Making Halloween Fun For All

It's Halloween time! Many of us think it is fun, whereas others are not feeling the same amount of joy as the rest of us! In hopes of making the holiday more pleasant for all, I have provided a link on ideas for adapting this holiday for a child with Autism Spectrum Disorder. I also think these ideas could work well with any disability or young child:

http://www.autismsupport.org/halloween.html

My small family of four likes to dress as a theme. Last year we all dressed up as characters of Toy Story. This year we will be characters from Peter Pan...even the dog is dressing up as a pirate. Since my three year old son gets scared of "spooky" things easily, we probably will be wearing "happy" costumes for a while. Last year, he became very upset with the decorations we had on our front porch, and would only go out the back door until the decorations were taken down the day after Halloween. So, if you have a case like this, some of the ideas in the link may work well for you even with a child who doesn't have a developmental delay or diagnosis of autism.

Enjoy trick-or-treating and HAPPY HALLOWEEN!

Obstacle Courses

One of my favorite things to play with my daughter and the older toddlers that I work with as an O.T. is "obstacle course". My daughter likes to set up a few movement activities in a sequence in the living room, and then maneuver through the obstacles while I time her with my stop-watch. I like this activity because it is good for strength, coordination, balance, praxis, sensory processing, and cognition. The activities we often include within the obstacle course at home are: crab-walking, fabric tunnel, exercise ball with handle (AKA hippity hop), hula-hoop, dining room chairs, and large pillows. Sometimes I challenge her more by having her crawl backwards through the tunnel, jump into the hula hoop with both feet as it is laying on the floor and then hop out of it on one foot, slither under the chair, and bounce on the ball while circling a piece of furniture. She gets the biggest kick out of this!



When I am in a client's home I just search through the play room, toy box, and other areas to find objects that are in the environment that could be included within an obstacle course. Below are some common things within homes that could be used:

• Place mats: place 2-3 in a row and have the child jump from one to the next
• Blankets and chairs: create a tunnel to crawl through by draping a blanket over 2 chairs
• Large pillows or couch cushions: pile a bunch of pillows together and have the child climb over them, slither under them, log roll or forward roll over them
• Coffee or end tables: slither under them like a snake or walk around them forward or backwards
• Exercise ball: roll, bounce (on bottom, standing, back, or belly), carry over head, "crash" into it
• Heavy quilts: take a "magic carpet" ride by being pulled on it or pulling sibling on it as they sit or lay down
• Laundry basket: the child can push it while it is inverted, or sit in it and be pushed or spun
• Balled up socks: toss balled up socks into a box or large plastic bowl
• Stairs: walk up or down them, "booty bounce" as the child bumps down as he sits on his bottom
• Common toys kids have: trampoline, rocking horse, tricycle or other ride-on toy, tunnel, tent
• Activities to incorporate: marching, jumping, hopping, running, walking or jumping backwards, rolling, bear crawl, crab walk, army crawl, galloping, spinning, donkey kicks

Bedtime Routine

My children are very routine oriented. They like to know what to expect and do well with predictability. But this week Grandma is visiting which changes everything for them. I just overheard my daughter giving my husband a hard time as she was brushing her teeth, getting pajamas on, and being read to at bedtime. She ended up getting in trouble! This is not like her at all to act that way at bedtime! Want to know what I think was the problem tonight? She stayed up 45 minutes past her usual bedtime and didn't have a 30 minute "quiet time" or nap in the middle of the day. Seems crazy that only 75 minutes can make a difference, but it does. Also, Grandma is lots of fun so that changes how tired my daughter gets! Tomorrow I will make sure the bedtime is more predictable in the order of events and the time that it occurs! I guess we live and learn! But overall, I highly recommend keeping the bedtime routine as predictable as possible so that the kids can calm down enough to fall asleep.

Some other quick ideas for making the bedtime routine more successful is to quit "rough housing" or other alerting play activities at least 45 minutes prior to "lights out". Many young children can't "shift gears" quickly and then have trouble calming down enough to sleep. If your child is sensitive to touch, then do teethbrushing and bathing at least 45 minutes prior to "lights out". This is because the activities that are aversive to them over-alert them and then it is hard for them to calm down. Trying more calming activities prior to bed are better choices for promoting the child to fall asleep quicker. Ideas include reading or being read to, soft music, playing with quiet toys, and cuddling with family members. Don't use loud or brightly blinking toys close to bedtime. Some kids can't play games that require a lot of problem-solving close to bedtime because they then can't slow down their mind enough to fall asleep. My daughter fits into this category....she is a deep thinker and wants to solve the world's problems. So, I really have to choose pre-bedtime activities wisely with her. I definately don't let her watch the news, that would worry her too much. For now "Good night, sleep tight!"

Preschool Readiness: Explaining Disabilities to Other Young Children

t's time to start preparing for back-to-school or the first time to attend school. I work with children with disabilities under the age of three years of age. So, when they go to "school" it is usually one to three days a week at a local preschool or at a church's Mother Days Out (MDO) program. A couple of worries that many of the parents have in sending their young child with special needs to school is "Will the other children understand my child's issues?" and "How will I explain my child's disabilities to the other young children?". I usually respond by telling them to meet with the teacher ahead of time and discuss how you will handle it. Usually giving the other children a short explanation on the first day of school solves the problem. I think that this is a hard thing for some of these parents due to past experiences. Maybe they had other children just stop and stare at their child in public. Or even worse, they have had another adult do the same thing. Typically developing children are more understanding than we give them credit. It is often the parent of the typically developing child or another adult in their life that mishandles the situation or causes a fear reaction. Because if you just give the child a short explanation when they are staring, and tell them not to stare, that usually fixes things.



I like to think that my children will learn from example. I try to treat all people with respect. When I see another person in the elevator or stand next to someone in the grocery store line, I look them in the eye and talk to them...no matter the race or if they have a disability. So, teaching my children to treat others with respect hasn't been hard so far, because they see their parents doing it already. This can be the root of the problem in explaining disabilities to other children...they haven't seen their parents interact with persons with a disability or haven't seen them show respect. This includes making fun of people or insulting someone by calling them "retarded"....how rude can you get! When I hear another person do such a thing, I am sure to set them straight!



When I am explaining a child's (or adult's) disability to another young child, I keep my explanations simple. I am thinking back to how I explained things to my now 5 year old daughter when she was 2 1/2 or 3 years old...I definately kept is short and simple. Although I am an occupational therapist and have taken my daughter to birthday parties of some of my young clients, she has also been exposed to persons with a disability elsewhere including church, stores, and our home.



When I explained to her about a child or adult who is visually impaired, I simply said "Her eyes do not work the same as ours do. Her hands and the special "machine" she has helps her to see." I did not explain the diagnosis or why the child was visually impaired nor did I talk about all of the intricacies of the adaptive equipment the child might have had. For young children, the simpler the better.



When I explained to her about a child or adult who uses a wheelchair, I simply said "His legs do not work the same as ours do, the wheelchair helps him to get to places." The only problem I had with adults in wheelchairs who were strangers was my daughter asking if she could take a ride. This is because one of our good friends who is paralyzed lets her sit on his lap and "go for a spin".



When I explained to her about developmental disabilities such as an Autism Spectrum Disorder (ASD) or Down Syndrome, I never told her the "diagnosis". I simply said, "He can't talk or play the same you and I do." This was enough for her, and she would play with them on the level that they could play. She even learned more sign language than I had initially taught her.



I think that my daughter now understands all of this better than some adults do. This last school year in her preschool class she enjoyed playing with a young boy with a severe speech impairment. She liked "translating" what he had to say or meant by his gestures. She had fun giggling and playing with him, and wasn't even the slightest bit bothered by his disability. She even seemed understanding when he had meltdowns and tantrums!

Food Allergies & Vacation

I just returned from vacation. We had lots of fun! Since both of my sweet children have extensive food allergies, I must really plan ahead for food during our vacations. It would be a lot simpler to pack for a trip if I didn't have to think about every meal and snack for each outing, but by now I have come quite used to this. It is a serious problem if my children eat a food they are allergic to. This is why I always have the jr. epi-pen and lots of benadryl in my purse. They both have had anaphylatic reactions (hives, dropped blood pressure, throat closing up) since being small babies.

I first knew my daughter had food allergies around 4 months of age...she is now 5 1/2 years old. What gave it away for sure that she had food allergies was that I looked down at her chest when changing her clothes about 20 minutes after I breastfed her, and saw at least 100 little hives on her neck and chest. Since I am a healthcare worker, I was probably alot calmer than most moms. I made her vomit, washed her off, and gave her benadryl. She got worse, so I drove her to the doctor's office. They gave her epinephrine, because by this time she looked white as a ghost yet flushed at the same time. I remember this day like it was yesterday! After thorough testing it was revealed that she was allergic to egg, dairy, nuts, soy and wheat. So, since I breastfed her I had to avoid these foods for then on. The only other choice was to feed her an elemental formula, but those are bitter tasting and expensive. So, I chose to continue breastfeeding her. She has now outgrown all of her food allergies except for dairy, eggs, and red food dye....3 biggies.

In terms of my son, I was absolutely for sure he had food allergies by 2 months of age. But I had my suspicions at 7 days of age when he had projectile vomitting after being breastfed. I know the difference between infant reflux and vomitting, and this was definately vomitting. The other clues were redness around his bottom, a runny nose, mucous in the stool, and a significant amount of gas. He was too young to test for food allergies, so the doctor suggested that I avoid eating dairy, nut and egg products. At 5 months of age he was old enough to be tested and the results revealed: soy, dairy, peanuts, almonds, eggs, and oats. He is now 13 months old. I just recently weaned him and he drinks hemp or rice milk for calcium. On a good note, I was finally able to eat anything I wanted as of last week when weaning was over with....so vacation food was more fun for me!

While packing for the trip I thought of every little outing we would be on and planned accordingly. Most restaurants even add butter for flavor to vegetable dishes, so I brought lots of produce. I got us a room at the hotel that had a small refrigerator for all of my kids' special foods.
It seems like I had to explain many times on our trip why I was bringing in food to an amusement park or other facilities that do not allow outside food. After many minutes of explaining, I was let in with the food each time. The sad thing is that these places sell alot of junk food (nachos, candy bars, slushies with food dyes, etc). My children eat lots of fruit, veggies, and foods with little or no additives. Because of this my kids are probably much healthier than the kids who don't have food allergies!

Most importantly, we had so much fun on our trip. Seeing the smiles on my two children's faces and looking back at the souvenirs and photos makes all of the extra planning worth it!

Being on the Same Page

As parents my husband and I should be on the same page when it comes to our parenting styles and discipline. But sometimes we are not. The most recent reminder of this was yesterday when my 5-year old daughter looked up at me after I had asked her to do something, and said, "Mom, you are the leader." So, I responded with "What do you mean?". With quite a serious look on her face she said "Well, you are the one that makes up the rules and makes me mind." Of course, I knew where she was going with this. She knows that I am consistent with discipline, and she can persuade her Dad to bend the rules. I then added "Mommy and Daddy are both in charge and we try to make the rules be the same." She smiled back at me, but I'm not so sure she believed what I was saying. After all, 10 minutes prior to this conversation I took an ink pen from her toddler brother's hand. And where did he get this pen? That's right, from Dad.



Children need predictability in their life. They need to know the rules. This means that parents need to be on the same page, at least most of the time. My children are typically developing, and I find it difficult for my husband and I to agree on all parenting issues. Although, we do agree on most issues. It must be even harder for two parents to agree on their approaches when the child has special needs. Unfortunately, while I am at work it is not an uncommon sight for me to see parents on opposite ends of the spectrum in their approach to parenting. So often, one is more leniant because they are a "softee" or feel sorry for the child. The other parent might be stricter and expect more of the child no matter if he has a special need or not. Of course this depends on the special need, if it is medical, developmental, or learning problems. However, these children need consistency between their parents more than anyone else does.



Some suggestions on how to get on the same page on parenting your child with special needs are:

• Discuss your opinions and how you will respond to things before the situation arises. Do not bicker, argue, or debate in front of your child. This is super confusing for the child and lets them know the two of you are not in agreement. This is especially the case for a divorced couple. So, unless the child is in harm, don't disagree with the other person in front of the child.


• Understand the rules at daycare, preschool, the babysitter's home and other places that your young child may be during the week. Try to use some of those same rules at home. This might include not eating a snack before washing hands. It might be that the word "stupid" is considered a bad word; if they can't say the word at school, don't let them say it at home.


• After therapy sessions (physical, speech, occupational, or other), discuss any techniques that might need to be updated by the parents. If the speech therapist recommended only giving the child a small amount of food at meal time so that the child needs to request more food with sign language or words, then do this at each meal if possible. And all caregivers need to carry this out, not just the parents.


• Be consistent and predictable. If the child's behaviors start to improve, don't all of the sudden switch approaches as this may alter the child's behavior again. Remember, that predictability can be calming. An example may include that if a toddler with feeding problems learned to chew food without gagging after 6 months of addressing the issue, then don't regress to offering him baby food because that is all you had in the pantry. Plan ahead if you need to, but if you let him have the baby food again, you just undid alot of the work. It may take another month to get him to eat table food or not scream when he does eat it.


• Keep open lines of communication. Discussing how to address behaviors that the child displays may need to be done on a regular basis; maybe once a week or once a month.


• Give lots of praise to your spouse in front of the child and in private. It is not easy to be a parent and it is even harder when there are special circumstances
  

Now, I hope this weekend and next week on our family vacation that my husband and I can be consistent with our parenting styles. I know that times where we are in a hotel and out of our environment can be a true test for us!

Part Two: Sensory Strategies for Adapting the Environment for Young Children with Sensory processing problems/ SPD

Well, I'll now begin the second part to my blog on helping young children with sensory processing problems or who have a diagnosis of SPD (Sensory Processing Disorder) by making adaptations to the environment. Part One was blogged on July 20, 2009.


Let me start by saying I am a believer in children receiving therapy services at a clinic, but I am also a believer in "home programs". Therapy only occurs a couple of hours per week, but the parents are with the child more of the time and therefore need to learn ways to help the child process sensations more effectively. Therapy helps with the remediation of skills, but that can take awhile. Immediate changes can occur when adapting the environment or altering the way you interact with the child.

Part 1 of this blog gave ideas for children with sensory over-responsiveness and sensory seeking behaviors.

The other categories and ideas are:

• Sensory Discrimination Disorder: this is when it is difficult to detect the qualities of sensations. A problem with auditory processing may be that the child is unsure of what direction a noise came from or can't discriminate if he heard the sound "p" versus "d". A child with a tactile processing problem may not realize he has a wrinkle in his sock or is unsure where he was touched. A child with a vestibular processing problem may get lost in space easily or look clumsy. There are many more symptoms, but these are some basics. Strategies include giving sensory rich opportunities such as those listed for sensory seeking children in Part One. Other ideas include:

Lots of movement as well as mazes and obstacle courses. This is good for visual, proprioceptive, and vestibular processing.

Take the long way when moving between rooms, and march en route.

Lots of tactile experiences such as play-dough, helping to cook, fingerpaint, bath tub toys, and helping to clean (without toxic cleaners).

In order to climb into the carseat, place a stool in the floorboard.

Place a stool or steps at the sink so that everytime the child goes to wash his hands, he is also working on balance.

In the car during rides, play a music CDs with words and listen to read-along story books- the type where you turn the page when you hear the ding or chime sound.

• Sensory Under-Responsiveness: seems slow to respond to sensation or being spoken to, may appear not as intelligent as they are because of slow responses, hypotonia (AKA low muscle tone), fatigues easily.

Once again, offer a sensory rich environment such as blankets/pillows for babies to be in tummy time, swings, rocking horse, ride-on toys, exercise balls, ball pit, mini-trampoline, push-pull toys such as a wagon, and tunnels.

Use lots of movement whether it be through toys or marching, running, "roughhousing", or bouncing on adults lap as this movement "perks" up the child. Often, balance reactions are better after participating in such activities.

During bathtime have the toddler climb into the tub if possible. Offer lots of toys during the bath.

Leave toys lying around the room in various spots, because this is a child that if the house is too tidy, they may not explore. When this is the case, they may get bored and start self-stimming (e.g. rocking back and forth, banging head, flicking fingers in front of eyes, etc.), play with same things in a perseverative way (e.g. blocks must be a tower, can't vere and be a train or house when building), watch too much TV, or just sit there passively.

Give time for the child to respond. He may need a few seconds to decide he wants to play with a toy, move, or answer a question. If he still doesn't respond, he may need a tactile cue such as touching his hand which reminds him to reach for the toy. He may need the toys moved to another location or the room re-arranged. But be patient and don't expect quick changes.

• Dyspraxia and poor motor planning: this is when a child has difficulty with sequencing the steps to an activity or has difficulties executing a task or movement which makes him look clumsy from not knowing where his body is in space. Apraxia is a term used when an adult has lost the ability to motor plan such as after having a stroke (CVA). It is also a term used by speech language pathologists to describe a child who has difficulties with speech and/or oral motor skills due to poor motor planning. These ideas will stick to just the body, from an occupational therapist's (OT) point of view. Adaptations might include:

Set up the room so that things are easily found. Once again, having a home with no toys setting out or in containers high up is not good for this child. Instead put toys in baskets, toy boxes, or low down in invisible containers for easy access to the young child.

Set up the environment for success. These children get frustrated when things become too difficult for him. have the layout of their bedroom be simple to maneuver such as the furniture across the walls and the middle of the room an open space.

Have cabinets or shelves in various rooms with safe items for them to manipulate. For example, have a kitchen cabinet without a safety device on it. Items in it could be plastic or wooden bowls, spatulas, etc.

These children need a certain amount of variety, but start to feel out of control if not having a lot of predictability. So the way you schedule your day should be fairly predictable. For example, after getting dressed and a diaper change then go eat breakfast, then play time, etc. This is why many of these tots do better at good daycares or preschool programs as opposed to when at home. Because at these places, the schedule stays fairly predictable. Although lunch may not be the same food everyday, the child knows that before lunch is circle time and that after lunch it is time for a nap. I don't believe that when at home, it has to be super-structured, just predictable.

When you see a dyspraxic child have a meltdown/ tantrum, know that the task may need to be made easier. Break down the activity. For example, if he is upset about trying to feed himself, maybe give some support at the elbow and help him with spearing the food and bringing it to his mouth for that first bite. Then, the next bite give less help. Do this until you are not helping at all. Often, children with dyspraxia just need a little "jumpstart'. This process just described can be either forward or backward chaining, depending if you retreat your help at the beginning or end of the activity.

• Poor postural control:

Although lots of balance activities will help this child to remediate his balance problems, he also needs physical support to be successful until his balance and equilibrium has improved.

Choose a high-chair that offers lots of support for the head and trunk. The wooden high-chairs wthat are often seen at restaurants require that the child have good balance, whereas some of the Graco and Evenflo high-chairs that are store bought can recline and have much more support.

Bumbo chair for the infant who can't play with toys simultaneous to sitting up.

Limit time the baby or young toddler spends in positional devices. 15 minute increments should be the most a young child spends in a bouncer (stand in)/ jumparoo or other devices.

Although some people swear by putting their baby in a walker, I am not a fan. Studies show that infants who use a walker are actually less likely to walk sooner than those who do not use one. This is partly due to the position a child is in in a walker is more forward as opposed to being upright with shoulders over feet for independent walking.

That's it for now!

Now there are numerous more ideas for lil' tots to adapt the environment to improve sensory processing skills. These were just a few I thought of off of the top of my head that tend to work with most young children. However, for some tots, I really have to put on my thinking cap and come up with other ideas.

For "red flags" of sensory processing problems in babies visit http://www.sense-ablebaby.com/ . Although, with babies it is not always so obvious that they have a problem. Sometimes it starts out as just a developmental delay and it later becomes obvious when they are toddlers that their ability to process sensations is not how it should be.

Sensory Strategies for Adapting the Environment to Help Young Children with Sensory Processing Problems / SPD: Part One

Since I work for an early intervention program, I get the opportunity to work in the homes and daycares of many young children under the age of three years. Even though I am providing ways for the child to improve his skills directly, I also provide ideas for altering the environment to help these children. For children with sensory processing problems, we may go through numerous ideas before something works for that child and family...after all intervention should be individualized. But there are some basic ideas that pretty much work for everyone (minus someone here or there). In my blog today, I am going to share a few of those basic ideas.

Sensory processing is the brains ability to detect and respond to sensory input it receives from the body, other people, and the environment. Young children (toddlers and preschoolers) often respond well to adapting the environment in order to help them process sensations better. Below are some categories of sensory processing problems and some possible ways to adapt their surroundings:

1. Over-responsiveness: these children over-respond to sensations by getting upset, avoidance, shut-down, and/or anxiety.
Adaptations include:

• Reduce clutter on the walls and floor: this can over-stimulate these children. Organize the room and remove the excess wall decorations. Put toys in containers and baskets versus scattered all over.
• Go shopping at times that are less crowded versus a chaotic time like Saturday
• Give them plenty of space when they are playing next to another child, this reduces the chances of accidentally getting bumped or hearing noises perceived as annoying
• Don't let them be a loner, this is a sign of being over-whelmed. Pair them up with a calmer child on the playground or a calmer sibling at home

2. Sensory Seeking: these children can't seem to get enough of movement, touch, noise, etc. It is like they are driven by a motor. Adaptations include:

• Make sure they have lots of toys and opportunities for movement: swing set, trampoline, tunnels, bicycles, scooterboards
• Give a variety of opportunities for play during daily routines: bath tub toys while bathing, textured fabric on high chair seat or chair cushions, bag of toys to fidget with during car rides, bag of toys to fidget with while in a cart/stroller for shopping trips, etc.
• Look through catalogs that sell sensory integration products. There are many toys made especially for these children. Look for the words "vestibular" and "proprioception" equipment
• Let them sing songs with motions: "wheels on the bus" or "ring around the rosie" are good choices
• As you play with them, have them pretend to be an animal and set the room up for such. If they are crawling around pretending to be a bear, then add large pillows to the floor or crawl through tunnels. Make believe play is good, especially at home when you don't have the expensive sensory integration equipment that is at therapy clinics

Stay tuned for Part 2 to cover the other categories of SPD/ sensory processing problems. Also check out some ideas for working with babies with sensory processing problems at

http://www.sense-ablebaby.com/

Would finish now, but I am off to go play with my two children on the floor as we pretend to be snakes slithering on our bellies to provide imaginative play and tactile input to our bellies!