Tag Archives: autism

How an Occupational Therapist Can Help The Siblings of Special Needs Children

 

joao-rafael-662575-unsplashThe parent of one of my clients recently returned from a conference related to her youngest child’s genetic disorder, and she told me that the presentation on helping the siblings of special needs kids really only offered one niblet of advice: “Try to give each sibling 10 minutes a day of “just us” time.”

My shoulders, and my heart, fell.  Telling exhausted and worried parents that they need to find more time in their day, every day, isn’t fair.  This mom could have used so many more specific strategies.  She didn’t need another way to feel inadequate to the challenge.  When you have a special needs child, you don’t have extra time.  Some days you aren’t sure you will be able to shower and shampoo.  Even if you could carve out some time by delegating and hiring help, the truth is that living with constant worry about the present and the future, running chronically short on sleep, and perhaps still recovering from a NICU nightmare…this doesn’t lend itself to stellar time management.

There are things that really do help.  Among them are getting the right kind of assistance and support, sharing the knowledge you receive from specialists, and handling everybody’s feelings with compassion (including self-compassion) and honesty.    Occupational therapists are out there helping families deal with life, since we have a solid background in the science of occupational demands and the psychological responses to illness, injury and trauma.  We aren’t psychotherapists, but we study the science of healthy life routines and behaviors.  We also spend a lot of time learning what special needs kids need to thrive, and this includes supporting the siblings and parents of our clients.

Here are some of the things I wish that the presenters had suggested:

  1. Ask your child’s therapists to train more of your family members and caregivers.  This means the partner that isn’t the primary caregiver for a special needs child, but it also could be the grandparent or the babysitter that is the backup emergency caregiver.  There are parents who feel they can never take a break because a half-spa day would mean that no one knows how to prevent their child from falling down the steps or how to know when a child is going in the direction of a meltdown that will derail the day.  If you have a medically fragile child, more people need to know how to keep them safe and healthy.  Your child’s therapists are skilled in providing training in their area of specialization.  They may not offer it to your other family  members unless you ask for it to be done.  This is an investment in your peace of mind.  Make it happen.
  2. Find out if your child’s siblings can enter a therapy session and learn more about how to help or encourage their special needs sibling.  Therapists can teach your child’s siblings, and because they are seen as authorities and not parents, this can work well to foster understanding and interest.  Even preschool kids can learn why the baby isn’t playing with them( but she is watching) and that means “I like you”.  Your therapists are pediatric specialists and are good at helping children of all ages, even if your social needs child is an infant.
  3. Learn methods to spread your warmth and concern without promising time commitments you may not be able to keep.  Something so simple (and explained in more detail in my new book below) is to talk with your child’s siblings about your feelings of anticipation before some fun event, even if it is reading a chapter in Harry Potter.  Telling them, days ahead, that you can’t wait to be with them can feel so good.  Later, you can remind them how much fun you had.  Don’t require them to reciprocate.  You are speaking about your feelings, and if they brush it off then don’t take it personally.  Tweens especially struggle with how to respond.  They still need to hear your warmth.
  4. Express your frustrations honestly, but mindfully, to your child’s siblings.  You will both feel better for it.  You don’t have to wail and keen, and in fact I would discourage that.  You can do that with your partner or your counselor.  But your other children need to know that feeling less than blissfully grateful for their special needs sibling is normal and not shameful.  When some feelings are perceived as unacceptable, they grow in importance and sprout little behavioral problems of their own.  Start by speaking about how tired you are.  It is honest and it is probably already visible.  Mention that you feel both things; love and frustration.  You have to adjust for your other children’s age and emotional tolerance, but I promise you:  this is going to really help.
  5. Ask for help.  And accept it when it is offered.  Some people don’t think they need help, and some don’t think they deserve it.  Some think that it will be seen as weakness or laziness.  Some ask for help and get a casserole instead of babysitting.  Some get advice instead of a casserole.  And some turn down help to avoid feeling as tired and frightened as they really feel deep inside.  Think carefully about how and why you don’t have or accept help, and try doing what doesn’t feel natural or easy.  It could be the best move you make this week.
  6. Reconsider the amount of therapy and tutoring you are doing.  I know; what therapist thinks you can overdo their own treatment?  Me.  Overscheduling therapies can backfire when you, your special needs child, and the rest of your family suffer from the demands.  The time demands, the loss of participation in real life fun like hayrides and playgrounds, etc.  The downtime that any normal person needs and so few parents and special needs kids get.  That affects siblings too, in lost time with parents and exhausted parents trying to wedge “me time” into a free moment.
  7. Make choices about what your priorities are, but allow yourself to have a priority that is not all about your child.  For example, you may have to accept that your house isn’t going to be spotless, and that you may be buying rather than making most of the holiday cookies.  But if making a few batches of a precious family recipe (my best friend from college always makes her Scottish grandmother’s recipe for fruit squares) will make you feel like a million bucks, then go ahead.  Yes, life with a special needs child is different from what you expected.  But you get to have some things from your previous life that bring joy!

I am so excited to report that my newest e-book is finally done!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years is designed to empower the parents of hypermobile kids ages 0-5.  There are chapters on picking the right high chair, toys, even pajamas!  One section is just on improving communication with your family (including siblings), teachers, therapists and even doctors.  No other book answers questions that parents have about finding good eating utensils and how to navigate playdates and social events more successfully.

It is available on Amazon as a read-only download and on Your Therapy Source as a printable and click-able download.  Look for more information and a sneak peek at the ways every parent can learn what therapists know about positioning here:The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today!

rawpixel-798161-unsplash

Binaural Beats and Regulation: More Than Music Therapy

josh-wilburne-501952-unsplash

When you have so much to choose from, how do you pick the right one?

Binaural beat technology isn’t new.  But it is powerful.  This post is designed to answer some questions about how it works, why it works, and how I use it effectively in the treatment of sensory processing issues.

For people who have read about or tried Quickshifts  Quickshifts: A Simple, Successful, and Easy to Use Treatment For Processing, Attention and Postural Activation, you may be wondering what all the fuss is about listening on headphones versus speakers, and why the music has that echo-y tone.

The use of binaural headphones or speakers placed close to the child allows the ears to hear the full range of sound with as little interference or absorption from the environment.  It is important that the left and right ear are hearing the sounds separately.  The echo-y sound?  What you are hearing is the BBT; binaural beat technology.  The slight alteration in sound frequency between what the brain hears from the left and right speakers forces the brain to synch up at a frequency that matches this level of difference.

BBT isn’t new.  BBT has been used and researched since the 70’s.  It is out there in many forms; you can even find recorded BBT music on YouTube.  There are enough studies done to prove that this technology has real effects on alertness, attention and mood.  It makes sense that therapists would like to use it to help kids with self-regulation issues.  BBT is helpful for learning and self-regulation, but only if you know what brainwave state you want, and why you want it.  And that is where skilled therapists can help.

But which one to use?

 I only use Quickshifts in my therapy sessions.

 

Why do I prefer Quickshifts to deliver BBT?

  • Quickshifts entrain an alpha brainwave state.  This state is associated with calm focus the ability to move to a more powerful focus or downshift into sleep, and, wait for it, interoception.  Yup, the biggest new word in occupational therapy is interoception, and there are some excellent studies done by neuropsych researchers that indicate that alpha brainwave states increase interoception.  Yeah!  Interoception is the ability to perceive internal states, and this includes basic physiological states such as fatigue, hunger, and the need to eliminate.  So many of our clients struggle with knowing what they feel.  Quickshifts can help.
  • Alpha brainwave states are theorized to act as a gating mechanism for anxiety, which means they help kids block anxiety.  Anxiety isn’t a great state for kids with ASD, SPD, or any of us.  Anxiety is a component of so many diagnoses, and it isn’t easy to do cognitive behavioral strategies like CBT or DBT with children under 10 or 11.  Quickshifts also work well for adults with anxiety as well! Should the PARENTS of Kids With Sensory Issues Use Quickshifts?
  • The music used in Quickshifts is very carefully designed to enhance specific functional states, and every occupational therapist is all about functional performance.  We don’t want just relaxation; we want engagement in life.  The way that Quickshifts uses music allows BBT to address specific behavioral performance abilities.  There are albums for attention, for movement, and for regulation.  They all use BBT.  For each particular album, one functional goal will predominate.  I don’t need to induce a meditative state in a child that is working on handwriting.  I need calm focus and better movement control.
  • The avoidance of pure tones means I don’t have to worry about seizure activity in kids with a seizure disorder.  The use of pure tones is a risk for seizures, so if a child has frequent seizures, I can be confident that I am not increasing them with this treatment.
  • The choice of instrumentation on Quickshifts albums is often more grounding than other BBT choices.  I want kids to feel grounded, not floating on a cloud.  That state makes it harder to pay attention, to speak, move, etc.  Being jolted into a high level of engagement without grounding isn’t great either.  Remember:  OT is all about functioning.  This happens at that “just right” point of arousal.  I really like the way Quickshifts address anxiety and trauma.  Even if a child’s trauma reactions are based on their difficulties managing school with sensory processing or autonomic disorders.  Not all trauma reactions are from profound abuse.  But when trauma IS the issue, Quickshifts have the edge over the Safe And Sound protocol.  Dr. Porges dropped the ball on understanding the HPA axis and how sound treatment can overwhelm a system that is biased for fear.
  • There is a progression of instrumentation and rhythm on many Quickshift albums that guides the brain into more environmental awareness and postural activation, but it is done gently.   Getting to an alpha state is a goal, but improving functional performance with less risk of overload is most important to me.  I have to give kids the ability to leave our session in a great state of mind.

Get the right headphones!  I just wrote Doing Therapeutic Listening? Get These Affordable, Comfortable, Kid-Size Bluetooth Headphones From PURO!  because the right headphones deliver the best results.  Don’t think you can use expensive headphones that cancel outside sounds; they destroy the binaural beats!

rawpixel-1054665-unsplash

He picked out his perfect pumpkin!

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

jeremy-paige-146338-unsplash

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!

david-clode-635942-unsplash

Effective sensory processing treatment helps kids feel safe in big spaces

Does Your Special Needs Child Have a “Two-tude”? Its Not Just the Age; Its Cumulative Frustration Minus Skills

 

patrick-fore-557736I spend a lot of my work week with toddlers, and they can be a challenge.  One minute sunny, the next screaming because their cookie broke.  Special needs toddlers can have a ‘tude as well, but many professionals sweep it under the rug.  They tell parents that this is normal, and that they should be grateful that their child is going through a completely normal stage of development.

Except that many parents who have already raised typically-developing kids KNOW that there is a difference with THIS child.  It could be the intensity of the ‘tude, or the frequency of the meltdowns, or the types of events that trigger the tantrums.  OR ALL OF THEM!  Parents know that this behavior doesn’t feel the same, but they often shut up when they are told that it is so normal.  Perhaps their eyes, and ears, and memory, aren’t telling them the truth.

They aren’t wrong.

Their perception that something is a bit different can be totally correct.  And the reason(s) are quite obvious to me.

Special needs kids come in an almost endless combination of needs.  Some are physical, some are communication needs, and some are cognitive or social skill needs.  Some kids have all of these.  Having challenges in moving, speaking, comprehending language and/or understanding concepts, or struggling to interact, will create more frustration in every single day of a child’s life.  That’s the reality of disability.

The image of the placid and sweet special needs child, patiently waiting to be assisted and supported is just that: an image.  Most kids bump into frustrating barriers every day.  The toddler that has just learned to walk but can’t run, the toddler that is talking or signing but still isn’t understood by their older brother, the toddler that cannot handle a change in routines…it goes on and on.

Typical toddlers spend less time frustrated that they are unable to accomplish simple skills.  The typical 14 month-old that can’t tell you what he wants becomes the 18-month old that can say “cakker, pease” for “cracker, please”.  A special needs child could be 2 1/2 years old and still struggling to explain that he wants another cracker.  That is a long time to be frustrated over getting another cracker.

The typical 26 month-old that can’t run after their big brother in the backyard becomes a runner at 30 months.  A special needs child may not run for years.  That is a long time to be left in the dust when everyone else is running.  Is there any wonder that parents see more frustration, more tears, more stubbornness?

My saddest story of failed inclusion is when a family placed their special needs child in a toddler development group with mobile kids.  Even though this child had a personal aide, he still watched as his peers got up from the snack table and ran outside.  They left him with the aide, who then carried him outside so he could WATCH his peers climb and run.  He became distraught at home when he was left alone in a room.  A puddle of tears.  It was so sad to see.  No one (that made the decision to mainstream him) had thought of the emotional cost of inclusion to this toddler, only the social and academic benefits.

What can be done?

I teach families the Happiest Toddler on the Block strategies as soon as they are appropriate.  Dr. Karp’s techniques build a child’s skills while enhancing interpersonal connections Teaching Children Emotional Regulation: Can Happiest Toddler on the Block Help Kids AND Adults?.  Yes, sometimes you have to provide consequences for physical aggression, but mostly you focus on building frustration tolerance and emotional intelligence.  For everyone.  I use these techniques all day long.  I could never handle so many toddlers for so many years without them!

Looking for more information on special needs toddlers?  Read Need to Support A Child’s Independence? Offer to Help Them! and Safety Awareness With Your Hypermobile Child? Its Not a Big Thing, Its the Biggest Thing.

park-troopers-221402-unsplash

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

rawpixel-798161-unsplash

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.

josh-wilburne-501952-unsplash

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

Not Making It To the Potty In Time? Three Reasons Why Special Needs Kids Have Accidents

56494543081585p__3

If your special needs child isn’t experiencing a medical reason for incontinence (infection, blockage, neurological impairment) then you might be facing one of these three common roadblocks to total training success:

  1. Your child has limited or incomplete interoceptive awareness.  What is interoception?  It is the ability to sense and interpret internal cues.  The distention of the bladder, the fullness of the colon, etc are all internal cues that should send them to the potty.  Unfortunately, just as poor proprioception can hinder a child’s ability to move smoothly, poor interception can result in potty accidents, among other things.  Working with them to become more aware of those feelings can include monitoring their intake and elimination routines.  You will know when they should have more sensory input, and can educate them about what that means.  Listen to how they describe internal feelings.  Kids don’t always know the right words, so use their words or give them a new vocabulary to help them communicate.
  2. Your child’s clothing is difficult to manage, or their dressing skills aren’t up to the task.  They run out of time before nature calls.  Tops that are hard to roll up, pants that have tricky fasteners, even fabrics that are hard to grasp and manipulate.  All of these can make it a few seconds too long once they get into the bathroom.  If you are not in there with them, you may have to ask them to do a “dry run” so you can see what is going on and what you can change to make undressing faster.  In my e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, I teach parents the best ways to teach dressing skills and the easiest clothing choices for training and beyond.  If you have ever had to “go” while in a formal gown or a holiday costume, you know how clothing choices can make it a huge challenge to using the toilet!
  3. Your child is too far from the bathroom when they get the “urge”.  Children  with mobility problems or planning problems may not think that they are in trouble right away.  They might be able to get to the bathroom in time in their own home.  When they are out in public or at school, the distance they have to cover can be significant, and barriers such as stairs or elevators can be an issue.  Even kids playing outside in their own yards might not be able to come inside in time.  If you can’t alter where they are, teach them to use the potty before they go outside or when they are near the bathroom, instead of waiting.  Taking the time to empty a half-full bladder is better than an accident.

Looking for more information on toilet training?  Read How To Teach Your Child To Wipe “Back There” and Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty.  and of course, my e-book is available for more extensive assistance The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

rodolfo-mari-81201-unsplash

Teaching Safety Awareness To Special Needs Toddlers

daiga-ellaby-699111-unsplash

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.

david-clode-635942-unsplash

 

Why Pediatric Occupational Therapists Need The Happiest Toddler On The Block Techniques: Neurobiological Regulation

joshua-coleman-655076-unsplash

 

Pediatric occupational therapists are usually all-in when it comes to using physical methods to help children achieve affective modulation.  We use the Wilbarger Protocol, Astronaut Training, Therapeutic Listening, and more.  But are we using Dr. Harvey Karp’s Happiest Toddler on the Block techniques?  Not so much.  All that talking seems like something a teacher or psychologist should do.  Folks, it’s time to climb off that platform swing and look at all of the ways children develop state regulation.  Early development is the time when children experience attunement with caregivers and create secure attachment.  But this is a learning process that grows over time and can be damaged by events and by brain-based issues such as ASD.  The Happiest Toddler on the Block techniques aren’t billed as such, but they are the best methods to create attunement and attachment while teaching self-regulation skills that I have found.  Combined with sensory-based treatment, progress can be amazing!

Research has told us that the way we interact with children and the way they feel has direct effects on neurotransmitters and the development of autonomic reactivity.  If you don’t believe me, check out Stephen Porges’ work on the ventral vagal component of the autonomic nervous system.

When we use The Fast Food Rule, Toddler-Ese and Patience Stretching ( Use The Fast Food Rule to Help ASD Toddlers Handle Change and Stretch Your Toddler’s Patience, Starting Today! ) to get a child focused, calm, listening, and recognizing that we “get them” even if we don’t agree with their toddler demands, we shift more than behavior.  We shift their neurophysiological responses that can become learned pathways of responding to stressors of all kinds.  We are using our social interactions to create neurobiological regulation.  I believe that the use of Happiest Toddler techniques can make a significant neurophysical change in a young child even before we put them on a swing.  I am going to go out (further) on a limb and say that if our interactions aren’t informed by understanding attunement and engagement, our sensory-based treatment might be seriously impaired.

Long story short:  if you aren’t using effective methods of developing social-emotional attunement and engagement with young children, your treatment isn’t taking advantage of what we now know about how all children learn self-regulation.  And if the child you treat has ASD, SPD, trauma from medical treatment, etc…..you know how important it is to use every method available to build the brain’s ability to respond and self-regulate.

conner-baker-480775

 

The Cube Chair: Your Special Needs Toddler’s New Favorite Seat!

Finding a good chair for your special needs toddler isn’t easy.  Those cute table-and-chair sets from IKEA and Pottery Barn are made for older kids.  Sometimes much older, like the size of kids in kindergarten.  Even a larger child with motor or sensory issues will often fall right off those standard chairs!

Should you use a low bench or a chair?

I am a big fan of the Baby Bjorn footstool for bench sitting in therapy, but without a back, many toddlers don’t sit for very long without an adult to sit with them.  Independent sitting and playing is important to develop motor and cognitive skills.   The cute little toddler armchairs that you can get with their name embroidered on the backrest look great, but kids with sensory or motor issues end up in all sorts of awkward positions in them.  Those chairs aren’t a good choice for any hypermobile child or children with spasticity.

Enter the cube chair.  It has so many great features, I thought I would list them for you:

  • Made of plastic, it is relatively lightweight and easy to clean.  While not non-slip, there is a slight texture on the surface that helps objects grip a little.  Add some dycem or another non-slip surface, and you are all set.
  • Cube chairs can be a safe choice for “clumsy” kids. Kids fall. It happens to all of them.  The design makes it very stable, so it is harder to tip over. The rounded edges are safer than the sharp wooden corners on standard activity tables.
  • It isn’t very expensive.  Easily found on special needs sites, it is affordable and durable.
  • A cube chair is also a TABLE! That’s right; turn it over, and it is now a square table that doesn’t tip over easily when your toddler leans on it.
  • Get two:  now you have a chair and table set!  Or use them pushed together as a larger table or a stable surface for your child to cruise around to practice walking.  That texture will help them maintain their grip.  The chairs can stack for storage, but you really will be using them all the time.  You won’t be storing them.
  • It has two seat heights.  Look at the photos above:  when your child is younger, use the lower seat with a higher back and sides for support and safety.   When your child gets taller, use the other side for a slightly higher seat with less back support.
  • The cube chair is quite stable for kids that need to hold onto armrests to get in and out of a chair.  The truly therapeutic chairs, such as the Rifton line, are the ultimate in stability, but they are very expensive, very heavy, and made of solid wood.  They are often rejected by kids and families for their institutional look.  If you can use a cube chair, everyone will be happier.

Which kids don’t do well with these chairs?  

Children who use cube chairs have to be able to sit without assistance and actively use their hip and thigh muscles to stabilize their feet on the floor.  Kids with such significant trunk instability that they need a pelvic “seatbelt” and/or lateral supports won’t do well with this chair.  A cube chair isn’t going to give them enough postural support. If you aren’t sure if your child has these skills, ask your occupational or physical therapist.  They could save you money and time by giving you more specific seating recommendations for your child.

Your child may be too small or too large for a cube chair.  Kids who were born prematurely often remain smaller and shorter for the first years, and a child needs to be at least 28-30 inches tall (71-76 cm) to sit well in a cube chair without padding.

You may add a firm foam wedge to activate trunk muscles if they can use one and still maintain their posture in this chair, or use the Stokke-style chair (A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair ) or the Rifton chair until your child has developed enough control to take advantage of a cube chair.  If your child sits on the floor but uses a “W-sitting” pattern, learn about alternatives in Three Ways To Reduce W-Sitting (And Why It Matters) .  And for high chairs, read How To Pick A High Chair For Your Special Needs Child

Looking for more information on positioning and play?  Check out Kids With Low Muscle Tone: The Hidden Problems With StrollersFor Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance .

And of course…my NEW e-book!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One The Early Years is now available on Amazon.com  as a read-only download and at Your Therapy Source as a clickable and printable download.

It has an entire chapter on seating and positioning for ages 0-5, and so much more.  You will learn what therapists know about positioning, and then some!  Chapters on how to carry and hold a child, how to build safety at home and in the community, and how to talk with your family, teachers, friends and even your doctor about your child’s needs!  Read more here: Parents of Young Hypermobile Children (and Their Therapists) Finally Get Their Empowerment Manual!

Worried about toilet training?  I wrote the e-book you are looking for!  

Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn why my book will help you more than a generalized special needs toileting book.  OK, I’ll tell you:  you learn why low tone makes thing harder, and why doing pre-training is like investing money for retirement.  It pays off in the long run!  Loaded with checklists and quick reference summaries made for busy parents, this book is filled with things you can start using immediately, even if your child isn’t close to independence.

OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues

shopping-2.jpeg

shopping-1.jpegshopping.jpeg

Does your child knock over her milk on a daily basis?  Do utensils seem to fly out of your son’s hands?  I treat kids with hypermobility, coordination and praxis issues, sensory discrimination limitations, etc.; they can all benefit from this terrific line of cups, dinnerware and utensils.

Yes, OXO, the same people that sell you measuring cups and mixing bowls: they have a line of children’s products.  Their baby and toddler items are great, but no 9 year-old wants to eat out of a “baby plate”.

OXO’s items for older kids don’t look or feel infantile.   The simple lines hide the great features that make them so useful to children with challenges:

  1. The plates and bowls have non-slip bases.  Those little nudges that have other dinnerware flipping over aren’t going to tip these items over so easily.
  2. The cups have a colorful grippy band that helps little hands hold on, and the strong visual cue helps kids place their hands in the right spot for maximal control.
  3. The utensils have a larger handle to provide more tactile, proprioceptive and kinesthetic input while eating.  Don’t know what that is?  Don’t worry!  It means that your child gets more multi-sensory information about what is in her hand so that it stays in her hand.
  4. The dinnerware and the cups can handle being dropped, but they have a bit more weight (thus more sensory feedback) than a paper plate/cup or thin plastic novelty items.
  5. There is nothing about this line that screams “adaptive equipment”.  Older kids are often very sensitive to being labeled as different, but they may need the benefits of good universal design.  Here it is!
  6. All of them are dishwasher-safe.  If you have a child with special needs, you really don’t want to be hand-washing dinnerware if you don’t have to.

For more information about mealtime strategies, please take a look at Which Spoon Is Best To Teach Grown-Up Grasp? and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

thanh-tran-369711.jpg

Help Your Special Needs Toddler Make The Transition To School Routines

 

wu-yi-302799.jpg

 

Many developmentally delayed toddlers move their therapeutic and educational services to a toddler developmental group, A.K.A. special needs program, when they are between 18 and 30 months old.  Not all of them slide into the routine easily.  There can be a few tears and a lot of complaining about fitting into a schedule /leaving a fun activity because it is time for circle or therapy.

After speaking with a handful of clients and doing a few consultations, I thought it might help to provide some strategies to help parents make their child’s first school experience easier:

  1. Learn how teachers mark activity transitions, and commit to using them at home.  Some teachers sing the  “clean-up song”, some ring a bell or turn lights on and off.  Find out exactly how the staff help children, especially non-verbal children, anticipate and adjust to changes.
  2.  You don’t need to copy the exact transition strategy, but make it very similar and use it for activities at home that are the easy transitions.  Examples of easy transitions at home are getting into a bubbly tub, leaving the table once full and satisfied, putting on a coat to go outside and play, etc.  The transitions that are easiest are going to be the calmest, and children learn best when calm.  This positive spin makes the school’s routine more acceptable when a child isn’t completely on board with new situations.
  3. Find out how snack is served, and offer snacks in the same way at home.  If small cups are used for water or juice, practice cup drinking at home with the same sized cup.   If there are specific foods offered, then stock up.   Model your enjoyment of these snacks so that the food is familiar and has your seal of approval.

Good luck this year to all the toddlers that have made the leap to school!!

 

Lining Up Toys Doesn’t Mean Your Toddler Has Autism

 

danielle-macinnes-88493-unsplash.jpg

After head-banging (see Why Head Banging Doesn’t Make Your Toddler Autistic), this is the other common behavior that seems to terrify parents of young children.  Seeing a row of vehicles on the carpet makes parents absolutely sprint to search online.

Well, I want all of you to take a deep breath and then exhale.  The truth is that there are a few other behaviors that are more indicative of autism than head banging.

Here is what I think that row of tiny toys often means:

Very young children have a natural interest in order and understanding spatial relationships.  Kids like routine and familiarity way more than most adults.  Some children who line up toys are just experimenting with how lines are formed or seeing how long a row of cars they can create.  Some will even match colors or sizes.

It is OK if Lightening McQueen has to be the first in the line at all times.  Sometimes rigid routines have a beneficial developmental purpose.  When your child tells you that you just read Goodnight Moon wrong (you just paraphrased the story get him to bed), he is really saying that he likes the familiarity and the orderliness of hearing those words said in exactly that order.  Boring to you, comforting to him.

Experts in early literacy will tell you that a child’s fondness for hearing the same story over and over is actually a developmental milestone in phonemic awareness, the cornerstone of language mastery.

Controlling their environment and creating patterns is another reason to line up those cars.  Very young children (under an 18-month cognitive level) do not create complex play schemes about races or adventures.  Lining them up is developmentally correct play for these children, and it can easily expand with a little demonstration and engagement with you.  Build a garage from Megablox or MagnaTiles, and see if your child will enjoy driving each one into the garage to go to “sleep at night”.  Don’t mention that in real life we all use our garages as storage units, not vehicle parking!  Typically-developing children may even repeat this game independently later the same day, having learned a new way to play with their toys.  Or they will hand you a car and say “night-night?” so that you can play this game with them again!

When does lining up toys become troublesome?

When it is the ONLY way that your child interacts with those toys, or with any toys. And when you try to expand their play as above, they just about lose their lunch because it is all about rigid routines, not object exploration.  If your child is on the spectrum, that line of cars is part of their environmental adaptation plan for security and stability; it’s not actually play at all.  There isn’t a sense of playfulness about changing things around or using these objects for imaginative play.

A lack of developmentally-appropriate play skills is certainly a concern to a child development specialist, but it still doesn’t translate into autism.  Here are a few of the behaviors in 1-2 year-olds that concern me much more:

  • little or no eye contact when requesting something from you.  They look at the object or the container, not at you.
  • no response when her name is called, or not looking toward a specific person when the name of a family member is mentioned.
  • using an adult’s hand as a “tool” to obtain objects rather than gesturing, pointing or making eye contact to engage an adult for assistance.
  • a non-verbal toddler (over 18 months old) that doesn’t use gestures such as pointing or babbling to communicate needs or desires.

Always discuss your concerns with your pediatrician, and in the U.S., consider a free evaluation through your local Early Intervention program if you continue to see behaviors that keep you up at night.  Therapy services are free as well, and they continue until your child is eligible for school-related services provided by your local district.

3/21/20:  Since parents are particularly concerned about coronavirus, please read How to Get Young Children to Wash Their Hands to make this as easy as possible. Then read Is Your Toddler Home From School? Save Your Sanity With Fun Routines !!

Most posts to help you!

Need more help with your child’s behavior?

I have transformed my own reactions to challenging toddler behavior with Dr. Harvey Karp’s Happiest Toddler on the Block methods.  To teach your child self-control skills without punishment or shaming your child, take a look at Stretch Your Toddler’s Patience, Starting Today! and Discipline and Toddlers: What Do You Say if You Don’t Want to Constantly Say “No”? .  If your child is on the spectrum, these strategies will work for you as well.  It may take longer for success, and you may have to look for small signs of comprehension and calmness, but they will work.

Are you struggling with potty training your child with low tone?  Then I wrote a book just for you!

 The Practical Guide to Toilet Training Your Child With Low Muscle Tone is the e-book that gives you real assistance, not just “don’t rush him” or “wait until you see signs of readiness”.  What a cop-out from pediatricians!!  I teach you how to spot and create readiness, and build your child’s skills so that they can succeed! Read more about my book at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! .  You can purchase my e-book on my website Tranquil Babies , on Amazon , or at Your Therapy Source , a terrific site for occupational therapy materials.

My newest e-book is finally done!  

The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years helps parents of kids with low muscle tone and joint instability figure out things like how to position their child in a stroller properly, how to teach them to eat with a spoon, and how to pick the best chairs, trikes, toys and even pajamas!

Parents who know what to do and what to expect feel empowered, not anxious.  There are even chapters on how to communicate with teachers, doctors, and even members of your family so that you get the right kind of support and your child is both safer and more independent….today!

It is available as a read-only download on Amazon and as a printable and click-able download (and they are also offering an option to bundle it with my first e-book, saving you some money!) at Your Therapy Source

cindy-bonfini-hotlosz-354736-unsplash.jpg

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

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

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

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

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

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

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

Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing

 

ksenia-makagonova-274699I gave a crash course in utensil instruction to an interested dad recently.  Speaking with him, answering his questions, made me realize that I had spent years refining my approach to teaching young children how to use spoons and forks.  I had never written it all down.

Select your tools carefully.  Many parents and nannies are handing over the narrow, long-handled infant spoons to their toddler.  That would be like me providing you with my spatula.  Take a look at  Which Spoon Is Best To Teach Grown-Up Grasp?  for the best design choices for older kids.  The blue spoon in the photo line-up is a great toddler/beginner spoon.  This Gerber spoon has a non-slip handle with dots on the surface where a young child should place their palm.  Yes, toddlers use a fisted grasp.  The bowl of the spoon is not too shallow and not too large.  The handle is thick and just long enough for a toddler palm.  Why shouldn’t they use a plastic disposable spoon?  All of the above features are missing, plus the light weight doesn’t provide the sensory input that helps children feel what their hand and arm are doing while they scoop and place the spoon into their mouth. Those plastic spoons say they are disposable, and that is what you should do when you are done with them.  Take a look at OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues for more ideas on great tableware.  If bowls and cups tend to tip too easily, try a silicone baking mat for a non-slip surface, or go pro and get some Dycem The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem.

Where you hold their spoon determines where they hold their spoon.  Guiding their beginning attempts at scooping and their attempts to bring a loaded spoon to their lips usually involves your physical assistance.  Some parents opt for what teachers would call “hand-over-hand” assistance.  I use that type of assist sparingly, since most young children resist it.  In my opinion, they resist it because they do not understand why you are gripping their hand.  I opt for holding the spoon, not the child.  If they aren’t actively bringing the spoon to their mouth, neither am I.  No fights.  If you hold the handle in the middle, a child will grasp the part of the handle that is available:  the tip.   Children naturally reach for the tip, they often pick up a utensil at that spot when the spoon is resting on the table. That is, however, not a functional grasp, and even an adult wouldn’t be able to successfully load a spoon with food and eat with that grasp.

Place your hand so that it covers the tip of the handle, at the end.  If your child is old enough to try to feel herself, she will reach for the shaft of the handle, not the food in the bowl part of the spoon.  Her hand is now in the right spot start eating!

Choose food that sticks to the spoon.  The dad that I mentioned in the beginning had given his son some thick ricotta-like cheese for breakfast.  Perfect.  Even when the child tipped the spoon upside down, the cheese stuck to the spoon.  There are other choices that make learning successful and less frustrating.  I am thinking of mashed avocado, mashed potatoes, especially sweet potato or yams, very thick Greek yogurt, and the old favorite, oatmeal.  The worst choices?  Peas, unless mashed, rice, and pasta.  Having your food roll away is just so discouraging.

Use a plate or a bowl?  Suction cup base or not?  I prefer a shallow bowl, so that scooping can be done against the sides of the bowl and the angle of the spoon is small.  The hardest set-up?  Scooping out of a deep cup like a yogurt cup.  Some parents buy bowls with a suction cup base.  For super-curious children, this is catnip.  They have to figure out why the bowl isn’t moving.  Inevitably it does, right to the floor.  My favorite hack is a damp paper towel under the bowl.  Grips the bowl, but not fully, is familiar enough to prevent at least some exploration, and you can use it to clean up when the meal is done.  Take a look at OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues for an attractive line of dinnerware and utensils that don’t break and don’t look like “equipment” but function as well as therapeutic tools.

The first 3-7 bites are key.  I suggest to parents that they prompt for spoon use when a child is eager to eat, but the first bites are provided.  Some children are so hungry that having to work to get a bit of food makes them angry.  If they have a little taste, they are willing to work on scooping to get more.  After about 7 bites, a lot of children aren’t that hungry any longer.  The ones with small appetites will stop making an effort.  The ones who are resistant to using a spoon will wait for you to feed them.  That isn’t a terrible solution for very young children, as long as you got some cooperation and practice in while they were still hungry.  After all, there are more meals coming. 

Consistency between all caregivers.  If parents, the nanny and the other caregivers know the plan, simple as it is, learning comes faster.  Make the effort to explain and even demonstrate.  Children do not appreciate different strategies.  They default to “no”.

Make it fun.  My post on fun ways to practice utensil use, Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child, gets a lot of hits because everyone wants to have fun, no one wants to “work”.  Me too, which is why OTs generally use toys and play to build skills.  Here is a new post for those children that are read to try knife use: How to Teach Your Child to Cut Food With a Knife…Safely!

Good luck, and have some fun at the table today!

vicko-mozara-324955