Tag Archives: occupational therapy

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

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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!

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Teaching Safety Awareness To Special Needs Toddlers

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

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

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

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

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Have a Child With Low Tone or a Hypermobile Baby? Pay More Attention to How You Pick Your Little One Up

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Carrying and holding kids is such a natural thing to do.  But when your child has hypermobility due to low muscle tone, joint issues or a connective tissue disorder, how you accomplish these simple tasks makes a difference.  Your actions can do more than get them from one position or location to another: they can build a child’s skills, or they can increase the risk of damage by creating excessive flexibility or even accidentally injure a child’s joints.

How could something so simple be both a problem as well as an opportunity?  Because hypermobility creates two issues that have to be addressed:  Less strength and stability at vulnerable joints, and less sensory feedback regarding pain and position sense in your child.  The ligaments, tendons, muscles and joint capsule at every hypermobile joint are more likely to be damaged when excessive force is placed on them.

Knowing how much force is too much isn’t easy without some instruction from a skilled therapist.  Depending on your child to react quickly and accurately to accidental stretch or pressure by crying or pulling away isn’t a good idea.  Their excessive flexibility reduces firing of receptors deep within all of these tissues in response to excessive force.  You may have looked at your child’s shoulders or ankles and think “That looks uncomfortable.  Why isn’t she fussing?”  This is the reason.  It means that you will have to be altering your actions to reduce the risk of harm.

As I mentioned earlier, this is also an opportunity.  It is an opportunity to teach your child about safe movement and positioning, right from the start.  Even the youngest child will pick up on your emphasis on alignment, control and safety.  They are always listening and learning from you every day, so incorporate effective movement into your handling and help your child build awareness and independence today!

Here are some strategies for you and your child:

  1. Always spread the force of your grasp over their body, and place your hands on the most stable locations, not the most flexible.  Lift a child through their trunk, not by holding their arms.  If they cannot steady their head, support it while you lift.  If you feel those little bones in their wrists and ankles moving under your grasp, support those joints instead of pulling on them.  Not sure how to do this correctly?  Ask your therapist for some instruction.
  2. Do not depend on a child’s comfort level to tell you how far a joint should stretch.   Think about typical joint movement instead.   If their hips spread very wide when you place them on your hip, think about holding them facing forward, with their knees in line with their hips, not pressed together.
  3. Give them time to move with you.  Those over-stretched muscles are at a mechanical disadvantage for contraction.  This means that when you tell a child to sit up, you have to give them time to do so before you scoop them up.  They aren’t  being defiant or lazy (I have not, in fact, ever met a lazy baby!).  This is a neuromuscular issue.
  4. Discourage unsafe movements.  Some children find that overstretching their joints gives them more sensory feedback.  It feels good to them.  This is not OK.  You will not be able to stop them every time, but they will eventually learn that their is a right way and a wrong way to move.  Knowing why isn’t necessary.  Yet.  Teach them to respect joint movement and use things like graded joint compression and vibration (your occupational therapist should be able to help you with this) to give them the sensory feedback they want.

Still concerned about safety?  Read Teaching Safety Awareness To Special Needs Toddlers to learn more methods to build independence without injury.

 

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How To Spot A Gifted Child In Your Preschool Class (Or Your Living Room!)

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Bright kid: “Are there any sharks out there?” Gifted kid:  ” The most common shark in the Atlantic Ocean is the ….”

Do you have a gifted kid?  Do you teach one?  You might not be able to tell the difference between a bright child and a gifted child by the number of letters they know, or the facts about dinosaurs they can recall.  Here are some distinct signs that your child, student or therapy client is actually gifted:

  • They are not a joy to teach.  Bet you didn’t expect that!  Yes, the gifted child isn’t usually sitting there soaking up knowledge.  They are out there arguing points and doing their own experiments.  They see the subtle differences, so they are going to bring up the exceptions to ALL of your rules.  They don’t like rules and correct answers nearly as much as the bright kids.  They are interesting to teach, but they won’t be as easy to teach as the bright children who simply learn what they are told and repeat it back to you.
  • They learn fast.  Really fast.  The typical child will need 15-20 repetitions or demonstrations and practice to learn a skill. The gifted children may only need 1-2 repetitions to learn.  The bright children need 5-8 reps.  So if you demonstrate a dance move or how to write a letter and your child copies you perfectly the first time, you may have a gifted child in front of you!
  • They NEED complexity and novelty.  Note that I said “need” versus “prefer”.  These kids don’t love routines.  They learn them quickly, but they find them boring, not comforting.  They don’t want to hear a favorite book again as much as they want you to read the next book in the series.  Without sufficient stimulation, the gifted child will go find her own entertainment and probably tell you what to do with your routines!  Bright children are often happiest when they can show you what they remember.  Gifted kids like to show you what you aren’t seeing or mentioning about a topic.
  • Gifted children are intensely curious.  This is different in magnitude from a bright child, who is interested in many things and consistently pays attention to stories and lessons.  The gifted child wants to know everything, and they want to know it now.  If the questions that you are asked show a level of synthesis you would not expect based on age and exposure, you may have a gifted child in front of you!
  • They have a lot of energy.  The gifted child may not need that nap, or they may collapse suddenly due to their full-on approach to life.  They could wake up totally ready to go, and go to sleep talking as well.  This is a child that isn’t going to want to be quiet when they have something to say.  The bright kids raise their hands and wait to be called on.  Be prepared to expend some energy yourself to engage with a gifted child.
  • Their passions and ideas can result in daydreaming and preferring to work alone on their projects.  This doesn’t mean they can’t be social.  But it may mean that they see no point in gluing construction paper triangles onto a pumpkin when they could be creating a pumpkin patch and a corn maze like they visited this weekend.  They won’t passively complete your project when they have a better idea of their own.

If you have spotted a child that may be gifted, you will want to offer them the opportunity to expand and explore within your classroom or your home.  You don’t need to label them.  If you find that their abilities place them far outside the reach of your class plan or they complain about school, it may be time to pursue formal testing.  Linda Silverman, a psychologist with a specialization in working with the gifted, suggests that any child that tests more than 2 standard deviations from the the mean (statistically far from average) is in need of special educational services.  Just because gifted kids are not below average doesn’t mean that they don’t have needs.  To learn more about gifted kids, read How To Talk So Your Gifted Child Will Listen and Sensitivity and Gifted Children: The Mind That Floods With Feeling.  Some gifted kids have other issues.  Read Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help.

And remember that “gifted” doesn’t mean “better kid”.  It just means better skills.  The gifted population has been hammered for being elitist, when in fact, they receive a lot of criticism and prejudice as well as glory.  Treating these kids fairly will allow them to thrive!

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Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility

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Welcome to the world of faster (and faster) movement!  After mastering walking and possibly even running, older toddlers and preschoolers are often eager to jump on a ride-on toy and get moving.  If a child has had motor delays and has had to wait to develop the strength and balance needed to use a trike or another ride-on toy, they may be a bit afraid or they may throw caution to the wind and try it all as soon as possible!

Selecting the best equipment for kids that have low tone or hypermobility doesn’t end with picking a color or a branded character ( Thanks, Frozen, for bringing up my Disney stock almost single-handedly!).  In order to find the right choice for your child, here are some simple guidelines that could make things both easier and safer:

  1. Fit matters. A lot.  Hypermobile children are by definition more flexible than their peers.  They stretch.  This doesn’t mean that they should be encouraged to use pedals so far away from their bodies that their legs are fully extended, or use handlebars that reach their chins.  In general, muscles have their greatest strength and joints have their greatest stability and control in mid-range.  Fit the device to the child, not the other way ’round. Choose equipment that fits them well now,  while they are learning, and ideally it can be adjusted as they grow.
  2. Seats, pedals and handlebars that have some texture and even some padding give your child more sensory information for control and safety.  These features provide more tactile and proprioceptive information about grip, body positions and body movements.  You may be able to find equipment with these features, or you can go the aftermarket route and do it yourself.  A quick hack would be using electrical tape for some extra texture and to secure padding.  Some equipment can handle mix-and-match additions as well.  Explore your local shops for expert advice (and shop local to support your local merchants in town!)
  3. Maintain your child’s equipment, and replace it when it no longer fits them or works well.  Although it is more affordable to receive second-hand items or pass things down through the family, hypermobile kids often find that when ball bearings or wheels wear down, the extra effort required to use a device makes it harder to have fun.  The additional effort can create fatigue, disinterest in using the equipment, or awkward/asymmetrical patterns of movement that aren’t ergonomically sound.  Repair or replace either than force your child to work harder or move poorly.

Looking for more information about low tone and hypermobility?  Read The Hypermobile Hand: More Than A Strength Problem and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.  My new e-book on living and thriving with hypermobility is coming soon on Amazon.com!

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Is Compulsive Gaming A Disorder…Or A Symptom?

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

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

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

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Is Automaticity The Key To Handwriting Success?

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I know that this is a bold statement.  Handwriting is a complex skill, with visual-motor coordination, perceptual, cognitive and postural components.  But when I evaluate a child’s writing, and I watch them having to think about where to start and sequence movements to form a letter and place it on a line, and then decide how far apart the letters and words should be, it makes me think that the lack of automaticity is often a child’s biggest hurdle.  Even if their motor control isn’t terrific, they can still have legible and functional writing if they make fewer errors and write fast enough to complete their work in a reasonable amount of time.  Slow and labored writing isn’t functional, even if it is beautiful.

Think about how important it is for any visual-motor skill to become automatic in order to be efficient.   You cannot hit that ball if you have to think about it.  You just can’t.  It has to be a smooth and automatic response that comes from practice and refined feedback loops developed by experience.  While practicing, professional athletes drill down on minute aspects of the swing, but during the game, they choke if they “overthink”.  Ask anyone who has done a ton of free-throws in basketball (you get an unimpeded chance to drop that orange ball into the hoop) for practice but cannot make it when the game is on the line.

In this current culture, teachers have so many skills to impart.  Handwriting is still a skill children need.  Paper workbooks and worksheets are still used extensively until 3rd or 4th grade.  You cannot wait it out until kids get old enough to keyboard.  And a struggling writer in second grade is already feeling bad about their abilities. Sometimes so bad that they don’t want to do the language arts work that develops spelling, vocabulary and creative expression.   So waiting until they can type isn’t the answer.  You want excitement and enthusiasm for reading and writing early on.  Nothing develops excitement like success.  Nothing kills enthusiasm like boredom and failure.

If automaticity is the key to handwriting success, how do you develop it in children?  I think the folks at Handwriting Without Tears have figured it out.  I no longer use any other handwriting materials.  Their workbooks and pre-K multi-sensory learning tools are just too good.

  1. If you look at the pre-K and early primary workbooks carefully, you will see that the left-to-right, top-to-bottom orientation is embedded in everything.  Even the cute animals for little kids to color are all facing left-to-right!
  2. The two lines (baseline and midline) are simple to use.  No wondering where to place letters.   The pre-K letters are at the bottom of the page, creating an emerging automatic sense of baseline.
  3. The developmental progression (versus the alphabetical progression) builds slowly from vertical and horizontal lines to curves and diagonal lines.  Letters are grouped by the way they are formed, making automatic movements emerge early and consistently.
  4. Workbook pages aren’t overwhelming with activities, but the skills are repeated to intentionally develop writing automaticity.

For example, instead of writing 12 letter”B”s and 12 letter “b”s,  uppercase letters, with their larger and simpler hand movements are taught together and earlier.  Letters “b” and “d” aren’t taught together since they can easily be reversed.  Letters “b” and “h” are taught together since the formation is very similar.  Fewer reversals, more success without having to go back and re-teach letter formation.

Take a look at the best “pre-K into K” book I have ever seen, HWT’s KickStart Kindergarten.  It is the perfect summer bridge activity for your preschooler or your older special needs child.

Happy summer writing!

 

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