Tag Archives: ASD

How To Pick A High Chair For Your Special Needs Child

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My first Early Intervention home visit always involves seeing the child sitting in their high chair.  I learn a few things.  I learn how the child is handled by the parent or caregiver, including whether they use the available strapping to secure them.  Many don’t, and don’t realize that it is part of the problem.  I learn how well the child fits into the chair, and how well the child can balance and reach in this chair.  And I hear about what problems the parent or caregiver is having with using this seating system.

This post is intended to share some of what therapists know about seating, and how to pick a better chair for kids that have challenges.

Every parent reading this post should know that their child’s therapists are their best source for getting the right high chair.  Never consult Dr. Google when you have licensed professionals available.  There is a reason for that license!  The folks you meet online cannot evaluate your child and provide safe recommendations for you.  This includes me; my comments are meant to educate, not prescribe.  That would be unethical and unsafe.

Typical children need a high chair when they can maintain their head balanced in the center and can start reaching and holding a bottle or finger food.  Before that, they use a feeding seat.  Feeding seats are slightly-to-moderately reclined and do the job of a parent cradling a child while feeding.  A child in a feeding seat usually isn’t expected to independently steady their head or hold a bottle. There are usually straps that stabilize a child’s chest and shoulders as well as a strap that stabilizes their pelvis.

Again, not every adult uses these straps correctly to give a young child the best support.  I will always do some education on methods to correctly position and adjust strapping.  The adult’ reaction (relief, curiosity, resistance, disinterest) tells me a great deal about what is coming down the pike.  Some special needs kids will use a feeding chair well past 12 months of age.  The commercially-made feeding chairs aren’t large, so some kids won’t fit  into one much past 18 months.  After that happens, we have to think about either a commercial high chair or adaptive seating.

Commercially-made high chairs in the US are gigantic.  They could hold a 4 year-old! This is always a problem for special needs kids.  Too much room to move in the wrong way isn’t helpful.   These chairs may or may not have chest/shoulder straps, and they may not have an abductor strap (the one between a child’s legs, that prevents them from sliding under the waist belt).  The best chairs have the waist belt low enough that it sits across a child’s lower hips like a car’s seat belt.  This is always preferable to sitting at the bellybutton level.  It provides more stability.

If a special needs child collapses their posture while sitting in a high chair, when I stabilize their hips in a way that doesn’t allow them to collapse, they might complain.  They were allowed to slouch so much that this new position, with appropriate core activation, feels wrong to them.  It can take a while for a child to learn that eating and playing in a chair requires them to use their core.  I allow them to gradually build up their abilities with short periods of eating and playing.  Not every parent is comfortable finding out that they were contributing to core weakness by allowing a collapsed posture.  I don’t add to that feeling; you know more, you do better.  Simple as that. No guilt.

Some providers insist that every child, at every age and stage, have a place to put their feet.  The strongest proponents of this idea are usually not therapists but educators or speech therapists who attended a positioning lecture or inservice.  Occupational therapists know that a child that doesn’t have the hip control and emerging knee and foot control to place weight into their feet will not be able to use their feet to steady their trunk.  They will, however, figure out how to use a footplate incorrectly.  Unless a child is older than 2 and requires lower leg stabilization to avoid tightening their hamstrings (which will derail their positioning) and sliding forward, or to prevent sensory-seeking or ataxic movements, I don’t strap a child’s feet onto a footplate, or even worry about providing a footplate.  A child that is in a feeding chair, or just beginning to use a high chair, isn’t going to use a footplate correctly, and is more likely to use one to ruin previously decent positioning.  A child that is able to bench-sit or is starting to take weight into their feet?  That child can use a footplate to build sitting control.  Here is a post to help you use one well: A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair

Special needs kids that have very limited head and trunk control will often need an adaptive seat that gives them more support.  It can transform them!  More support can allow more freedom, not less.  These chairs are able to be customized, are obtained through DME vendors and can be paid for by insurance or EI.  They are expensive, and considered medical equipment, not chairs.  Parents need instruction in their use to avoid harming a child by too intensive strapping and incorrect adjustments.  But when done right, they can transform a child’s abilities in ways that no commercially-available chair can accomplish.  Giving a child a seating system that frees them to reach and look and eat and communicate is a wonderful feeling.  Those of us that are trained in seating evaluation know that the right chair can build skills, not substitute for them!

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How To Help Your Toddler Hold a Spoon

hal-gatewood-e3Y23rtVk8k-unsplash.jpgHolding a spoon or fork isn’t an intuitive skill for children.  Neither is assisting another person, of any age, to self-feed.  Parents really have struggled with this issue, and there must be many more out there who are struggling still.  This post is intended to help both parties be more successful.

Young children use a “gross” or fisted grasp to hold a utensil; see the photo above.  This continues until 3-4 years of age, when they have the hand strength and dexterity to use a mature grasp that incorporates the fingertips and thumb:

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Trying to force a toddler to use a mature grasp is almost impossible, and allowing a toddler to use an atypical grasp is also unacceptable.  It is inefficient and frustrating.  The amount of spillage almost always makes parents decide to feed a child that should be learning to feed themselves.

Parents need to teach utensil grasp, and support it with the right tools and assistance until self-feeding becomes easy and natural to a child.  Here is how to make that happen:

  1. Have the right tools.  Once a child is old enough to try to self-feed, they need toddler utensils.  Adult utensils have thinner, longer shafts.  This makes it much more difficult to hold.  Not impossible, just harder.  Make life easier on both of you and invest in toddler spoons and forks.  Infant feeding spoons have a tiny bowl and a very long shaft.  That is because they help scoop food from a jar and reach a baby’s mouth:  adults are the intended users!  Do not give them to your toddler.  They are harder for toddlers to use.  Shallow plastic bowls with a non-skid base are very helpful.  OXO sells the best bowls for this purpose, and since they are well-designed, you don’t have to get rid of them as kids get older.  They will be attractive and useful for years to come.
  2. Provide the right assistance.  In the very beginning, I encourage parents to load a fork with a safe food such as a cooked piece of carrot.  Food on a fork doesn’t fall off as easily.  They place the fork in the child’s hand and assist them in bringing it to their mouth.  Adults need to “steer” the utensil until a child develops the motor control sequence to successfully get food on the utensil.  Parents should be holding the end of the handle so that the child can place their hand in the center of the handle shaft.  Children will grasp the end of the spoon if the parent uses any other hand placement.  Young children will not automatically hold a utensil correctly.  It is the parent’s job to know how to present the utensil for grasp.
  3. Make it fun.  Feeding shouldn’t be difficult or unpleasant.  I wrote a popular post on the best way to make learning to use utensils enjoyable Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child .   This works even with children with ASD and SPD.  In fact, it might be the best way to get kids with these diagnoses to learn to use utensils.  There is an opportunity to develop social skills and turn a daily living skill into a fun game!

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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Does Your Child Hate Big Spaces? There is a Sensory-Based Explanation

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Space; the final frontier?

When you see it, it looks like Helen Keller crossed with a Roomba.  A child enters a space, even a familiar space, and runs the perimeter without stopping to play or examine things.  They may trace the room with their fingers, or repeat this process many times before they “land” and engage in some kind of purposeful activity.  If they get upset or challenged, they may resume this behavior.

One explanation for this behavior is that it is a solution to spatial processing difficulties.  When a typical child over the age of, let’s say 14 months, enters a room, they use their visual and auditory skills to tell them about the shape, height, and contents of the room.  As we mature, we use higher-order sensory input to inform our awareness and thinking.  We use sound in particular to tell us about the space to our sides and behind us that we cannot see.  Kids with ASD and SPD are stuck using immature types of information, and need to use them more often and more intensely to get the same knowledge.

How does this feel for them? Think of Notre Dame cathedral (before that awful fire).  The soaring ceilings and the long aisles create an other-worldly feeling you cannot escape.  Your brain knows you are not in your living room, or even in your own place of worship back home.  The medieval architects knew this too.  That was exactly the effect their were aiming for.  To set you back on your heels with the wonders of G-d.  How?  By making the spatial characteristics very unfamiliar and difficult to square with everyday experience.  To have you feel smaller and less in control in the presence of the almighty.

Now imagine that every space you inhabit gives you that feeling.  You enter a room and your eyes go everywhere.  You want to walk around to give yourself more information about where you are.  You don’t, but your nervous system is suggesting it.  You feel off balance and vulnerable.  Sound familiar?

What can you do?  Treating spatial processing issues isn’t easy.  Addressing limitations in vestibular and visual processing can really help, but I think that sound-based treatments are some of the easiest and most effective.  I use Quickshifts effectively to address spatial processing issues  Quickshifts: A Simple, Successful, and Easy to Use Treatment For Processing, Attention and Postural Activation.  Of course, it is best to address all the sensory processing issues any child has to get the best results.  You want to cement in the skills of better sensory processing by achieving good functioning in multiple situations.  But spatial processing problems have to be addressed to achieve a calmer and more organized state.  You want every child to feel safe and supported wherever they go!

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Effective sensory processing treatment helps kids feel safe in big spaces

Halloween is Coming: For Sensory Sensitive Children, It’s No Celebration

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I wonder what the little girl with the sparkler is really thinking?

I love Halloween, but not everyone does.  Kids with sensory sensitivity top THAT list!  The strange transformation of their classrooms, homes and yards aren’t exciting; they are disorienting.  The masks and loose costumes?  Pure Hell.  But at least here in America, it often seems like it is almost unpatriotic to shun this holiday unless you have a religious objection.  What can you do?

I am re-blogging this post since I think it is worth another look: Have More Halloween Fun When Kids Don’t or Can’t Trick-Or-Treat , and because even if you DO take your child out for treats, the ideas could help them handle things more easily.

In this climate of diversity challenge, I sincerely hope that there is room for all of the people, young and old, who don’t really have fun with Halloween in it’s traditional forms.  I would like to think that holidays could be what you make them.

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Just because the squash on the left aren’t orange, that shouldn’t mean they aren’t great symbols of the season!

Spatial Awareness and Sound: “Hearing” The Space Around You

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Just floating along in a big ocean……..

I hear a lot about kids who aren’t comfortable in big spaces: cafeterias, churches, gyms. Many parents, and even some therapists, attribute it to lack of familiarity: these are places they use inconsistently and are filled with more strangers.  Or they mention noise intolerance:  to music, to shouting, and to sounds like balls bouncing or people clapping.

But how about spatial issues?  We use our hearing to know where we are in a space, and to monitor our position in relation to people and objects as we move through space.  Kids who are poor at orientation to sound (I hear it, and I know where it is coming from) are usually also fair to poor at discriminating sound (I know what that sound is like and what it is or could be).  They may have a diagnosable hearing issue, or they may have a processing issue with no organ limitation.  Or they have both.

As sounds bounce off surfaces, we hear them and determine, like RADAR, how close we are to that surface.  We might turn our heads slightly, but we can hear in both ears, giving us stereo comparisons that tell us about what is behind us, above us and even below us.

In large spaces, sounds are “swallowed up” and give us less information.  This is part of the design of gothic cathedrals; you have a different sense inside them, a sense of being a bit “lost”, of how small you are in the face of the almighty. Not just luck.  Our ancestors understood the effect of altering spatial awareness on our sense of safety and stability.  But for people with spatial issues, they feel uncomfortably lost, very off kilter in environments that make them struggle to get a sense of their position in these types of locations.  For kids with poor sensory processing, it can happen in a grocery store or a new classroom.

What other sense is involved in spatial awareness?  Vision.  Vision is only helpful for about the 180 degrees in front of us, and not all of that vision is acute.  Our peripheral vision is fuzzy but still gives us some information about things going on to our extreme right and left.

The kids with poor auditory skills will use their vision excessively, and the kids with poor vision will try to use their auditory skills to shore up what they can’t see.  What does this look like?  Kids who are turning their heads constantly as they move, trying to get a sense of their location as they move, when their auditory system should be telling them about the distance between them and the boundaries of the room and it’s contents.  Kids who seem to hear everything, and yet not your voice telling them not to step on their brother’s LEGO car, which they don’t seem to see on the floor.

Poor spatial awareness often makes kids anxious.  This can sometimes be interpreted as a psychological issue, but CBT and drugs will never make it better.  That is a hint that perhaps it is a sensory issue.  Spatial issues can also make kids rigid about where they will go.  They may refuse unfamiliar parks, pools, playgrounds and new classrooms.

What can you do to help kids?  Work on auditory and visual skills, and always use vestibular and proprioceptive input as modulators and regulators.  I especially like the Therapeutic Listening Spatial series.   I am using the “Space” and “Body n’ Space”Quikshifts successfully Quickshifts: A Simple, Successful, and Easy to Use Treatment For Processing, Attention and Postural Activation with so much less hassle than the modulated music; they are downloadable too!

Spatial skills are important for kids to function in school, home and the community, and they can be improved!

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Teaching Safety Awareness To Special Needs Toddlers

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Parents anxiously wait for their special needs infants to sit up, crawl and walk.  That last skill can take extra months or years.  Everyone, and I mean everyone, uses walking as a benchmark for maturity and independence.

They shouldn’t.  A child with poor safety awareness isn’t safer when they acquire mobility skills.  Sometimes they are much less safe.  Yes, they may be able to move without your help, but they may need to be more highly monitored and given more assistance to learn how to be safe.  They are exploring their environment and their new skills that took them a long time to develop.  They have been wanting to climb on the couch for months.  Now they can.  Getting down the “safe” way isn’t as important to them, and maybe not as easy as sliding or rolling off.  Oops.

What can parents do to help their child be a safer (notice I didn’t say “safe”) ambulator, crawler, cruiser, etc?  

  1. Talk about safety before they are independent.  Will they understand what it means?  Probably not, but your tone and your insistence on how movement is done says that you value safety and you want them to do the same.  Kids learn from all of our actions.  Make this one familiar to them by being very obvious and explicit.
  2. Take your physical therapist seriously when she or he teaches you how to work on core strength and balance skills.  Yes, I still maintain that safety is more than a sensory-motor skill, but having the best possible sensory and motor skills is important.  Having good safety awareness and safety behaviors without these skills will make a child more vulnerable to falls and injuries.
  3. The same goes for sensory processing activities.  If your child cannot perceive the movement of falling, the tactile and proprioceptive change as they crawl or step on something, or tolerate multiple sensory inputs at once, they are much less safe, even with good strength and coordination.  Really.
  4. Know your child’s cognitive and social/emotional skills.  Impulsive children are less safe overall.  Children that cannot process your instructions or recall them without you are less safe.  Children that enjoy defying you more than they want to avoid falling are less safe.  If you know any of these things, you can gauge safety and react more appropriately.  You will be less frustrated and more helpful to them.
  5. Reward safe execution and do not reward unsafe behavior.   My favorite way to avoid punishment but also to send my safety message home?  Not providing eye contact or much at all in the way of conversation as I stop unsafe actions, and either removing a child from an unsafe situation or assisting them in using the safe method to execute their move.  They get no satisfaction from seeing me react strongly, and they get the message that I am not accepting anything but their best safety skills as they move.
  6. Stop a child that is moving in an unsafe way, and see if they can recall and initiate the safe choice before assisting.  You don’t want to teach them that only you will make them safe and they need someone to be safe out there. They have to learn how to assess, react and respond, and all children can build their skills.  Some need more teaching, and some need more motivation to begin to take responsibility for their safety.  Give them both.

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Is Compulsive Gaming A Disorder…Or A Symptom?

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The WHO has recently classified compulsive gaming a mental illness.  I am not so sure.  What I do believe is that doing anything compulsively is a big problem for developing brains.  Is your child heading in the direction of using gaming or web surfing to deal with issues such as social anxiety or poor executive function skills?  Here is what you should be thinking about when you see your young child screaming because you have unplugged them from their tablet (or your phone, or your tablet):

  1. Have you (unintentionally) modeled this behavior for them?  I  don’t know any adult that isn’t tethered to their phone.  Whether for business or to keep track of where their spouse or children are/what they are doing, most of us have a phone that we look at repeatedly all day long.  When you are with your family, think carefully about how important it is to model the opposite and put it down as quickly as possible.  In effect, you are saying “You are more important to me than this device”.
  2. Be clear about what you are doing when you put down the phone in their presence and why.  In the spirit of The Happiest Toddler on the Block, which my readers know I adore, young children need to hear and see you explaining why you are doing what you do.  They don’t assume things the way we do.  Really.  The older they get, the more it appears that they are ignoring you, but don’t you believe it.  Parents are and always will be the most powerful models in a child’s life.  Forever.  Your teen may roll her eyes, but they are still open, and she is watching you.  So tell your child that you want to focus on them, and your phone is a distraction and you can always look at it later.  You want to be with them and pay attention to them.  I know this sounds a bit weird, even awkward and preach-y.  It isn’t if you do it with warmth and confidence.  Find your own wording, but the message is the same: I care more about you than I do about data.
  3. Look around.  Are your child’s activities, toys and games unsatisfying?  Don’t count the toys, look at them and what they offer your unique child.  An artsy child may need new paints, clay, yarn, etc.  A reader may need to go to the library or get a new book series.  Not a digital copy.  A young scientist might need a kit or a microscope.  A social kid may need more playdates or a creative class like cooking.  Their interests and needs may have changed since the last birthday or holiday.  If you want them to play instead of look at a screen, they need things that excite and inspire them, or the digital world will fill in the blanks.
  4. Does your child need help in building skills?  Shy kids, kids with ASD, or kids that don’t make friends easily can find the less-demanding digital world much easier to navigate.  Siblings sit quietly side-by-side, not fighting but also not learning how to solve interpersonal issues.  This isn’t preparing them to go out there and succeed.  The earlier you realize that your child is struggling, the faster you can stop bad habits and prevent rigid behaviors.
  5. I read a challenging piece this week on the origins of addiction to porn that might change your mind on dealing with gaming and digital devices.  The author’s suggestion was that early experiences have impressive power to wire the brain, to the diminishment of alternative methods of engagement and interaction.  I know, not exactly what you would expect me to discuss on my site.  But the problems of finding easy satisfaction through a non-challenging (and solitary) source of excitement fits this post.  Once a behavior is hard-wired into the brain’s system, it is going to be really difficult to change.   Not impossible, but really, really difficult.
  6. Should you ban all media?  You could, but you would be denying the reality that the world they live in is heavily digital.  I tell parents of the kids I treat that I use my tablet in sessions to teach kids that this is just one activity or toy, in the same way that I will eat cookies but not to the exclusion of everything else.  Putting the phone or the tablet away isn’t the end of the world, and using it is not a fabulous reward.

Looking for more on using technology with intent?  Read Want A Stronger Pencil Grasp? Use a Tablet Stylus .  To help kids engage and learn social and emotional skills, read Stop The Whining With The Fast Food Rule.  Yes, it really works!

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Make Wiping Your Child’s Nose Easier With Boogie Wipes

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It is cold and flu season here in the states, and I have already seen my share of snot-caked little faces.  Little children get more colds than older kids and adults, and they can turn into an agitated mess when you say “Honey, I need to wipe your nose”.  These wipes are going to make your job as chief booger-wiper a lot easier!

When I first saw Boogie Wipes, I will confess that I thought it was another expensive product to separate first-world parents from their money.  After all, I grew up on dry tissues and I survived.

I was wrong.  These really work.

At first, I thought that the use of moisture was the key to their success.  Not so.  Parents told me that using a regular baby wipe didn’t “do the deal” the way a Boogie Wipe took care of the snot problem and made kids calm down about nose-wiping.  I had to find out what really made this product better.

  1. Boogie Wipes have a few important ingredients that separate them from the standard baby wipes.  The first ingredient is water.  The second ingredient is sodium chloride; good old salt.  Saline is a combo of these two ingredients, and saline softens the gluey crud that is dried-on snot.  It also thins the still-wet snot so you can wipe it away without pressing so hard on tender skin.  Yeah!
  2. The next four ingredients are aloe leaf juice, chamomile flower extract, vitamin E and glycerin.  All gentle and (to most children) non-irritating skin conditioners.  I am a huge fan of Puffs Plus tissues, but these wipes are gentler than my fave tissues.  Children’s skin is so much more delicate than ours, and the ingredients in snot are so irritating.  That is even before it becomes a dried-on coating.  Boogie Wipes leave a thin coating of skin conditioners after you wipe your child’s face.  This coating acts as a slight skin barrier for the next drip of snot.  Brilliant!

The remaining ingredients are preservatives that prevent your open container of Boogie Wipes from becoming a source of germs instead of a source of relief.  I am sure that there are children who react to these preservatives, but I haven’t yet met any families that report problems over the years that this product has been available in NY.

Unless you know your child will react to these specific preservatives, I recommend trying the unscented version first (they come in fresh and lavender scents too) and using them before your child gets a cold.  It is kinder to find out that they are sensitive to any ingredients before their skin is already irritated by all that snot from an illness.  Kids whose skin is going to react will likely do so when well, but their skin can recover from any irritation more quickly when their immune system is not also fighting a bad cold.

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The Boogie folks do sell a saline spray as well as wipes, and I am all for using saline spray to loosen up internal nose crud.  The problem with sprays isn’t that they don’t work.  They do, and they work well.

The problem is that children are naturally avoidant of us sticking things up their noses, and they are really bad at controlling the “sniff” in order to efficiently suck the spray up into their sinuses.  I teach children how to blow their noses and how to handle sprays.  It is part of my job as an OTR.  Not the best part, but nevertheless, a part of teaching ADLs.  I haven’t had much success teaching children under 3 to use nose sprays.  They just get more frightened and upset.  If you have an older child or a child that seems less afraid of nose examinations at the pediatrician, then go ahead and give sprays a try.  It can really loosen up a clogged nose.

Good luck trying Boogie Wipes, or try the generic versions that I am starting to see on store shelves.  Imitation is the sincerest form of flattery, so manufacturers are telling us that they also know that these products really work!

How to Help Sensitive Kids Handle Greeting People (Including Their Own Parents!)

 

Many kids with ASD and SPD struggle with agitation and even tantrums when people enter their homes.  It can happen when their parent returns home from work, eager to scoop them up.  These kids become shy, run away, even hit!

Many, even most parents, believe that this is “bad behavior”, being defiant, or expressing anger at having people entering their space.  As an OT, I think about it differently.  Here is what I think is happening, and how to help your child handle this experience more effectively.

Sensitive children, which includes but isn’t limited to kids with sensory processing disorders, experience transitions as big charges of energy.  We all register a charge when events end or we switch locations, and when people come into our space, but those of us with less sensitivity do not react as intensely, and we return to our baseline level of arousal very quickly.  So quickly that it isn’t even on our radar.  You would have to hook yourself up to a device that measures symptoms of arousal such as galvanic skin resistance to see the small reaction from a person without sensory sensitivity.

Not so for the sensitive person.  They are super-charged by transitions, and with little kids, it often is expressed as outsized and socially inappropriate aversion or agitation.  Thus, the scream, the withdrawal, the running away.  This response is often followed with agitation as the adult walks away and the child is now sad to lose the connection.  It can all seem a bit strange.

The long-term answer?  A good treatment plan that reduces overall, everyday arousal levels.  The short-term answer?  Here is my protocol that helps kids avoid getting so out-of-sorts with greetings, and builds social skills.  The nicest thing about this protocol is that it looks normal, not clinical, and it does indeed lower the brain’s level of arousal.  Keeping calm, but staying in the game socially, trains the brain to handle more interaction, not to flee.

  1. Greet the child from a distance.  This may be 5-15 feet.  Use a warm but not over the top tone.  Keep it short but friendly.  Don’t linger on eye contact.
  2. The child has been provided with an object to handoff to the greeting adult.  It doesn’t have to be meaningful, especially if the child is under 2.  Anything will do.  The idea is that it is a meaningful interaction that the child controls.  They release it to the adult.  You may have to repeat it with two objects.  The adult’s grateful response is also warm but not effusive.
  3. Now is the time to offer a hug or a kiss.  Sometimes it works, sometimes not.  With older kids that have language, I use “Handshake, hug or high-five?”.  I offer the child a choice of contact, and this alone can get them from feeling imposed upon to empowered.
  4. If the child is still protesting, the adult sits near the child, engaged in something that could be fun for the child.  A book, scribbling, something appealing.  No offer or invite; the position and the activity are the invitation.  The child may come over and begin to engage.  Connection accomplished!

Grandparents and others can think that this is coddling, or too much work.  After all, why doesn’t she greet me warmly like other children?  It is hard to parent a child with sensitivities, but your primary focus is on helping the child feel calm and comforted.  Explain that this is helpful and that the child really does love them.  He just needs a bit of help to express it.

We should be able to get out of the way emotionally for the sake of little people.  If a family member cannot wrap their head around the need to support instead of impose themselves on a clearly agitated child, then they need more help to understand sensitivity.

 

 

Child Writing Too Lightly on Paper? It Might Not Be Hand Strength Holding Him Back

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If your child barely makes a mark when he scribbles or writes, most adults assume that grasp is an issue. Today’s post suggests that something else could be the real reason for those faint lines.

Limitations in postural and bilateral control contribute far more to lack of pressure when writing  than most parents and teachers realize.  For every child in occupational therapy that is struggling to achieve good grasp, I see three whose poor sitting posture and inability to get a stable midline orientation are the real issues.

Think about it for a minute:  if you sat with your non-dominant (not the writing hand) hand off to the side and you shifted your body weight backward in your chair, how would you be able to use sufficient force on a pencil or a crayon?  Try this right now.  Really.  You would have to focus on pressing harder while you write and hope your paper doesn’t slip around.  That would require your awareness and some assessment of your performance.  Children don’t do “awareness and assessment” very well.  That ability comes from frontal lobe functions that aren’t fully developed in young children.  But they can learn where to place their “helper hand”, and that sitting straight and shifting forward is the correct way to sit when you scribble or write.

If a child has sensory processing or neuromuscular issues such as cerebral palsy, Ehlers-Danlos Syndrome or Down Syndrome, achieving adequate postural stability may take some effort on the part of the therapists and the teacher.  Well worth it, in my experience.  There are easy hacks that help kids; good equipment and good seating that won’t cost a fortune or inconvenience the class.  Every child can learn that posture is important for writing.  But the adults have to learn it first.  Kids take their cues from what adults appear to value, and if they figure out that they are allowed to slump or lean, they almost always will.

I am doing a lecture on pre-writing next week, and I intend to make this point, even though the emphasis of my lecture is on the use of fun drawing activities to prepare children to write and read.  Why?  Because it may be the only time these preschool teachers hear from a pediatric occupational therapist this year, and I want to make a difference.  Understanding the importance of postural control in pre-writing and handwriting could help struggling kids, and make decent writers into stars!

 

For more information, take a look at For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Better Posture and More Legible Writing With A “Helper Hand”.

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Low Tone and Constipation: Why This Issue Delays Toilet Training Progress

Kids with low tone and sensory processing disorders are not the only children who struggle with constipation, but it is more common for them.  The reasons are many:  low abdominal and oral tone, less use of available musculature because they use compensatory sitting and standing (the schlump, the lean, the swayback) patterns, and even food choices that have less fiber.  If you struggle to chew and swallow, you probably aren’t drinking enough and eating those fruits and veggies that have fiber.  Sucking applesauce packets may get you Vitamin C, but it has pulverized all that fiber.  Now add discomfort with the sensory experience: the smells, feelings, sounds of bathrooms and using the potty.  It can all be too much!

Without fluids, fiber and intra-abdominal pressure to support peristalsis (the automatic contraction of the intestines), children with low tone are at a huge risk for constipation.  And constipation makes pooping harder and even painful.  Sensory overload makes kids agitated, distracted, and sometimes even aggressive.  Not good for learning or letting it go into the toilet.  Hence, resistance and even fear of pooping, and therefore more stress and withholding of stool.  A really big problem, one that you may have to get your pediatrician’s assistance to solve.

It can change.  Here is your secret weapon: your child’s occupational therapist.  If you haven’t been involved in your child’s therapy before, this might be the time.  Research has shown that sensory-based issues can contribute to toileting problems, and OTs are capable of evaluating all the sensory and motor-based contributors.  While  your pediatrician gives you recommendations on diet, laxatives and more, your OT can help your child stay in the alert-but-calm zone where digestion is relaxed, get better core stability to help push that poop along, and adapt the toileting experience for minimal sensory aversion and maximal sensory perception.  Take a look at Low Tone and Toilet Training: How Your Child’s Therapists Can Help You and Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended).

Update:  Many of my clients have been successful with a creative combo approach:  they use stool softeners, they limit refined carbs (sorry, Goldfish crackers are cheese plus refined carbs!), ensure lots of fluids and then add some tasty fiber.  Prunes covered with chocolate have been popular, but beware the results of too much of a good thing!  They use abdominal massage and make sure that their physical and occupational therapists are working those core stabilizers.

There are medications that improve gastric motility, but they aren’t always tolerated or even prescribed for small children.  Pediatricians are very hesitant to be aggressive with a small child that could dehydrate in a few hours of diarrhea.  Find a doctor that listens to you and is creative.  My suggestion?  Think outside the box and consider an osteopath.  They are “real” doctors, but they have more training in alternative and manual treatment approaches.

Think constipation is only going to affect pooping?  Wrong!  Read Is Your Constipated Toddler Also Having Bladder Accidents? Here Are Three Possible Reasons Why to understand more about how this problem can contribute to other toilet training struggles.

Good news!

My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available at  Your Therapy Source ( a terrific site for parents and therapists!), on Amazon as well as on my website, tranquil babies !!  Just click on the “e-book” section, and start making progress with your child today!

I include detailed readiness checklists and a full explanation of how to train your child in all aspects of toilet training.  You will know how to get the right equipment, what clothes to use so that dressing doesn’t derail your child’s best efforts, and how to deal with defiance and distress.  And yes, constipation is addressed in more detail than in this blog post.  It may turn out to be only one of the issues that you have to confront.  Don’t worry, help has arrived!

If you want a hard copy, contact me through my site and request a mailing address for your payment.

            As I say in my book:  be prepared, be consistent, expect to practice, and be positive that you and your child can do this!

 

 

 

 

Use The Fast Food Rule to Help ASD Toddlers Handle Change

Kids With ASD can react strongly to changes in their routines or environments.  Even changing the location of furniture they don’t even use can create screaming and aggression.  Why?  Often they use their external concept of home and environment to provide internal consistency, structure, and spatial comprehension.  We all do, in reality.  Ask anyone who travels for business how nice it is to come home and wake up knowing where things are without searching for them. It is not just exhaustion from travel, but the constant reorientation to new places and looking for needed things that make business travel hard.  Kids with ASD just depend on the familiarity of their external world and their routines much more.  When faced with disruption, they don’t have a wider range of coping skills to fall back on.  They can fall into chaos.

The Fast Food Rule, Dr. Harvey Karp’s fabulous strategy for communicating with agitated toddlers, works well with kids whose ASD issues make them rigid and upset when small changes occur.  The technique is to use simple statements with slightly exaggerated emotional tone and gestures to first express what you think the child is thinking, wait for a sign of lower agitation, and then provide an explanation, alternative, or both.

Toddlers are usually not good at reading subtle language and other cues.  They need explicit interaction that says “I understand why you are upset.  I really do.  Here is what is happening, and here is what we can do.”  All upset toddlers benefit from the Fast Food Rule.  Toddlers with ASD need this kind of support throughout the day, every day.  Their world is so much harder for them to understand and handle without stress.

I worked with a family this week, and saw what can happen when an adult fails to communicate effectively.  A 2.5 year old’s trike was brought into the kitchen entry hall instead of being left in the mudroom.  It wasn’t blocking anything.  It just was not where it  is usually stored.  They were doing some repairs later that day in the mudroom, so it had to be moved.  He went ballistic.

Screaming, hanging on it but not trying to ride it, absolutely beside himself that it was out of place.  The mom tried to tell him that they would “go to the park later”, thinking that he wanted to use it.  This was not the case, as he wasn’t mounting it or doing anything that would suggest he was interesting in riding it at the moment. He screamed louder when she told him that “everything was OK”.  It was not OK to him!    She turned on the TV briefly, and then took out the tablet.  That distracted him and he quieted down.  This ended the drama but it didn’t solve the problem.  In fact, she has been trying to limit screen time because he prefers to use these devices rather than engage in social/communication/ fine motor play.  Now she would have to decide when to announce that his turn was over, face that complaint, and the trike was still sitting in the hallway instead of the mudroom.

If she had used the Fast Food Rule, she could have had a chance to explain and support him in accepting that the trike was there until work was done in the mudroom.  Is this a guarantee that he’d be perfectly calm?  Not at all.  But it would have been an opportunity to use language and emotional connection to develop self-calming, methods of communication that he needs for success in school, at home, well, everywhere.  It would have acknowledged his feelings and his perspective while helping him to accept a change in the routine/environment.

If you have tried the Fast Food Rule with your Toddler, please write a comment and share your success or your struggle!

 

 

Why Cutting Nails Is Such a Challenge for Autistic and Sensory Kids

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Most children resist nail trimming.  But kids on the autism spectrum, kids with sensory sensitivity, and children with significant language delays can turn this simple grooming task into an epic contest of wills.

There are some good reasons why cutting your child’s nails can be so difficult for them to handle.  If you can identify the “why”, you can adapt the experience to help a child handle this grooming task.  Even if your child doesn’t immediately calm down, you may be calmer and more compassionate when they squirm.  And a calmer parent can inspire calmness in their child.

BTW, even though some of my links are to previous posts with the word “toddler”, these techniques work equally well for older kids with ASD or with SPD.  In fact, they work well with any child who is upset or demanding during grooming, haircuts, etc.

 

Here are some good reasons why your child is so distressed:

  • Most typically-developing young children do not enjoy nail trimming.  They don’t see the need for it, and they really don’t like leaving a fun activity to do a not-fun activity.  A child with ASD or SPD may not be so unlike their sibling or cousin.
  • Typical kids put up with nail care because they have the following abilities:  they understand your explanation, they tolerate the frustration of sitting passively, and they tolerate the awkwardness of having their finger held by another person and don’t mind the pressure applied to each nail.  In addition, they do not see the nail as an essential part of themselves, and they do not fear that you will injure them by accident.  If your child still doesn’t yet have some of these skills, then you are going to have problems when you want to trim your child’s nails.
  • Children with ASD,SPD, global developmental delay, or significant language delays do not have most or all of the above skills.  Sometimes they have only one or two. They may genuinely find your touch irritating, and they often have very little frustration tolerance for the things that they do not want to do or struggle to understand.
  • Nail trimming is usually an occasional event, not a daily part of a familiar routine.  Parents of children who fight nail trimming often leave this task until it is unavoidable,  Rare events are almost always seen as unwelcome or even threatening.

There are practical and simple things that parents can do to make nail trimming less aggravating:

  • Build your child’s frustration tolerance for other small events and annoyances with Patience Stretching, Dr. Harvey Karp’s wonderful technique from Happiest Toddler on the Block.  I wrote a post on this technique, Stretch Your Toddler’s Patience, Starting Today!, and it gives you some insight into the how and why of this simple strategy.
  • Use Dr. Karp’s “toddler-ese” language and Fast Food Rule techniques when you get some push back; see  Taming Toddler Tantrums Using Sympathetic Reframing.  Simplifying what you say, and empathizing but not agreeing with a toddler who balks at nail trimming can reduce the resistance.  Children will then understand that you get their point of view: they don’t want to do this.  Most kids are well aware that they will be asked to do things they do not want to do.  Diaper changes, clothing changes, tooth brushing (see my series of toothbrushing posts for specifics on that subject.)  Just hearing that you know they don’t like it is sometimes enough to help them allow you to trim their nails.  They feel heard.  Most kids will not assume that you understand them by reading your tone and body language alone, and ASD kids struggle with this more than the average child.  You are giving them information about your mindset that they cannot understand unless you spell it out in this manner.
  • Don’t go wild when they ARE cooperative.  I know you are excited to see progress.  Keep most of it to yourself.  Sensitive kids need some finessing when it comes to praise.  Here’s how to handle it so it doesn’t backfire on you: Sensitive Child? Be Careful How You Deliver Praise
  • Choose a comfortable position for both of you.  Some kids really like beanbag chairs as they feel cradled while the chairs also supporting them.   All that deep pressure helps them stay calmer and they can’t squirm as much.  Some prefer to be lying down, and some want to be watching Paw Patrol.  I don’t know that using distraction is such a terrible idea.  You might even sweeten the deal with a special DVD like home movies that feature them!
  • Use good technique and equipment.  There are nail cutters that protect children’s fingers better than the standard clippers you buy for yourself.  Clippers that are easy for you to hols steady are essential.  Buy them today!
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Hammacher Schlemmer sells these well-designed clippers.  Expensive…but worth it!

 

  • Make it clear why their nails need attention.  One of my clients had a great idea to show her child that his nails were too long:  she asked him to run his nails along his own upper thigh and see if they were “scratchy”.  Scratchy nails need to be trimmed.
  • Try a little hand massage.  Nothing too hard, but never ever use light, flighty touch.  Light touch is always stimulating to the nervous system, and light moving touch is even more stimulating.  Don’t add fuel to the fire.  Use firm grasp that doesn’t roam on-and-off their hand during nail trimming.  If you don’t believe me that light touch is irritating, imagine getting a massage of flighty fingers running up and down your back. Can you feel that?  It is alerting, and a bit annoying, right?  Certainly more stimulating than relaxing.  Well, when you hold a child’s fingers loosely, and then grasp/release their hand over and over….their brain perceives it as light touch. Oops.  I use my skills as a licensed massage therapist with my OT skills to create a calming pattern of hand and finger massage either prior to or after nail grooming.  Usually after, as I can use lotion then (lotion before trimming creates slippery hands for both of you!)
  • Pair the experience of nail trimming with something your child enjoys.  You could try offering a healthy but tasty snack right after nail trimming.  Read a beloved book after nail trimming.  Something that they like and can look forward to.  My trick: have it visible but out of reach, so that an upset child who is more literal and less likely to understand your words will see evidence of the positive experience he will have immediately after nail trimming.  You might be surprised that even though your child is calm enough to speak, his response to nail trimming is so much better with the visual cue of the actual treat.
  • Some children need to do nail filing before they can tolerate trimming.  Daily filing can be less scary and still keep things well groomed.  This really works!  Once filing is well tolerated, you may be able to move to clipping.  If not, a calm child that can handle filing every other day is a lot happier than a squirming, screaming child who learns to fear your grooming routines.  i like the foam filing rectangles rather than the emery boards.  If a child suddenly becomes agitated, I am not as worried about accidental eye injuries.
  • I will use a distraction such as a video on a tablet at times while I do nail filing/cutting and massage.  It’s not a bribe.  Really,  I try to pick really short videos and definitely move back and forth between letting them watch and bringing their attention to their hands.  I directly discuss a child’s nails and hands with them, naming the fingers and talking about whether their nails are smooth or bumpy.  Why?  Zoning out totally doesn’t reduce overall anxiety over time, but being able to toggle back and forth between targets of attention is active use of the frontal lobes, the ones that can stay calm and think things out….!
  • Try to do a small trim on a weekly basis (or even every other day) so that it can be expected and part of a routine.  Familiarity really helps all of us.  That is why tax time can be stressful.  It only comes once a year.  And here in the U.S., we are about to enter into the least happy time of the year!  So make nail trimming part of a routine and it could be less of a surprise.

Remember to be patient with yourself as well. The challenges of parenting a child with sensory sensitivity and modulation issues can really affect how you see the world.  It is important to acknowledge how you feel, as well as how your child feels.  If you feel angry or hopeless, talk to your partner, a friend or a counselor that can help you maintain your focus and positivity about caring for your child.

Need more information to make things like nail trimming, bath time, dressing and mealtime easier?

I wrote 2 e-books just for you!  The JointSmart Child:  Living and Thriving With Hypermobility Volume One: The Early Years and Volume Two: The School Years give you strategies that you can use TODAY! Even if your child’s hypermobility isn’t their biggest issue, my strategies will make life easier for you and your child…I promise! My books provide simple guidelines for picking the best equipment like chairs and strollers, building independent dressing and grooming, making bedtime easier, and even how to communicate better with your family, teachers, and even doctors!

Knowing how to help your child develop independence and safety awareness isn’t intuitive; parents deserve skilled guidance.  These books are filled with practical information and insights from my 25 years as a pediatric occupational therapist.  It is time that parents know all the tricks and techniques that therapists use to find good equipment and select the right strategies for success.  Parents need to feel empowered…today!

Read more about these books: The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! and A Practical Guide to Helping the Hypermobile School-Age Child Succeed

They are available on Amazon as read-only downloads, and on Your Therapy Source as  printable and clickable downloads.  Your Therapy Source also sells my other books (see below) bundled for an amazing deal!

  My e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, also helps children with sensory processing issues and ASD make faster progress with potty training.  

Read  The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about how the pre-training strategies in The Practical Guide will help your child speed up potty training at any age, and why understanding how low tone impacts your child’s sensory, motor, and social skills will make a huge difference for both of you.  To purchase my e-book, visit Your Therapy Source or Amazon .

 

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Improve Transitioning Skills in ASD By Helping Kids Pay Attention To The Sounds Around Them

Kids with ASD often have limited auditory awareness and processing.  Imagine your life if you struggled with this:  Should I pay attention to the hum of the fan or your voice?  That ringing; is it a doorbell, a toy, or a phone?  I didn’t notice you speaking to me, and now you tell me that I don’t get snack because I didn’t respond?  Their difficulties with auditory processing can fuel a lot of the daily whining and tantrums.

Being able to transition from one activity or place to another is a huge issue for so many kids.  You can help them do a better, calmer job if you “fill in the blank spots” in their processing while they work on making progress in treatment with therapeutic listening programs and other approaches.

Kids on the spectrum often demonstrate limitations in how they attend and process auditory (sound) information.  This is more than language, although processing language is of huge importance.  The ability to attend to, locate and interpret the sounds in the environment is something that we take for granted.  It is incredibly important for a sense of safety and calmness. Our ability to know where we are in space, especially a crowded or large space, is informed by our ability to listen to sounds as they bounce off the perimeters of an enclosed space.  Ever see a child run the edges of a room before he can settle down?  That can be a spatial substitution, since auditory processing is used for spatial awareness.  Ever see a child hit out when an unfamiliar sound, not even a loud sound, is made?  Excessive aggressive responses can arise because the lightening-quick processing that should have determined that it was not an immediate threat wasn’t effective enough at that time.

When a child with ASD struggles with transitions, I am much more aware that I will need to highlight the meaningful sounds as we work together to identify them, shorten and repeat my phrases, and emphasize my words/use meaningful gestures (Dr. Harvey Karp’s toddler-ese approach works great here.)

Using this approach to support auditory processing seems simple, but it is actually a dance as the child first attends to a sound or the conversation about a sound and is then assisted to make an adaptive response instead of tantrumming in frustration and confusion.  If I do not get a response that indicates good processing of sounds and language, I will adapt my responses to boost his skill.  I will modify the environment, my body language, and my spoken language to help him stay calm and on-task.  It looks something like this:

Event:  Sound of doorbell ringing while we are playing nearby.

Desired Response:  Child attends to sound or to my words, and is able to stop playing to walk to the door without agitation.

Me:  “I just heard the doorbell.”

Child:  No glance at the door or at me, keeps playing.

Me:  ” Who IS it…at the DOOR?”  I make a sweeping gesture that ends in a point toward the door. My play actions end, signifying that I am paying attention to something else.   I pause to allow the child to process my words and gestures.

Child:  Stops playing, looks at me and my extended finger pointing, but doesn’t follow it visually to the door.

Me:  “Come….let’s see who it IS!”  I stand up and move the toys we were using away from us, just slightly.  This indicates some shift is happening.  I offer my hand and point again, very clearly at the door.

Child:  Gets up and takes my hand but starts to walk toward another toy.

Me:  “Door time. Open door.”  I  don’t pull the child, but I stand still while I speak.  I don’t want pulling his arm to confuse the message that I want to go to the door.  I have shortened my phrasing down and repeated door twice.

Child:  Stops walking away and slowly walks to the door with me.

This whole encounter could take 10 seconds.  In that time, a child with auditory processing is working and learning, not screaming and fighting.  What a difference!

If you try this and it works for you, please write a comment and encourage other parents to give it a try!