Changing the Environment & Interaction Style to Help Kids with Developmental & Sensory Processing Delays

I have worked in a variety of settings: school system, hospital, outpatient clinics (more than one), early intervention, and home health. I have been working in early intervention and home health over the past 6 years, because I have found it to be my "niche". Why is that you ask? Well, I believe that helping children in their natural environments such as the home, daycare, and other community settings is where the biggest changes will be made. Now I am not saying therapy clinics are a bad place; I have worked in those settings and thoroughly enjoyed it and know that most of the kids had fun there. But the main focus of working with a child in a clinic, is the child and his deficits. Yet, in their natural environments the focus is not only the child but all of the people that come into contact with him on a regular basis and how every one and thing can help. Isolating the child in a clinic to work on fine-motor, feeding, language, behavior or whatever other skills doesn't necessarily carryover to how the child will function in another environment in which all of those "therapy toys" are not present; it may carryover for somethings and it may not. In home health settings, a therapist helps the family utilize what they already have in the places the child will be at on a regular basis.

A recent example of what a difference I was able to make in a child's life was through teaching the daycare staff how to work with a particular young boy. He is almost 2 years old and has significant developmental delays as well as mild spasticity due to some complications with being born at 27 weeks gestation- "a preemie". He has limited range of motion in his upper body in which it is hard for him to raise his arms over his head. He also has difficulty with tight hamstrings- the muscles in the back of the legs. So, when I observed "music and movement" time at the daycare, I was able to help the teacher incorporate some stretches and movements that would benefit this child as well as his peers, including touching toes while sitting in the floor. Now, he will get to do these stretches 5 times a week since he goes to daycare 5 days a week and they follow the same schedule each day. In addition, we altered the chair that he sits in at lunch time to a shorter chair so that he can now independently climb in and out of the chair. Other areas that were helped were naptime, outdoor play on the playground, and "centers" for fine-motor play. By teaching the teachers how to adapt the activities, alter their interactions such as by saying particular phrases, and by altering things within the environment, this child became more independent. If I had seen this child in a clinic, my focus would have been to teach some of these skills but without meeting the daycare staff and watching the sequence of the routines, I would not have been able to help this child as much.

Another example includes a child I see at his home who has significant behavior problems, sensory processing problems, and a short attention span. By teaching his mom to set up activities that he can be independent with at a small table within her line of vision, she can now cook dinner without him "getting in trouble". In the past, this child only acted well when given immediate 1:1 attention by an adult. So, I taught Mom to help him with an activity, and initially be on the other side of the room from him. Then, she progressed to leaving for 1-2 minutes, which then led to her being away from his side for 5-10 minutes. Within no time, she was able to do this in the kitchen and successfully cook supper without any (or at least only at times) "meltdowns". If I had not been in the home to teach his mom this activity, and only told her how to do it, he would probably not have been successful with this. The first time we tried to leave his side as he played alone even briefly, she wasn't thinking "it was going to work". So often, the parents and other caregivers just need us (therapists and other professionals) to show them how to do something and then they can do it on their own.

In the past, I thought that when I worked in a clinic and typed up a home program full of suggestions that that would help; that may be the case for some families, but most need to be shown! Also, I was giving general suggestions even if I thought I was individualizing it, because I had never walked into that child's daycare or home, so how could I have been completely individualizing it! Really, I was giving exercises and strategies aimed at decreasing the child's deficits such as poor balance, hand weakness, etc. I now realize I was only helping such a small portion of that child's daily routines.

If your child receives private OT, PT, SLP or other services at a clinic or other place than the home or daycare, ask the therapist to come do one or more home visits. If that is not possible, make video recordings of the different routines that don't work well.

Finding Christmas Gifts For Toddlers With Developmental Delays

For some reason Christmas shopping starts sooner and sooner each year. I noticed that before Halloween had even come, Christmas stuff was already out. When I was younger, I would always go shopping with my mom, sister, and other female relatives the day after Thanksgiving. We would shop hard and hunt for the best bargains. We would have a car full, and had finished off at least half of the list in an 8-hour period...how exhausting! So, instead of fighting off that shopping starts earlier, I'm going along with it. Last year, I had everything purchased by the first week of December. Boy, was it relaxing to enjoy the rest of the time to absorb what Christmas is all about. I attended church plays, parties, and other events from mid to late December without the worry of not having completed my shopping.

Even though I get an earlier start, I don't always find it so simple to know what I'm buying for whom. I don't like to charge too much money, and I like to pay off things, which means I get gifts that are thought-provoking but not huge money items (e.g. TV, vehicle, etc). I'm finding it a bit hard to find toys for my 17-month old son. Because alot of "boy" toys are more for two year olds and older. Unfortunately, he still mouthes toys. However, his imagination is emerging and he likes to roll cars as he makes car noises and places the Little People (R) animals in the farm; he seems to have fun doing these things. He stacks blocks and similar things, but he gets bored with simple toys. If he could learn to not stick toys in his mouth, we could advance to more complex toys.

Now, as hard as I find it to know what to buy whom, I know that it is even harder for parents, friends, and relatives of a developmentally delayed child. My suggestion for those families is to ask the parents what to get the child. Because a 2 1/2 year old (chronologically) child, may only be developmentally at a 1 1/2 year old level. For parents who aren't sure what to get, ask your child's clinicians: speech, occupational, or physical therapist, as well as preschool teachers. Also, go to websites such as Target (R) or Toys R Us (R) and look up toys that are at the child's developmental level, not chronological age. I think that some sites out there on the Web even have kid's gift registries. What a great idea for a child with special needs! Whether you are part of a registry or not, start to write down some ideas from these sites. I also frequently go to consignment (used) stores for kids and can find some amazing bargains. That way if the child doesn't like the toy, I didn't spend too much. You have to go to these places often to get the better items because toys such as train tables, doll houses, and other popular gifts don't last long. The local store that I go to only takes items that are in good shape and won't resale them unless they have all of the pieces. Another option for bargains is garage sales and toy exchange programs (rental).

Also analyze the toy for what it does or doesn't do. If you have a delayed child who isn't speaking yet, then musical or speaking toys may be good stimulation for them. If you have a child who doesn't know how to play with toys, then try open-ended items such as blocks, cars, Tinker Toys (R), Bristle Blocks (R), and balls, then as they progress doll houses, Barbies (R), action figures, etc. may be more beneficial. Also, buy toys that expect skills that are slightly ahead of where the child functions presently, in order to challenge the child. Now saying this, I do believe toy size and material should be taken into consideration- foam blocks may be chewed on, but plastic ones wouldn't. A simple "swallow" test for toddlers is to get the cardboard insert from a roll of toilet paper and try to fit the toy in it. If it fits, then it is too small for a child who still "eats" toys. The insert is supposedly similar in size to the throat. Finally, check out information on development at www.zerotothree.org website, which has information mainly in English and some in Spanish; it even has printable handouts on how to play with children during everyday activities.