When is a comfort blankie not OK?

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Dear Melissa,

My 3-year-old daughter is identified as having Sensory Processing Disorder, and she just LOVES her blanket. She sleeps with it every night and rubs her hands on it as she falls asleep. Throughout the day, she will even take “breaks” from playing with her sister, go to her room and fidget with her blanket for a few minutes before coming back into the playroom to rejoin her sister. My husband is concerned that we are encouraging an abnormal behavior. What should we do about this?

To be honest, this is not the type of thing that really has much research behind it. So, I will give my opinion as an OT who has worked for years with kiddos on the Sensory Spectrum.  

In my opinion, all kids (and adults!) do their own quirky, sensory, self-soothing activities.  When these activities are repetitive and frequent in nature, it is referred to as “stimming.”  In general, as long as the stimming behavior does not interfere with daily living and does not break social norms, I say “leave well enough alone.” The stimming serves a very important function to calm the body down. If you suddenly take away the calming activity, it can often lead to meltdowns. These are no fun for anyone!

Again, people regularly have all types of self-stimming behaviors. Many people twirl their hair, pace while talking on the phone, chew gum, twirl their pencil, jingle coins in their pocket, etc.  These are all self-calming behaviors which society has deemed to be acceptable. Once again, as long as they do not interfere with daily living or social norms, they are not problematic. 

However, what do you do if you decide that the stimming behavior is interfering with daily living or social norms? For example, it could be problematic for the child to take the blanket everywhere, such as to the park where it would get torn and dirty. Or one might be concerned if a child wants to hold her blanket all the time and never plays with her sister.  

Addressing a stimming behavior needs to be done very carefully.  If you simply take it away,  1) it can lead to extreme sensory meltdowns, and 2) the child will replace it with another self-stimming behavior, possibly one that is even less desirable! Therefore, when trying to stop a self-stim, make sure you replace it with a similar activity, but one that will not disrupt daily living activities or break social norms.  

For a child who is carrying a blanket everywhere she goes, you might start with limiting blanket usage to her room or in the car. You can set a timer to ensure that she does not use it for extended periods of time. You might also try to find a similar fabric to the blanket that could be tied to a belt loop or a bracelet so that the child could fidget with it throughout the day. 

This is the perfect time to work with your child’s Occupational Therapist or Child Psychologist. They will know your child and her likes/dislikes. Together, you can create even more ideas to help replace the stimming behaviors with more appropriate activities .

Further Related Reading: 

Reducing Self-Stimulating Behavior in Children with Autism, May Institute

Why do Kids with Autism Stim? By Temple Grandin

Sleep Worries

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Dear Melissa,

I have 3 boys ranging from preschool to elementary school. We have had a very relaxed summer, staying up late to play outside and sleeping until 9 or so every morning. I’m worried that starting back to school will be a bit of a shock to their currently lenient sleep routine.  What can I do to help them to get “back on track” for school? 

The backpack and lunch box have been picked out; new school clothes are selected; fifteen trips have been made to the store to ensure that you have the EXACT items on the school list (the 24 pack of crayons, not the 16 or the 64 pack, but the 24 pack of Crayolas!). Kudos to you for realizing that sleep health should also be on your back-to-school list!

Importance of sleep:  In order to feel calm and rested, the National Sleep Foundation makes the following recommendations:

• 1-3 years: 12-14 hours per day (including an afternoon nap of 1-2 hours)
• 3-6 years: 10-12 hours per day (most children stop the afternoon nap sometime in this age range; only 24% of 5-year-olds continue to nap)
• 7-12 years: 10-11 hours per day
• 13-18 years: 8-9 hours per day

Many, many children fall far short of the recommendations listed above….and this creates the cranky, sleepy child situation that we all want to avoid. (Is anyone noticing a general theme of my blogs: “How to prevent the cranky child”?) But it is not just irritability that we need to worry about. Think back to your days as a new parent. Remember how little sleep you got?  Remember how you felt physically ill, grouchy and foggy-headed? Don’t recall this? Clearly the lack of sleep has affected your memory! 

A sleep-deprived state obviously has a negative impact on a child’s academic performance. Multiple studies on a wide age range of students consistently report that children who get more sleep per night perform better on individual tests, as well as overall academic performance. In addition, research from the University of Michigan found that as many as 25% of kids diagnosed with ADHD have an underlying sleep disorder causing their symptoms.   

So, you've “drunk the Kool-Aid.” You are ready to focus on healthy sleep, but how? The following are tips that we could ALL use to get better sleep: 

1) No TV in the bedroom. Ever. Period. This also goes for iPads, computers, smart phones, video games, etc. The bedroom is a place for sleep and relaxation. Electronics are for other areas of the house.  

2) Consistent bedtime/wake time, even on the weekends.  The body is simply unable to follow 2 different schedules in a 7-day period.

3) Establish a sleep routine.  In my house, it is bath, 1 show (NOT in the bedroom), books, bed. This will vary for each family. Some kiddos find the bath calming. However, my personal little monkeys get wound up at bath time, so it is at the beginning of our routine. Know your child. Find a reasonable routine. Stick to it – even on the weekend. 

4) Sleep environment.  The TV is already gone.  Ideally toys are out as well. This creates a space that is just for sleeping.  Temperature should be slightly cool. Overhead lights are off. A nightlight is generally good (but optional). “White noise” machines are often fantastic for the kiddo who really has a hard time sleeping. This takes some trial and error, but you can work with your child to create what works for them. 

5) INDIVIDUAL sleep environment. This is not necessarily a separate room, but this separation often is beneficial. However, each child should have his own bed, even if it is just a mattress on the floor. This prevents territorial wars between kiddos at bedtime. In addition, the child should sleep in the SAME SPACE each night.  Avoid the “musical bed” situation where he sleeps in the family room on the weekend, your bed sometimes during the week and his own bed at other times. Again, consistency is the key!

6) No caffeine. Hopefully your child doesn’t eat/drink any caffeine...but if your older child enjoys an occasional Coke, make sure that it is early in the afternoon and not close to bedtime. 

7) Snack. Some children find a light bedtime snack helpful as part of the bedtime routine. However, avoid a heavy meal 1-2 hours before bedtime as it can keep your kiddo awake.

What are your plans for getting back on track 
with your sleep habits for the new school year? 

I would love to hear your tips and ideas!

Also, if you have a question you would like me to address in my Weekly Blog,

send it to share@ChildrensTherapyTEAM.com 

Resources

National Sleep Foundation: Children and Sleep

NIH:  How Much Sleepis Enough?

New York Magazine: Snooze or Lose?

National Psychology Today: Naps During School? For Preschoolers, Yes

What should I share about my child?

Dear Melissa,

My son will start kindergarten this fall. He has been in private Occupational Therapy for the past 2 years addressing sensory and behavioral difficulties and mild developmental delay.  My son’s OT says he is doing so well and advises us to decrease our therapy from 2x per week to 1x per week when school starts. Although he doesn't have any specific diagnosis, should I let the school know ahead of time about his delays? Or, do I just let him begin and see how kindergarten goes? I don’t want him to have a negative stigma, but I also want to set him up for success. Any ideas? 

What? A parent is worried about sending his/her little one to kindergarten? You are not alone!  I think I get asked this question by EVERY kindergarten parent this time of year! Yes, most parents worry about their child’s first day of school. However, if your child has been identified as “delayed” in the past, this can cause even more anxiety than usual. While I have listed several resources below, this decision is a tricky one and is largely based on your own attitudes, beliefs, and preferences. I think this is a good time to collaborate with your spouse, other family members, your child’s OT and any other adult who you trust who may know your child well.  Because there are no easy answers, I will simply state the pros and cons of the disclosure as I see it. 

If you decide to talk to the school, you may ask your spouse or child’s OT to join you for a meeting with the school principal before school starts. They will likely not know the identity of your child’s kindergarten teacher, but a kindergarten teacher representative can attend as well.  These meetings often occur the week or two before school starts. In this meeting, you can discuss your child’s strengths/weaknesses as well as any modifications that have worked well in the past that may help (behavior charts, picture schedules, timers, sensory diet, etc). Though you generally can’t request a specific teacher, you can also discuss what parenting/teaching styles work best for your child, and the school can try to assign the best match for your child. A quick poll of my friends who are teachers offers a resounding “YES, please let us know ahead of time!” The downside to having this conversation is that you have potentially given the child a “label” before the teacher has had the opportunity to see your child and make her own judgments. 

  

If you decide not to talk to the school, the teacher gets to observe your child with a fresh set of eyes, just as she does every other kiddo in that classroom on the first day of school. The CDC reports that 1 in 6 school-aged children have a developmental delay. And, approximately half of children with delays are not identified when they start kindergarten. Therefore, any good kindergarten teacher should be very aware that the kiddos in her class may have difficulties that have not yet been identified. Maybe she will pick up on the fact that your child may need a bit of extra help. Or maybe all those years of therapy will make your child SO prepared for school that he just fits right in. (Because that’s the goal of therapy, right?) OR, maybe your child will be completely overwhelmed by the natural chaos of the new kindergarten environment and completely shut down. It is a bit of a gamble…

If your child gets to kindergarten and you decide that he would benefit from additional help in the school setting, you can talk to the teacher/principal about beginning the process for services through the school (in addition to your private services). This can be in the form of special education, speech therapy, occupational therapy, etc. However, there is a long specific process for getting the ball rolling on these services, and it often requires several months. If needed, the Arkansas Support Network is a wonderful resource to help parents navigate the services which the school system can provide and help set your child up for success.

References: 

CDC Report on Developmental Disabilities in US

Resources: 

Arkansas Support Network, 479-927-4100

Early Childhood News:  What Do I Say To Parents When I’m Worried About Their Child?

Parents.com:  If Your Child Has Developmental Delays:  5 Reasons Not to Freak Out. 

My Child Without Limits

Are you a parent of a kindergartner? How has your family dealt with this transition?

I would love to hear any more ideas that you may have!

Also, if you have a question you would like me to address in my Weekly Blog

send it to share@ChildrensTherapyTEAM.com 

Too young for treatment?

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Dear Melissa,
My son was recently diagnosed with Autism by a Developmental Pediatrician. The pediatrician recommended several different types of services, but it seems very confusing. Is all of this really necessary? He is only 2!

Forgive me for being blunt, but the short answer is YES!!! Study after study has found that beginning early with intensive services provides the best outcomes. But there are many, many, many different options. For most of us, after a problem has been identified, we simply want to “fix it” as quickly as possible. However, there are no simple “quick fixes” when it comes to Autism. In fact, many adults with Autism Spectrum Disorders (ASD) argue that they don’t want to be “fixed” at all! As I stated last week, the Autistic brain works in a fabulously different way than what is considered “typical,” and this causes many people with ASD to have wonderful strengths, even above and beyond what is considered “typical.” It is important to find treatment options that work well with your child, your family and your philosophies. This will help your child meet his fullest functional potential while continuing to retain his Autistic gifts. 

As stated earlier, there are many different treatment/therapy options.  Most of these can be provided in home, daycare, school or clinic settings (depending on your area).  Some different interventions for ASD include:

1. Occupational Therapy (OT):  teaches skills needed for daily living such as dressing, writing, eating, bathing and socializing.
2. Speech Therapy (ST):  helps to improve both receptive and expressive communication skills. They can also use various types of devices (from very simple to quite complex) to help children with low verbal skills learn to express themselves more effectively.
3. Physical Therapy: helps a child with gross motor coordination, which is often affected by ASD. 
4. Sensory Integration Therapy: helps a person interpret and appropriately handle sensory information such as sight, sound, smell, taste and touch. This therapy is often done in OT sessions. 
5. Applied Behavioral Analysis (ABA): a specialized behavior training technique which breaks tasks down into very small parts and provides immediate rewards for appropriate responses.  
6. Other types of behavior modification therapy: often completed with a psychologist, ST, OT or teacher trained in various behavior techniques. 
7. Dietary modifications: typically involves eliminating foods that can negatively impact behavior.  
8. Medical/pharmacological approaches: this can potentially help with the symptoms of ASD, but no pill can actually “cure” Autism. 
9. *Complementary and alternative treatments: These can include various supplements, chelation, hyperbarics, etc...  

Still confused? Totally understandable! Feel free to seek further advice from your child’s pediatrician. In addition, check out other resources such as your local ASD support group, a pediatric therapist or your child's preschool teacher.

*An important note about alternative treatments: The CDC reports that approximately one-third of all parents of children with ASD have tried complementary and alternative treatments.  

However, 10% of these parents may actually be using potentially harmful treatments. It is important to discuss all treatments, both traditional and non-traditional, with your child’s doctor.  Many of the alternative treatments fall under the category of parent thought such as “can’t hurt, worth a try, everyone child is different,”  but you definitely don’t want to risk your child’s health with a potentially dangerous intervention. 

Local Northwest Arkansas Resources:

Children’s Therapy TEAM, 479-521-8326

ABA Service Providers, TEAM Parent Resource

Arkansas Support Network, 479-927-4100

Other Resources:

American Academy of Pediatrics:  Early Intervention 

National Institute of Health:  Autism Fact Sheet

Autism Science Foundation

Centers for Disease Control and Prevention: ASD Treatment

Do you have a question you would like me to address in my Weekly Blog? 

Send it to share@ChildrensTherapyTEAM.com