Monday, September 15, 2014

Oral Sensory Seeking Help

Credit: Envato
Dear Melissa,
My 4 1/2 year old grandson is a “chewer”. He has no developmental delays, but he seems to chew on EVERYTHING! He chews on his shirt collar, he chews on sticks, he chews on straws, he chews on toys…I tried to give him a chew necklace, which he seems to think is cool, but he still chews on everything. When I pick him up from daycare, his teacher says that she notices him inappropriately chewing in the classroom too. However, she also claims that this happens more during inside “work” time and less during outside play time. Shouldn't he have grown out of this by now?

Thumb sucking, chewing on toys, chewing clothes, biting fingernails…it seems like most kiddos go through a chewing phase. Babies tend to use their mouths to explore their environment. Older children (and adults) tend to chew for calming oral input. Trying to completely eliminate oral sensory-seeking activity is challenging because the behavior provides calming sensory input. Sometimes when children are repeatedly told "no," the child switches to alternative sensory calming activities. Unfortunately, the child's alternative can be even more socially unacceptable than the initial behavior. 

It can be effective to find a more acceptable replacement for oral self-stimming behaviors. The following are more appropriate ways to provide oral or other calming input: 
  • Chew items: These could include various chew necklaces (amazon.com), rubber bracelets, paracord/titanium necklaces (Academy Sports), bubble gum, taffy, or licorice. 
  • Strong flavors: Add spice to your child’s life with strong flavored snacks,candy, or gum. Think strong mint, cinnamon, spice, & sour. Examples include salsa, Altoids, Hot Tamales, and fresh lemon to water. 
  • Temperature: Warm tends to be soothing..ice cold tends to pack more of a punch! Consider using frozen teethers, ice cubes, snow cones, or popsicles. 
  • Texture: Play around with various textures that may be similar to the behavior you are trying to correct. This may be in the form of manual toothbrushes, electric toothbrushes, and vibrating back massagers placed on the cheeks. You can also use crunchy snacks such as chips and raw fruits/vegetables. 
  • Sucking/blowing: These also provide lots of calming oral input. Again, it was one of the first survival skills that we learned in infancy. Try using various crazy straws, sport bottles, & juice boxes. One of my ultimate favorites is drinking a pudding cup through a standard straw that is cut into thirds. Chocolate AND calming sucking…win win! You can also use various whistles, harmonicas, kazoos, and blowing noise makers if your ears can handle it!
  • Proprioceptive input: This is generally provided in the form of deep pressure to calm a child. Think about the squishy/snuggly input you provide when you swaddle a baby, or how your joints get squeezed together when you run or jump. This is proprioceptive input. Some good ideas for proprioceptive input include weighted vests or blankets, big bear hugs, wrapping the child up in a blanket like a burrito, lying under bean bags, running, jumping, climbing, and helping with heavy work.  
Unfortunately, none of the above is magic fairy dust!  It takes trial and error to find out what will work and what will not. If your child is able, share these ideas with him and see what appeals to him the most. For a more complete reference list, you can refer to my Oral Input Guide which contains over 100 ideas for appropriate oral input. 

Do you have ideas for providing appropriate oral input that have worked for your child? I would love to hear them! Or, if you have a question you would like me to address in my Weekly Blog, send it to share@ChildrensTherapyTEAM.com  

Resources:

Monday, September 8, 2014

Football Games and SPD

credit: envato images
Dear Melissa,
My 4-year-old son has sensory processing disorder and is the type to be more sensitive than most kiddos. He seems to enjoy watching the Razorbacks with me on TV, and I really think it is time for our first father/son football game. Any tips on making this “Boys’ Day” a success?

Woooooo….Pig Sooie! Razorback football season is upon us! Here in Arkansas, it seems like going to your first Razorback football game is a rite of passage. And, if you believe the rumors that this season might be a little rough, this could be the perfect time to score some cheap tickets! Unfortunately, a college football game can be total sensory overload for anyone. The roar of the crowd, the booming loudspeakers, the rumbling vibration in the bleachers as the fans stomp their feet, fireworks at touchdowns (we hope!), the hot/cold weather, being shoulder to shoulder with strangers, new/unfamiliar clothing...the list goes on. It is enough to make even the most enthusiastic little fan want to run away!

I have helped coach many families through this Arkansan rite of passage and have taken my own little fans to cheer on the Hogs in person. While these ideas mainly apply to larger college games, they also apply to smaller arenas such as high school or even big brother’s little league games.

1.  Consider a practice run. You might want to try just going to a tailgate party rather than attend the game. Or you might want to take your youngster to a high school game in the area.  These mini-experiences will help you determine if your little guy is ready for the real deal before you waste your money in order to create a total sensory shutdown.

2.  Study your own playbook. Know the rules/regulations for your venue -- there is a link to the Arkansas Razorback Game Day rules below. Know where you will park and if you will walk or take the shuttle. (If you decide to walk, know that you will likely be carrying your little guy most of the way!) Know your child’s dietary needs...and if there are acceptable options available in the stadium. Know what you can/can’t bring. The website says that backpacks are not allowed except for childcare/medical reasons. When I have taken my preschooler to a game, I have never had a problem bringing a backpack that is filled with kids' clothes, snacks, & juice boxes. They will just double-check it and put a tag on it. In addition, in researching this article, I noticed that the Razorback website offers locations in the stadium to obtain a child ID bracelet with your info on it. This is a particularly good idea if your youngster is the type to wander off. 

3. Prepare for the weather. Take layers AND sunblock! This is Arkansas!  It can be 40 degrees in the morning when you arrive, and 80 degrees by halftime. Make sure to pack/wear several layers to help maintain a comfortable temperature. It is also a good idea to have your child practice wearing these layers so you will know ahead of time if the warmer layers are too scratchy and need to be traded out for a soft fleecy blanket. A word of caution: you might want to make sure that ALL of the layers are in your team color or a neutral black. You don’t want to make the mistake of having your son wear a Tennessee orange jacket over his Razorback red t-shirt, subjecting you and your child to frowning looks & negative comments! (No, I don’t know this one from personal experience. Nope. Not at all!)

4.  Teach the cheers/chants ahead of time. The game will be much more fun if these cheers are a predictable distraction rather than a novelty to be feared. YouTube and iTunes can help with this. Go ahead...teach the arm motions to all the songs as well! Just watch the band, and they will show you all you need to know. These rhythmical calisthenics can be quite calming!

5.  Prepare for sensory defensiveness. For auditory defensiveness, you can bring headphones, ear buds, earplugs, or have your little guy wear his hoodie over his ears.  For tactile defensiveness, he can wrap up in the blanket like a burrito so that he doesn’t feel the other fans touching him – this will also provide calming deep pressure input. If your son will tolerate it, have him wear sunglasses to help block out the bright sun or the bright stadium lights. It is also a good idea to occasionally get up, walk around, and hang out in a quieter spot for a few minutes before returning to the game.

6.  Have a plan B. As with all things involving kiddos, ALWAYS have a plan B. Know which friends/relatives are also at the game that your son can go and “visit” when he needs a change of scenery for a moment. Bring along another adult who is not as invested in the game (often a wife or grandma) who would be willing to leave the game early with your youngster if the game gets to be too much. Finally, be prepared to have your own exit strategy if things get hairy.  Again, consider things such as parking, walking, and traffic in your exit plan. 

The Out-of-sync Child: Recognizing and Coping with Sensory Processing Disorder, by Carol Stock Kranowitz


If you have a question you would like me to address in my Weekly Blog,

Monday, September 1, 2014

Behavior 101

Dear Melissa,
I recently started watching my 4 ½ year old nephew while my sister works full time.  He is a really sweet boy, but he is so impulsive, so full of energy, and is very quick to throw a tantrum. I feel like I have to watch him more closely than I watch my own 2 year old! Do you have any tips to help with behavior problems in a preschooler?

If I had a one-size-fits-all quick fix for behavior problems, I would be a millionaire!  However, I do have a large bag of tricks which I have used as a mom and as an Occupational Therapist. That is one of the things I love the most about my job! I get to try new ideas at home, then practice them at work, and vice-versa! Now, I absolutely do NOT claim to have all the answers. My own children have their cranky/meltdown moments, just like any other child.  However, here are a few of my favorite ideas to help solve behavior difficulties in ANY child, both those with disabilities, and those without: 

Be consistent.  
This is parenting/childcare rule #1.  If a child is able to cry for 10 minutes and gets his way, then he will try crying for 15 minutes the next time to get his way.  If you say something is a rule, it is a rule.  Period.  Let your word be your bond.  I will admit, there have been times...especially after my child has screamed for 20 minutes...when I have thought to myself, “Why do I even care if my child takes his plate to the sink? It’s really no big deal! I will just take it there myself!” However, if you said something needs to be done, it needs to be done. Stand your ground! You can do this!

Avoid saying “NO.” 
Yes, all children need to learn to remain calm when they hear the dreaded “no,” but I have learned that avoiding “no” as much as possible makes your life so much easier. This does NOT, however, mean that you should give in. It means rather that you learn to get creative with your responses to your child’s requests. I always like to respond to requests with “of course” followed by a qualifier. When the child asks “Can I go outside?” you reply, “Of course you can, when it stops raining.” When a child asks “Can I have a snack?” you reply, “Of course you can, after you pick up your toys.” When a child asks, “Can I watch TV?” you reply, “Of course you can, after school.” When the child asks, “Can I have a private island in the Bahamas?” you reply “Of course you can, when you win the lottery!” You get the idea. 

Keep to a regular schedule.  
Children thrive on structure and routine. The more struggles a child has with impulsivity, attention, and behavior, the stricter the routine needs to be. It may seem cruel to leave a party early in order to respect the bedtime routine, but it really is for the best. Children are just little guys & gals. They don’t know what to expect from their world, and they have little control over it.  The more they can learn to predict their daily routine, the more they can learn to remain calm and not worry about what is happening next. If you notice the schedule posted in any quality preschool classroom, you will find that they have the full day scheduled down to the minute.  Again, this predictability makes life calmer and simpler for everyone. 

Use picture/written schedules.  
This helps to keep things on schedule even more. Depending on the reading abilities of the child, this can either be written out with words, or you can use photographs or drawn pictures.  The “Super Nanny” Jo Frost always created a huge poster board schedule when working with her families on TV, and she had some doozies!  I always use this technique in the clinic and with my own children as well. This helps make a clear picture of the predictable schedule and can be used to prepare a child for any changes in the day (which are bound to happen). If a child needs pictures rather than words, consider taking photos of activities, printing them off, laminating the pics and adding Velcro to the back. This will allow you to create a quick visual schedule each day and easily make changes as needed.

Use a visual/auditory timer.  
This goes back to the fact that kiddos need predictable schedules and structure. Whether utilizing an alarm app on your phone, a wristwatch alarm, a kitchen timer, or a simple sand timer, you can create a definite cue that it is time to move to a different activity.

 Give choices as much as possible.  
OK, this one really does seem like “magic fairy dust,” but hear me out and give it a try. You tell the child to brush his teeth, and she refuses. Then you simply ask if she wants to brush her teeth in the upstairs or the downstairs bathroom. And she magically chooses to brush her teeth upstairs!  I am completely floored that this one actually works.  It seems too simple! Please, give it a try, and let me know. I promise that you will be amazed more often than not!

Avoid the hungry/sleepy/tired situations.  
Simple, right? Wrong! This singular concept will probably be the topic of many future blogs. But in short, respect regular meal and snack times, respect nap times and bedtimes, and always keep a healthy snack on hand for emergencies!

Again, I could go on, and on, and on…These are just my favorites! In addition, these are only tips for setting a child up for success. Yes, sometimes consequences are necessary, but we will save those for another day. My philosophy is that it is much easier to set a child up for success than try to get creative with deciding on appropriate consequences. I would love to hear your favorite tips/tricks to help with difficult behaviors at home. Please share!

If you would like additional tips for addressing behavior difficulties in your child, please explore the following resources: 

Monday, August 25, 2014

When is a comfort blankie not OK?

image credit: Envato
Dear Melissa,
My 3-year-old daughter is identified as having Sensory Processing Disorder, and she just LOVES her blanket. She sleeps with it every night and rubs her hands on it as she falls asleep. Throughout the day, she will even take “breaks” from playing with her sister, go to her room and fidget with her blanket for a few minutes before coming back into the playroom to rejoin her sister. My husband is concerned that we are encouraging an abnormal behavior. What should we do about this?

To be honest, this is not the type of thing that really has much research behind it. So, I will give my opinion as an OT who has worked for years with kiddos on the Sensory Spectrum.  

In my opinion, all kids (and adults!) do their own quirky, sensory, self-soothing activities.  When these activities are repetitive and frequent in nature, it is referred to as “stimming.”  In general, as long as the stimming behavior does not interfere with daily living and does not break social norms, I say “leave well enough alone.” The stimming serves a very important function to calm the body down. If you suddenly take away the calming activity, it can often lead to meltdowns. These are no fun for anyone!

Again, people regularly have all types of self-stimming behaviors. Many people twirl their hair, pace while talking on the phone, chew gum, twirl their pencil, jingle coins in their pocket, etc.  These are all self-calming behaviors which society has deemed to be acceptable. Once again, as long as they do not interfere with daily living or social norms, they are not problematic. 

However, what do you do if you decide that the stimming behavior is interfering with daily living or social norms? For example, it could be problematic for the child to take the blanket everywhere, such as to the park where it would get torn and dirty. Or one might be concerned if a child wants to hold her blanket all the time and never plays with her sister.  

Addressing a stimming behavior needs to be done very carefully.  If you simply take it away,  1) it can lead to extreme sensory meltdowns, and 2) the child will replace it with another self-stimming behavior, possibly one that is even less desirable! Therefore, when trying to stop a self-stim, make sure you replace it with a similar activity, but one that will not disrupt daily living activities or break social norms.  

For a child who is carrying a blanket everywhere she goes, you might start with limiting blanket usage to her room or in the car. You can set a timer to ensure that she does not use it for extended periods of time. You might also try to find a similar fabric to the blanket that could be tied to a belt loop or a bracelet so that the child could fidget with it throughout the day. 

This is the perfect time to work with your child’s Occupational Therapist or Child Psychologist. They will know your child and her likes/dislikes. Together, you can create even more ideas to help replace the stimming behaviors with more appropriate activities .

Further Related Reading: 

Monday, August 18, 2014

Sleep Worries

Image Credit: Envato
Dear Melissa,
I have 3 boys ranging from preschool to elementary school. We have had a very relaxed summer, staying up late to play outside and sleeping until 9 or so every morning. I’m worried that starting back to school will be a bit of a shock to their currently lenient sleep routine.  What can I do to help them to get “back on track” for school? 

The backpack and lunch box have been picked out; new school clothes are selected; fifteen trips have been made to the store to ensure that you have the EXACT items on the school list (the 24 pack of crayons, not the 16 or the 64 pack, but the 24 pack of Crayolas!). Kudos to you for realizing that sleep health should also be on your back-to-school list!

Importance of sleep:  In order to feel calm and rested, the National Sleep Foundation makes the following recommendations:

  • 1-3 years: 12-14 hours per day (including an afternoon nap of 1-2 hours)
  • 3-6 years: 10-12 hours per day (most children stop the afternoon nap sometime in this age range; only 24% of 5-year-olds continue to nap)
  • 7-12 years: 10-11 hours per day
  • 13-18 years: 8-9 hours per day

Many, many children fall far short of the recommendations listed above….and this creates the cranky, sleepy child situation that we all want to avoid. (Is anyone noticing a general theme of my blogs: “How to prevent the cranky child”?) But it is not just irritability that we need to worry about. Think back to your days as a new parent. Remember how little sleep you got?  Remember how you felt physically ill, grouchy and foggy-headed? Don’t recall this? Clearly the lack of sleep has affected your memory! 

A sleep-deprived state obviously has a negative impact on a child’s academic performance. Multiple studies on a wide age range of students consistently report that children who get more sleep per night perform better on individual tests, as well as overall academic performance. In addition, research from the University of Michigan found that as many as 25% of kids diagnosed with ADHD have an underlying sleep disorder causing their symptoms.   

So, you've “drunk the Kool-Aid.” You are ready to focus on healthy sleep, but how? The following are tips that we could ALL use to get better sleep: 
1) No TV in the bedroom. Ever. Period. This also goes for iPads, computers, smart phones, video games, etc. The bedroom is a place for sleep and relaxation. Electronics are for other areas of the house.  
2) Consistent bedtime/wake time, even on the weekends.  The body is simply unable to follow 2 different schedules in a 7-day period.
3) Establish a sleep routine.  In my house, it is bath, 1 show (NOT in the bedroom), books, bed. This will vary for each family. Some kiddos find the bath calming. However, my personal little monkeys get wound up at bath time, so it is at the beginning of our routine. Know your child. Find a reasonable routine. Stick to it – even on the weekend. 
4) Sleep environment.  The TV is already gone.  Ideally toys are out as well. This creates a space that is just for sleeping.  Temperature should be slightly cool. Overhead lights are off. A nightlight is generally good (but optional). “White noise” machines are often fantastic for the kiddo who really has a hard time sleeping. This takes some trial and error, but you can work with your child to create what works for them. 
5) INDIVIDUAL sleep environment. This is not necessarily a separate room, but this separation often is beneficial. However, each child should have his own bed, even if it is just a mattress on the floor. This prevents territorial wars between kiddos at bedtime. In addition, the child should sleep in the SAME SPACE each night.  Avoid the “musical bed” situation where he sleeps in the family room on the weekend, your bed sometimes during the week and his own bed at other times. Again, consistency is the key!
6) No caffeine. Hopefully your child doesn’t eat/drink any caffeine...but if your older child enjoys an occasional Coke, make sure that it is early in the afternoon and not close to bedtime. 
7) Snack. Some children find a light bedtime snack helpful as part of the bedtime routine. However, avoid a heavy meal 1-2 hours before bedtime as it can keep your kiddo awake.

What are your plans for getting back on track 
with your sleep habits for the new school year? 
I would love to hear your tips and ideas!

Also, if you have a question you would like me to address in my Weekly Blog,
Resources

Monday, August 11, 2014

What should I share about my child?


Dear Melissa,
My son will start kindergarten this fall. He has been in private Occupational Therapy for the past 2 years addressing sensory and behavioral difficulties and mild developmental delay.  My son’s OT says he is doing so well and advises us to decrease our therapy from 2x per week to 1x per week when school starts. Although he doesn't have any specific diagnosis, should I let the school know ahead of time about his delays? Or, do I just let him begin and see how kindergarten goes? I don’t want him to have a negative stigma, but I also want to set him up for success. Any ideas? 

What? A parent is worried about sending his/her little one to kindergarten? You are not alone!  I think I get asked this question by EVERY kindergarten parent this time of year! Yes, most parents worry about their child’s first day of school. However, if your child has been identified as “delayed” in the past, this can cause even more anxiety than usual. While I have listed several resources below, this decision is a tricky one and is largely based on your own attitudes, beliefs, and preferences. I think this is a good time to collaborate with your spouse, other family members, your child’s OT and any other adult who you trust who may know your child well.  Because there are no easy answers, I will simply state the pros and cons of the disclosure as I see it. 

If you decide to talk to the school, you may ask your spouse or child’s OT to join you for a meeting with the school principal before school starts. They will likely not know the identity of your child’s kindergarten teacher, but a kindergarten teacher representative can attend as well.  These meetings often occur the week or two before school starts. In this meeting, you can discuss your child’s strengths/weaknesses as well as any modifications that have worked well in the past that may help (behavior charts, picture schedules, timers, sensory diet, etc). Though you generally can’t request a specific teacher, you can also discuss what parenting/teaching styles work best for your child, and the school can try to assign the best match for your child. A quick poll of my friends who are teachers offers a resounding “YES, please let us know ahead of time!” The downside to having this conversation is that you have potentially given the child a “label” before the teacher has had the opportunity to see your child and make her own judgments. 
  
If you decide not to talk to the school, the teacher gets to observe your child with a fresh set of eyes, just as she does every other kiddo in that classroom on the first day of school. The CDC reports that 1 in 6 school-aged children have a developmental delay. And, approximately half of children with delays are not identified when they start kindergarten. Therefore, any good kindergarten teacher should be very aware that the kiddos in her class may have difficulties that have not yet been identified. Maybe she will pick up on the fact that your child may need a bit of extra help. Or maybe all those years of therapy will make your child SO prepared for school that he just fits right in. (Because that’s the goal of therapy, right?) OR, maybe your child will be completely overwhelmed by the natural chaos of the new kindergarten environment and completely shut down. It is a bit of a gamble…

If your child gets to kindergarten and you decide that he would benefit from additional help in the school setting, you can talk to the teacher/principal about beginning the process for services through the school (in addition to your private services). This can be in the form of special education, speech therapy, occupational therapy, etc. However, there is a long specific process for getting the ball rolling on these services, and it often requires several months. If needed, the Arkansas Support Network is a wonderful resource to help parents navigate the services which the school system can provide and help set your child up for success.

References: 

Resources: 
Arkansas Support Network479-927-4100



Are you a parent of a kindergartner? How has your family dealt with this transition?
I would love to hear any more ideas that you may have!

Also, if you have a question you would like me to address in my Weekly Blog


Monday, August 4, 2014

Too young for treatment?

image credit: Envato

Dear Melissa,
My son was recently diagnosed with Autism by a Developmental Pediatrician. The pediatrician recommended several different types of services, but it seems very confusing. Is all of this really necessary? He is only 2!

Forgive me for being blunt, but the short answer is YES!!! Study after study has found that beginning early with intensive services provides the best outcomes. But there are many, many, many different options. For most of us, after a problem has been identified, we simply want to “fix it” as quickly as possible. However, there are no simple “quick fixes” when it comes to Autism. In fact, many adults with Autism Spectrum Disorders (ASD) argue that they don’t want to be “fixed” at all! As I stated last week, the Autistic brain works in a fabulously different way than what is considered “typical,” and this causes many people with ASD to have wonderful strengths, even above and beyond what is considered “typical.” It is important to find treatment options that work well with your child, your family and your philosophies. This will help your child meet his fullest functional potential while continuing to retain his Autistic gifts. 

As stated earlier, there are many different treatment/therapy options.  Most of these can be provided in home, daycare, school or clinic settings (depending on your area).  Some different interventions for ASD include:
  1. Occupational Therapy (OT):  teaches skills needed for daily living such as dressing, writing, eating, bathing and socializing.
  2. Speech Therapy (ST):  helps to improve both receptive and expressive communication skills. They can also use various types of devices (from very simple to quite complex) to help children with low verbal skills learn to express themselves more effectively.
  3. Physical Therapy: helps a child with gross motor coordination, which is often affected by ASD. 
  4. Sensory Integration Therapy: helps a person interpret and appropriately handle sensory information such as sight, sound, smell, taste and touch. This therapy is often done in OT sessions. 
  5. Applied Behavioral Analysis (ABA): a specialized behavior training technique which breaks tasks down into very small parts and provides immediate rewards for appropriate responses.  
  6. Other types of behavior modification therapy: often completed with a psychologist, ST, OT or teacher trained in various behavior techniques. 
  7. Dietary modifications: typically involves eliminating foods that can negatively impact behavior.  
  8. Medical/pharmacological approaches: this can potentially help with the symptoms of ASD, but no pill can actually “cure” Autism. 
  9. *Complementary and alternative treatments: These can include various supplements, chelation, hyperbarics, etc...  
Still confused? Totally understandable! Feel free to seek further advice from your child’s pediatrician. In addition, check out other resources such as your local ASD support group, a pediatric therapist or your child's preschool teacher.

*An important note about alternative treatments: The CDC reports that approximately one-third of all parents of children with ASD have tried complementary and alternative treatments.  
However, 10% of these parents may actually be using potentially harmful treatments. It is important to discuss all treatments, both traditional and non-traditional, with your child’s doctor.  Many of the alternative treatments fall under the category of parent thought such as “can’t hurt, worth a try, everyone child is different,”  but you definitely don’t want to risk your child’s health with a potentially dangerous intervention. 

Local Northwest Arkansas Resources:
ABA Service Providers, TEAM Parent Resource
Arkansas Support Network479-927-4100

Other Resources:

Do you have a question you would like me to address in my Weekly Blog?