Monday, July 7, 2014

iPad Time: How much is too much?

Dear Melissa,
"I feel like we are raising a generation of children who spend hours upon hours a day living in an altered iPad reality. What are the recommendations for iPad usage for children with special needs?" 

This question is tricky. If you Google “iPad recommendations for children with special needs,” you are BOMBARDED with tons of fabulous apps. There are almost no articles exploring the dangers of being so absorbed in electronics that children forget to interact with the real world. The simple answer is everything in moderation, but the full answer is much more complicated than that!

First of all, I always like to look at the literature. I don’t trust what someone writes in a blog (except this one of course). I want the hard facts. However, that is precisely the problem here. There are no hard facts. The iPad is so new that researchers have not yet studied large samples of children with disabilities and measured how they responded to these devices over time.  National Public Radio (NPR) recently did a wonderful story on this exact topic. But even they were hard pressed to locate research studies on more than a dozen kiddos. 

So, I guess I am forced to give my opinion. The American Academy of Pediatrics (AAP) reports that the average 8-10 year old spends 8 hours per day engaged in various forms of media. These include TV, phones, video games, and, yes, iPads. This is too much! I totally agree with the AAP that screen time should be avoided for children under 2 years of age and limited to less than 2 hours/day for older children. The AAP has numerous research studies showing correlations between greater amounts of screen time and the following: 
1) increased rates of obesity, 
2) decreased attention, 
3) increased behavior problems, 
4) decreased academic performance and 
5) poor sleep. 
These findings included samples of “typical” children as well as studies involving children with ADHD and Autism Spectrum Disorders. 

But there are exceptions to every rule, and this is where it gets tricky. The iPad can be a magical device for children with various special needs. It is highly motivating. It can be used to practice handwriting, increase fine motor speed, practice counting money, improve typing slices, it dices…but wait! There’s more! It is used as a communication tool as well!  The communication aspect is especially important for a child with Autism, as he needs to have at least SOME form of communication...that is not screaming!  If an iPad does the trick, then so be it.  But it is not magic fairy dust. Just like the augmentative communication devices of old, it still requires many hours of education to master as a communication tool.

I also hear parents praising little Johnny for doing all of these splendid things on the iPad and claiming that he can spend 8 hours/day on it because "they are educational games!”  But again, everything in moderation. We would all agree that a child reading a book is fabulous and worthwhile, but if he is reading in his room for 8 hours a day, when is he socializing?  When is he outside playing and developing gross motor skills?  When is he learning to tie his shoes?  Same with the iPad.  I don’t care if a child can sort the jelly beans into colored jars on that popular iPad app if he can’t help the family by sorting forks from spoons in the silverware drawer!    

I would love to hear personal experiences and comments on this topic!

For more information, please follow the links below: 

Monday, June 30, 2014

Tummy Time for Babies

Dear Melissa,
I just had a baby and I want to make sure that I am doing everything I can to give her a good start!  What is “tummy time” and how do I make sure I am doing it right?

Ahh, "Tummy Time"…It seems like this is such a common buzzword among new parents these days! And this is for good reason - tummy time is SO important for babies! The American Academy of Pediatrics (AAP) recommends that babies are placed “back to sleep”, but they also recommend “tummy time.” What’s a new parent to do?  To put things simply, the current recommendation of the AAP is to place babies on their backs when they sleep in order to reduce the risk of Sudden Infant Death Syndrome (SIDS). However, the AAP and therapists alike recognize that babies NEED to have playtime on their tummies for proper muscle development. 

Tummy time helps a baby develop the head, shoulder and back muscles required to progress with their gross motor and fine motor skills. Research shows that babies who get more tummy time gain the strength and coordination to roll over, reach and crawl sooner than babies who do not receive time on their stomachs. Tummy time also helps prevent flat spots on a baby’s head known as positional plagiocephaly. In addition, as an Occupational Therapist, I love how tummy time helps a baby develop the visual, fine motor and gross motor skills needed for handwriting. These handwriting building blocks start in infancy! 

Tummy time can begin when your baby is only days old. How does tummy time actually work? Here are a few steps for successful tummy time with your baby when he/she is awake and alert:

1. Start with gentler positions. For example, consider placing your baby on her tummy in your lap, or lay down on your back with your baby on your chest facing you. If she still has her umbilical cord stump, make sure that it is not making her uncomfortable. 

2. Progress towards allowing the baby to lay on her tummy on a blanket on the floor. 

3. Make sure to use toys, mirrors, and your face to make tummy time FUN! Try to incorporate tummy time into daily activities such as applying lotion, burping your baby, and towel drying after bath. 

4. Always supervise tummy time! “Rescue” your baby if she seems frustrated or is having difficulty raising her head off the surface. 

When introducing tummy time, begin with only a few minutes at a time, several times per day.  Recommended tummy time for a 3-4 month old ranges from 20-90 minutes per day.  I like to focus on frequent, fun, short bursts of tummy time; I then work to increase that time until your little one is rolling and crawling all over the place! 

For further information on this topic, please consult:
Establishing Tummy Time Routines to Enhance your Babies Development, American Occupational Therapy Association

Monday, June 23, 2014

What is SPD?

Dear Melissa,
My 4-year-old son is very smart.  He knows all of his colors, numbers, and ABCs. Therefore, I was shocked when his preschool teacher said that he can’t sit in his chair, throws frequent tantrums and even occasionally hits the other kids. At home he has always been very active, but I thought that was typical for a four-year-old boy. His teacher suggested that we seek help from an occupational therapist to see if he has Sensory Processing Disorder. What is sensory processing disorder, and how could therapy help?

Sensory Processing Disorder (SPD), formerly known as Sensory Integration Dysfunction (SID), occurs when a person has difficulty regulating the sensory input from his environment.  This challenge relates to the 5 basic senses of sound, touch, taste, sight and/or smell. It can also relate to the 2 movement senses of vestibular input (which gives input for balance and where your body is in relation to the ground) or proprioceptive input (which gives input as to where your joints/limbs are in space). 

Children (and adults) who have SPD can have a wide range of difficulties. Some children with SPD are very timid and seem to be overly sensitive to the world around them. Other children tend to be “crashers”. They run, jump, climb (and often fall), and it seems like nothing phases them! When a child has difficulty interpreting the world around them, he can often react in inappropriate and unpredictable ways.  It is for these reasons that SPD can often mimic other illnesses such as Oppositional Defiant Disorder, behavior problems, anxiety, depression or ADHD. 

SPD is NOT a medical diagnosis but rather a symptom, often stemming from an immature neurological system. This does not mean, however, that one should neglect treating SPD. For example, fever is also simply a symptom. The fever could be from a virus, strep throat, ear infection, etc. However, you would still give your child plenty of fluids and possibly medication to bring the fever down. 

The treatment of SPD generally involves working with an occupational therapist (OT) with special training for children with sensory difficulties. Ideally, much of this treatment would take place in a sensory-rich gym area with swings, ball pits, trampolines, etc. True sensory therapy often looks like play, but it involves working with the child to carefully regulate their sensory system. This may mean encouraging the timid child to try new things or teaching the “crashing” child to choose activities which can help him obtain the sensory input he needs while learning safety awareness. Once the OT and child learn which activities work to help regulate his sensory system, then they can work together to educate parents, teachers, etc. about activities that can take place in the home and school settings. These activities can help with regulation in all areas of life. Once the child's senses are regulated, then other areas of deficit such as strength/coordination, handwriting, and dressing skills can be addressed far more effectively.

For more information on Sensory Processing Disorder, please refer to:
The Out-of-Sync Child by Carol Kranowitz

Monday, June 16, 2014

Water Safety Worries

Dear Melissa,
"It gets SO hot here in Arkansas during the Summer. I have 3 boys (one on the Autism Spectrum) and I love to take my children to the neighborhood pool or to the pool at Grandma’s house.  What can I do to keep my kiddos safe around the water?" 

Ahhh!  Nothing is better than a relaxing day at the pool!  But with kiddos in tow, don’t be fooled and let your guard down!  While swimming is excellent exercise and a great way to cool off, it can be a highly dangerous past time. This is especially true for children with Autism. Accidental drowning accounted for 91% of deaths of children under 14 years of age with Autism from 2009-2011. This is largely due to the tendency of children with Autism to elope (either from randomly wandering off or from actively running away due to sensory overload). 

Children with Autism tend to have very poor safety awareness and may lack an ability to effectively respond to verbal cues. For example, while many children respond when their name is called, this may not be the case for a child with Autism. If an adult does see a child wandering/running toward water, the child may completely ignore the adult calling the child’s name and shouting “Stop!”  Most water accidents and drownings are not due to a complete lack of supervision, but rather they are due to a brief lapse in supervision. 

Drownings generally do not involve thrashing and shouting as is often depicted on TV.  Rather, it is generally a silent event. Therefore, if a child is missing, for even a second, adults should first search the pool before exploring other options.    

Now, with these scary scenarios out of the way, what can YOU do to help keep your children safe?

1. Teach your child to swim!!! 
I can’t stress this point enough.  Teach him to swim however you can and as early as possible. Being able to swim can save your child’s life. Short of keeping your child locked in a bubble, there is only so much you can do to keep a child with Autism from getting in the water when you turn your head.  As I mentioned the topic of this blog to several of the parents I work with, they shared many stories of “close calls.”  In fact, 32% of parents of children with Autism report a “close call” with their child and drowning.   Some children with Autism take like a fish to water and learn to swim immediately. Others are very hesitant around water. If your child is of the more hesitant type, ask around for a reputable swim instructor with experience teaching children with Autism and other Sensory Processing Disorders.  Your child’s Occupational Therapist should be a valuable resource for this information. 

2. Teach pool safety “rules.” 
Most children with Autism are very concrete thinkers.  They respond well to rules and consistency.  Therefore, you should discuss water safety rules with them.  I even like to use “The rule is…” so that it is completely clear that this is a black and white, non-negotiable issue.  For example:  “The rule is, you must always have an adult present when you are near water.” Depending on the concrete nature of the child's thinking, you may need to define “near” as an arm’s length away;  “water” as a pool, creek, lake or ocean; and you may need to define “adult” as mom, dad, grandpa, etc.  Then, role play and write social stories to make these rules even more integrated. Adapt the rules to your particular situation. In addition, a younger child may not understand the term “the rules” but you can practice to ensure that he/she always holds an adult’s hand when walking on the concrete around a pool. 

3.  Practice wearing a life jacket.  
Many children with Autism have tactile defensiveness and this may make wearing a life jacket difficult.  If necessary, practice baby steps of wearing the life jacket unbuckled in the house while watching TV, then buckled, then outside, buckled, while blowing bubbles. You get the idea.  If you need further help, ask your child’s Occupational Therapist for advice.  Wearing a life jacket is non-negotiable!

4. Safety proof the pool. 
There are many things a pool owner can do to keep their pool safe for everyone:
a) Install a 4 foot tall fence with locking gates around the perimeter of the pool.
b) Make sure that a child could not move furniture, use a retaining wall, climb a tree, etc. in order to scale the pool fence.   
c) Keep toys out of the pool when the pool is not in use. 
d) If the children will be in the house, install additional security to the exit doors including hook and eye locks on the door above the child’s reach and wireless door alarms (found at Wal-mart and hardware stores). 
e) Deter access to the pool/hot tub by removing ladders and using pool covers. 

And as always, use sunblock and have fun!!!  

For more information (as well as the sources for the statistics listed above), please visit the websites below:  

 If you have more ideas on how to keep kids safe around water, I would love to hear them!

Monday, June 9, 2014

Vacation SOS

Dear Melissa,
So, my 4 and 7 year old survived the car ride to the beach. What tips do you have for making the vacation fun for my 4 year old son with Autism AND fun for the rest of the family as well? 

First, congratulations on surviving the road trip!  Now, take a deep breath…and relax!  This is a vacation after all!  The most important thing is to know each family member's special needs (because EVERYONE has special needs), and then set REALISTIC expectations.  Have you ever seen the classic Chevy Chase movie Christmas Vacation?  No vacation/holiday can be all things to all people! Here are a few tips to help make everyone as happy as possible: 

1. Prepare your child for new situations. 
Watch videos, read guidebooks, write social stories, role play.  All of these will help make these new situations predictable for your child. For example: What is appropriate personal space for standing in line or observing an animal at the zoo?  What are the rules for the swimming pool?

2. Keep a regular schedule as much as possible.
We all have know that a hungry, sleepy, tired child is more temperamental than the rattlesnake at the zoo!  It does you no good to try to squeeze in one more activity if your children are too cranky to enjoy it.  Respect bedtime.  Respect nap/rest time.  Respect mealtime.  Take breaks.  This is a vacation after all!

3. Broaden dietary horizons another time. 
There are those kiddos who are adventurous eaters and who will relish in the idea of trying new foods on vacation.  Most kiddos do NOT fall into that category!  Children with Autism tend to be particularly picky in this area.  Don’t just assume that because a restaurant has a plain cheese quesadilla on the menu that it will be prepared exactly the way your child expects it to be prepared. They may refuse it.  This goes back to the fact that a hungry child is NOT a happy child.  I am a firm believer in broadening a child’s dietary horizons, but a vacation may not be the best time to address this.  Again, know your child and try to pack healthy snacks as a back-up when possible.  Dried fruit, cheese sticks, trail mix, fruit/veggie juice boxes and peanut butter crackers tend to travel well and can serve to supplement a meal when necessary.  In addition, don’t forget to ask the wait staff about ingredients and food preparation if your child has a food allergy.  No one wants to end up in the ER on vacation due to a food allergy!

4. Consider your child’s sensory needs. 
What seems relaxing and fun to you may very well be a nightmare to a child with a sensory processing disorder. If a child can’t stand the tactile input of the sand on his feet then allow him to wear shoes or spend more time at the pool with an adult.  If a child has difficulty with bright sun, provide a hat/sunglasses (as tolerable).  If a child craves/avoids the vestibular input of the roller coaster, pair him up with another family member with a similar attitude toward the roller coasters.  If the ocean is too noisy, allow for headphones or a hoodie sweatshirt pulled over his ears. You get the idea.  If you need help, talk to your child’s OT for specific recommendations for your child’s sensory needs for a specific vacation. Better yet, give your OT a “heads up” several months in advance so the sensitivities can be addressed (and hopefully negated somewhat) ahead of time.

5.  Don’t forget your child’s favorite ____. 
Vacations tend to be times of constant new situations and transitions.  That favorite blanket, book, stuffed animal, etc. can be just what he needs to transition more easily from one situation to the next.

6. Visit guest services at the zoo, amusement park, etc. 
I know from personal experience that Silver Dollar City will put a wrist band on your child with your cell phone number in case he gets lost (as well as the child’s height so you know exactly which rides he can ride!).  Depending on your child’s tendency to wander off, determine the best way for your child to reach you if he gets lost.  If your child is unable to memorize important safety information such as your name and phone number, consider a medical ID bracelet, a card with ID information in his pocket, or in a pinch, write it on his hand with a permanent marker.

7. Take extra care at hotels.
Again, know your child's potential wandering habits. At the very least, always use the safety latch at the top of the door. You can also look for hotels with the designation as “Autism friendly” by the Center for Autism and RelatedDisorders.  Many of these hotels supply door alarms as well as other items to assist with sensory needs such as extra blankets/pillows for sensory input or mini fridges to house diet-specific foods. 

8.  Prepare for water safety. 
Accidental drowning is the leading cause of death among children with Autism. This is largely due to the tendency of children with Autism to wander off and have poor safety awareness. Have your child practice wearing a life jacket prior to your vacation. If possible teach your child to swim and to use water safety rules.  Compromising safety is NOT an option!  (More tips on water safety will be discussed in next week’s blog.)

For more information, please visit the following: 
Autism Speaks Travel Tips
Family Travel Forum
Travel Tips for Children with Autism, by Ruth Manuel-Logan, Parents Magazine 2013

If you have more ideas for family fun on vacation, please let me know!

Monday, June 2, 2014

Travel Time!

Dear Melissa: 
Help!  I am about to take my children (4 and 7 years old) on a road trip to the beach!  Any ideas to keep us all sane for a 12 hour drive?

So you and your family have spoken to friends, consulted the internet ( possibly even Facebook) and have planned the perfect family vacation.  The hotel is booked, the travel route planned, the car is packed. Then it hits you like a rock in the pit of your stomach…you and the kiddos are about to be “trapped” in the car for 5, 10, 15 hours.  What to do? It may be tempting to just use the ipad and DVD player for entertainment, but you can do better than that!  Never fear!  The following are tips for keeping the whole family sane on those long road trips.  While these ideas were created for children with Sensory Processing Disorders in mind, they are great ideas for all kiddos stuck in the back seat of your car: 

1.    Books on CD. Some favorites in my house are The Magic Tree House series, Junie B. Jones and Harry Potter.  These can be checked out (for free!) at most local libraries. 
2. Silly putty/play-doh in a zip top bag.  This allows the child to squeeze and squeeze til his hearts content without the putty getting stuck in your floor mats. 
3. “Drinking games.”  This idea helps to keep your kiddos from chugging down those juice boxes too fast.  Make it a game so that they can only take a sip when they see a certain item.  For example, the letter “T” or a yellow car.  An added bonus is that a slower sipping time will also lead to fewer bathroom stops.
4. Origami.  Check out an origami book at the library, get a folder of paper and go to town.  Voila!  Mess free art!
5.  Aluminum foil animals.  The origami too complicated?  Give each child a sheet of aluminum foil, have them create an animal and see if the rest of the car can guess what it is.  More mess free art!
6.  Color wonder books.  I know these things are a bit pricey, but they are fantastic mess free fun and a great treat for long trips. 
7. Sing along.  Yes, you could sing along to the soundtrack from Frozen for the hundredth time (today), but what about the songs YOU like?  Download/make a CD of great sing along pop songs from your youth.  Some favorites in my house include “Sweet Caroline,” “Brown Eyed Girl,” “I Love Rock and Roll,” and “Funky Town.”  There are also a lot of great rock/pop songs from the Shrek series and other current kids’ movies that will appeal to both the kids and the adults. 
8. Pencil pouch eye spy.  Fill a clear-sided pencil pouch with dried beans/rice.  Then add a few colored buttons or other small trinkets and have contests as to who can find a given item the most quickly. 
9. Gross motor at the gas station.  When you DO stop to eat/potty/refuel, take 5-10 minutes for gross motor time.  If a small strip of safe area is available, have the children “race” from one adult to the next, standing at each end of the safe area.  If this is not possible, have the children do frog jumps, jumping jacks or simply just dance next to the car for a few minutes. 
10. Unwrap a mystery.  Take old scraps of tissue, wrapping paper or newspaper and wrap up any of the new toys, sticker pages, trinkets or games I have mentioned.  Getting to choose and unwrap the mystery item will create double the fun!  These “presents” can also be held back as rewards for good behaviors at certain check points if needed as well.
11. Sleep?  Scheduling travel time during nap/bed time can be tricky.  If your child always sleeps well in the car, then this can give you an hour or two of blissful silence.  However, if you loose this gamble, you may well end up with an extremely cranky pre-schooler for hours on end. 
12. Pack a survival kit.  Must-haves include wet-wipes, napkins, snacks/drinks, sport bottles, empty cups (for snacks) and lots of slide-top plastic bags.  Also include the standard first aid kit with Tylenol, bandaids, antibiotic ointment, Dramamine, Benedryl, etc. as your doctor approves. 
13. Stay buckled!  Last, but most important, keep each child in his/her recommended car seat/seat belt at all times.  Compromising safety is NOT an option!

For more tips and ideas, visit the following websites/links:

If you have your own fabulous car trip survival ideas, please let me know!