review or clarification of a technique or treatment when therapists give them instructions.  This can come from fearing criticism, having been taught not to question authorities, feeling judged by therapists they perceive as punitive authorities, and even being dissociative during their child’s therapy session.  “Spacing out”, forgetting, being confused, etc. are all possible dissociative responses.  Parents who are reliving a NICU nightmare or who are triggered and recall their own medical trauma or physical abuse may have a lot of difficulty learning to do treatments on their child that involve any level of restraint or distress.  This can be managed, but only if it is addressed.

Your child’s therapists have many different ways of holding and positioning a child, and different ways of administering a treatment technique.  You can express your discomfort in general terms or you can tell us that this is a trigger for you, and you can ask us to make things easier for you without having to tell your own story.  Asking for a few reviews of home programs is seen by most therapists as indicating interest in what we do.  We aren’t offended; we are flattered.

Some parents need to be out of the treatment room during a session for their own comfort, and that is also OK.  We like to share your child’s progress, and we welcome you into the session, but we understand if you need to have some distance.  Scheduling treatment at your child’s school or in a therapy center, rather than at home, may be easier for you.  Your child will still receive excellent treatment.

Trauma survivors can be extremely distressed when their child cries in therapy, or even while witnessing their child struggle to learn new skills.  This can bring up distressing childhood memories for them, some of which they may not fully recall or even connect with their responses to their child’s therapy session.

Therapists can be healing models for actively managing a child’s distress and expressing how they handle their own feelings when children struggle.  A parent that grew up in a punitive home may not have seen adults model healthy reactions to a child’s distress.

Therapists can teach you their techniques for grading challenge and providing support that reduces your child’s level of agitation.  My favorite book to learn how to respond to young children warmly but with limits is The Happiest Toddler on the Block by Dr. Harvey Karp.  His techniques support healthy attachment and children respond much more quickly than parents expect.  Everyone feels better, not just the kids!  Read Teaching Children Emotional Regulation: Can Happiest Toddler on the Block Help Kids AND Adults? for more on this amazing program and how it can help both of you.  Today.

Some of the OT treatments that help children also can help their parents with regulation issues and/or trauma histories.  Read Should the PARENTS of Kids With Sensory Issues Use Quickshifts?  and Stress Relief in the Time of Coronavirus: Enter Quickshifts about one easy treatment to develop a wider window of tolerance that works well for both children and adults.

UPDATE:  I was a speaker at the Healing Together conference in Orlando FL this month (Feb.2020). It was an amazing gathering for adults with dissociative disorders, their loved one/supporters and clinicians.  I highly recommend this conference to parents who are trauma survivors that struggle with dissociation.

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