Do Children with Autism understand Consequences? Tips for Countering Misbehavior in the Home

Typically developing children get to a certain age where they have the cognitive capacity to understand consequences of their actions. They also begin to understand that certain actions based on bad behavior leads to discipline (i.e. hitting another sibling or a parent leads to getting favorite toys taken away from a certain time). The lines are fuzzy when determining the best age range to start disciplining your child with negative consequences if you are relying on information from parent and children’s health blogs. So, we go to the evidence-based research for answers.

According to the Canadian Paediatric Society (2004), typical children between the ages of 3 to 5 years old begin to understand that bad choices or behavior leads to negative consequences. Although their language capacity is still small, they can partially appreciate basic rules and why parents discipline them with timeouts or small punishments. So, if 3 to 5 years of age range for “typically” growing children, what does this mean for children with autism spectrum disorder? Does a young child with autism understand discipline for their actions similarly to their peers?

Many parents seasoned in autism-related literature and research may already understand what impairments are featured in autism spectrum disorder (ASD) cases and how those impairments impact fully understanding rules and consequences. For those parents who are still grasping for answers, let’s first break down what it means for a child to receive a diagnosis of ASD. The DSM-5 states that a child can be diagnosed based on the following criteria:

Persistent deficits in social communication and social interaction across multiple contexts

  • Deficits in social-emotional reciprocity
  • Deficits in nonverbal communicative behaviors used for social interaction
  • Deficits in developing, maintaining, and understand relationships

Restricted, repetitive patterns of behavior, interests, or activities

  • Stereotyped or repetitive motor movements, use of objects, or speech 
  • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
  • Highly restricted, fixated interests that are abnormal in intensity or focus
  • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (American Psychiatric Association, 2013)

Besides social communication impairments and restrictive patterns, cases of ASD can also be paired with intellectual and language impairments which contributes to the severity of each case. In more simple terms, a child with ASD does have to exhibit symptoms laid out in the DSM-5, but each child’s severity varies thus their ability to understand things on any cognitive level will be different in each case.

What does this mean for disciplining a child with ASD who is misbehaving? If your child has ASD, you cannot expect typical punishments and durations to work. For a typically developing to understand consequences set up by parents, several factors need to line up including: the bond between the child and the parent, the child’s communication and language abilities, the child’s ability to understand what is “fair”, and the child’s ability to learn discipline from parents in order to self-discipline in the future (Canadian Paediatric Society, 2004).

Children with ASD not only have limited or different understanding of discipline, but they also “misbehave” for completely different reasons as compared to their peers. Poor behaviors such as self-inflicted injuries, hitting other family members, throwing toys, spitting out food, screaming at the top of their lungs, or refusing to complete tasks set up by parents and/or teachers often stem from internal processes that aren’t obvious. This may include: pain, sensory processing disturbances, anxiety, and stress. Typical methods for discipline not only may NOT work, but could also worsen the child’s behaviors.

Occupational therapy as well as many other disciplines can assist parents and their children with ASD by providing tailored plans for their family to counter poor behaviors. Consult with a specialist (i.e. pediatrician, psychologist, behavior specialist, occupational therapist, speech therapist, etc.) if your child is struggling with behaviors that you are at a loss for how to resolve on your own.

References:

Effective discipline for children (2004). Canadian Paediatric Society. Paediatric Child Health, 9(1): 37-41. www.ncbi.nlm.nih.gov. Viewed on Feb. 4, 2019. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Food Allergies: How a Pleasant Eating Experience for a Child May Have Hidden Adverse Effects on Behavior

Self-feeding should innately be a pleasant experience for any human being. Ingesting foods and liquids nourishes the body and mind, jumpstarting a person to continue on with their day and to participate in other activities that matter to them. For children, having healthy diet plans provides them with energy to complete school work, to play outside, to take part in sports, to finish their chores, and to participate in other daily living tasks (i.e. dressing, toileting, showering, sleeping, etc.).

Unfortunately, self-feeding doesn’t always have happy results especially if parents and caregivers are unaware of finely masked problems with food: food allergies and food intolerance. According to WebMD (2018), the terms “food allergies” and “food intolerance” have very different meanings and are often mistaken for each other. A food allergy occurs when the immune system is actively fighting against something in the body when it doesn’t need to. Food intolerance produces symptoms of discomfort (i.e. indigestion), but the immune system isn’t actively doing anything (Food Allergy Intolerances). Of course, food allergies and food intolerance produce a long list of symptoms depending on the child’s body type and can include: skin reactions (i.e. hives, rash), respiratory problems, flu-like symptoms, indigestion, headaches, and other body aches to name a few. These reactions can range from very mild to extremely severe. In this article, we will be focusing on the connection between childhood food allergies and changes to behavior.

Physical reactions to food allergies and intolerance can rightfully make a child very moody or angry due to discomfort or pain. Common foods that children struggle with may include: dairy, wheat, gluten, barley malt, sugar, soy, nuts, shellfish, and eggs. Additional elements found in food that may be a cause for problems include preservatives, food dyes, foods high in salicylate (i.e. which is found in aspirin), and pesticides.Dr. James Greenblatt (2017) wrote an article regarding dietary elements that influence behavior in children, particularly those with ADHD. He discusses and references several studies about how the following food compounds increase behavioral problems: sugar, casein (a milk-based protein), gluten, and food dye. Some of these compounds, when ingested, have been found to increase the likelihood of an ADHD diagnosis in children as well as the following: anxiety, brain fog, hyperactivity, inattention, impulsivity, aggression, and delinquent behaviors.

Health Day News (2018) references a study that involved almost 200,000 children in the United States from ages 3 to 17 years. One finding emphasized how children with autism were more likely than their typical peers to have food allergies (Allergies More Common In Kids With Autism ). Another article referenced a renowned naturopath and acupuncturist, Duane Law, who has heavily researched food allergies causing inflammation and a stress response (Dunckley, M.D., 2013). He made a connection between inflammation in the digestive system and sending the body into fight-or-flight mode. For children with autism, this inflammation and stress response can be a cause for endless behavior problems especially because some of these children are unable to verbally communicate or describe their symptoms or reactions.

As far as food allergies go, what does this mean for parents and caregivers?

Food allergies and food intolerance are issues that all parents and caregivers should consider for their children, even in the absence of other medical diagnoses. For parents of children with developmental or psychiatric disorders, consider that your children may be at higher risk for having food allergies and intolerances. Observe your child. Make note of what their behaviors are like before and after meals. Write out a daily log about foods and liquids that your child ingests, the portions, and the subtle behavioral changes. Some behaviors may not be food-related at all, but it is best to log everything. Do your research. If your child does have a diagnosed medical, psychiatric, or developmental disorder then read up on highly reviewed material about allergy risks associated with your child’s condition. Consult with a professional, particularly an allergy specialist, before making drastic changes to your child’s diet. Appropriate testing may reveal information about your child that you would not have seen otherwise in regards to their diet.

Reference: Greenblatt, J. (2017). Dietary influences on behavioral problems in children. Viewed on Nov. 12, 2018. Stephens, K., Dunckley, V.L. (Ed). (2013). Food, Inflammation, and Autism: Is there a Link? Viewed on Nov. 12, 2018.

Summer Activities promoting your child’s mental Health: Ages 3-5 years

As parents, when we contemplate our child's overall growth and development, how many of us get caught up in their mobility and physical capability that we forget about their mental growth? Mental health is already a realm approached with caution and stigma in the adult world, so it's fair to say that we shy away from this topic when it comes to children.

The CDC (Centers for Disease Control and Prevention) reveal that 1 in 5 U.S. children from ages 3 to 17 years old have a diagnosable mental, emotional, or behavioral disorder. Only 20% of these children receive an actual diagnosis and 80% do not get treatment. (Generation at risk: America's youngest facing mental health crisis) This data collection does not just include the typically heard of childhood diagnoses such as autism and ADHD. This information encompasses children who are battling depression and anxiety disorders as well.

Hold on. Some parents may think that depression or anxiety cannot possibly be concerns for children this young. However, the signs are more prevalent during this time of life than we think. The symptoms just manifest themselves differently compared to adults with depression or anxiety. If these conditions aren't appropriately addressed during childhood, then behaviors escalate and turn into unmanageable challenges during the teen years. For example, according to the CDC, serious depression is worsening in teenagers and the suicide rate among specifically teenage girls reached a 40-year high in 2015.

So, how do you know if your child's mental health is less than optimal? By comparing their behaviors to other children their age. The Child Mind Institute (2019) provides a wide variety of tips for parents regarding what signs to look for in children 3-5 years old with behavioral problems:

  • Is your child having more serious tantrums than typical kids their age?
  • Are they abnormally more exhausting and difficult to manage>
  • Have they been suspended from early school programs or excluded from play dates?
  • Are they intentionally withdrawn from those around them?
  • Is your child's behaviors seriously disrupting family life and straining other family members?
  • Are you concerned about your child hurting siblings or others?
  • Is your child's behavior converting your relationship with them into a negative one? (Problem Behavior in Preschoolers)

Ages 3 to 5 years is the prime time to focus deeply on positively influencing your child's mental health because just in a short while after, they will be in school when managing behavior becomes increasingly more difficult. Please consider the following tips pertaining to helping your child stabilize their mental health in the form of a summer activity schedule:

  • Make your own observations. Put down your phone and "busy hands" work and study your child throughout the day. Watch how they participate in the day-to-day activities, whether it's alone or with other children. Ask thoughtful questions without judgment about their feelings and about whether certain activities and people help their mental health or set them off into a ball of stress and anxiety.
  • Consult with a professional. If you as a parent are not experienced in behavioral assessments, consult with a professional who can give you a second opinion about your child's behavior. Yes, some tantrums and ballistic behavior is normal for kids of this age group, but a professional will have an eye for details that go unnoticed by most parents.
  • Take goals one week at a time. Identify only one item that you want to work on with your child in order to better their mental health.  Examples include: anxiety, outbursts at home, outbursts in public, shutting down or withdrawing when activities get too difficult, etc. Choose just one item and take it one week at a time. Mental health is delicate and it is easy to bombard a child with too many techniques which can make matters worse.
  • Apply breathing techniques. Teach your child active breathing techniques. When things get tough and you can see the tension in your child bubbling, get them into a pattern of breathing slowly, deeply, in through the nose, and out through the mouth. Tell your child why they are actively breathing and how it reduces anger and stress.
  • Try out some summer yoga. Yoga for children is growing and becoming a very popular technique to self-manage difficult behavior. If you are already a yoga guru, research some new techniques that you and your child could use together. Get on your computer and look up community resources for pediatric yoga. (Poses for Kids)
  • Try out some mindfulness strategies. Like yoga, mindfulness is growing in popularity among children to reduce stress and anxiety. Research mindfulness strategies (Mindfulness Activities for Children And Teens: 25 Fun Exercises For Kids) on your own or consult with a professional who is certified or educated in providing mindfulness sessions for children.
  • Assess your own mental health. Keep your own mental health in check because your child will only feed off of your own stress and anxiety.  Find a stress-reducing strategy that works for you. Make time to treat yourself every once in a while. Get adequate sleep and food/water intake. Your child may learn to mimic the self-care that you provide yourself.

Mindfulness and Children

Before your imagination runs wild, keep in mind that the term “mindfulness” is not a dismissive practice used by hipsters among the adult population. Mindfulness has become a well-respected practice used by many skilled professionals (i.e. occupational therapists, social workers, psychologists, etc.) as well as laypeople and caregivers. Mindfulness can be defined as the following, according to a Psychology Today article:

  • Returning to the present moment
  • Letting go of taking things for granted
  • Self-regulation of attention with an attitude of curiosity, openness, and acceptance. (Niemiec, 2017)

Another relevant definition also can include:

“Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.” (Mindfulness Staff, 2014).

In a more functional description, applying mindfulness to daily activities looks like purposefully slowing down in order to mind and to experience things for everything they are. For example, mindfully eating a raisin would include appreciating everything about the activity with all senses: what does the raisin smell like, look like, feel like between the fingers and on the tongue, sound like when being chewed, etc.

Mindfulness is used to pull ourselves out of the automatic mindset, so instead of doing our day-to-day tasks mindlessly (which is easy to do for repetitive activities such as eating, showering, toileting, performing work-related tasks, etc.), we thoughtfully consider all of the elements that go into one or all of these tasks.

So, why should we even use mindfulness? What health benefits does it address? According to Davis and Hayes (2012), mindfulness can provide individuals with the following: increased focused, enhanced working memory, decreased stress, reduced rumination (or reduced deep thought that can lead to unhealthy and persistent distress), increased emotional regulation, improved satisfaction in relationships, and increased cognitive flexibility.

Mindfulness can be inadvertently advertised to the general population as a technique used solely by adults. In fact, mindfulness has become well-researched in its uses and benefits among children. Although adults experience daily problems that can stress and other jabs to their mental health, children are just as susceptible to mental and emotional strain. Depend on what a child is going through, he or she can experience stress, anxiety, irregular emotional issues, and depressive symptoms that hinder their ability to perform activities that are most meaningful to them (forming friendships, completing homework, participating in sports and other extra-curricular activities, playing in their free time, etc.).

David Gelles is an author who has practiced mindfulness for the last 20 years. He published an article with the New York Times regarding mindfulness and children. Aside from providing some fantastic resources and insight about using mindfulness with children, he proposes that mindfulness techniques can be used with children as young as infancy. Of course, little babies are not going to be able to participate in mindfulness strategies on their own because they lack developed movement and language skills. Mindfulness in infancy is only effective when parents and/or caregivers actively use mindfulness techniques themselves which then can be shared with the baby. Examples include:

  • Putting away all distractions (i.e. phones) in order to fully engage with the baby. This means making consistent eye contact, making faces, talking to your baby, or any other communication forms that mean that you are connecting with the child.
  • Practicing a sense of calm when your child is distressed (dirty diaper, gassy, hungry, sleepy, hurting, etc.)
  • Finding ways to move and to meditate during the baby’s down time or when the baby does not require your immediate and consistent attention.

Mindfulness is very beneficial for children across the lifespan, but can only be effective if someone is willing to embody and to guide them in practicing the techniques. Sift through the following references at the end of this article and study additional material in your free time. Consult with a doctor or other healthcare professional about how to learn mindfulness and how to apply it in your home.


References

Davis, D., M. & Hayes, J.A. (2012). What are the benefits of Mindfulness. American Psychology Association, 43(7), p. 64. https://www.apa.org/monitor/2012/07-08/ce-corner.aspx. Viewed on Jan. 2, 2019.

Gelles, D. (n.d.). Mindfulness for Children. New York Times. https://www.nytimes.com/guides/well/mindfulness-for-children. Viewed on Jan. 2, 2019.

Mindful Staff (2014). What is Mindfulness? Mindful. https://www.mindful.org/what-is-mindfulness/. Viewed on Dec. 31, 2018.

Niemiec, R.M. (2017). 3 Definitions of Mindfulness that might Surprise You: Getting at the Heart of What Mindfulness Is. Psychology Today. https://www.psychologytoday.com/us/blog/what-matters-most/201711/3-definitions-mindfulness-might-surprise-you. Viewed on Dec. 31, 2018.

Wiggles for 3 to 5 year olds: Summer Ideas for Motor Development

Summer is on its way, which means for many parents across the United States more time with kids. Yearly preschool and other fall and winter programs are over, so now you are on your own in your quest to keep your children occupied. You probably have building up an arsenal of summer activities during these hibernation months, and you probably think that you have those long, 3 months handled. Then, the first two days of summer pass and you have used up every single idea and you are now left high and dry with children who are driving you crazy.

Time to switch the gears. From an occupational therapy standpoint, there are endless amounts of summer activities that you could apply in order to get your children moving. OTs are all about the goals, and there is much truth in being able to utilize your time wisely with your children if you have goals in mind. Children from the ages of 3 to 5 years old are very busy growing and learning. Parents can facilitate that growth by implementing activities during the summer schedule.

In order to keep things simple, let’s only focus on a child’s motor development. This means developing skilled movement patterns in order to participate in daily tasks that are the most meaningful or necessary for a particular age group. Motor development is broken down into fine motor (using fine movements of the hands) and gross motor (using large muscle groups to perform bigger movements) development. According to the CDC (2019), typical growing children between the ages of 3 to 5 should be able to do the following:

3 years:

  • Climbs well
  • Runs easily
  • Pedals a tricycle (3-wheel bike)
  • Walks up and down stairs, one foot on each step

4 years:

  • Hops and stands on one foot up to 2 seconds
  • Catches a bounced ball most of the time
  • Pours, cuts with supervision, and mashes own food

5 years:

  • Stands on one foot for 10 seconds or longer
  • Hops; may be able to skip
  • Can do a somersault
  • Uses a fork and spoon and sometimes a table knife
  • Can use the toilet on her own
  • Swings and climbs

Of course, the CDC is not the only foundation that provides developmental milestones information so parents should do their research and review all sorts of developmental charts. If your child appears behind or delayed in some motor performance skills, this is not always a sign of alarm. However, parents should make themselves aware about their own children’s development so that in the event there is a concern then help can be provided early on. This is an essential growing period that prepares children for more complex tasks outside of the home including school and community programs.

Rather than going down the bullet point list and making your child follow a rigid activity agenda, consider using some of the following tips to foster your child’s motor growth:

  • Set up play dates: It is hard when you’re a parent of very young children, and getting out of the house every day can be a terrible hassle. However, scheduling play dates can be very beneficial for your child’s development. Purposefully have your child hang out with other children who are at similar or even higher motor development levels. It is astounding how much children learn from each other by simply watching each other move around in their environment.
  • Go to the playground: If you do not have that swing set or jungle gym in your backyard, go to your local playground. It’s free and full of obstacles that can appropriately challenge your child to move (hopping, jumping, ducking, climbing, crawling, etc.). If you are capable, join them and play on the equipment with your child. Make a habit out of “playground hopping” so that your child can utilize new and different obstacles each week.
  • Take your children on picnics: Schedule a time during a nice afternoon where you can take your children on a picnic. Load your basket with fun foods with a variety of textures. Let your child help with setting up the picnic area including passing out plates and plastic ware, laying out the blanket, pouring the drinks, etc. It doesn’t have to be perfect and yes, your child will probably spill things. However, it gives your child exposure and opportunity to practice meal prep and self-feeding demands.
  • Send your children outside no matter what the weather looks like: With the exception of severe weather and hail, let your child go outside no matter what type of precipitation is coming out of the sky. Have them dress appropriately by donning and doffing weather-appropriate clothing. This gives children lots of practice in self-dressing tasks, manipulating buttons and zippers, lining up Velcro, tying shoes, etc.

References

Learn the Signs. Act Early. Important Milestones (2019). Center for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-5yr.html. Viewed on March 27, 2019.

Pediatric Home Health

Early Onset Schizophrenia and its Impact on Child Development and Function

When we think about the term schizophrenia, we reasonably picture an adult exhibiting bizarre or unexplainable behaviors. However, there is a very rare condition called early onset schizophrenia in which children under the age of 18 experience a break down in mental health. What is early onset schizophrenia? According to the Mayo Clinic (2019), this type of schizophrenia can present with the typical symptoms of hallucinations and delusions in teenagers:

  • Hallucinations: Hearing or seeing things that do not exist (i.e. hearing voices, seeing people who others can’t see).
  • Delusions: Holding false beliefs (i.e. believing that you are famous when you are not, believing you have superpowers, etc.).

Other symptoms of typical schizophrenia include disorganized thinking or disorganized speech (i.e. word salad or reciprocating inappropriate or odd conversation) as well as negative symptoms with is a reduced capacity to function normally (i.e. lack of hygiene, social withdrawal, disinterest in activities, lack of emotion, monotone speaking, etc.). These symptoms can present in teenagers, but may not yet come to light in children with early onset schizophrenia under the age of 13.

In extremely rare cases, children between the ages of 7 and 13 years can be diagnosed with early onset schizophrenia but the symptomology presents a little differently. The following may or may not be symptoms of schizophrenia in early childhood, according to the Mayo Clinic (2019):

  • Language delays
  • Late or unusual crawling
  • Late walking

Other abnormal motor behaviors — for example, rocking or arm flapping https://www.mayoclinic.org/diseases-conditions/childhood-schizophrenia/symptoms-causes/syc-20354483. The American Academy of Child and Adolescent Psychiatry (2013) states that the following symptoms are often found in children with early onset schizophrenia as the approach the teen years:

Schizophrenia is still being heavily researched regarding its etiology. Researchers believe that there are both genetic and environmental explanations for why schizophrenia is triggered in some individuals. As far as function is concerned, schizophrenia left untreated can have a detrimental impact on a person’s ability to carry out day-to-day living tasks. Imagine how hard it would be on a child who is just starting to get used to the requirements of life.

Pediatric occupational therapy has a place in the world of mental health, including any affected individual across the age span. When it comes to early onset schizophrenia for a very young child, an OT’s work may include the following:

  • Consultation and Evaluation: The OT will want to complete a detailed evaluation of the child, whether that is in the home or in a clinical setting. Assessments will include testing the child’s developmental milestones, tracking strengths and weakness, and how delays are impacting a child’s ability to participate in activities typical of their age.

  • Interdisciplinary communication and collaboration: Schizophrenia is a very complex disorder, no matter how old the individual. Thus, it would be wise of the OT to collaborate with relevant clinicians who may also be working with the child. This will include pediatricians, mental health counselors, and/or psychiatrists. The OT will need to review the child’s medication schedule, if there is in fact one that has been recommended by a doctor already. The medications schedule will need to be coordinated with the OT intervention in order to help the child participate in the most optimal way possible. Intervention planning: After the evaluation period, the OT will then plan out interventions and goals with the parents and the child. Goals are related to developmental milestones as well as to what area the child or parent’s find the most important. Examples include hygiene, dressing, motor activities (crawling, walking), social participation, academics, play, self-feeding, dressing, sleeping, and community activities just to name a few.

  • Caregiver/parent education: Of course, all interventions need to be followed up with education for the parents and caregivers of the child. This includes providing handouts and information that proves helpful for parents and caregivers to carry out interventions in the absence of the OT.

What Parents can do at home with their Child to Prepare for Airline Travel

Airports are giant vessels for stress and anxiety, even for full-grown adults. Climbing into a compact, metal bird with dozens of other people certainly doesn’t ease any of that tension. Thus, it is reasonable to ascertain that young children often do not take well to this set-up either. How many parents are limited in their travels because their children do not tolerate airplane rides? How many parents absolutely refuse to bring their child on a plane because their special needs far outweigh the benefits of a trip through the skies? It should come as no shock that there is a significant number of families who will choose ground travel or no travel at all.

However, a time will come where walking aboard a plane with a young child (or several) becomes inevitable for some families. You are weeks out from your trip and you are sweating about all of the possible scenarios in which this trip can go terribly wrong because of your child’s behaviors. There are some things you can do several days or weeks before your trip begins in order to prepare your child for the long haul:

  1. Call the airport regarding special needs and accommodations: If your child has a clear history of behavioral issues or developmental concerns that will impede travel, call the airline ahead of time to arrange for accommodations. By law, airlines in the U.S. must make reasonable efforts to accommodate for a passenger’s special needs. This includes wheelchair and other durable medical equipment accessibility, shortening wait times at security, etc. If you are lucky, you might be able to arrange a tour of the aircraft where your child can check out the plane and get comfortable with the seating arrangements.
  2. Warn and mentally prepare your child: If this is the first time that your child has flown on an airplane, you will want to inform them of the trip (especially if they are old enough to grasp the concept). Give them a daily countdown until the trip using a visual calendar. If you think it will help, show them Youtube videos of airplanes (interior and exterior) taking off and landing at airports. Let them participate in packing their own luggage.
  3. If you can, spring for first class seats: If you are financially able, spring for the first class seats. First class has a ton of leg room, less people, recliner seats, and faster flight attendant services.
  4. Consider sensory triggers that may aggravate your child: Before you trip, organize and assess all of the triggers that set your child off: noises, lighting, foods, medications, touch and proximity to others, lack of sleep, hunger, dehydration, bodily pains or discomforts, certain activities, etc.
  5. Bring items that will alleviate or stall behavioral problems: Account for and bring any toys, games, books, blankets, snacks, or other items that you frequently use at home to calm your child. Call and confirm with the airport that said items are appropriate and will be allowed in carry-on luggage.
  6. Practice long waiting periods at home or in other community settings: Find opportunities to practice and to work up to long waiting periods in sitting. Practice according to how your child will be seated on the plan (i.e. parent’s lap or an individual seat). Using a public transit bus is effective because you can increase waiting periods per stop or you can get off of the bus at any stop if your child is having trouble. Some children struggle with wearing a seatbelt on the plane, which can be difficult for flight attendants to work around. If that’s the case, find time to go on long car rides with the child wearing their seatbelt and incrementally work your way up.
  7. Have a plan when something does go wrong: If you are going on a long flight, face the fact that your child will most likely have a melt-down despite your best efforts. Have a game plan for how you will handle it and whether or not you will be recruiting flight attendants for help. Let the airline know ahead of time what these meltdowns look like for your child and what kind of space and accommodations will help ease the problem.

Not all parents with children have to be limited to ground travel, but it’s also safe to assume that airline travel will not always go smoothly. Prepare now, well in advance so that you and your child can manage a waiting period in the sky.

Childhood Obesity and its impact on Daily Function

When children are still in their infancy, round tummies and pudgy legs are cute and even encouraged. Pediatricians and other childhood clinicians emphasize the importance of providing children with plenty of nourishment including healthy fats in order to foster development. However, there comes a time in a child's life when fat rolls are no longer cute but are in fact dangerous to the child's health and ability to function.

According to the CDC (2018), 13.7 million children and adolescents in the United States between the ages of 2 and 19 years old are obese. Roughly 14% of children in the U.S. between the ages of 2 and 5 as well as 18% of 6 to 11 year-olds are considered obese (Centers for Disease Control). This leads us to an obvious question: What exactly does it mean when a child is considered obese?

A parent or clinician can determine if a child (or anyone for that matter) is overweight by using the Body Mass Index, which is calculated using weight and height measurements in order to determine body fat percentage. This percentage can be compared against charts (Centers for Disease Control) that reflect BMI readings of children across the U.S. in order to gauge a child's weight. Children whose BMI percentile is at or above 85 are considered overweight.

Obesity-related medical conditions are highly talked about and dangerous among the adult population, so what does this mean for children? According to the CDC, the negative consequences to a child's health are really not that much different from an adult. Immediate health risks from childhood obesity include: glucose-insulin imbalances and Type II diabetes, cardiovascular problems, asthma, anxiety, depression, joint and musculoskeletal problems, sleep apnea, high blood pressure, high cholesterol, esophageal reflux, liver diseases, and gallstones to name a few (Centers for Disease Control).

According to the Childhood Obesity Foundation (2015), some children run a higher risk for obesity because of some of the following reasons:

  • Consume food and drinks that are high in sugar and fat on a regular basis such as fast food, candy, baked goods, and ESPECIALLY pop and other sugar-sweetened beverages
  • Are not physically active each day
  • Watch a lot of TV and play a lot of video games, activities that don't burn calories (sedentary time)
  • Live in an environment where healthy eating and physical activity are not encouraged
  • Eat to help deal with stress or social problems
  • Come from a family of overweight people where genetics may be a factor, especially if healthy eating and physical activity are not a priority in the family
  • Come from a low-income family who do not have the resources or time to make healthy eating and active living a priority
  • Are exposed to the aggressive marketing of energy-dense foods and beverages to children and families
  • Have a lack of information about sound approaches to nutrition
  • Have a lack of access, availability and affordability to healthy foods
  • Have a genetic disease or hormone disorder such as Prader-Willi syndrome or Cushing's syndrome (Childhood Obesity Foundation)

Childhood obesity can drastically hinder a child's ability to perform daily tasks, ranging from tasks that need to be done (i.e., schoolwork, chores, daily hygiene routines, sleep, etc.) and tasks that they may want to participate in (sports, playing with friends, etc.). While there are some legit medical reasons for childhood obesity, many cases can be prevented or changed if a child and their immediate caregivers are willing to make some lifestyle transformations.

Occupational therapy can play a relevant role in a child's life if obesity is the major barrier to functional participation.  Approaches would include:

  • A full evaluation of the child including medical conditions, barriers to functional performance, the child's daily routine, the child's favorite activities and preferences, etc.
  • Therapeutic exercise routines and schedules that would match the child's interest and engage them in regular movement.
  • Lifestyle redesign which would include reducing or eliminating maladaptive behaviors and habits that contribute to the child's obesity (i.e., screen time, food choices, etc.).
  • Cognitive or behavioral intervention which would be helpful for children who struggle with hidden issues that could be negatively impacting their ability to participate in healthy routines (i.e., anxiety, depression, stress, developmental or mental disorders, etc.)
  • Caregiver or family education in order to assist the child in staying consistent with their intervention plan. Parents or immediate caregivers have a lot of say and more power in determining whether or not the child sticks with healthy changes.

Consult with a pediatrician today if you think that your child is at risk for obesity. Proactively prevent medical and functional problems that your child would go through now and in the near future.

Spatial Awareness in Children: What it is and its Impact on Daily Participation

Before we hop into the basic definitions of “spatial awareness”, let’s also define some similar terms and determine how those terms are related. If you google the word “spatial awareness” just for the sake of your own research, several similar terms pop up: spatial cognition, spatial perception, and visual spatial awareness. What do these words actually mean?

  • Spatial cognition: This refers to a branch of cognitive psychology that focuses on assessing people regarding how the use and gain knowledge about their environment in order to get around and to survive. (https://www.apa.org/pubs/books/4318108.aspx)
  • Spatial perception: According to Britannica.com (2018), spatial perception is:

    “[the] process through which humans and other organisms become aware of the relative positions of their own bodies and objects around them. Space perception provides cues, such as depth and distance, that are important for movement and orientation to the environment.” (https://www.britannica.com/science/space-perception).
    Visual spatial skills: This refers to a person’s ability to orient themselves to space around them using objects and other items in their environment through eye sight and to organize that information into meaningful patterns. (https://www.britannica.com/science/space-perception)

  • Spatial awareness: According to Hohmann, Weikart, & Epstein (n.d.), as referenced by Kathuria of the Plainfield Public School District, spatial awareness is "an awareness of the body in space, and the child's relationship to the objects in the space." Additionally, spatial awareness includes two main factors: orientation and visualization. (https://www.state.nj.us/education/ece/pd/spatial/PresSection1.pdf)

Don’t get too caught up in the technical information. In simplest terms, spatial awareness is what we are focusing on, but it should be noted that “spatial perception” and “visual spatial skills” are encompassed in the whole idea of spatial awareness. So, what does this have to do with your child?

Spatial awareness is a process sourcing from your child’s brain. As they develop after birth and are exposed to all sorts of things in their environment, they are fine-tuning their spatial awareness in order to participate in all daily tasks. Kids have to have good spatial awareness skills in order to navigate the stairs, walk around furniture in the house, sit down on a chair, jump over toys, etc. Aside from movement, spatial awareness is crucial in the less obvious activities such as handwriting, eating, drawing, navigating a school setting or a neighborhood, using a pair of scissors to cut paper, and so on.

Some children may experience delays or deficits in spatial awareness skills, which can have a long-lasting impacting on their ability to function day to day. What makes it so difficult is that, like many cognitive functions, spatial awareness is not physically visible to the untrained eye and so parents/caregivers may not even recognize that there is a problem. Children with developmental delays and certain diagnosable conditions may have spatial awareness issues: autism, Down syndrome, unspecified learning disabilities, dyslexia, Turner syndrome, blindness, developmental coordination disorder, and cerebral palsy to name a few.

If you suspect that your child is struggling with some underlying issues that you find challenging to identify, especially if those issues are hindering movement or their overall participation in tasks that are most meaningful to them (i.e. school, community sports, playing with friends, home activities and responsibilities, etc.), consult with a pediatrician as soon as possible. Spatial awareness deficits can be identified through testing administered by a professional.

Pediatric occupational therapists can also help parents and children identify whether or not limited spatial awareness skills is a concern. Although OTs can’t make medical diagnoses, they can utilize standardized tests to see if a child is in fact struggling with tasks that require spatial awareness skills.

After testing, OT can also provide skilled interventions to improve or to compensate for spatial awareness challenges. Such interventions can be provided in the home or in an outpatient, pediatric setting. Consult with a doctor today, and conduct your own research about spatial awareness and what can be done today.

Reference
Educating Young Children, Chapter 16, Space (p.428) by Author(s), Mary Hohmann, David P. Weikart, and Ann S. Epstein- 3rd Edition, Ypsilanti, MI: High Scope Press, High Scope Educational Research Foundation.

Reading with Your Children: A Few Points to Touch Base On

A long-standing activity that parents make daily efforts to participate in with their children is reading books with them. Why? It is because it provides obvious educational benefits that intensive research doesn't have to tell us to make it true. Exposing children to reading activities at a young age encourages language and communication development. However, what else is reading with your child doing for them?

The New York Times published an article this year regarding a massive study with child participants and their parents. 675 families, which included parents of a child between the ages birth to 5 years old, participated in a randomized trial in which 225 of those families received intervention services from the Video Interaction Project (https://www.videointeractionproject.org/). The goal was to video record the parents reading and playing with their child and then working with an interventionist who would point out certain trends in the videos. This study was a follow-up of a study completed 2 years prior, which found that the children who participated in intervention had reduced aggressive and hyperactive behavior. 2 years later, this most recent study found that those behaviors stuck with them (2018, https://www.nytimes.com/2018/04/16/well/family/reading-aloud-to-young-children-has-benefits-for-behavior-and-attention.html).

What was so interesting about this study was the researchers' assessment of the parents' unique interactions with their child and how interactions shaped behavior. Examples included: using toys while reading, using silly and various voices to act out the reading material, relating characters to the child, explaining the book to kids, etc. Researchers noted the potential for children to better develop healthy social and emotional relationships through reading with parents.

So in simple terms, reading to your children can provide all sorts of developmental benefits if done in a positive way. Instead of droning out a book with stifled enthusiasm, consider what flare you as a parent could to the book:

  • Incorporating toys or costumes: Act out characters in the book using your child's favorite toys. Wear unique clothing items like hats, scarves, bandanas, sunglasses, etc. If the child is old enough and would like to give it a go, have them act out parts in unique attire.
  • Taking your child through imaginative play: Make the book come to life for your child by acting out the story with them. You don't have to go overboard with a formal stage. Use what you have in your own home. If the story is about saving the princess from an evil monster, act out the harrowing journey using the tools and toys within your house or out in your yard.
  • Comparing characters to your child: Talk to your child about the characters in the book as if your child was able to meet them and get to know them. Would they be best friends? Would they be scared to approach them? Would they be just like you or your child? This opens up a social and emotional connection that drab reading from page to page would not.
  • Discussing the book: Talk about the book with your child, during the story and after it ends. Ask your child if they had questions about the story and if there were parts that they did not quite understand. 
  • Guiding your child in reading portions of the book: If your child is approaching reading age, encourage your child to read some of the book with you. Be willing to sit down next to them and to guide them through the more complicated words and sentences.

Reading to your child does not have to be a burdensome chore, and you do not have to read to your child 24 hours per day to be a good parent. If you are not what you call a "reading kind of family", incorporate reading in small chunks. Commit to reading one children's book with your child once a week. Then, if you think you and your child can handle it, progress to reading one book per day at roughly the same time. There is no one size fits all when it comes to how often you should read with your child, so go with what works for you and your family.

References
Mendelsohn, A.L., Cates, B. C., Weisleder, A., Johnson, S.B., Seery, A.M., Canfield, C. F., Huberman, H.S., & Dreyer, B.P. (2018). Pediatrics, 141:5.