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!

Social Stories to Improve Behaviors

I am a big fan of social stories to teach young children and/or children with special needs (any age) when there is a problem with a behavior or the child is anxious about a situation. The concept originated by Carol Gray. Although social stories are often used with children with an autism spectrum disorder, I have found that you can use them with many children with developmental delays or young children with no delays. Here is a link on how to make one:

http://www.ehow.com/how_5135970_use-social-stories.html

This link probably gives ideas for grade school children, and adapting it for the toddlers would mean doing more of the work. I have had my own children help me by coloring some of the pictures in the book.

I have made quite a few for my own children, and they like to read them even after the issue has been solved. Back when my daughter (now 7 years old) was three years old, she was very scared to go to swim lessons. So, through reading the story to her daily she became less anxious. That is because the predictability of the lessons lessened her anxiety. So often, children act up when they do not know what to expect, and through writing an individualized story about what may happen and what is expected of them, their anxiety may lessen.

Some of the stories that I have taught families to write for their child have included: going to the dentist, airplane rides, gymnastics class, swimming lessons, birthday parties, Christmas day, potty training, the choir singing at church, and the list goes on. Remember, when writing a social story to stay as positive as possible and emphasize the behavior you want from the child and don't say a bunch of "no" and "don't". For example, if the child has a problem with running in the hallways at school you may say in the book "we walk in the hallway quietly and slowly while listening to the teacher" as opposed to "we don't run in the hallway and disobey the teacher".

I would love to hear stories about some of your favorite social stories that you have helped write!

Autism Speaks, Community, Family Services,

I came across an amazing website "Autism Speaks" recently. I was so impressed with how they had very detailed videos displaying what a typically developing child would look like for a particular play or language skill, and how a child with autism may look like doing the same task. Also on this site was a huge data base of different types of treatment in the various cities in each state. What a great source for a parent of a newly diagnosed child or for a family that will be moving to a new town! Here is the link with the names and numbers to some facilities in Texas:

Autism Speaks, Community, Family Services, Texas: Categories

Even though this link is for Texas, the other states are represented also. Some of the links include: ABA, early intervnetion (birth to three years), preschools, OT/PT/Speech therapy, biomedical interventions, doctors, and community support. I will definately be sharing information from this site with the families that I work with!

Gifts for Kids With Special Needs

It's that time of year already! Whether you celebrate Christmas, Hanukkah, or any other holiday filled with gift giving, it is time to think about what to give your loved ones. This can be difficult when thinking of what to get a friend or relative with special needs. Here is a link filled with considerations for gift giving to children with Autism:

Gifts for Kids With Autism | eHow.com

Many of the parents of the kids I work with like to identify adapted toys in therapy catalogs as potential gifts. The families then provide their friends and relatives with links to the therapy companies' websites. This is especially a good idea when the child has physical disabilities that limit the way he can manipulate commercial toys found in local retail stores. Here are a few companies to consider purchasing special needs toys from:

For infants, toddlers, and preschool age children: http://www.beyondplay.com/index.htm

For children of all ages: http://www.southpawenterprises.com/

and http://www.pfot.com/ and http://www.therapro.com/

Toothbrushing Tips

Just the word "toothbrush" can raise levels of anxiety in some parents. Especially the ones who feel as if they either have to force toothbrushing on their kids or just go without doing it. Kids with oral aversions, sensory processing disorder (SPD), and autism especially have a difficult time with teethbrushing. Add the toddler stage to those diagnoses and the resistance to the routine is even stronger!

I know that when my own two kids have had a long, over-whelming day the toothbrushing routine (as well as bathing and sleeping) doesn't run smoothly for us either! Here are some tips from Marsha Dunn Klein on the Meal Time Notions website to make it run more smoothly:


http://www.mealtimenotions.com/GuestOpinions/12-2009Toothbrushing%201-2-3.pdf

I think that when this routine finally starts to go smoother, it opens up the door to try other strategies with other routines such as dressing, bathing, and meal time. If these tips don't help, ask your occupational therapist for some home strategies. If your child doesn't have occupational therapy, maybe it is time for an evaluation!

What Ever Becomes of the Children I Work With?

Recently, I have bumped into families that I had previously worked with. Each time, I recognized the mom first, not the child. And it was just a fluke that I was even in those places, because they weren't stores or times that I would have been typically shopping. It was meant to be that I ran into them! I have been an occupational therapist in this city for 12 1/2 years, so I should expect to be "wow-ed" to see what my young clients have grown into. It is a good thing that I don't forget faces and names very often. However, when I do forget a name, it usually comes back to me after talking to them for awhile.

The most amazing encounter was this young man who is now a teenager; I provided occupational therapy from pre-K through first grade with him. Wow, what a handsome young man he has become. He is now over 6 feet tall! Just think, he was once small enough for me to toss around over a therapy ball! This young man has a diagnosis of cerebral palsy and he continues to walk with a reverse walker. I had hoped that one day he would ambulate without any devices. But I think by watching him walk, his leg muscles are just too tight, especially since he is so tall. Often kids who walk briefly on their own when they are small, can't walk independently once they have grown because of tight tendons. On the happier side, it was nice to see how bright, articulate, and handsome he is!

Three times this past year, I have ran into families that have a child diagnosed with autism. These children that graduated the ECI program I work with at the age of 3 years are now in pre-K or kindergarten. All of them have made amazing progress in either the private or public school programs they have attended. All of them have made massive progress with their language skills, behavior, and attention span. All but one are in a regular education classroom. The one common thing with these families was that they work with their child at home, enroll them in a program while the child is 3-5 years old, and are on "special" diets. This really makes me smile, because when I quit working with children at the age of three years there are so many roads that family and child could go down.

Up intil 2004, I worked primarily in outpatient settings with children birth to 18 years of age. So, I know what children with autism, down syndrome, cerebral palsy, and other developmental disorders look like as babies, children, teenagers, and adults. There is such a wide range of how these children look and function. But once again the common thread of the children who make the most improvement is families who are willing to work with their child...not just take them to a clinic or school and let someone else do all the work. After all, their are seven days in a week which can also be thought of "there are 168 hrs in a week". Even if therapies total 10 hours a week, school totals 40 hours a week, and the child sleeps 70 hours a week, there is still a remainder of 48 hours in the week. What is the child doing during this time? Well, hopefully a little bit of rest and relaxation mixed in with family time in the home and community.

Head Banging

When a young child bangs his head repeatedly, it can be scary to us parents. My 15 month old son recently went through a stage in which he wanted to bang his head on the stroller and high-chair. I don't think he was doing it for any particular reason; he did it once and seemed to like it, so he kept doing it. I nipped this behavior in the bud by completely reclining the back of the stroller and the high-chair. This meant if he was to throw himself back, nothing was immediately there to bang his head on. He tried it once, and realized it made him lay down. So, he quit trying it.

It is not considered abnormal to head bang, however, many children with special needs bang their head and do so excessively. Some kids do it to the point that you are left wondering how they aren't in excruciating pain. More than one book on raising infants and toddlers reports that up to 10% of typically developing young children head bang in order to fall asleep. This statistic sounds a bit high to me, but maybe it included children in the statistics who were similar to my son where they just tried it for a month or so. Yet, many of the kids I work with are chronic head bangers. I try to put my thinking cap on and help the parents come up with solutions to diminish the head banging. Often, we are successful, but sometimes not. Many of those kids eventually outgrow the behavior when they were ready. Listed below are some tips that have worked for some kids that I have worked with over the years. Consider why the child is head banging:

• Is the child frustrated with a toy or person? If so, help him come up with other ways to appropriately release anger. One idea includes a place to retreat to when he is upset such as a tent. Within this tent provide toys or music that are typically calming and/or fun for him. For some kids, don't place anything in the tent other than a pillow or bean bag because they may need only minimal input.
• Is he upset that you don't understand his wants and needs? If he is completely non-verbal, then PECS, sign-language, augmentative communication devices, or other strategies taught by a speech-language pathologist, ABA therapist, or other special educ. staff may need to be implemented. If he is verbal, but just can't express himself when upset, then give a couple of choices. This makes him feel validated as well as helping him express his wants and needs. The choices can be with words, sign language, gestures, or pictures.
• Is the child just bored? Many kids, especially those with sensory processing disorder (SPD) or an autism spectrum disorder (ASD), need lots of movement opportunities or they get bored. Indoor activities may include: trampoline, tunnel, rocking horse, help clean and do chores, and obstacle course. Outdoor activities include: playground equipment with swings, slides, and climbing structures; swimming, walking/running, bikeriding, wagon rides, and yard work. Even a toddler can "help" dig weeds or water the flowers. Maybe the child is bored because he doesn't know how to play with toys or by himself. Get suggestions from your special education staff (OT, PT, SLP, ABA, developmental teacher, EIS, etc.) on toys and activities that may be easier for the child to learn to play.
• Is the child a sensory seeker and needs that deep input head banging provides? Try lots of "rough housing" (supervised), jumping, and the other activities listed in the previous question-answer. Head massage or vibration may be helpful too.
• Does he have seizures or migraines on a regular basis? Even if he is on medications that doesn't mean these problems are under control. I have had numerous kids over the years head bang, eye poke, & nose poke during, before, or after a seizure. Some kids have mixed types and although they may usually stare off, that may not always be the case.
• Does the child have a visual impairment or functional visual deficit? For children with some vision (low vision) or who see double (diplopia), they may get eye aches and think it feels good to bang their head. In this case, darken the room and minimize the work the eyes must do. If the child is head banging as you are having them work on puzzles or other fine-motor activities, then give frequent breaks or cut the session short. If the child should be wearing glasses, then insist they do. Build up to all day starting with 30 minute increments; but don't skip a whole day or play with toys up close without the child wearing the prescription glasses.
• Is he dependent upon head banging to rock himself to sleep because he has no other strategies? If so, help teach self-reglation and self-calming activities. Some kids suck their thumbs until they fall asleep whereas others hum, sing, or hold a soft toy. For this child, provide lots of motion activities throughout the day which may shorten the length of time the child head bangs in the evening. Some kids do well with compression such as tightly tucked in sheets, large heavy pillows placed around their bed, and tight pajamas.
• If the head banging is so severe that the walls or furniture are getting damaged, then this is excessive force. Consider having the child wear a soft helmet to protect his own head as well as the surfaces he hits. Try using lots of pillows too.
• Is the child head banging for attention or avoidance? If so, behavioral strategies may be needed to stop this behavior. If it is for attention, then quit being the audience and try your best to ignore it. Now, everyone in the family and at school (preschool) must be on board, or the child thinks he just has to head bang harder or longer in order to gain your attention. Try to give attention to him when he is not head banging...save the computer, TV, and phone talking that you do for another time, and give the child lots of positive attention during his waking hours.
• Does the child have a reason to have an itchy head? Lice, eczema, dandruff, scabbs, etc. should be considered. If you do not know what lice or their eggs look like, then search the Web and I'm sure you can find loads of information. Discuss treatment for lice with your child's physician. If eczema is a possibility, then discuss this with your child's physician; the child may need prescription shampoo and lotion for his head.

Humpty Dumpty Had a Great Fall

Why are some kids so clumsy? They fall often or bump into things...accidents waiting to happen! Well of course, each child is different. Some possible reasons are listed below and may require intervention from a physcian, therapist, or other healthcare practitioner:

• Ear infections or vertigo. The balance receptors are in the inner ear, and any disturbance with the ear can hinder balancing abilities
• Orthopedic impairments: whether it be pigeon-toed, bow-legged, tippy toe walkers, flat or pronated feet, or other differences, it could be the bones out of alignment for whatever reason including muscle tone, joint laxity, or muscle weakness. Also, kids who tend to "w-sit" often have hips that turn in and pronated feet (collapse at the arch and turn in)
• Sensory processing: vestibular (sense of motion and balance), tactile (sense of touch), vision, and proprioceptive (body-in-space awareness) senses contribute to balance, and if there is a problem in one of these senses, the child may fall often or bump into things
• Needing glasses for visual acuity
• Cross-eyed (AKA strabismus)
• Shoes: lack of wearing them or poor fitting shoes can hinder balance skills
• Environment: maybe the room set-up is too "busy" and hard for the child to maneuver without falling.
• Strength and tone: some kids are "floppy" and/or have low endurance
• Hyper-activity or autistic spectrum disorder (ASD): these kids may be extra busy, therefore use momentum as they zoom around the room, so fall often. This is even the case for a child with advanced gross motor skills who can climb the staircase as a baby, but when not on an apparatus (swingset, stairs, slide, etc), he falls

Mommy Radar Versus "He'll Grow Out Of It"

It makes me cringe anytime I hear a friend complain that her doctor told her that her child will "grow out of it" or "don't worry, he's fine" for something that the child truly will not grow out of...or at least in my eyes. It also makes me cringe when I am at work and see a child with orthopedic impairments that could have been corrected had the parent not been told the child would grow out of it...hind sight is 20/20! Most of all, what makes me cringe is when a young toddler show signs of autism such as language delays and social-emotional or sensory processing differences, yet the parent is told the child will be fine...yikes! Although children with a mild language delay may truly grow out of it, these are children who are not displaying major "red flags" for autism. It is a shame when a child is supposedly going to grow out of things, yet so much time is wasted when it is realized that the child never did "grow out of it". My opinion is to err in favor of the child and get a speech, occupational, or physical therapy evaluation when there is a concern. If the evaluation results indicate that the child is fine, then maybe he will be. But it can never hurt to have the child looked at.

I have a mommy radar and it has helped in so many situations. I believe that all moms have some built-in radar, and just need to listen to it. When my son was a couple of weeks old and was massively spitting up, I knew in my gut that he had a dairy allergy just like my daughter had. So, I quit consuming dairy so that my breast milk wouldn't have any. Guess what, my son got somewhat better. By the age of 5 months, he got tested by the allergist, and results indicated what my radar told me...my son is allergic to dairy products. Good thing I didn't wait until he was old enough to be tested...I listened to my gut! That would have been alot of unnecessary belly aches and hives had I not quit consuming cow's milk. I also pushed for my son to get on reflux medications, because he was losing weight, congested, gassy, lots of hiccups, and spit up quite often. I had to convince the doctor that my child needed the med.s...guess what, my son got better with two med.s, not completely perfect, but much better. For some reason, our regular doctor was out of town during this time, so I had to see one of his partners. She didn't know me, nor do I think she knew I was a pediatric OT until after our discussion on reflux. I would like for a doctor to listen to me as a mom, and not have them listen more because they know that I work with special needs infants. I would hope that as a mom my word is good enough, and that I should get some help for my kid. This is why so often at work, I have to talk personally to the doctor or type up a letter for the doctor to know what I am seeing during therapy sessions.

So many of the mothers of my clients or so many of my friends start to doubt their "mommy radar". Maybe it is because other friends or their mother-in-law convinced them that the child is okay. Or maybe they are more passive and don't want to argue with a physician. But there is another category of moms, and those are the fiesty little women who let their "mommy radar" be the driving force to figure out what is going on with their child and how to fix whatever is going on. I see this drive in many moms of children with degenerative diseases. I also see this drive in moms of kids who have been diagnosed with autism....especially since the etiology of autism is such a debated topic. And of course what mom isn't going to become an investigator to figure out why the child is the way he is and what can be done for the child to be as functional as possible....or depending upon the diagnosis, find a cure for the child's disease or disability.

There is another category of moms that I sometimes work with and that is the group who are in denial. This is a typical stage of grief but it can also be a hinderance to the child making some progress. Because I work with infants and toddlers, it is much easier for a parent to be in denial than when the child is older. Especially if a child has behavior problems, the parent will say "He's just acting two years old". Now, two year olds are known for being stubborn, independent, "busy", and at times inattentive. But, a child with a developmental disability is different. It might be that the tantrums are more frequent, longer or more intense than most kids that age. Or it might be that the child is "fleeting" around the room disorganized like a hummingbird, whereas two year olds are "busy", but not disorganized. Even my son who is 14 months old can sit and stack blocks or focus on a fine motor activity for 5 minutes if he so wishes. Now, he doesn't do that all day long, but he can briefly stick to one activity. This is where so many of the kids with a developmental delay differ. Because they can't focus for long, their speech, cognition, and fine-motor skills suffer! So, this makes me wonder is the denial a lack of knowledge on what typical development is or is it a purposeful coping mechanism in which in the back of that parents mind they know there really is something wrong. Well, it is obviously a different answer for different families. Culture, education, and family dynamics can all feed into the reason for denial or appearance of denial. I have witnessed moms being told by a physician that the child has cerebral palsy. Then, when hearing the mom talk to other people she will say the child is fine neurologically. This could be her not understanding, not wanting to reveal the information, or could be denial.

The last group of moms I see is the ones who initially had worries. Those worries were put to rest by medical staff that were giving off wrong information by saying the child will "grow out of it, he'll be just fine!"...not purposefully wrong, of course, but that is what they truly thought at that time. FYI, I see this happen frequently with sensory processing problems (see www.sense-ablebaby.com for "red flags" of poor sensory processing with infants). Then, as months go on the mom is wondering why the child hasn't improved. Then, right before the kid turns three years old and is about to graduate from the early intervention program, the child will receive a definitive diagnosis. The parents will want to make up for lost time and have us "fix" the child or do as much as possible before the kid turns three years old. So, all of the sudden, a family that didn't want my services more than twice a month, wants me at their home at least twice weekly. This category happens alot with genetic diagnoses (e.g. chromosomal abnormalities, mitochondrial diseases). The parents also tend to have a lot of guilt for not listening to their initial gut instincts and for "wasting" time. It is not uncommon for this category of moms to have even had us do an evaluation a year before receiving services. But after the evaluation, the doctor talked them out of receiving therapy services. Or maybe, the doctor didn't do this and the parent just wasn't ready yet. FYI: there are many excellent physicians who suggest parents go get therapy evaluations and yet the parent is not worried, & the evaluation never takes place. So it is not always the doctor to blame!

Listen to your "mommy radar", and for those men out there, listen to your "daddy radar"!