Understanding Social Cues

Today is Easter. Yesterday, our subdivision had an Easter party and mini-carnival in the nieghborhood park. Not only do I love these type of events because they are fun, but I enjoy watching children play. I think it is fun to watch the kids during the Easter egg hunt. And this year a little excitement was added when a baby rabbit jumped across the park, then 10 minutes later the mama rabbit jumped out too. The kids were squealing ecstaticly as they watched and chased the rabbit. Of course the kids were also happy to participate in the games such as the bean bag toss, "fishing", sack races, and the cake walk.

It was at the cake walk that I was in such a state of analyzation while I observed my son. At first, he was watching the other kids (including big sister) walk around the course of numbers as he sat in his stroller. Then they stopped and if their number was called out, they won a cake or other treats. Eventually, he repeatedly said "walk, walk", so I let him out of the stroller. My gut was that this 21 month old is going to run all around aimlessly. But he didn't. I was pleasantly surprised when he went over and joined the school-aged children at the cake walk. He even went the correct direction and walked about the same distance from the numbered markers as the other kids. What impressed me the most, is when the music stopped he looked around and noticed the other kids stopped at a marker. So he stopped and he stood there for about 2-3 minutes just like the others did. When the music began again, he participated again. I was in such awe that I didn't have to teach him how to participate; he just took social cues and used them correctly. I have 6 year old clients with developmental delays or autism spectrum disorders that don't know how to do this. It always amazes me how effortlessly a typically developing child learns to perform such skills. Maybe because I was an occupational therapist for 9 years before I had my first child, but I am always flabbergasted that such things don't have to be taught. This makes me appreciate the littile kids that I work with even more, because they have to work soooo HARD for every new skill they learn. And for many reasons, social skills are one of the last things to come along. Language and motor skills are often the focus of therapy initially. Later on, emotional, behavioral, and cognitive skills are addressed. But it takes all of these skills combined to have decent social skills. Whether it be reciprocating during conversation, imitating the action of peers, or not blurting out something inappropriate, social skills do not come easy to many young (and older) kids with disabilities.

Sometimes to work on client's social skills, I meet clients and their parents within the community such as at McDonald's (R) playground and parks. These places seem to always have other children present which makes it the perfect location to work on social skills. Sometimes, I have clients that progress to reading the cues of the other kids, but so often we are working on the basics such as waiting in line at the slide, not pushing or hitting other kids, and playing near other children. I do think however with repetition that many children eventually learn these skills, especially when imitation is a focus in individual therapy sessions. Those who do not catch on naturally over time may benefit from a social-motor group at a local therapy or psychology clinic. At first, the parents and therapist are exerting a lot of energy for the kids to play together. Over time, it is nice to see how the adults can back-off because the kids are improving...yeah!

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.

Helping Special Needs Kids Minimize the Risk of Contracting the Seasonal Flu & Swine Flu

Even though the swine flu is two words, these days it is as if it were a dirty four-letter word. If you have it or have had it, you know that people treat you as if you have the plague. Now, for you and I or people who are otherwise healthy, we are probably fine to catch it. But not so for many special needs kids especially those who are medically fragile or who have not-so-great immune systems. Knock on wood, I have had patients and relatives come down with it and even cough on my face as they were ill, and I still haven't caught it. Sure am glad I take my multi-vitamin and probiotics daily! Now, as sure as I type this I will start coughing and get body aches with a high fever, but I do think there are ways to minimize the chance that you catch it. Notice I said minimize, not a guarantee of not getting either kind of flu. I am not going to tell you anything awe inspiring that anyone else hasn't said: wash your hands many times throughout the day and after contact with a suspected or confirmed infected person, cover your mouth when you sneeze or cough, take your vitamins, eat healthy foods rich in vitamin C and anti-oxidants, etc, etc, etc.

But how can we minimize the risk of a kid with special needs getting either the swine flu or seasonal flu? Well, if you are a parent of a special needs child who is homebound, change clothes after coming home from work or the community, wash hands thoroughly with soap and water for at least 15 seconds, keep the house clean, and STAY away from hugging, kissing, or touching saliva if you have a fever, headache, body aches or any other symptoms. Doesn't this sound like common sense. You would think! But so many of us are so focused on caring for the children that we ignore a fever or body aches.

For children who aren't homebound, teach them to not lick/mouth on non-food items such as toys, because if they touch a toy after a sick child at preschool, church, or elsewhere has touched it, then "WHAMMO", the virus has a chance to attack the mouth! Teach the child to wash hands regularly or for the caregiver to remind and help the child wash hands. If you can avoid places with a bunch of children such as fast-food playgrounds, that might be smart to avoid during flu season. If you must go to those places, go at a slower time such as during the week as opposed to the weekend.

Getting the flu shot may be beneficial for some kids, but not an option for others. This may be due to allergic reactions to eggs or other vaccine ingredients. My children are allergic to eggs, so I can't really do much about that except to make sure they get lots of rest, water, fruits, and vegetables as well as supplements. This may help the immune system fight a potential invading virus. But if doing those things doesn't help your child, take him or her to the doctor at the first sign of the flu so Tamiflu (R) or other medications can be given if the doctor deems it necessary.

Surviving Birthday Parties with Kids with Special Needs

This weekend, my daughter is having a birthday party. It will be at a tea room and she is so excited about the tea party they will have there as well as the dress up, make up, nails painted, and other fun! I just bought the party favors this morning and I am ready for the party, except for making her the "special" cupcakes because of her food allergies- I will make those the morning of the party.



This gets me thinking of alot of the birthday parties I have attended of some of my clients, or where I have went to a party and a kid with special needs has been there. Parties are hard for many of these kids, especially if they aren't verbal or mobile, or get easily overwhelmed by the noise and movement of all of the other kids.



A couple of tips I see that have helped kids with special needs survive the party is:

• Prepare them for what will be happening at the party and talk about it or show pictures ahead of time. Consider making a story about it so the events aren't so unpredictable. If the party is at a facility or home he has never been to, show up a few days ahead of time to familiarize the child with the surroundings.


• Find out what is on the menu. If the child is a picky eater or has food allergies, make sure you pack snacks.


• Allow the child to not keep up with the others or sit next to the others if he is not ready. If he has difficulties transitioning from one activity to another, don't expect him to participate in all activities. His idea of fun may be different than the other kids' ideas of fun. If the child has poor balance or afraid he'll fall, then maybe being near the child or partnering him up with another "helpful" kid might make him more willing to participate.


• If he is slow to warm up, show up 15-30 minutes early to the party.


• If the child is overly sensitive to noises, go in another room or go outside while the "Happy Birthday" song is being sung or horns are being blown


• If the child is obsessed or "stuck" on a balloon or other birthday decoration, don't hesitate to let him play with it if the hostess is okay with that. If you know that this may happen ahead of time, maybe buy a special balloon for your child.