Mindfulness and Children

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

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

Another relevant definition also can include:

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

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

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

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

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

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

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

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


References

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

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

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

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

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

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

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

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

3 years:

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

4 years:

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

5 years:

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

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

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

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

References

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

The Importance of Learning to Gauge Problem Size

Teaching problem solving in speech language pathology can encompass many skills including learning to identify when there is a problem, and helping providing solutions to problems. Being able to do both of these enables a person to be safer and more independent within various environments (home, community and school). One aspect of problem solving skills that I like to focus on when working on problem solving is learning to gauge the size of problems. While this might not seem as imperative as being able to identify and solve when problems are happening, this skill addresses two important areas: safety and reaction/pragmatics.

When teaching this skill, I like to provide criteria for each problem size. In simplest terms, a small problem is easy to solve, only effects ourself or one other person, and can be solved quickly. Examples of small problems could include the Ipad is not charged, don’t like the food choices of a meal, unable to do a desired activity, etc. A medium problem may effect a small group of people, and the problem is of longer duration. More resources or time may be needed to solve this problem. From a pragmatic perspective, a medium problem may involve hurt feelings. Examples of a medium problem could be a dropped birthday cake, you don’t get picked for a team, or your friends aren’t talking to you. A large problem effects a large number of people and/or may take a lot of resources or time to solve. Any problem where danger may be a possibility is viewed as a large problem. Examples of a large problem could include you cut your finger and don’t know if it needs stitches, you get separated from your parents on vacation, or a stranger is trying to talk to you .  (You can also address the problem size of catastrophic problems (house fire, natural disaster, etc). However, all of these would have a parent or trusted adult involved automatically.

So, why is being able to determine the size of a problem such an important skill? I find there are two benefits to working on this skill. One, being able to correctly gauge the size of a problem as small, medium, or big helps provide criteria for if help from a parent or trusted adult is needed. Knowing when help from an adult is needed improves overall personal safety, whereas knowing when a problem can be safely handled on one’s own improves independence and confidence.

Secondly, if we are taught to gauge the size of a problem appropriately, then we can work on the skill of matching our reaction to the problem size. If someone has a big response to a small problem, this has pragmatic implications. For example, if a child is told they have to share a toy and has a meltdown, they are having a big reaction to a small problem. By learning this is in fact a small problem, we can then help the child learn to have an appropriate sized reaction (play something else while you wait, know they can have a turn later, it is good to share with our friends). Likewise, the reverse can also happen. If a large problem is happening, for example, flunking classes, but the child is having a small reaction (indifference) we can lead them to understand this is a large problem and therefore a larger reaction is necessary (study more, get grades up, be able to graduate).

Gauging problem size correctly is a good skill for all age groups, child to adult. While an often overlooked scope of problem solving, learning to correctly gauge problem size enables those learning this skill to improve their overall safety and independence, and can lead to an improvement of social skills by improving appropriateness of reactions to given problems that can happen in everyday routines and situations.

How to teach gauging problem size:

Decide your criteria for each problem size (I like using this packet when teaching this skill in therapy sessions) and teach the differences between them.

Explain and provide examples of each type of problem size. (The teaching of the skill must come before the question/answering of a skill).

Start with visual examples (flashcards that depict everyday problems, freeze frames of problems depicted in media, etc.) Show the example and ask what size problem it is and why. I like to match my examples to those that could realistically happen within my child’s (or my client’s) daily environments.

Once there is good understanding with visual examples, move to verbally presented ones. (“Your wanted to wear your favorite shirt today, but it is dirty. Is that a small, medium, or big problem?”). Discuss why it is a small problem–Only effects one person, easy to solve (wear a different shirt, you can wear it again as soon as it is laundered).

This goal is easily linked to common problem solving goals by expanding the task. For example, we can ask  to identify the problem in a photo, then determine the size of that problem. Once problem size has been determined, we can then prompt for solutions to the given problem.

Katie Sullivan, M.S., SLP-CCC

has been a pediatric Speech Language Pathologist for 23 years, and is a Therapy Supervisor with Theracare.  She is the mother to five children, ages 8-18,  including twin teenage sons with special needs. You can follow her at the My Sweet Homeschool blogfacebook, twitter, and instagram.

 

 

 

 

Pediatric Home Health

Early Onset Schizophrenia and its Impact on Child Development and Function

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

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

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

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

  • Language delays
  • Late or unusual crawling
  • Late walking

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

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

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

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

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

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

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

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

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

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

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

Childhood Obesity and its impact on Daily Function

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Inside the Terrible Two’s: This much yelling can’t be normal…can it?

p>period does in fact exist. Kiddos at this age can be so full of life and love, and wonderful memories can be made based on their adorable disposition. Then, in a split second, everything good morphs into an engulfing darkness that seems to last for months: intense temper tantrums at home and in public, endless crying over seemingly small things, weird shouting matches in strange tongues, and extensive trails of broken toys and household objects.

"Terrible twos" does not necessarily mean that your charming baby will transform into a raging tyrant at the very stroke of midnight on their second birthday. Depending on your child, this stage can start much earlier or slightly later (i.e., 18 months to 2.5 years of age). The goal for parents is to be able to discern from the typical signs of the "terrible twos" and atypical behaviors in need of unique attention. So, let's start with answering why toddlers often act so terribly during this time in life:

  • Language is developing: By the time a child turns two years old, he or she now has a handful of single-words and possibly a few short sentences. The majority of their verbal expression comes in the form of commands in order to get what they need or want (i.e., sleep, food, diaper changes, medical attention, toys, etc.). Unfortunately, their language is still quite limited compared to older children thus the frustration begins. Toddlers try desperately to communicate with their family, but misunderstandings come up and tantrums are thrown. This is a point of aggravation for both toddlers and their parents.
  • Motor skills are refining: By now, a typical-growing toddler is walking or maybe even running around the house. Other movements include navigating the stairs, climbing all over the furniture, escaping cribs or gated beds, getting in and out of the tub by themselves, partially dressing and undressing themselves, coloring on the walls, removing and replacing lids, ripping open packages or bags, etc. This is an exciting bag of tricks for toddlers and they can't wait to use their newfound skills. This often results in kiddos getting into things that they really aren't supposed to, causing minor episodes of household destruction.
  • Cognitive development allows for boundary-testing: Brain development helps toddlers see past simple black and white rules. Now, they want to test parents' boundaries and see how far they can go before they get into trouble. This often results in attempts to turn parents or other family members against each other because the child figures out that every adult varies in authority and rules.
  • Maturing expression of independence: Because the child is developing new language, cognitive, and motor skills he or she is going to want more and more opportunities to do activities on their own. Friction happens because as much as the child wants to do everything independently, parents realize that the child still has some limitations. In order to keep the child safe or to minimize frustration, parents naturally intervene and help which thoroughly irritates independent-minded kids.

Parents can't control all of the dismal factors of the "terrible twos", but they can conduct a few things to minimize problems and promote their child's growth:

  • Keep your own emotions in check: As a parent of a toddler, it can be very challenging to keep your cool when your child completely loses it 24/7. It is your job to keep your emotions under control in order to give your child a sense of love and security.  Call on family and friends for assistance when (and you will) need a break from your child.
  • Purposefully find moments for teaching: Your child may act like they have everything figured out, but two years of age is just a sliver of lifetime experience.  During those moments where your child gets angry or does something that breaks the rules, lovingly use those times to teach your child. Listen carefully to what they are trying to tell you, even if it's muddled or confusing. Guide them to finding the right answers and solutions
  • Maintain a structured day: Try to create a relatively predictable, daily pattern for your child. This does not necessarily mean that you have to do the exact same activities in the exact same order every day.  Attempt to grasp some consistency (meal times, community errands, nap times, bath-times, etc.). Structured days also means having consistent rules and expectations among both parents.
  • Consult with professionals if needed: Some children are going to require specialized and professional attention due to developmental delays or other childhood conditions. The "terrible twos" is a period of growth for a child that should come to an end before grade school, which means the child can regulate their emotions in order to successfully participate in activities outside of the home. If you believe that your child is behind or struggling with motor, language, cognitive, or emotional development, or if you think their behaviors are escalating beyond the toddler norm do not hesitate to consult with a professional. Start with your pediatrician who can then refer you to other relevant healthcare providers.

You’re not paying Attention: Working memory in Children and Functional Participation

As parents of young children, we are so easily blown away by the things that they say and do. The day she finally figures out the potty, the day she buttons her shirt for the first time, the day she recites the whole alphabet, or the day she says thank you without being prompted by you or another adult. These are just a handful of examples that highlight the potential growth of a young child.

On the other hand, parents are easily frustrated when our children do not do what they are told to or do not complete things in a timely manner. Some instances may include a child being told to go potty, a task that can be completed in less than 5 minutes. Instead, with consideration of the fact that the child is only 3 years old, she decides to take a few detours on the way: takes her socks off and on a few times, puts a sock on her sister’s hand, knocks a few DVDs off of the shelf, runs over to the table to finish that last bite of food from lunch, finds and fiddles with a pen that she has been looking for all day, throws herself on the floor and whines about how she never gets candy, and then slowly but surely she steps into the bathroom (which at this point could take an hour to just take the pull-up off).

How many times a day do parents reprimand their children for not paying attention? For families with small kiddos, the answer could be at least one thousand times. As children get older, their ability to attend to tasks, to situations, and to people matures so that they can participate in activities that matter to them. So, what about children who struggle with “paying attention” or with completing an indefinite number of tasks? Attention is influenced by several complex processes in the brain, one of which is called working memory. Working memory is a mental skill that allows a person to temporarily retain information that can be used in the moment. It is our ability to juggle thought processes in order to meet the demands of our environment: writing a book reports, cleaning up the playroom, drawing a picture, talking to a friend, etc.

Working memory retains a certain level of information in order for a child to be ready to use it immediately, such as following several steps of instruction from a parent. What happens when working memory does not work? According to the Child Mind Institute (2018), there are several childhood disorders that exhibit symptoms of limited working memory: learning disorders, ADHD, dyslexia, auditory processing disorders, and autism to name a few https://childmind.org/article/what-is-working-memory/. A child who has limited working memory may look something like the following scenario:

Dillon is a 6 year old boy who lives at home with his mother and his sister. His mother tells him that he needs to complete several tasks before he can go to a birthday party. His mother says, “Wash your face, change your pants, make your bed, and pick up all of the toys in your room. 10 minutes goes by, and his mother learns that Dillon did not complete anything according to her instructions. Instead, he placed his toys on the couch in the T.V. room and he took off his pants without putting a new pair on. He proudly told his mom that he washed his face though.
Sometimes, it is not as simple as telling our child that they are not paying attention. If working memory is impaired, then parents need to take some alternative steps to better guide their child. Examples include:

  • Breaking down instructions: Avoid bombarding your child with a long, wordy, verbal list of instructions. Instead break it down, step by step. At the beginning, maybe only give them one task to complete. As your child improves and consistently follows one-step instruction, give them two and so on and so forth.
  • Using a picture calendar: Working memory is part auditory (hearing) and part visual-spatial. If your child struggles with retaining verbal instruction, try visual cues such as picture calendars that the child can look at on a daily basis. Similarly to verbal instruction, do not overload the calendar. Provide pictures that represent a small number of tasks and then gradually increase the tasks as the child improves.
  • Exercising patience: One of the best things a parent can do is self-improve their capacity for patience. When we get impatient with children, they can see and feel it which only worsens their performance.
  • Consulting with a professional: If you are concerned about your child, specifically about their development and their ability to attend during the day, contact your pediatrician who can potentially refer you to some specialists (i.e. occupational therapy, psychiatry, behavior specialist, etc.).