Managing Car Rides with your Kids: Techniques from an OT’s Perspective

Taking a drive to the store, to a doctor’s appointment, or even just around the block can sometimes be the only outlet for a stay-at-home parent of a young child or children. It’s a break in the day-to-day home routine, even if that means that your child goes with you. On occasion, car rides with your children are a necessary part of life in order to get to those required appointments. Car rides can also be your primary form of transportation for family vacations. Every seasoned parent knows that car rides are not always relaxing when children come along. In fact, some car rides are so awful that you wish you would have stayed home.

So, why do children find car rides so miserable AND make sure to communicate their opinions loudly to their parents?

  • Uncomfortable car seats and seat belts
  • Boredom
  • Hunger
  • Bladder and bowel needs (i.e. dirty diapers, a much needed trip to the potty)
  • Siblings looking at them wrong
  • Car and traffic noises
  • Interior temperature of the vehicle
  • Fatigue
  • Car sickness

No child will have the exact same car discomforts as another child, and along with the verbal communication young children lack it is often a puzzle as to why they tantrum or melt down in the car. Furthermore, turmoil that the child and the parents face worsen when there is a developmental or behavioral issue to consider (i.e., autism, Down syndrome, ADHD, generalized anxiety, etc.). As a result of uncontrollable emotions, car rides come to a screeching halt, appointments are missed, family vacations are tainted or delayed, and the list goes on.

Here are a few tips that may help ease the tensions of the car ride with your child. Note: not all of these tips are going to be a guaranteed fix-all for your child, but it never hurts to try and to experiment with ones that could be relevant to your situation.

Car seats and seat belts: Some things are non-negotiable when it comes to car rides, and being securely buckled into a car seat is one of them. First things first: never give your child the impression that it is alright to take a car ride without being buckled in, even if it is for a “quick trip” or else you will be having this re-occurring fight until the day your child moves out of the house. Warm your young child up to the idea of being safely strapped into the car seat by having them sit in it for short spurts at a time. Gradually increase their sitting time without over-stressing them. You want them to build up the toleration to the seat without making it a traumatic experience.

Boredom: This can sometimes easily be solved with favorite toys, favorite songs, and favorite movies if you are fortunate enough to have a TV screen in your car. Spread out the bag of tricks over the length of the car ride. Introduce only one or two toys at a time. Exposing your child to everything you have (i.e., songs, movies, toys) will leave you empty-handed 5 minutes into the ride.

Hunger: Make sure the child eats a wholesome meal and drinks plenty of liquids prior to the car ride. If you are expected to be out for a while, bring snacks and drinks that will be easy to juggle in the car with minimal spillage.

Bladder and bowel needs: Have your child use the toilet prior to the ride, even if they don’t necessarily have to go. This gets your child in the habit of using the bathroom before leaving. If your child is too small for the toilet, make sure you change their diaper RIGHT before leaving. Have extra diapers and wipes with you for if and when your child needs a change during the ride.

Car and traffic noises: This discomfort is not necessarily preventable, and it will take several car trips for the child to get used to the noises. If your child tolerates wearing earmuffs or a long hat to cover their ears, this might be a good option to minimize the noise.

Interior temperature: Properly dress your child prior to the car ride, which includes bringing extra layers or blankets for air-conditioning freeze-outs.

Fatigue: Attempt to coordinate your car rides with your child’s nap schedule. If your child gets a full nap prior to the ride, then the less likely they will get snippy with you. If this is not possible, bring comfortable items such as a favorite blanket or stuffed animal to help lull them to sleep in the car.

Car sickness: Parents will have to take the time to observe their child to see what types of triggers may set of car sickness. This could include the motions of the car, the sun blaring through the window, the temperature setting, the tightness and placement of the seat-belt, or a combination of several noxious stimuli. Attempt to minimize the triggers the best you can, take several rest stops, and experiment with ways to reduce sickness (i.e., chewing or sucking on a piece of candy, anti-nausea or anti-motion sickness medicines, etc.).

The most essential thing a parent could do is practice by going on consistent car rides, even if some attempts become total flops. The more experience the child gains from riding in the car, the less difficult future trips will become.

Biofeedback Therapy: What is It can my child use it at Home?

Biofeedback therapy is a technique used to teach a person how to control functions of their body, specifically the ones that you can't voluntarily control such as heart rate, respiration, blood pressure, etc. Biofeedback therapy is typically provided via specialized machines with sensors that can tell a person about what their own body is doing under various circumstances (Mayo Clinic, 2018). Researchers are still unsure about why biofeedback works for some children and adults. All they know is that it can work, and that it "promotes relaxation, which can help relieve a number of conditions that are related to stress" (WebMD, 2018).

Clinical professionals who often specialize in biofeedback therapy include nurses, physical therapists, and occupational therapists to name a few. Biofeedback techniques involve the use of unique equipment that is usually comprised of sensor attachments and a monitor. The monitor picks up whatever information the sensors scan about the body, which varies depending on where the sensors are attached. Sensors can be attached to the head, the abdomen, specific muscle groups, hands, feet, or chest detecting specific functions (i.e., breathing rate, skin temperature, heart rate, etc.). Therapists are very deliberate about where to place the sensors because different placements treat different conditions.

Combined with the sensor placement, the patient is taught certain techniques on how to relax and how to control otherwise uncontrollable body functions. Biofeedback has been used to treat the following physical and mental conditions in children and adults:

  • Anxiety or Stress
  • Asthma
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Chemotherapy Side Effects
  • Chronic Pain
  • Constipation
  • Fecal Incontinence
  • Fibromyalgia
  • Headache
  • High Blood Pressure
  • Irritable Bowel Syndrome (IBS)
  • Motion sickness
  • Raynaud's Disease
  • Ringing in the Ears (tinnitus)
  • Stroke
  • Temporomandibular Joint Disorder (TMJ)
  • Urinary Incontinence (Mayo Clinic, 2018)

Biofeedback therapy can and has been used in a private home setting. However, there are some steps that parents' caregivers should take before independently taking on biofeedback sessions with their child at home. Thanks to the ease of access provided by the internet, biofeedback equipment can be easily purchased online without authorization from a clinical professional. It would be in the parents'/caregivers' and the child's best interests to use biofeedback appropriately and safely:

  • Research and consult with an outpatient professional who specializes in biofeedback therapy: Search for clinicians in your area who specialize in biofeedback therapy in an outpatient setting. Make sure to review their credentials and their certifications. Biofeedback can be practically used by anyone, so make sure you access a clinician who has completed specialized training in biofeedback therapy.
  • Consult with your health insurance company: Due to the lack of empirical research, most insurance companies (federal and private) will not cover biofeedback therapy in any setting. Sometimes, if you look hard enough, there will be exceptions but realize that you will most likely be paying for biofeedback therapy out-of-pocket.
  • Attend regularly if recommended: If your child requires a certain schedules amount of sessions, make sure that you as the parent are in attendance. That way, you are well aware of what goes into biofeedback sessions and how to translate it for home use.
  • Be proactive about education: Ask questions and get your questions answered. It is very simple to use biofeedback therapy machinery on your own at home. However, it's more complex to use the equipment properly, safely, and effectively.
  • Introduce biofeedback sessions per the professional's recommendation: Consult with your clinical professional before starting biofeedback therapy sessions in your own home. Be very clear about what kind of equipment needs to be purchased, how often and regularly sessions should take place, what relaxation tips to use that best works for your child, etc.

REFERENCES

  1. Biofeedback. (2018). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664. Viewed on July 30, 2018.
  2. Overview of Biofeedback. (2018). WebMD. https://www.webmd.com/a-to-z-guides/biofeedback-therapy-uses-benefits#1. Viewed on July 30, 2018.

Auditory Processing Disorders in Children and How to Talk to Your Little Ones

Reciprocal conversation can come so easily to some children. They hear a command, a compliment, or just a simple question and can respond with ease and often with socially appropriate responses: “You want to play?” “Sure!” Starting at infancy, a little one has to start putting millions of pieces together with their brain at a phenomenal rate in order to develop, process, and communicate language. So, what happens when some of those pieces don’t quite align correctly?

First things first: the types of auditory processing disorders that this article will be talking about has nothing to do with a child’s ability to hear. In fact, all of the inner ear structures for typical hearing would be intact, thus the source of the problem is harder to locate because it starts in the brain. The Hearing Health Foundation defines auditory processing disorder as the following:

“Auditory Processing Disorder (APD), also called central auditory processing disorder (CAPD), happens when the brain is unable to process sounds. Individuals with APD have a neurological defect in the pathways from the auditory nerve through the higher auditory pathways in the brain” (2018).

APD often accompanies learning disabilities and other developmental conditions such as Down syndrome, Attention Deficit Disorder (ADD), and autism. Disruptions to pathways in the brain lead to all sorts of problems for a child. For example, a typical child may have little issue with talking to another person in public surrounded by other people and other noises because their brain can filter out extra noise while the child can pinpoint what that one person is saying to them. Children with APD can have trouble focusing on one sound or one talking person in a noisy environment. Additional problems can include children having difficulty interpreting certain sounds into actual words, trouble with processing instructions one time through, and delayed responses to other people’s verbal communication.

APD can result in some behavioral outbursts and rightfully so. Having the inability to fully understand what other people are telling you is enormously frustrating. Furthermore, parents and other adults in a child’s life may feel irked because they might feel like the child is intentionally ignoring them or not paying attention.

Due to its increased public awareness, APD can be diagnosed early in order to get the child the right services Understanding Auditory Processing Disorders in Children. It usually requires a multi-disciplinary approach in which the child is assessed by multiple professionals at a very young age. Once a diagnosis is obtained, then clinicians and parents can move forward with helpful steps for the child.

One of the most difficult adjustments for a family is learning how to appropriately communicate with a child with APD in the home. Minor mishaps can lead to behavioral issues which severely decreases a child’s ability to participate in daily living tasks that are needed or enjoyable for them to perform (i.e. academics, playing with friends, feeding, dressing, toileting, showering, chores, sports, etc.). Parents can take proactive steps by consulting with professionals and applying learned communication techniques at home. Some of the following tips should be considered.

  1. Volume is not the issue: Remember, APD is not hearing loss. Speaking to your child in a louder voice will not improve communication; in some ways, increased volume might make your child think that you are losing patience or are getting angry with them.
  2. Pace your words: Actively think about how fast you are speaking and how many words per sentence you are communicating. Depending on the severity, your child may only be able to process a small handful of words at a time. Don’t be afraid of silence and pauses, and use them to your advantage. Carefully vocalize instructions slowly and intentionally, and wait for a response from the child before overloading them with more auditory information.
  3. Punishment may not work at all: Remember, if your child has APD then in many instances they are most likely not ignoring you on purpose. Make your diligent attempts to communicate with them slowly with direct eye contact. Wait for appropriate responses from your child before assuming that your child is misbehaving. Immediate punishment will not get anything done, will not improve communication, and will probably end badly for both the parent and the child.
  4. Acknowledge and limit additional noise: Consider all environmental noise: the T.V., music, other family members, the dishwasher, the dryer, passing cars, rain…just about any noise that a typical person can usually ignore during the day. All of the least obvious noises are going to be very disruptive for you child when they are trying to talk to you. Do your very best to limit those noises in order for your child to best communicate with you.

Parents on Smartphones: How are you unknowingly shaping Your Child’s Behavior?

First off, this article isn’t necessarily a platform for bashing smartphones. Advanced technology that fits in your pocket provides several daily benefits: immediate access to familial and work-related contacts as well as emergency assistance, calendar apps to map out your day and your children’s day, educational resources from the internet, email and digitalized documents, GPS systems to get your family to important events, camera and video features to record those special moments, and the list goes on.

Now let’s talk about all of the good things that can take a turn for the worst if used in excess: camera use and endless selfie takes, Facebook, Instagram, Twitter, texting, Face Warp, gaming, and pretty much everything else that a smartphone provides. This includes anything on a smartphone that increases screen time to an unhealthy level, which simply means that the person is distracted from real life and is unable to complete necessary daily living tasks away from their phone. We will not be delving into the details about what happens to a child’s mind when you put them on your smartphone for several hours at a time. That’s a discussion for another day. In this article, we’ll be focusing on what happens to children when their parents can cut their own screen time down.

Myruski et al. (2017) made a connection between mothers’ cell phone use and infants’ socio-emotional development. Fifty infants, along with their mothers participated in the study. Mothers were asked to complete two questionnaires regarding daily cellphone use in front of their family and their infant’s behavior during the day. Researchers found that increased cellphone use in the presence of an infant drastically reduced a child’s desire to explore their own environment and increased negative interactions (i.e., negative facial expression, angry vocalizations and protests, etc.) towards the mother.

McDaniel and Radesky (2017) investigated how several forms of technology use impact a child’s behavior, including smartphone use. Authors specifically analyzed a phenomenon termed, “technoference”. It refers to the small day-to-day intrusions of a cellular or computer device. Technoference was originally coined by a professor from Brigham Young University named Sarah Coyne. In her studies, she assessed how increased cellphone use negatively impacts the relationship between partners (i.e., more fights, reduced satisfaction, and depression). Authors found that technoference can cause similar negative reactions in children, leading to difficult behavioral problems.

Research regarding smartphone use around children is still very new, and there is so much to be learned about its long-term impact on child development. For now, many studies out there are telling parents the same thing: play it safe and get off your phone while with your child. Smartphone use is so easy to fall for, especially when carrying for young ones who you think aren’t really paying attention to you. Increased smartphone use leads to mental and emotional distance while being physically present. If your friends and adult family members get frustrated because of how much of your attention gets sucked away by technology, then expect your children to do the same. Except in children, expect more screaming and poor behavior that will grab your attention more than a passive-aggressive verbal jab.

Parents are not meant to be just “around” in order to help a child properly develop, to participate in healthy activities, and to succeed at life. Parents who are not distracted by device use are socially and emotionally available for their child during the moments that count: the times when you should be cheering for their accomplishments, the times when someone or something hurts them, the times when they get into trouble and need help repairing the damage, and the times when they simply want to talk to or play you because you are the single-most important person in their life. Put down the smartphone when you are with your child!


References:

Sarah Myruski, S. Gulyayeva, Birk, S., Pérez-Edgar, K., Buss, K. A.,Dennis-Tiwary, T. A. (2017). Digital disruption? Maternal mobile device use is related to infant social-emotional functioning. Wiley Developmental Science, DOI: 10.1111/desc.12610.

McDaniel, B.T. & Radesky, J.S. (2017). Technoference: Parent Distraction with Technology and Associations with Child Behavior Problems. Child Development, 89(1). https://doi.org/10.1111/cdev.12822.

Behavioral Management for a Child: Viewing the Entire Picture

There is nothing quite like being a brand new parent to a newborn child. Excited to start the next phase of your life, you bring the baby home from the hospital and start your routine: feedings, diaper changes, naptime, play time, and bath time. As a parent, you do everything in your capacity to fulfill your child's needs to keep them healthy and growing. When your little one cries, you learn to pick up on what exactly they are crying for. Once their immediate need is met, they predictably calm down...sometimes.

What about the times in which your baby is crying, you have gone through the list of all basic needs, and nothing has been resolved. Your child continues to uncontrollably weep and you are left clueless, not knowing what your next move should be. You grow tired, frustrated, and heart-broken because you feel completely helpless and are at a loss as to knowing how to change your baby's behavior for the better.

Let's view those gambits of emotion as it pertains to a parent of an older child with behavioral issues. This is a parent who has been around the block and probably has read EVERYTHING about good parenting techniques; however, their child still has problems which could include: aggressively acting out towards others, failing in school, having daily meltdowns, inability to verbally communicate their needs, losing friends, yelling at parents and teachers, refusing to complete chores or homework, etc. What worsens the situation is that the child doesn't seem to positively respond to punishments or rewards. This an example in which there is more to this child's story, despite being raised by a good parent.

For parents who have or are currently experiencing this, what is your initial reaction? Is it self-doubt about how you are raising your child? Is it concern that their might be something developmentally wrong with your child? Is it anger and sadness that completely clouds your ability to trace your next steps? Raising a child with severe behavioral problems can be debilitating for you, for your child, and for other relevant family members and friends.

Occupational therapy can effectively address behavioral management for children. Due its holistic nature, occupational therapy can help parents break down behavior triggers by getting them to ask the right questions in order to best help their child. Some of the following areas may come up during OT sessions:

  • Evaluation of developmental milestones: An OT can incorporate several standardized assessments into therapy in order to best identify the child's unique functional abilities. For young children, such tests usually include developmental milestones including motor (movement), language, and cognition. If a child is not up to par with their milestones, then it's a starting point for OT to begin appropriate interventions. Other assessments may include more detailed items such as sensory processing issues, academic skills, etc.
  • Assessment of pertinent medical history: An OT would have to consider the child's medical and psychiatric history prior to starting therapy (i.e., cerebral palsy, autism, Down syndrome, muscular dystrophy, etc.). That way, all health-related factors and symptoms weigh in on the child's therapy sessions.
  • Referrals to relevant disciplines: An OT may find it appropriate to consult with fellow disciplines who can appropriately address the child's behavioral issues (i.e., psychologists, behavior specialists, primary physicians, pediatricians, allergy specialists, etc.).
  • Collecting information about the child's preferences and triggers: The OT would need to conduct an in-depth analysis of the child's interests and distastes to see what specific activities may or may not change the child's behavior for the worst. Favorite foods, movies, music, sports, hobbies, people or least favorite foods, sounds, activities, and people are just some basic examples.
  • Documenting the child's daily routine: The OT would also need to know about the child's daily routine in great detail: waking up in the morning, eating breakfast, bathing, dressing, school activities, extracurricular activities, expected chores and activities at home, dinner, hygiene tasks, free-time activities, etc. Additionally, the OT would probably ask about how the child handles transitions between each activity or how the child responds when their daily routine unexpectedly changes.
  • Analyzing parenting techniques and habits: No parent likes to be called out on their parenting styles, especially if they really are raising their child in the best manner possible; however, behavioral management includes changes in the child, in the child's environment, and in the child's parent's teaching strategies. The OT might talk about what strategies the parents use that positively change the child's behavior and what strategies they use that could make it worse. This will include assessing how the parent communicates with the child during good and bad behaviors, how the parent organizes transitions, how the parent reacts during aggressive meltdown, etc.

Occupational therapy interventions can benefit a child and modify their behavior. However, it is essential for an OT as well as parents to view the entire picture. Rather than focusing on "fixing" the child, acknowledge all environmental and parental factors that may or may not need to change to best help the child.

An Exercise Ball: Therapeutic Uses for a Child from an OT’s Perspective

For parents who have actively enrolled their child in occupational or physical therapy services inside or outside of their home, have you noticed some commonalities among therapy equipment? Yes, there are the dozens if not hundreds of toys that fill the pediatric setting but there are additional tools that help a child grow and develop. One of these tools is a plain, ordinary exercise ball. The typical exercise ball varies in size but is made of the same, inflatable and bouncy rubber material. Exercise balls are frequently advertised as a useful and relatively cheap option for adult exercise regimens. What about for children? Why do therapists often introduce an exercise ball to a child? What purpose does it serve?

  • An exercise ball meets multi-sensory needs: For a child with sensory processing delays or disorders, an exercise ball provides beneficial stimulation. This may include proprioceptive input (i.e. bouncing on top of the ball, lifting the ball overhead, hitting the ball, etc.), tactile input (i.e. feeling the smooth texture of the ball), vestibular (i.e. balancing on top of the ball, bouncing or rolling over the ball), and auditory (i.e. listening to the sounds of the ball getting hit or bouncing against the floor). Feeding the senses may result in increased emotional regulation.
  • It provides an opportunity for playful exercise: Playing with a big, rubber ball takes certain muscle power. Throwing, kicking, bouncing on, or smacking the ball is a great way for a child to release some energy and to work the whole musculature of the body.
  • The ball is a great mediator for social participation: Since a giant, rubber ball can be hard for a small child to control it provides a great opening to social interaction with others. This could include siblings, parents, therapists, or friends of the child simply playing a game of catch or kickball.
  • It’s a tool for improving gross and fine motor development: All physical interactions with the ball require motor skills of the gross and fine motor nature: throwing with the arms, smacking the ball with the lands, lifting the ball off of the ground, crawling on top of the ball, kicking the ball into the air, etc. Playing with a ball can further improve a child’s overall motor development.
  • Using a ball assists with delays in reflex development: Every typical child is born with a set of primitive reflexes. Such reflexes assist with other developmental milestones as the child ages such as motor, cognitive, and social development. Reflexes assist with reactionary movements, such as knowing what to do when there is a loss of balance. Visit Primitive Motor Reflexes & Their Impact on a Child's Function for more details. Using an exercise ball may assist a child in eliciting delayed or absent reflexes. This is done by carefully planned movements and exercises determined by the child’s therapist.
  • An exercise ball can address cognitive development: Effectively playing with an exercise ball requires lots of brain involvement including problem-solving, decision-making, emotional regulation, novel learning, short and long-term memory, attention, etc.
  • It’s fun! An exercise ball is a great way to capture a child’s interest for a therapy session because it is fun, interactive, and can be used in endless ways in order to prevent boredom.

An exercise ball is a wonderful therapy tool for children of all ages. However, before parents get too gun-ho about running out and purchasing a ball for your child make sure of the following:

  • Talk to your child’s therapist: Consult with your child’s physical and/or occupational therapist, especially if they are already using an exercise ball during therapy sessions. Ask about what goals the therapists are trying to accomplish by using the ball or what developmental skills they are addressing. Have a discussion about how you as a parent or a caregiver can replicate their uses of the ball to best assist their child outside of therapy sessions.
  • Always consider your child’s safety: Although an exercise ball is helpful for a child of any age, think about what types of safety concerns could come up. This is especially important for very small children or any child with delayed milestones of any kind. Talk to your therapist about how often or what ways you should be supervising your child when they are playing with the ball.
  • Think about your availability: Although playing with a ball by themselves can be fun for a time, a child would greatly benefit from having you around as well. A parent or a caregiver can make an excellent playmate for the child and can introduce them to all sorts of games and two-person interactions that are more exciting and therapeutically appropriate for the child.

The therapeutic benefits of playing outside: An OT’s Perspective

Improving technology and the growing comforts of being indoors has many of us, including children, intentionally and unintentionally avoiding the outside world. School-aged kids already spend most of their waking hours inside a school building metaphorically chained to their desks and to their demanding textbooks or computers. Then, once the school bus drops them off at home, they immediately retreat to their rooms to complete homework, to watch, TV, or to play games on their I-PAD into the late hours of the night. If they were lucky, they spent anywhere between 10 to 20 minutes on the playground to enjoy that long lost friend called "fresh air".

Harvard Medical School referenced a man named Richard Louv (2008) who coined the term "nature-deficit disorder" which is a condition that plays off of attention deficit hyperactivity disorder (ADHD). Researchers have found in recent years that children who are deprived of exposure to the outdoors have increasing trouble with concentration. Additionally, children with ADHD have an easier time concentrating during the day if they spend time outside. A prescription for better health: go alfresco

So, aside from improvements in concentration, what other health benefits does spending time outside grant to young children? Here are some examples from an occupational therapy perspective:

It's one of the best forms of exercise for children
The outdoors automatically takes away boundaries that indoor environments innately provide. There's more space to run around, to play sports, to climb playground or treehouse equipment, etc. Outdoor spaces allow children to participate in activities that provide tons of feedback to muscle tissue and to burn excess energy.

Playing outside teaches self-exploration and creativity
Children have an opportunity to be adventurous and to try activities that they haven't explored before. Sifting through the dirt, climbing trees, rolling through the grass, catching bugs, splashing in puddles, and building snow forts…these are all examples of outdoor activities that spark those creative flames in children.

Playing outside enhances social participation
Participating in play activities outside allows for more opportunities to develop friendships outside of a classroom or other structured setting. Such activities like playing tag, kicking a ball around, or playing hide-and-go-seek teaches children how to see each other in a different light and to develop healthy communication and relationships.

Outdoor amenities allow for gross and fine motor skill development
Collecting rocks, shoveling sand, throwing a Frisbee, dribbling a ball, scaling the monkey balls, riding a bike, and self-propelling on a swing are all outdoor activities that offer children necessary opportunities to further develop essential motor skills. Movement learned in outdoor play activities can be translated to other essential activities as the child grows (i.e., chores, competitive sports, etc.).

Outdoor play provides opportunity for self-regulation
Self-regulation is defined as having the ability to monitor and control our own behavior. Children who lack self-regulation skills struggle when emotions and sensory stimulation runs high. For children who can't find a healthy outlet for over-stimulation indoors might be able to let off some overwhelming emotions by simply being outside. R.M. von Kampen (2011) presented a thesis about outdoor play and self-regulation skills in a child with autism. Her results revealed that the participating child showed positive improvement in self-regulation skills by participating in selected tasks outdoors as opposed to indoors.

Outdoor exposure exercises all of the human senses
By keeping our children indoors on a constant basis, we only allow their senses to experience artificial living scenarios. By providing our children with outdoor exposure, we allow their senses (taste, touch, smell, hearing, vision, vestibular, and proprioception) to fully experience what the world has to offer.

As a parent or a caregiver, here are some tips on how to incorporate outdoor activity into your child's lives:

  • Intentionally get your child outside every day, even if it's only for a few minutes due to tight schedules or bad weather.
  • Set rules about time spent on computers, phones, TVs, or I-pads.
  • If your child doesn't want to spend time outside, come up with a to-do list of fun outdoor chores that they need to complete before coming back inside the house
  • Play with them! Get outside yourself so that your children can play with you and have more reason to enjoy the outdoors

Seeing the Whole Picture: An OT’s Perspective on Literacy Skills Development Challenges in Children

When it comes to this article, we define “literacy” as simply having the ability to read and write. Many young children are able to grasp on to literacy skills as early as kindergarten, sometimes earlier in exceptional cases. Has anyone ever sat back and really examined what it takes to effectively read and write? There is actually more in the works than brain activity and eyes scanning the pages:

Vision: This is about having the optical parts of the eyeball available to a person to actually see what is on the page. The eyes capture the light and colors that make up the paper, the letters, the writing utensil, and so on. Children who experience visual disturbances such as blindness or near-sightedness require the use of corrective lenses or alternative reading aids (i.e. Braille) in order to learn and to maintain literacy skills.

Perception: Perception is actually not the same as vision; instead, it is the next step. Our eyes may see one thing, but our brain processes can make us see something entirely different depending on the person. This is where dyslexia comes up because there is nothing structurally wrong in the eyes. However, their brain for some reason flips around letter and numbers on the pages making it very difficult to read.

Posture: The spine is directly connected with vision because it holds the head steady in order for a person to scan reading material and to write text. Disorders that impact spinal alignment include muscular dystrophy, cerebral palsy, some forms of traumatic brain injury, childhood post-stroke conditions, spinal cord injury, etc.

Fine motor/gross motor: Purposeful movements of the hands and the arms are heavily involved in literacy, performing such movements as flipping pages, scanning words with a finger, flipping pages, and typing. Those muscle movements are in direct communication with the brain, feeding the child information that helps them learn literacy rather than just the physical movements involved. Hand injuries, cerebral palsy, hemiplegia, and other forms of paralysis pose some challenges for children attempting to learn.

Sensory dysfunction: This includes impairments of any of the sensory systems involved in literacy skills development: visual, tactile, auditory, vestibular, and proprioceptive systems Your 8 Senses. Underlying sensory processing issues can impact a child’s ability in holding themselves upright, grasping a pencil, hearing a teacher’s oration, and so on.

Cognition: The brain is probably the most complex body part involved in reading and writing development. In a way, it a collective box that is constantly taking in information and releasing information to other body processes (i.e. the eyes as discussed in the above paragraph about perception). Various areas of the brain are on fire: processing, expressing, and comprehending reading and writing material. The brain is also assisting with attention requirements and pulling out long-term memory information (i.e. learned numerical systems and the alphabet). Some conditions disrupt those processes including attention deficit hyperactivity disorder (ADHD), Down syndrome, autism, fetal alcohol syndrome, etc.

Pediatric occupational therapy is one of those disciplines that offers a holistic approach in evaluation as well as treatment. Highly skilled OTs can see the bigger picture in literacy skills development, what it takes to learn those skills, and what barriers can surface in the event of injury, disease, or disorder. As far as intervention goes for literacy, OTs can introduce any of the following approaches depending on what your child needs (to name a few):

  • Reading/writing aids or devices: For some children, effective reading or writing may just need some adaption with the use of tangible supports. Examples include textured writing paper, widened pencil aids, custom chairs, angled writing boards, etc.
  • Sensory integration techniques: For children who struggle with reading and writing due to potential sensory processing disorders, there is help available. Consult with therapists who are specifically trained or certified in sensory integration techniques. Such therapists will provide comprehensive evaluations and heavily detailed interventions for your child.
  • Fine motor activities: Some children who struggle with literacy development may have unaddressed challenges in fine motor development. If this is so, OTs may introduce fine motor activities and practice sessions outside of literacy in order to fine-tune those movements.
  • Cognitive training exercises: This includes any intervention that addresses those cognitive processes mentioned earlier: attention, processing, expression, memory, etc.
  • Postural alignment techniques: OTs can use hands-on intervention methods with children in order to facilitate the child’s ability to hold themselves in an upright position for reading and writing. Techniques may include activities that strengthen and elongate muscle tissue, improve communication between the brain and muscle groups, etc.

The Forgotten Senses: What Are They and How Deficits Impact Function in Children

Here’s the simplified version: sensory systems involve input from environmental influences. Sensory receptors pick up changes to the body, signal to the brain about those changes, and the brain allows the body to react a certain way. For example, the tactile (touch) sensory system would pick up information about a ball being thrown at someone’s face. The receptors in the skin pick up pain and touch from initial contact with the ball, signaling to the brain which then signals to the rest of the body to react, “Ouch!”.

In some situations, an individual with a sensory processing disorder of the tactile system might react differently or not react at all. Sensory processing disorder occurs when something in one or more sensory systems is thrown out of whack, leaving a person to over-react or under-react to certain environmental stimuli.

Much of the general public is already familiar with the list of human senses: touch, taste, smell, sight, and hearing. To the credit of many parents who have basic knowledge regarding sensory processing disorder, some adults also know about proprioception and vestibular input. The following information specifically defines the purpose and the effects of both the proprioceptive system and the vestibular system on general functions of a child. Additionally, the following information addresses an even more unfamiliar sensory system called the interoceptive system.

Proprioceptive System

Proprioception is really about knowing where your body is in space. Muscle spindles in skeletal muscle tissue, along with sensory receptors located in your joints and tendons, signal back and forth to the brain in order to identify position and motion of your body. A classic example of understanding proprioceptive input is closing your eyes while waving your hand, bringing you finger to your nose, or clapping your hands together. Without the aid of sight, you still know where your arms and hands are in space in order to perform these activities.

http://helix.northwestern.edu/article/proprioception-your-sixth-sense.

Proprioception is a key ingredient in a child’s participation in daily activities, mostly because he/she is constantly on the move. Proprioceptive dysfunction can be made manifest in multiple ways, but can result in some of the following:

  • Difficulty with coordinating planned movements (like navigating a playground)
  • Challenges with postural alignment and stability
  • Difficulty with grading strength and pressure (breaking crayons and pencils)
  • Desire for constant movement to the point where he/she can’t focus on anything else

Vestibular System

The vestibular system is primarily responsible for providing the human body with a sense of balance. The vestibular apparatus is located within the inner ear and plays a role in spatial orientation, equilibrium, and motion. http://vestibular.org/understanding-vestibular-disorder/human-balance-system. Here is the anatomical breakdown. The utricle and the saccule of the vestibular system are responsible for detecting gravity or vertical orientation while the semi-circular canals detect rotational movement. Together with proprioception and vision, a healthy vestibular system provides balance.

Vestibular dysfunction can result in some of the following:

  • Trouble with reading
  • Dizziness or vertigo
  • Fear of moving or participating in tasks
  • Head-banging

Interoceptive System:

Interoception is the sensation concerning the internal, physiological processes of the body. Interoceptors are located on internal organs and can pick up certain phenomena such as hunger, thirst, heart rate, respiration (breathing), and elimination (relieving urine or fecal matter). https://www.spdstar.org/basic/your-8-senses#f8. The interoceptive system is still being extensively investigated, but researchers assume that it interrelates with and impacts all other sensory systems on a level that we don’t quite understand yet.

  • Have trouble knowing when he/she is hungry or thirsty
  • Not knowing if he/she is hot or cold
  • Challenges with self-regulation
  • Not knowing if they are tired or energized

Sensory processing and dysfunction are very difficult to comprehend and to identify on your own as a parent or a guardian. Consult with a specialist, which can include a physical or occupational therapist who specializes in sensory integration and sensory processing disorder.

Getting to Know Your Child’s Interests for the Sake of OT Intervention

Parents, foster parents, day-care providers, and guardians of children who require therapy services are in a valuable position regarding plan-of-care development: you know the child better than anyone else involved in their care. You are around them more around-the-clock than any other person in their lives. This means that, compared to an occupational therapist who only visits the child a few times in a month, you know the child’s:

  • Daily schedule, structured and unstructured pieces of their days
  • Talents, hobbies, and interests
  • Favorite foods, movies, toys, songs, etc.
  • Struggles or challenges
  • Personal and environmental barriers to success
  • Triggers for poor or maladaptive behavior
  • Dreams or aspirations
  • Comforts and discomforts
  • Friends or other individuals they consistently interact with
  • Chores or other work-related activities that are expected of them

Occupational therapists who come into a home in order to evaluate and treat a child are in desperate need of this information. As mentioned before, the OT is a complete stranger as compared to any caretaker in the child’s life. So, why does an OT need this kind of information?

  1. To develop rapport with your child. Like any other human being, a child is receptive to someone else when they share or acknowledge their interests and know how to talk to them effectively. By providing the OT with this information about your child, you might save a lot of time and trouble which means that your child’s therapy time is put to better use.
  2. To create goals that best suit your child’s needs. In some cases, parents and/or their children have goals that don’t sound particularly enticing like learning how to crawl, how to feed themselves with a spoon, how to walk, how to improve their handwriting for school, how to handle transitions better, etc. If you help add information about your child to the plan, goals can take on a more exciting appearance such as learning how to ride a bike, how to eat chocolate pudding, or how to crawl to grandma. Thus, the drab-sounding but necessary developmental goals still get addressed while peaking the child’s interest.
  3. To conduct interventions that are meaningful and effective for the child. The child will probably be more engaged in therapy interventions if the OT introduces activities in which they are comfortable with or find fun. Furthermore, this gives the therapist some leverage so that the child still participates in essential tasks that may not be as interesting.

So, what can you do to better investigate and notice your child’s preferences? There are many times in which parents and caregivers don’t know this information, whether by no fault of their own or due to unrecognized neglect. Here’s how you can learn more about your child in order to better their therapy sessions:

  1. Put down the screen. We live in a world in which every adult who walks the earth has access to a cellphone, a laptop, television, or some other digital screen. We are constantly sucked into Facebook, twitter, news, online work, or texts for good reasons and for simply wasting time. Unplug for a while, walk away from the screen and visit with your child. You just might be missing the essential pieces by not watching them grow.
  2. Make them put down the screen. Get your child off of the I-pad, phone, or video game. Shrink their screen time down so that you have their full attention and also allow them time to participate in other meaningful tasks during the day. By being away from the screen, your child has the opportunity to participate in activities that will help them grow and will stem other future interests.
  3. Make time for them. This can be tricky for those parents who have to work full-time, but it is possible. Even if it is only for a couple of hours in the evening, interact with your child. Take to them, play with them, and let them know that you care.
  4. Consult with daycare providers and other relatives. If you do have to work full-time as a necessity, gather others’ input about your child’s day. Talk to daycare providers, nannies, the other spouse, relatives, or whoever spends most of the day with them. Consult with their teachers about how your child is doing academically and socially. There are still ways to bring valuable information to the table when coordinating your child’s therapy plan at home.