Positive and Negative Reinforcement for Children in the Screen-time Age: An OT’s Perspective

At times, parents get desperate and the reasons behind it are totally relatable to others in a similar situation. Your child has a major melt-down in the grocery store, usually in the check-out line and a typically swift procedure turns into a grueling crisis that holds up the rest of the line. Maybe your child decides the best time to freak out is in the middle of church where even a minor disruption among the reverence earns your family everyone’s eyes and ears. Or, your child is at home and you are at your wits end because he/she has been screaming for the last 6 hours. So, as a parent, what do you do? You give your child something that usually shuts them up immediately: your phone, your tablet, or whatever small device with a screen will grab their attention and silence the evil noises penetrating the house.

Today, many kids and adults in the U.S. have unlimited access to these devices that harbor endless forms of entertainment. As a result, phones, I-pads, and tablets have become the new candy for children. Parents just merely have to hand over a device to a young child and there is an immediate change in their behavior. Those changes appear good to parents because it provides a period of quiet time absent of difficult behavior… for now.

Before we dive into the repercussions of handing over the phone to a young child, let’s get a couple of definitions clarified:

Operant conditioning: B.F. Skinner, a behaviorist who is well-known in the psychology field, defined operant conditioning as a method of learning that occurs through punishment and reward of human behavior. Such a punishment and reward system occurs through positive and negative reinforcement.

Positive reinforcement: Positive reinforcement strengthens a person’s behavior by providing a consequence that the person finds appealing or rewarding. In the case of a phone, a child may figure out that they need to behave a certain way in order to earn time on the phone.

Negative reinforcement: Negative reinforcement occurs when an unappealing or unpleasant consequence is removed from the situation causing a strengthening in a human’s behavior. https://www.simplypsychology.org/operant-conditioning.html. A child may attempt to behave in a good way in order to avoid getting the phone taken away from them or having their time on the phone reduced.

If used correctly by parents, positive and negative reinforcement strategies could be very effective for shaping their child’s behavior over the lifespan. However, here are some ways in which parents take the wrong turn:

  • Giving the child the phone in order to stifle a temper tantrum: It has become common practice amongst parents to hand over the phone to a screaming child in order to silence them. This isn’t much different from other examples such as handing them a piece of candy or a favorite toy in order to produce immediate results. This practice will often worsen behaviors in the future, making it more difficult for parents in the years to come because the child automatically believes that they just have to drive their parents insane in order to get what they want.
  • Giving the child the phone to reduce boredom: If a child is bored, this often leads to some exploratory behavior that drives the parents up the wall: getting into things that don’t belong to the child, breaking stuff, harassing siblings, etc. So, once again the parent hands over the phone which gets the child to sit in one place for longer than 5 minutes. Similarly to handling temper tantrums, this teaches the child that it is alright to destroy things out of boredom in order to earn time on the phone.
  • Giving the child the phone as a substitute for all forms of entertainment: Putting your child on a phone or a tablet for entertainment purposes will eliminate their awareness or desire to occupy their time with other engaging things (i.e., playing with friends and family, going outside, completing schoolwork, playing sports, etc.).

In short, giving your child the phone doesn’t have to be a bad thing in the end if you know the tricks of the trade behind operant conditioning. Develop a system with your child, including positive ways they can earn the phone and specific minutes earned for certain behaviors. Don’t let the phone become the all-encompassing reward either. Take charge and keep time on the phone very limited so that the child knows that there is more to the world than a screen.

Oppositional Defiant Disorder (ODD) in Children: Can OT help parents with managing difficult behaviors?

Oppositional defiant disorder (ODD) is not and should not be such an easy condition to diagnose. Young children, especially as they develop and learn, will at many times exhibit problematic behaviors. They will fight with, yell at, and maybe even hit family members when things don’t go their way and it is just part of growing up. What sets these typical childhood behaviors apart from symptoms of ODD is persistence and severity of the behaviors as well as the negative impact such behaviors have on other family members or relevant relationships.

According to the Child Mind Institute (2018), children with ODD will display some of or all of the following symptoms that will occur for six consecutive months and longer:

These behaviors tear at families and make schooling and community interactions incredibly difficult. A few examples may include continuous fights and principal’s office visits at school, horrible tantrums at the store or other public setting, and poor adherence to house rules such as chores and treating family members with respect. More often than not, children with ODD may find themselves in legal trouble as they get older and are at risk for their condition morphing into other disorders such as conduct disorder.

So, where does OT’s role come into play with children with ODD? Psychotherapy and medication management (for when the child has other coexisting disorders such as ADD, anxiety, or depression) are not within the OT’s realm of practice, but are common approaches for ODD through other disciplines (Mayo Clinic, 2018). With that in mind, it is essential for parents to embrace a multi-disciplinary approach and to consult with various professionals. Pediatric OT may introduce and apply some of the following intervention approaches when working with children with ODD:

  • In-depth initial evaluation: An OT can’t diagnose a child with ODD, nor can they provide additional diagnoses like a psychiatrist or medical doctors. OT evaluations sift out functional problems and patterns. In other words, they zero in on the activities in which the child has trouble with due to difficult behaviors. As a result, OTs may be able to provide a more holistic picture for the parents and possible causations for escalating behavior.
  • Social Skills Training: Pediatric OTs often provide social skills training for children with difficult behaviors who have trouble with making and keeping friends. Furthermore, social skills training teaches a child to reciprocate healthy conversations with friends and family by teaching them how to appropriately react in social scenarios.
  • Cognitive/Problem Solving Training Techniques: ODD is considered to be a neurological disorder, or a condition of the brain in which the cause is unknown. Therefore, it would make sense to use cognitive approaches. OT can teach the child specific problem-solving techniques where they have to work with difficult situations that may cause them to lash out inappropriately. Enhanced problem-solving skills are used to reduce negative behavior in order for the child to participate in daily tasks successfully.
  • Family-based interventions and education: OTs can also help target challenging interactions between children and their parents/caregivers. By doing so, the OT may use interventions that heavily involve positive communication between parents and the child. Improving interactions will reduce the child’s capacity to test and push parents’ authority through tantrums and manipulation.

There is no cure for ODD, thus a parent’s influence and approach is a daily process. At times, some of the best parents will start to question themselves and their parenting skills when raising a child with ODD. This is heart-breaking, but normal. Like any child with unique needs, a parent who has a child with ODD will be using different styles that best work for them and their family. Do not hesitate to consult with professionals as soon as possible. No parent is ever expected to know everything about raising a child, so expand your knowledge and get the help now.

Deep Pressure Activities for Your Child: Why?

For parents of children with autism, you are probably already familiar with the concept of deep pressure activities from a sensory integration standpoint. Some children with autism seem to crave that pressure stimulation, and the results are immediate and calming for their entire body. Why does this work and are deep pressure activities something that other children can benefit from?

Deep pressure techniques or activities are based on the sensory integration theory developed by Dr. Jean Ayres in the 1960’s, and the activities are widely used and apply by occupational therapists. Deep pressure, according to Krauss (1987), is defined as “the sensation produced when an individual is hugged, squeezed, stroked, or held”. Deep pressure activities are often used in a therapy setting in order to alleviate stress, anxiety, over stimulation, and low stimulation. Carefully tailored sensory diets can be purposefully laced with deep pressure activities by a certified SI occupational therapist in order to assist children with very complex conditions.

Children outside of the autism spectrum can also benefit from less formal deep pressure activities such as regular hugs, pillow squeezes, weighted blankets, wrestling with siblings, etc. Every child is susceptible to stress, anxiety, and over-stimulation. Sensory integration is a constant process for everyone and not just children on the autism spectrum. For parents who are at a loss for how to manage their children while they are bouncing off of the walls or while they are experiencing a relentless melt down, deep pressure activities might be the way to go.

Try some of the following methods. Keep in mind that deep pressure activities can be dangerous if not used correctly. Avoid covering your child’s mouth and nose and avoid squeezing their chest or stomach too hard. If you decide to wrestle with your child or squish them with a large pillow, never put your full body weight on top of your child:

Daily hugs: Some families might be surprised to hear this, but there are many people and families who do not practice regularly hugging children. According to the American College of Pediatricians (2018), hugging your child provides multiple health benefits. Hugs are shown to reduce your child’ stress and anxiety levels, increase their immune system, and enhance their relationship with their parents or whoever is hugging them (https://www.acpeds.org/do-you-hug-your-child-enough).

Pillow squeezes: Grab a few pillows off of your bed and have your child climb into the pile. Gently push the pillows into their body without placing your full weight onto your child. This produces similar effects that hugs would, but may provide a fuller long-lasting deep pressure. This is a good go-to activity for a child who craves or asks for hugs constantly.

Weighted blankets: Blankets with sand or other material inserts have become more increasingly available to parents as autism awareness has grown in recent years. Parents have also found ways to make their own weighted blankets for a fraction of the cost of sensory-related blankets. Additionally, there are weighted jackets and vests available in kid sizes that produce similar calming effects. Having the extra weight provides enough deep pressure to calm the child’s body, especially during times in which their over-stimulated and show signs of increasing anxiety or stress.

Blanket Burritos: Roll your child up in a blanket to provide that deep pressure sensation. Monitor and supervise your child, especially if they are too small to figure out how to get out of the blanket by themselves. Again, avoid covering their face to allow for them to breathe properly.

Massages: Massages aren’t just reserved for adults. Gentle rubbing of muscles and joints can be very soothing for a child as well. This would be a useful technique for a child who doesn’t mind holding still for a few minutes to enjoy a massage from a parent or a caregiver.

The therapy world is still heavily researching the benefits behind deep pressure activities and why they work for children. If your child has abnormally difficult behaviors that indicate certain diagnoses (i.e. autism, ADHD, Down syndrome, etc.), consult with an occupational therapist and/or a pediatrician prior to starting regular deep pressure activities. Your child’s symptoms may either stagnate or worsen with casually applied deep pressure techniques.


References:

K. E. Krauss, “The effects of deep pressure touch on anxiety,” The American Journal of Occupational Therapy, vol. 41, no. 6, pp. 366–373, 1987

Childhood Anxiety: What does it Look Like and How Does it Impact a Kid’s Ability to Function

Unbeknownst to many families, anxiety is not just an adult problem. Anxiety is a group of neurotic conditions that can easily affect a young child, but the symptoms look vastly different. Some of the following anxiety disorders impact adults as well as children (visit https://adaa.org/living-with-anxiety/children/childhood-anxiety-disorders regarding more descriptive information about each disorder):

  • Generalized anxiety disorder (GAD)
  • Obsessive Compulsive disorder (OCD)
  • Selective Mutism
  • Post-Traumatic Stress Disorder (PTSD)
  • Social Anxiety Disorder
  • Panic Disorder

 Dr. Roy Boorady with the Child Mind Institute has listed some common symptoms that a child could display who has an anxiety disorder:

  • Increased clinginess or avoidance behaviors around parents and caregivers
  • Random or unexplained emotional outbursts or tantrums
  • Trouble with sleeping at night
  • Complaining about stomach problems
  • Reduced attention such as seen at home or in classroom settings

Childhood anxiety can be very difficult for adults to identify to undeveloped communication skills. Young children lack the ability to verbally communicate with parents and caregivers regarding anxiety and its symptoms. Let's take a look at the following scenario:

Trevor is a 10-year old boy who attends a private school. His parents have set is educational standards high, and he is already making plans to attend Ivy League Colleges including Harvard or Yale. Over the past month, one of his teachers has noticed a decline in Trevor's schoolwork. Either is performance has dropped or he hasn't turned in several assignments on time. He has trouble holding still in class and fidgets with his pencil throughout the entire period. Every once in a while, Trevor has explosive outbursts in the cafeteria towards other students. Trevor has also called his parents 5 times in the past 3 weeks to come pick him up from school because of severe stomach pains. The school psychologist assumes that Trevor has ADHD, mostly due to the fidgeting behavior in class.

Through the uneducated eye, it would be easy to assume all sorts of diagnoses for Trevor. Because anxiety manifests itself differently in children, a proper diagnosis may never be identified.

Anxiety disorders wreak havoc on a child's ability to function. Daily activities are greatly impacted, including:

  • School work or academics
  • Social activities with friends and family
  • Sports or extra-curricular activities
  • Spare time activities of choice
  • Household chores
  • Basic tasks: dressing, feeding, toileting, sleeping, showering

Occupational therapy has its place when working with children with anxiety disorders because it's a child's overall function that is at stake. Instead of focusing on physical or cognitive problems, the OT redirects therapy to emphasize care for the child's emotional needs.  Methods include ways to reduce anxiety symptoms in order to promote functional participation in tasks that matter to the child.  Some methods may include:

  • Family/Caregiver Education: The OT may provide some intervention and educational techniques to parents/caregivers in order to reduce symptoms.  Some may include exploring ways to reduce or change expectations that they have of their child, mellowing out the daily routine, replacing tasks with emotionally-gratifying activities, etc.
  • ADL (Activities of Daily Living) Participation: The OT might encourage the child to participate in activities that are familiar to them in order to lower expectations and to reduce anxiety symptoms during therapy.
  • Revamping the Child's Goals or Expectations: Sometimes, it is not the parents pushing the child with strenuous expectations or life goals. There are times in which the child creates those goals for themselves and then breaks down when those goals aren't met or perfected within a certain time-frame. In those cases, the OT would introduce strategies to help the child reduce those inner expectations that they have of themselves.
  • Consulting with relevant disciplines: A good OT will never pretend to know more than they do, especially when it comes to topics that are well within the realm of other disciplines including psychology or psychiatry. For more complex disorders that need further explaining (i.e., OCD, PTSD), the OT may suggest consulting with a psychological professional in order to best round out the child's therapeutic intervention.

Start early and get the help now. If your child is dealing with some unexplainable symptoms or behavioral problems that are negatively affecting their participation in daily living tasks, seek help immediately.

References

  1. Boorady, R. MD (2018). Why Childhood Anxiety Often Goes Undetected (and the Consequences). Child Mind Institute. https://childmind.org/article/detecting-childhood-anxiety/. Viewed on July 24, 2018.

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.