Tag Archives: early intervention

Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation

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Every child loves music, but not every music is therapy!

What if you could add a sensory-based treatment that targets specific sensory, motor, and behavioral goals, doesn’t require expensive equipment or a large therapy space, and you could see the effects within a very short time?

Since adding Quickshifts to my therapy sessions, I have been able to successfully address some of the more difficult behaviors and sensory processing issues I encounter.  Very young children are often afraid of being on therapy balls and swings, and they don’t always tolerate the Wilbarger or Astronaut protocols Why Is The Wilbarger Protocol So Hard To Get Right?.  But everyone can listen to music.  Enter Quickshifts.

I am primarily using them over speakers, since even older kids are struggling with wearing headphones.  I find that this isn’t preventing progress, and I periodically try to reintroduce headphones with children over 2.  They change so quickly that I never know when “NO” will turn into “maybe”.

Every Quickshift album uses brainwave entrainment.  The use of binaural beat technology (BBT) for entrainment of an alpha brainwave state has made a difference with the kids who display predominantly anxious or dysregulated states, but it is also very helpful to entrain better attention and postural activation.  Read more about the science behind BBT in Binaural Beats and Regulation; More Than Music Therapy.  It is great for parents too: Stress Relief in the Time of Coronavirus: Enter Quickshifts.

Quickshift albums are intended to rapidly bring the brain into this alpha state, with a focus on reducing anxiety and building affective modulation.  Yes; this form of therapeutic listening has the ability to decrease, not increase, anxiety.  But there are a wide range of albums.  Some emphasize postural activation, some work on sensory modulation and sensitivity, and some improve attentional focus or social interaction.  Why would music affect posture or anxiety?  Because these albums use specific rhythms and melodies, as well as binaural beat technology.  OTs know a lot about how sound affects brain function, and this isn’t about “liking” the music, although kids do.  It is about creating differences in the brain.

I am particularly fond of the regulation albums and the social interaction albums, as my clients inevitably struggle with these issues.  I can see a shift (not a pun:  the shift is real) about 5-7 minutes into the 14-17 minute albums.  This is helpful in a session.  If I only have 30-45 minutes, I cannot do 15 minutes of sensory input to achieve regulation.  I need more time for treatment goals.  This gives me precious minutes, and helps kids see that regulation is possible.

Why Modulated Music Wasn’t Working For Me

I stopped using Modulated music a long time ago.  I rarely use it with children under 5 now.  Not because I don’t think it was an effective treatment.  Because I couldn’t get any compliance at home, and I saw very little progress with use only in my therapy sessions.  There was often a learning phase, in which I had to adjust the amount of listening time to prevent overwhelming young or very challenged children.  Parents start to question my clinical skills and I risk losing their confidence.  Families were resistant; even the families that really wanted to use this music.

The way Modulated music needed to be scheduled and used (two daily 30-minute sessions, 2-3 hour wait before sleep times and between listening times) made it almost impossible to use with very young children at home, regardless of how willing parents seemed to be.  And very few parents were that willing.  Maybe they would be able to do insulin injections on a schedule, but not therapeutic music. Everyone is so over-scheduled and busy.   I hated begging, so I had to find something easier that also worked well.

Quickshifts:  More Flexible, More Easily Tolerated, More Effective in EI

Quickshifts have been much more flexible, but just as successful.  Maybe more!  They can be used often throughout the day, any time of the day.  I haven’t seen one small child react in a way that indicated that they were overwhelmed.  The ability to target specific types of sensory-based goals means I can deliver results the parents can see.  the emphasis on alpha brainwave states seems to deliver an extra layer of calmness.

Gearshifters are similar to Qucikshifts, but they do not have the targeted immediacy that I find so helpful.  When are Gearshifters better to use?  When I need a longer-lasting modulation effect and I don’t have concerns about spatial awareness or need to reduce agitation.  Some kids need a Quickshift album followed by a Gearshifter to have a few hours of really good sensory modulation time.

Use the best headphones!  Read  Doing Therapeutic Listening? Get These Affordable, Comfortable, Kid-Size Bluetooth Headphones From PURO!  to learn what equipment is going to make this work for you.

Parents are happy to be able to download the albums onto their phones and use them to improve transitions, sleep, attention and more. The use of technology to entrain an alpha brainwave state means that if the album isn’t a perfect fit, I don’t get an overwhelmed child; there is always some degree of improvement in regulation and arousal.  But when I have seen kids generate more postural activation, calm down and even laugh, or tune into their environments in ways they never have before Quickshifts, I wonder why I waited so long to get this treatment on board.  It isn’t just for sensory sensitivity or modulation problems; read more about how it can help kids with motor control issues here: Therapeutic Listening Can Enhance Motor Skills….Really!

Wondering if adults can use Quickshifts too?  Read  Should the PARENTS of Kids With Sensory Issues Use Quickshifts? for more about how this music can help everybody in the family.

If you are tempted to go out and buy these albums without the guidance of an OTR that is trained in sound therapy, please reconsider.  The reason that I have had such success with Quickshifts is not just because this treatment works.  It works because I use it as part of a whole sensory-based protocol, in which I can select and prescribe the right music to be used at the right time.  There really is a reason to have an OTR help you.  You will get better results, avoid problems, save time and money, and have someone trained in treatment guiding you.  Not Dr. Google.  I do phone consultations to help people decide on a sensory processing treatment plan that saves them time and money.  Visit my website tranquil babies to book a session!

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Lining Up Toys Doesn’t Mean Your Toddler Has Autism

 

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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

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Bringing Home Your Preemie: What Your Therapists Would Like You To Know

Discharge day for a preemie is special, but it is just the beginning of a journey that often includes therapy at home.  As an Early Intervention therapist, I thought parents could use some insights into what your team is really thinking when they begin to work with you and your baby.

  1. We know that you are nervous.  This is your first experience with a medically fragile child, but it isn’t ours.  Most of us have worked in hospitals before, and are well-acquainted with universal precautions, shunts and feeding tubes.  We are always looking for signs that things aren’t going well, and we will do everything we can to ensure your child’s safety at all times.  That may mean that we will tell you that things like placing a Bumbo chair on a table is a risk, and those chairs do not give your child the correct support for growth.  Regardless of what your sister-in-law said about her child.
  2. We aren’t doctors, so we will not give you a diagnosis, even if we suspect something.  Legally, we can’t diagnose, so even though we suspect that your child may have cerebral palsy or another issue, you won’t hear it from us.  In the past 15 years, I have seen neurologists in NY delay diagnosing conditions such as CP for well over a year after birth, even when there isn’t any alternative diagnosis that fits.  Parents are left waiting and wondering, hoping that it isn’t so.  The internet allows parents to learn quickly what all that muscle rigidity and terms like “leukomalacia” can indicate.  I suspect that medical liability issues are at the heart of this delay, and it is tearing parents up inside.  But we aren’t allowed to tell you our suspicions.
  3. You are the greatest determinant of therapy success.  We can only guide you, demonstrate techniques, positioning, and give you therapeutic activities.  What you do every day is essential and will determine much of the success of our work.  If we suggest that you hold your baby in a manner that builds head control, reduces arching or encourages reaching, we know that your actions will determine if it works.  If you ignore our suggestions without discussing your concerns, or worse, tell us you are doing them when you aren’t ( we can actually tell),  you aren’t getting very much from your child’s therapy or your therapists.
  4. Babies can feel fear or confidence, so ask questions and get more reviews and guidance if you don’t really understand what your therapists have suggested.  We do this all day long, and most of us have been handling premature babies for years.  We know this is all new to you.  No judgements!

Why “Hand-Over-Hand” Assistance Doesn’t Work With So Many Special Needs Children

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This method of teaching fine motor skills has never worked well for me in Early Intervention.  In my professional experience, it has been a popular technique for many special educators.  But they aren’t always getting the results they want.  Very often, the scenario is as follows:  I get a call from a concerned parent, telling me that the teacher is wondering if their child has sensory aversion, since he or she resists the teachers’ touch during sessions.

Sometimes that is indeed the case.  More of the time it is not.  The true reason why “hand-over-hand” assistance is not accepted or working well is a little more complicated.  Here are the two situations in which sensory aversion is not the biggest problem, but there are less obvious reasons for the failure of this method of training:

  1. Children with low muscle tone.  Holding a child’s hand and guiding them, even moving their hand and arm, limits the necessary proprioceptive and kinesthetic information that is required for a child to learn effective hand control.  The tactile sensation and the imposed movement from an adult’s hand masks this subtle information.  The brain cannot process and learn if it isn’t receiving correct and useful information. Children with low tone are automatically placed in the category of “sensory processing issues” due to the diminished proprioceptive and kinesthetic information resulting from low tone  Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children.  Using hand-over-hand assist is creating more tactile input but less muscle and joint input!  One strategy that works for me is using the weight of my hand to create “drag”; I am giving the child more proprioceptive/kinesthetic information as the child moves intentionally to accomplish a task.  It cannot be too much drag, restricting their movements, and it cannot be too little movement or contact, which the brain interprets as offensive light touch.  And it has to follow their general movement, not passively bringing a child’s hand to the toy.  This takes practice to learn, and it helps if you are good at perceiving your own subtle movements.  Think Feldenkrais or Tai Chi.
  2. Children with cognitive and/or communication delays.  A child that doesn’t realize that “hand-over-hand’ assistance is intended to help them perform a task, or a child that doesn’t want to perform that task, will almost always resist the physical contact of an adult.  Imagine if the person sitting next to you suddenly grabbed your partially paralyzed hand and pulled  it off the table.  You would jerk it back.  If you knew that a spider was crawling toward your hand, you would be grateful, not resentful.  It’s dependent on your awareness of the person’s intent, and your agreement that this is the way you want assistance to move your hand!!   If a child is unaware or uninterested, it makes sense for them to resist physical intervention.  So many globally-delayed children are handled all day long without their full awareness or even their consent.  They may have no interest in stacking blocks or scribbling.  There are other ways to assist them.  Creativity and excellent observations of a child’s motivation to move are the keys to improving their participation.

What CAN you do to help these kids?  And what about kids who are truly aversive to being touched?

My approach to reducing tactile aversion is fairly simple:  touch needs to begin in areas that the child can accept, paired with emotional warmth and paced by the child but structured by the adult.  Remember:  light moving touches neurologically perceived to be alerting, firm and static touch is modulating to the nervous system.  Grade your touch accordingly.  If you cannot, ask your OT to show you how this is done.  Your OT can also teach you how to use deep pressure input correctly to reduce sensory aversion.

For children that are avoiding contact because they don’t understand why you are holding and placing their hand on a toy, play has to begin without an object and with lots of demonstration.  Yes, it looks like you aren’t doing anything.  That’s because you are doing preparatory activities.  A child that wants a toy, wants to hold a toy, and wants to manipulate a toy may be more open to your assistance.  You may have to spend some time at this stage.  Children need to re-learn habitual responses.  Don’t give up, but ask for help from your OT if no change in a child’s responses is observed.

What else can you do?  Use more force, not less, to give them more sensory-based information about what their hand is doing.  Read For Kids With Sensory and Motor Issues, Add Resistance Instead of Hand-Over-Hand Assistance to understand how to use this strategy instead of hand-over-hand helping.  And think about making a task more successful by creating more stability.  Read The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem for a simple strategy that really works.

I hope this clarifies why I rarely use traditional H-O-H with my clients.  It can work, but usually it works better with older special needs children, special needs children with fair to good receptive language, and children without sensory processing issues.

Do you need more information on how to help young hypermobile kids?

I wrote 2 e-books for you!  The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years and Volume Two: The School Years are now available on Amazon.com as a digital downloads, and on Your Therapy Source  as printable and click-able downloads.  Both are filled with practical strategies to build daily living skills in  home and at school, but it doesn’t stop there!

Parents learn how to improve their child’s safety, and teachers learn how to help kids hold crayons, sit still for circle time, and stay safe on the playground.  Therapists learn how to recommend the right equipment, seating, even the right pencils or mealtime utensils.  There are chapters on improving communication skills so that siblings don’t feel left out or develop resentment while their hypermoible sibling gets lots of attention, and forms to improve communication at school and with doctors.

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