Defying Gravity...Carnivals Should Be Fun!

Today my family of four along with my sister-in-law went to the carnival. Within the "kiddy" section, there were simple rides like the carousel but there were some more gravity-defying rides as well. My husband enjoyed riding the rides with my 6 year old daughter while my 21-month old son stayed in the stroller and I took pictures of everyone. But I did manage to get on one ride with my daughter, and boy was it fun! It was a ride that went in a circlular pattern while the kids/adults layed two people to an "airplane". While on our airplane, we were lying on our bellies and strapped in from behind. Not only did the ride go in a forward circular pattern, but it also went up/down making you feel as if you were "losing your stomach". Now, I grabbed my little one's hand, because I was thinking she may freak out. But I was wrong, she squealed with laughter. She had so much fun! And she should have. Once kids are of a certain age, they should think it is so much fun to move in various ways against gravity. It is not uncommon to see a toddler trying to be upside down off a couch or jumping off of furniture!

There are five directions to move within space: up/down, forward/backward, circles (rotary and axial), upside down, and sideways. Swinging on a swingset back and forth is a simple way to move, whereas riding the carnival ride today as described above was more complicated because it combined movements. When we move in these various directions, vestibular receptors in the inner ear are stimulated. The vestibular system can be a tricky sense. When a person has an ear infection or vertigo, this system can go haywire and throw the person's balance off. It is quite scary to feel off balance. That is why some kids with vestibular disorders don't like carnival rides. In fact, some would probably whether do anything but get on that ride!

If you have a child who doesn't like to play at the park on the swings, slides, or climbing devices, it is possible that he has difficulties with vestibular processing. If the child also has a gross motor delay or falls often, this should be discussed with the child's physician. Physical or occupational therapy services may be necessary to help the child. It may seem trivial when the child is only 2 years old, but if the problem is not corrected, the child ends up being a grade schooler who can't ride a bike or roller skate with his peers. He may also be the type who is clumsy, making him be the last one chosen to play games during school recess such as for soccer or dodge ball. If you suspect that your child has problems with vestibular processing, it is definately worth checking out.

Some other signs of the problem could include: low muscle tone, delayed development with two handed activities, clingy to parent when should be playing with peers (especially at birthday parties), fatigues easily, scared to sit in chair or on potty due to dangling feet, short attention span, and delayed eye-hand coordination. Those were all symptoms of kids who are over-responsive to vestibular input or who have sensory based motor disorders. Kids who are under-responsive are more lethargic and passive. Kids who are sensory seekers are described as the energizer bunnies and can never seem to get enough movement unless they are asleep. Some of these kids are even known to tire out the family's energetic dog! They tend to jump from high surfaces, fidget, and spin around. All of this over activity needs to be directed, especially if the child has a language or fine-motor delay. These children may or may not have a sensory processing disorder (SPD, AKA sensory integration dysfuncton), but should be checked out by a therapist. I don't think that every child with the above-mentioned symptoms necessarily has a vestibular disorder, there could be other things going on including neurological deficits, other disabilities, or environmental factors. An example of an environmental factor is lack of or decreased stimulation such as being at home all day with a mom who is on bedrest and can't help the child get the necessary exercise he needs, so he overly seeks out movement such as jumping off of high surfaces. This is the case where it is well worth it to pay extra for a young babysitter to come over to play or to invest in a mini-trampoline for the living room. So, not every referral to a therapist will mean the child needs intervention, but maybe at least some ideas can be generated for helping the child.

The Drive-Thru Carwash, What's Not To Like?

My two children love to go through the car wash after I fill up my car tank with gas. What's not to like about the drive-thru car wash anyways? The car gets sprayed with water, soaped up, and "blow dried" before you leave the tunnel. Well, it is quite the sensory rich experience, because the car is moving while all of these noisy machines are coming at you!

Although my typically developing kids think it is fun, I can see why a child with sensory over-responsiveness, poor motor planning (AKA dyspraxia), and/or anxiety would not think it is fun. If lots of noise, sights, movement, and smells tend to be over-whelming to a child, then the car wash is not the place to go for entertainment!

This gets me thinking, how many common daily or week events would be over-whelming to these children. Well, just to name a few: going to the grocery store, taking a bath including washing hair, mealtime (preparation and eating), singing at church, going to the local park, and playing with other children. Then, there's always the events that tend to happen on a monthly or quarterly basis: birthday or holiday parties, haircuts, zoo, and going to the movie theater. How fun would life be, if these things created more anxiety?

Children who over-respond to sensory input to the point where it interferes with functioning in life events, could benefit from occupational therapy services. Children who have difficulties with motor planning and learning new activities or with transitions could often benefit from occupational therapy as well; these kids tend to be clumsy and may need physical therapy, and may also have a speech delay requiring speech therapy.

One thing that is beneficial to do at home for these children is to make routines predictable. This helps them to feel in control because they know the order of events. But we all know that the unexpected can happen, so the best thing to do is be calm and provide calming sensory input (see www.sense-ablebaby.com ). Realize that the child gets upset and reacts the way he does because of the "fight, flight, or fright" response. If attending occupational therapy treatment, ask the therapist for a home program and ideas on how to handle tough situations. This is especially the case if the child has been diagnosed with sensory processing disorder (AKA sensory integration dysfunction).

Well, I'm off to go cook a new recipe- not a predictable experience. And I'm doing this after I attended a sporting event, took my child to a roller rink with her friend, and cleaned up my son's vomit...none of which are predictable experiences! Wow, and it's not even 5 pm yet!

Ambidextrous Versus No Hand Preference

Most children begin to prefer using one hand over the other for skilled activities (e.g. eating meal with a spoon, throwing a ball at a target) by the time they are in preschool (age 3-5 years). Technically, they aren't considered "behind" if they haven't done this even up until the age of 7 years when their brain becomes fully myelinated. Yet, some developmental standardized tests show that it's a skill that should be present at 2 years of age. It helps if the child has chosen a hand dominance by preschool and kindergarten when they are learning to write letters and draw pictures. Since 96% of people are right-handed, chances are you can put the crayon in the child's right hand and be correct about your choice. But definately, don't fight with the child if they start using the left hand, just let them do it. Maybe they can perform an activity such as cutting out shapes by taking turns with each hand. And eventually, one hand will feel "just right" to them, and they will choose a preference.

Not having chosen a hand preference yet should not be confused with being ambidextrous, which is being highly skilled in each hand such as writing just as neatly with either hand, manipulating chop sticks with either hand, or hitting the baseball with the bat in either hand. Often, it may not be known if a child is ambidextrous until middle elementary school years, since preschoolers are just learning to perform fine-motor activities.

So what is dominance confusion? Well, this is when the child isn't that skilled in either hand, and may only use the side of the body that is convenient for that moment. For example, if you placed a spoon to the left side of the child's plate, then he would eat with his left hand...and would probably be messy with it. If you had placed the spoon on the right side of the plate, he would have used the right hand to feed himself. He may not cross over the middle of his body as noted by not transferring items from one hand to the other and only reaching with the hand closest to the item he is about to grasp. This might also accompany other problems since crossing the midline of the body requires that the two sides of the motor hemispheres of the brain "talk" to one another. Often, I see global muscle weakness in these kids and a poor ability to perform 2-handed activities such as holding the paper with one hand while the other writes on/cuts paper or one hand holding Mr. Potato Head's (R) body while the other hand inserts body parts . This is known as poor bilateral (two sides of the body) coordination which is often seen with certain syndromes (e.g. Down), cerebral palsy, sensory processing disorder (AKA sensory integration dysfunction), prematurity, and developmental delay. Anytime you see poor bilateral body coordination, there is a tendency for the child to have a speech and language delay, since the mouth is on both sides of the body. These children might also be clumsy such as with climbing, falling when running, not jumping well, and delayed with learning to ride a bicycle.

If you are wondering if your child is ambidextrous, get a checklist of fine-motor skills a child his/her age should be able to do. Then, have the child perform all of the skills with the right hand, then later do the same with the left hand. If he could do good with both sides, then he may truly be ambidextrous.

Also, remember that a person with a right hand preference could be good at using the left hand for certain things, especially when taught a certain skill with the left hand. For example, I was taught to tie my shoelaces by my left-handed sister, so I do that skill like a left-handed person would do. I have tried to change how I tie shoes, shoot pool, and perform the other numerous skills she helped to teach me, but my brain has already learned those things using the left hand. Now, if I were ambidextrous (which I'm not), I would have been able to generalize those skills to the right hand and make the switch easily. So are you a lefty, righty, or amby?

Self-Stimming

Do you twirl your hair, tap your fingers on the table, or bite your fingernails? If you do, then you partake in self-stimming (AKA self-stimulating behavior). Many children with developmental delays, poor sensory processing, autism spectrum disorders (ASD), visual impairments, or mental retardation "self-stim", too. It is when a person perseverates on a particular behavior repetitively. They are sometimes odd behaviors, but not always. Many children with special needs do these types of behavior when they are bored, over-whelmed, upset, sensory seeking, unable to motor plan how to do an activity, or just do the self-stimming just to do it. Many children will become upset if you try to stop them from doing the behavior. Some children self-stim so excessively it is obsessive-compulsiove.



The following are some common self-stimulating behaviors:

• flicking fingers or waving hands in front of their face


• spinning toys continuously


• watching ceiling fan


• staring at lights


• staring at lines on the wall, floor tile, or within the furniture (e.g. legs of table)


• shredding paper


• pacing


• rocking


• spinning or swinging


• head banging


• teeth grinding


• playing with spit or fingernails


• acting out a movie scene or telling the same story repeatedly


• repetition of odd noises including throat sounds


• pinching or scratching self

A few ideas on how to stop or reduce the self-stimming behavior are:

1. If the child is self-stimming because he is bored or a sensory seeker, then provide activities that provide sensory input such as jumping on a trampoline, rocking horse, ride-on toy, tunnel, finger paint, play-dough, musical toys or instruments, etc. Also, make sure to leave toys setting out in baskets or containers that are visible, because some kids won't play with toys that are stored away in closets or drawers.


2. If the child is self-stimming because he is over-whelmed or upset, then figure out what could reduce his overloaded feeling. When he is upset because he can't express his needs or wants, then get ideas from his/her speech therapist. Also see the previous post this month on this blog on helping a child to talk if he is delayed in communication skills. If the child is upset because he is hungry or has another basic need, then help the child with it. If he is upset because he "Can't get his way", then hopefully working on behavior managment along with offering other things to do and play will help.


3. If the child is self-stimming because he is unsure of what to do or unable to motor plan well, then help him with doing something else or redirect it. For example, if a child with limited play skills perseverates on jumping, then jump next to him and say "You must want to be a frog, ribbit, ribbit" and encourage him to imitate a frog. Then, after a few minutes change animals and see if he can imitate you. Doing this helps with the motor planning problem by showing him what else can be done.


4. Some kids with limited play skills will only play with toys in simple ways. For example, mabye the child will only build blocks into a tower and become upset if asked to build a different structure. This can be slowly redirected such as to build a train next to his tower, and push the block train with "choo-choo" sounds. He may not build a train that day, but maybe will the next time you try this. Do not feed into the child's limited patterns of play! This is not helping his development in terms of cognition, social-emotional, language, or fine-motor skills. Teach him how to plan in other ways.


5. You can also redirect self-stimming by providing a distraction.


6. Be aware that some children will begin the self-stimming behavior as soon as you walk away. Others may stop the behavior you redirected but then gain a different self-stimming behavior; if that is the case, consider that the child needs more sensory input (AKA sensory diet) and is doing the self-stimming because he is a sensory seeker.

Often redirecting self-stimming or helping the child to play with toys in a new way requires a lot of thinking outside of the box and getting down on the floor to play with the child, such as with the DIR / floortime approach.