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.

7 Ideas for Sensory Safe Bedrooms

Having a child on the autism spectrum brings different challenges and rewards. For instance, many parents say their child with autism is less competitive and selfish than neurotypical children. On the other hand, there are situations that children on the Autism spectrum face that can cause conflict and challenge for parents such as dealing with sensory issues.

Giving a child with autism a sensory safe space can help them manage periods of feeling intensely overwhelmed, aggravated, confused or frustrated. Their bedroom is a great place to start. Here are seven ideas for creating a sensory safe bedroom for your child on the Autism spectrum.

  • Quiet Cleaning: Children on the autism spectrum can be more sensitive to noises. If you need to clean your child’s room, you should consider a robotic vacuum that reduces sensory stimulation and makes them more comfortable. Vacuuming often reduces pollutants in your home’s air, which helps your child stay healthier. Since robotic vacuums are quieter than regular vacuums and can be programmed to go on when your child isn’t home, they are a great option for limiting noise stimulation. Review this guide to choose the best appliance for your budget.
  • Calming Colors: Certain colors such as white, blue, green or purple can create a sense of calm. Painting your child’s bedroom walls in these colors can have a soothing effect. In addition, you can use an LED projector, bubble tube or fiber optics to add soothing colors, motions and sounds.
  • Swinging: A swing suspended from a single suspension hook gives your child a cozy place to relax and settle down. The back and forth and side to side motion of swinging can often soothe an upset child’s sense of self and security. It can also be a good distraction — your child can sit in his swing and rock while engaging socially with family or friends.
  • White Noise: Adding a white noise machine to your child’s bedroom can help them settle into sleep, relax after a busy day at school or calm down after a behavioral situation. It’s not uncommon for a child with autism to experience sleeping difficulties, making them more drowsy and irritable during the day. A white noise machine can help them fall asleep and stay asleep.
  • Texture Flooring: A child on the autism spectrum can be brought back into the present moment with access to a variety of full-body sensations like bean bag chairs, crash mats and carpet. To give your child the right amount of sensory stimulation, you can even purchase colored gel floor tiles that squish when kids step, jump, push, touch or play.
  • Minimal Decor: Keep the decorations to a minimum in order to limit sensory overload. That doesn’t mean that your child’s room can’t have any patterns, it just means you want to be sparse with them. For example, a child with Autism might have a hard time falling asleep under a busy Spider-Man-themed comforter. Try using a solid color comforter and give your child one Spider-Man pillow, instead.
  • Organization: Many children on the autism spectrum thrive off of routine and organization. Clutter can be an extreme intrusion on their senses. Help their room stay tidy and organized by giving them storage for toys with lids or containers so they stay out of sight when they aren’t being used. Use neutral colors for furniture like bookshelves and desks that would likely hold items that can be colorful and distracting.

Your child’s needs will be different from other kids, and not just because he or she has autism, but because your child is an individual with unique needs and wants. Having your whole family help with decorating your child’s space can bring everyone closer together and help them better understand what it means to be on the autism spectrum.

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

Scope of Speech Language Pathology

When most people think of speech therapy, working on speech sounds is the first thing that usually comes to mind. We all either know of or experienced a "speech teacher" when we were in school ourselves; not knowing the "speech teacher" worked on a lot more than just speech! Speech-Language Pathologists (SLPs) can work in schools, hospitals, rehabilitation centers, skilled nursing facilities, private clinics, universities, and even provide home based services.

According to the American Speech Hearing Association, the practice of Speech Pathology "continually evolves" and contains several domains of service delivery. I hope this list below helps you have a better understanding of all the many different areas in which an SLP may work on improving.  This list does not include domains such as counseling, collaboration, education, research, or specific etiologies within the categories listed. Please refer to the ASHA updated scope of practice for a full and comprehensive list of what the profession of Speech Language Pathology entails.

Speech-Language Pathologists (SLPs) work on many different areas of communication and cognition, including but not limited to:

DIAGNOSTICS

Screenings and Evaluations: including but not limited to speech screenings, speech/language evaluations, and bedside swallowing evaluations (to determine a patient's safest diet level). SLPs who work in hospitals may also perform endoscopy, videofluoroscopy, fiber-optic evaluation of swallowing (voice, velopharyngeal function, swallowing) and other instrumentation to assess aspects of voice, resonance, and swallowing.

SPEECH

Articulation: working on error speech sounds, such as /th/, /r/ and /s/

Phonology: working with whole sound classes that are being produced incorrectly, for example, a child is stopping (shortening) all of their "long" sounds (t/s, ch/sh, d/z)

Apraxia: Apraxia is the inability to coordinate the muscle movements for speech. The differentiation of apraxia versus a severe speech or phonological delay/disorder is determined when the SLP performs the initial speech/language evaluation.  Speech sound errors, phonology errors, and apraxia are all different diagnoses, and all have a different plans of treatment that your SLP will choose to follow.

Oral Motor: working on improving any oral motor weakness or decreased range of motion that might interfere with speech sound production or the mechanics of eating (biting, chewing).

Augmentative Communication: Teaching children and /or adults how to communicate via a device, such as an Ipad which has a communication program app installed, Vanguard communication devices, or other.

Sign Language: Speech pathologists who work with deaf individuals  or who work at Schools for the Deaf are fluent in sign. Speech therapists may also choose to teach  ASL signs to hearing children prior to them being able to communicate verbally, in order to increase their current ability to communicate their needs and wants, and thereby decreasing their frustration while learning to communicate verbally.

Stuttering: When a client has speech blocks, or repeats sounds, words, or phrases, and this has been determined to not be due to normal childhood dysfluency and is more than 3% of their total speech production, then a therapist will work with the client to teach them smooth speech techniques. For children who stutter, it is important they receive therapy prior to the age of 8 to have the best chance for fluency.

LANGUAGE- Spoken and written language (listening, processing, speaking, reading, writing, pragmatics)

Prelinguistic: joint attention, intentionality, communicative signaling

Expressive language: Work to improve a client's ability to express their needs and wants via speech, sign, or AAC. SLP's also work with clients to improve their grammar, syntax, and semantics. Describing, story retell, and conversation skills are also worked on under expressive language.

Receptive language: SLPs work on this to help a client's ability to understand what is being said to them. They work on improving a client's ability to follow directions, answer questions, and understand main ideas in both written and spoken language.

Social/Pragmatic Langauge: SLP's work on a client's ability to understand the components of non verbal language (tone, body language, eye contact), in addition to turn taking (both in activities and in conversations), sportsmanship (being a good winner/loser), friendship skills (making and maintaining)  understanding sarcasm, and the ability to participate in and maintain "small talk". Therapists also work on helping clients understand and use figurative language (idioms, similes, metaphors, etc) appropriately.

FEEDING/DYSPHAGIA (In certain states, it is the Occupational Therapist who addresses these issues, and not the SLP).

Feeding: SLP's work with clients who have a limited food reportoire (picky eaters) to help them expand their food choices and tolerances, including helping them overcome any sensory issues that are contributing to their limitations.

Swallowing: Children who had feeding tubes early on and adults/children who have had strokes can demonstrate difficulty with the process of  forming a bolus (our food mixed with our saliva to form a cohesive "package" that we easily swallow), moving said bolus to the back of the oral cavity to trigger a swallow reflex, and swallowing appropriately (ability to protect our airway during swallowing so that the food goes down the esophagus and into the stomach and not down the trachea where it can end up in the lung and cause aspiration pneumonia.) The elderly and those who suffer from dementia, including Alzheimer's are also at risk for needing this type of skilled speech therapy intervention. SLPs who work in medical settings who work with dysphagia clients will also perform bedside swallowing evaluations to help determine a patient's safest diet and will work in conjunction with radiologists and doctors to assess modified barium swallow studies.

Cognition/Safety

Problem Solving : Therapists work with clients of all ages to help them effectively and safely problem solve (including being able to correctly gauge the size of a problem and determine danger within the environment)

Divergent/Convergent Thinking: The ability for the brain to be able to both list and categorize (organize) information

Sequencing: The ability to sequence steps of tasks, specifically life skills, in order to complete the skill and improve overall independence.

Other

Voice: Speech therapists work with both adults and children who are recovering from vocal surgery, rehab from vocal abuse (think little boys who yell all the time on the playground, then develop hoarseness due to vocal nodules), and people whose pitch is either too low (hyponasal) or too high (hypernasal).

Cleft Palate/Craniofacial: Clients who have had surgery to repair a cleft lip or palate often need speech therapy to help them make their speech sounds appropriately, specifically plosives (sounds where air is built up and then released, for example, /b/ and /p/)   and speech sounds where nasal air emissions were previously present due to the cleft (/s/, /z/) or both /ch/.

Auditory Habilitation/Rehabilitation: Speech, language, communication, and listening skills impacted by hearing loss, or deafness. Auditory processing skills are also addressed by the SLP.

Play skills: Play is considered the building block foundation of language skills. Children who have limited play skills or do not play with toys appropriately (for example, line up their cars instead of moving them with a car noise) require intervention to expand their play skills. Often an SLP will work in improving vocabulary and ability to understand and follow directions into play goals.

Life Skills: Because so many life skills require the ability to categorize, sequence, and be safe, SLPs will work on life skills with their clients. This could be a teenager with autism who needs to learn how to fill out a job application, answer interview questions, do their own laundry, or follow a recipe. For an adult who has had a stroke, this can mean relearning how to do these things. By working with an SLP, the client who has had a stroke or head injury can, through speech therapy, teach a different part of the brain to "take over" these tasks from the part of the brain that has been hurt by the stroke or injury.

As all encompassing and vast as this list seems, there are still other things that are within an SLPs scope of practice, for example, a speech pathologist may choose to specialize in  early intervention (working with clients age birth-3 yrs old), helping second language learners work on accent reduction, or specialize in children who need help getting rid of a tongue thrust. I hope this has given you a window into the world of being a Speech-Language Pathologist.

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.

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.

Benefits of Early Intervention

Early Intervention typically refers to services provided to children from the ages of birth to three. Early intervention services can include occupational, physical and speech therapies. It can be overwhelming when a child is diagnosed with a disability or identified with a delay. The good news is that early intervention services can help set the stage for success for your child.

Who is Early Intervention For?
Early intervention is beneficial for both children that have a diagnosis that may impact their development and those children who are just delayed on milestones. Children with spina bifida, down syndrome, cerebral palsy, hip dysplasia, or other congenital conditions often need intervention in order to promote development and aide in meeting critical milestones. Sometimes, a parent or physician will notice that a child is not achieving their developmental milestones as they should. Early intervention services can help a child with a developmental delay hit motor, speech, and feeding milestones.

Why is Early Intervention Important?
During the first few year of life, children are learning and growing at rapid paces. Those first years are critical for setting the stage for critical life-long skills. By providing intervention during this crucial time period, outcomes are improved. Additionally, for children that have a diagnosis that impacts their development, early intervention can help with accommodations, assistive devices, and techniques to help facilitate development.

Early Intervention Services
Physical therapy addresses gross motor development. Some of the skills an early intervention physical therapist may work with your child on include:

  • Rolling Over
  • Sitting Up
  • Head and Neck Control
  • Walking
  • Crawling

Occupation therapy addresses fine motor development and sensory processing. Some skills early intervention occupational therapists may work with your child on include:

  • Self-feeding Finger Foods
  • Sensory Processing
  • Holding Crayons or Writing Instruments
  • Grasping

Speech therapy is more than just language development. Speech therapists not only address speaking and language delays, they also work with children on cognitive development and feeding and swallowing. Speech-language pathologists can work with your child on:

  • Swallowing
  • Eating Habits
  • Communication Skills
  • Expression of Needs and Wants

The benefits of early intervention are countless. If you have concerns about your child's development, ask your child's pediatrician if early intervention therapy services can help them with their development.

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.

Container Babies

Swings, jumpers, exersaucers, walkers, carriers, oh my! The possibilities for gadgets for babies to play in are endless. While these toys are a good tool for parents who need baby to play safely while they attend to tasks in the home with their hands free, extended times in toys that confine babies or “containers” can be detrimental to motor development delaying crawling, walking, and contributing to muscle weakness and lack of coordination.

It’s no secret that babies are usually fans of infant swings. The rocking and swinging can be soothing to a fussy infant. While a baby who is content in the swing for long periods of time may be a relief to parents as they tend to other things, excessive time spent laying at an incline in a swing can result in unfortunate musculoskeletal deficits. Laying on the back for a long period of time is one of the contributing factors to conditions such as plagiocephaly and torticollis. Infants need plenty of time to spend on the floor and doing tummy time to develop neck, core, and upper extremity muscles.

As infants grow, they enter a stage where they are curious about the world around them and want to see all that is happening. However, in the early part of this stage, they are not mobile or developed enough to sit themselves up on their own. During this time period, parents often turn to equipments such as exersaucers, jumpers, and walkers to help their baby play and be entertained safely. While these activities are fine in small, monitored amounts, long periods of time spent in these devices can result in gross motor developmental delays or even be dangerous.

Spending long amounts of time in equipment that keeps babies defined does not allow them to be down on the floor, exploring and developing critical core and upper extremity muscles that are necessary for development. While this equipment allows children to bounce, stand and walk, they do so without the necessary aspect of balance that is needed for further motor development and learning to perform those skills independently.

Not only can walkers contribute to delays in motor development, they can also be dangerous. Walkers can give a false sense of security that the baby is safe contained in the walker. However, there are many reported cases of infant injury such as falling down stairs while using infant walkers. Studies have shown that walkers can actually impede motor development.

While most of the latest gear for babies can be good in moderation, especially for exhausted parents looking to entertain their little one for a few minutes, excessive time spent confined without given room to play, explore, and test out those developing muscles can delay motor development during the critical first year.