Tag Archives: ASD

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!

 

 

 

 

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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.  If you are begging or struggling with your child, you are not alone.  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.  If you can identify the “why”, you can adapt some of this stressful experience to help your 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 on the spectrum or with SPD.  In fact, they work well with any child who is upset or demanding during grooming, haircuts, etc.

  • Most typically developing young children do not enjoy nail trimming.  They put up with it 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 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.  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 some things that parents can do to make nail trimming less aggravating.  Here are my most successful strategies:

  • 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 compliant.  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 so terrible.  You might 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.  Buy them now.
  • 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 upper thigh and see if they were “scratchy”.  Scratchy nails need to be trimmed.
  • Try a little hand massage.  Nothing too hard, but never use light, flighty touch.  Light touch is always stimulating to the nervous system, and light moving touch is even more stimulating.  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 more frequently) 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!

And 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.

Looking for ideas on helping your child with other grooming skills?  Read What Helps Kids Handle Haircuts? for ideas that work!  Want to see what equipment can help you with self-care activities?  I wrote a guest blog post for a terrific therapy equipment site, Therapro: Improving Daily Life Tasks for Kids With Special Needs that gives you lots of equipment ideas that really work!  Is your child aggressive?  Read How To Stop Your Toddler From Hitting You to get this behavior under control.

Are you looking for ideas to help your child with toilet training?  Well, I wrote a book that can help you make progress today!  My e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, also helps children with sensory processing issues and ASD.  Take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about how pre-training will help your child speed up potty training, 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 my website tranquil babies , 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!