Monday, September 29, 2014

Fine Motor & Pre-Writing Skills

Dear Melissa,
My son will be starting kindergarten next fall. Do you have any suggestions on getting his fine motor skills ready for this transition?

Good for you for thinking about this a year ahead of time! There are many, many areas that need to be addressed before the big day: social skills, emotional skills, self-care skills, gross motor skills, etc. As an occupational therapist, it is my job to assess and address ALL of these areas to prepare a little guy to enter kindergarten. For the simplicity of this blog, I will focus on the fine motor and pre-writing skills needed for kindergarten. There are ways to improve fine motor skills in fun and creative ways which will help ensure that you get little hands ready for all of the writing tasks that school will demand. 

Fine Motor Fun
There are so many fun ways to improve fine motor skills at home. The key is to make them a part of fun games rather than a chore of sitting down and “exercising.” Some of my favorites include water guns/water squirters, using tongs as “chopsticks”, Playdoh, clay, Legos, blocks, marble games, coloring, puzzles, stringing beads, lacing boards, tearing/crumpling paper, and helping in the kitchen...the list goes on and on!

Write, Write, Write  
Again, try as much as possible to make this fun rather than a “chore.” If a child loves using a pencil and paper, that’s great! But that is not the only way to work on fine motor skills. Try to have many different mediums available to help develop pre-writing patterns: sidewalk chalk, chalkboards, crayons, markers, dry erase boards, paint brushes, bath crayons, etc. This is the perfect time to go to the art or office supply section of your favorite store and just explore!

Don’t Forget Cutting  
Kiddos need to be able to use scissors well in kindergarten. They need to be able to position them correctly in their dominant hand and cut away from their helper hand. Not ready for this yet? Start with play-doh scissors and play-doh, then move to safety scissors and paper. Thicker construction paper is easier than standard typing paper. Start simply by snipping paper. Then move to cutting on thicker lines and finally to thinner and thinner lines.

The Diagonal Line Milestone  
How do you know if your child is ready to write? See what shapes he can copy. First, start with horizontal and vertical lines, then a circle, then a plus, then an X. Here’s a little-known fact in child development: children don’t develop the ability to replicate diagonal lines until they are approximately 4 to 4 ½ years old. Making a child write before they meet this developmental milestone can be quite frustrating for the caregiver, teacher and the child.  How do you know if your child has reached this milestone? Use the quick test below.

Quick Test for Writing Readiness
Draw an X and have the child copy it. If the child draws a +, then the child isn't ready yet. You can help your child develop this skill by using various writing tools to trace diagonal lines and Xs, both large and small. You can also start having your child trace upper-case letters (these are generally easier to form than lower-case letters). Is Kindergarten a few months away, and your child still hasn't developed the diagonal lines yet? Don’t panic! For most names, it tends to be easiest to learn to write the letters in upper-case letters, but don’t forget to consult your OT or preschool teacher for advice on this. 

Forming Letters
Most importantly, DO NOT let your child make up his own methods of letter formation! As a rule, every letter starts at the top. Give him starting dots with tracing to facilitate proper letter formation. If the child starts the bad habit of random letter formations in the beginning, it will create much more work to relearn letter formations in the future. Proper letter formation is crucial to developing quick, legible writing in the long run. Here is a helpful Handwriting Without Tears Letter Formation Chart.  

What are your favorite tips for improving fine motor skills for preschoolers?  
How did you help your child learn to write? 

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

Resources:  

Monday, September 22, 2014

Weighted Vests & Proprioceptive Input


Dear Melissa, 
My 5-year-old just started kindergarten, and she is having a hard time sitting still during rug time. The teacher suggested that my daughter get a “weighted vest.”  What is it; how do I get it; and how will it help? 

I hate to burst the bubble of every educator or parent who has ever been to a basic sensory course, but multiple research studies have shown that weighted vests do not work. Now, are they bad? No. Every child is different. I still continue to use the weighted vest as a part of my sensory tool chest, and I have used it both in the clinic and in my own house. Unfortunately, I have to agree with the literature. I have never seen it be the “magic fairy dust cure” that we all wish for. On the flip side, does it hurt? NO! The literature also shows that children and parents alike generally enjoy this type of intervention and often continue to use the weighted vest. So it MUST have some benefit. I personally place the weighted vest in the column of “it can’t hurt!” So, what is the concept of the weighted vest all about? 

The use of weighted or compression clothing is a form of sensory integration therapy. It is meant to provide deep pressure in order to calm the central nervous system. This type of sensory input is referred to as “proprioceptive input.” Think about when you have a new baby.  You swaddle her tightly in blankets and snuggle her firmly to your body in order to calm her down when she is upset. It also helps her to relax and fall asleep. This form of proprioceptive input is working off of this same concept. Some people prefer to use weight such as weighted vests or weighted blankets. Others prefer to use compression garments such as UnderArmour or special medical compression garments. 

Many people use these forms of proprioceptive input to help children with ADHD, Autism Spectrum Disorders, or Sensory Processing Disorders. Specifically, such devices can reduce anxiety, reduce fidgeting, reduce repetitive behaviors, improve attention to tasks, and help calm the body. Again, although the research does not conclusively demonstrate that a weighted vest will work, I am a firm believer that every child and every family is different. If a child wants to try a weighted vest, I say go for it!  If you DO decide to give it a try, here are a few tips:

1. Don’t spend an arm and a leg! If possible, borrow a weighted vest or have your child use the vest during her occupational therapy sessions to see if it will even be tolerated. If you do decide to buy one, they can be found for around $130 on Amazon. That’s not cheap! I personally do NOT sew, but I have made my own vest easily by purchasing a jean jacket from a thrift store and cutting off the sleeves to make a vest. Then I simply used BB shot and fabric to hand stitch heavy (washable) bean bags. I put the bean bags into the pockets of the vest, and I stitched additional beanbags to the inside of the vest. Ideally, the vest should be 5-10% of the child’s body weight (based on backpack guidelines). You can also check out various designs on Pinterest. This is a much cheaper alternative to the commercial vest. 

2. There are no standard guidelines for the actual usage for a weighted vest.  Many people try to use them all day. However, you will get more “bang for your buck” if the child wears it no more than an hour or two at a time (such as during rug time or during quiet work time). The child should then remove it when she will gain sensory input through other means (such as during lunch, recess, and P.E.). If the child wears the vest all day, she will simply integrate it, and the potential effectiveness will wear off after the 1-2 hour period.

3.  If you do decide to use a weighted vest, please make it look as “normal” as possible. Most of the children I know who have weighted vests have a variety of jean jacket vests which look super cute. Avoid the vests with big trains or teddy bears on them. These stand out as a “special intervention.” It seems to be easier on the kiddos if the vests help them blend in rather than stand out even more. 

Has a weighted vest or weighted blanket worked for your child? Did you find it to be a waste of money? Let's make our own case studies!  I would love to hear your feedback!


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

Monday, September 15, 2014

Oral Sensory Seeking Help

Credit: Envato
Dear Melissa,
My 4 1/2 year old grandson is a “chewer”. He has no developmental delays, but he seems to chew on EVERYTHING! He chews on his shirt collar, he chews on sticks, he chews on straws, he chews on toys…I tried to give him a chew necklace, which he seems to think is cool, but he still chews on everything. When I pick him up from daycare, his teacher says that she notices him inappropriately chewing in the classroom too. However, she also claims that this happens more during inside “work” time and less during outside play time. Shouldn't he have grown out of this by now?

Thumb sucking, chewing on toys, chewing clothes, biting fingernails…it seems like most kiddos go through a chewing phase. Babies tend to use their mouths to explore their environment. Older children (and adults) tend to chew for calming oral input. Trying to completely eliminate oral sensory-seeking activity is challenging because the behavior provides calming sensory input. Sometimes when children are repeatedly told "no," the child switches to alternative sensory calming activities. Unfortunately, the child's alternative can be even more socially unacceptable than the initial behavior. 

It can be effective to find a more acceptable replacement for oral self-stimming behaviors. The following are more appropriate ways to provide oral or other calming input: 
  • Chew items: These could include various chew necklaces (amazon.com), rubber bracelets, paracord/titanium necklaces (Academy Sports), bubble gum, taffy, or licorice. 
  • Strong flavors: Add spice to your child’s life with strong flavored snacks,candy, or gum. Think strong mint, cinnamon, spice, & sour. Examples include salsa, Altoids, Hot Tamales, and fresh lemon to water. 
  • Temperature: Warm tends to be soothing..ice cold tends to pack more of a punch! Consider using frozen teethers, ice cubes, snow cones, or popsicles. 
  • Texture: Play around with various textures that may be similar to the behavior you are trying to correct. This may be in the form of manual toothbrushes, electric toothbrushes, and vibrating back massagers placed on the cheeks. You can also use crunchy snacks such as chips and raw fruits/vegetables. 
  • Sucking/blowing: These also provide lots of calming oral input. Again, it was one of the first survival skills that we learned in infancy. Try using various crazy straws, sport bottles, & juice boxes. One of my ultimate favorites is drinking a pudding cup through a standard straw that is cut into thirds. Chocolate AND calming sucking…win win! You can also use various whistles, harmonicas, kazoos, and blowing noise makers if your ears can handle it!
  • Proprioceptive input: This is generally provided in the form of deep pressure to calm a child. Think about the squishy/snuggly input you provide when you swaddle a baby, or how your joints get squeezed together when you run or jump. This is proprioceptive input. Some good ideas for proprioceptive input include weighted vests or blankets, big bear hugs, wrapping the child up in a blanket like a burrito, lying under bean bags, running, jumping, climbing, and helping with heavy work.  
Unfortunately, none of the above is magic fairy dust!  It takes trial and error to find out what will work and what will not. If your child is able, share these ideas with him and see what appeals to him the most. For a more complete reference list, you can refer to my Oral Input Guide which contains over 100 ideas for appropriate oral input. 

Do you have ideas for providing appropriate oral input that have worked for your child? I would love to hear them! Or, if you have a question you would like me to address in my Weekly Blog, send it to share@ChildrensTherapyTEAM.com  

Resources:

Monday, September 8, 2014

Football Games and SPD

credit: envato images
Dear Melissa,
My 4-year-old son has sensory processing disorder and is the type to be more sensitive than most kiddos. He seems to enjoy watching the Razorbacks with me on TV, and I really think it is time for our first father/son football game. Any tips on making this “Boys’ Day” a success?

Woooooo….Pig Sooie! Razorback football season is upon us! Here in Arkansas, it seems like going to your first Razorback football game is a rite of passage. And, if you believe the rumors that this season might be a little rough, this could be the perfect time to score some cheap tickets! Unfortunately, a college football game can be total sensory overload for anyone. The roar of the crowd, the booming loudspeakers, the rumbling vibration in the bleachers as the fans stomp their feet, fireworks at touchdowns (we hope!), the hot/cold weather, being shoulder to shoulder with strangers, new/unfamiliar clothing...the list goes on. It is enough to make even the most enthusiastic little fan want to run away!

I have helped coach many families through this Arkansan rite of passage and have taken my own little fans to cheer on the Hogs in person. While these ideas mainly apply to larger college games, they also apply to smaller arenas such as high school or even big brother’s little league games.

1.  Consider a practice run. You might want to try just going to a tailgate party rather than attend the game. Or you might want to take your youngster to a high school game in the area.  These mini-experiences will help you determine if your little guy is ready for the real deal before you waste your money in order to create a total sensory shutdown.

2.  Study your own playbook. Know the rules/regulations for your venue -- there is a link to the Arkansas Razorback Game Day rules below. Know where you will park and if you will walk or take the shuttle. (If you decide to walk, know that you will likely be carrying your little guy most of the way!) Know your child’s dietary needs...and if there are acceptable options available in the stadium. Know what you can/can’t bring. The website says that backpacks are not allowed except for childcare/medical reasons. When I have taken my preschooler to a game, I have never had a problem bringing a backpack that is filled with kids' clothes, snacks, & juice boxes. They will just double-check it and put a tag on it. In addition, in researching this article, I noticed that the Razorback website offers locations in the stadium to obtain a child ID bracelet with your info on it. This is a particularly good idea if your youngster is the type to wander off. 

3. Prepare for the weather. Take layers AND sunblock! This is Arkansas!  It can be 40 degrees in the morning when you arrive, and 80 degrees by halftime. Make sure to pack/wear several layers to help maintain a comfortable temperature. It is also a good idea to have your child practice wearing these layers so you will know ahead of time if the warmer layers are too scratchy and need to be traded out for a soft fleecy blanket. A word of caution: you might want to make sure that ALL of the layers are in your team color or a neutral black. You don’t want to make the mistake of having your son wear a Tennessee orange jacket over his Razorback red t-shirt, subjecting you and your child to frowning looks & negative comments! (No, I don’t know this one from personal experience. Nope. Not at all!)

4.  Teach the cheers/chants ahead of time. The game will be much more fun if these cheers are a predictable distraction rather than a novelty to be feared. YouTube and iTunes can help with this. Go ahead...teach the arm motions to all the songs as well! Just watch the band, and they will show you all you need to know. These rhythmical calisthenics can be quite calming!

5.  Prepare for sensory defensiveness. For auditory defensiveness, you can bring headphones, ear buds, earplugs, or have your little guy wear his hoodie over his ears.  For tactile defensiveness, he can wrap up in the blanket like a burrito so that he doesn’t feel the other fans touching him – this will also provide calming deep pressure input. If your son will tolerate it, have him wear sunglasses to help block out the bright sun or the bright stadium lights. It is also a good idea to occasionally get up, walk around, and hang out in a quieter spot for a few minutes before returning to the game.

6.  Have a plan B. As with all things involving kiddos, ALWAYS have a plan B. Know which friends/relatives are also at the game that your son can go and “visit” when he needs a change of scenery for a moment. Bring along another adult who is not as invested in the game (often a wife or grandma) who would be willing to leave the game early with your youngster if the game gets to be too much. Finally, be prepared to have your own exit strategy if things get hairy.  Again, consider things such as parking, walking, and traffic in your exit plan. 

The Out-of-sync Child: Recognizing and Coping with Sensory Processing Disorder, by Carol Stock Kranowitz


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

Monday, September 1, 2014

Behavior 101

Dear Melissa,
I recently started watching my 4 ½ year old nephew while my sister works full time.  He is a really sweet boy, but he is so impulsive, so full of energy, and is very quick to throw a tantrum. I feel like I have to watch him more closely than I watch my own 2 year old! Do you have any tips to help with behavior problems in a preschooler?

If I had a one-size-fits-all quick fix for behavior problems, I would be a millionaire!  However, I do have a large bag of tricks which I have used as a mom and as an Occupational Therapist. That is one of the things I love the most about my job! I get to try new ideas at home, then practice them at work, and vice-versa! Now, I absolutely do NOT claim to have all the answers. My own children have their cranky/meltdown moments, just like any other child.  However, here are a few of my favorite ideas to help solve behavior difficulties in ANY child, both those with disabilities, and those without: 

Be consistent.  
This is parenting/childcare rule #1.  If a child is able to cry for 10 minutes and gets his way, then he will try crying for 15 minutes the next time to get his way.  If you say something is a rule, it is a rule.  Period.  Let your word be your bond.  I will admit, there have been times...especially after my child has screamed for 20 minutes...when I have thought to myself, “Why do I even care if my child takes his plate to the sink? It’s really no big deal! I will just take it there myself!” However, if you said something needs to be done, it needs to be done. Stand your ground! You can do this!

Avoid saying “NO.” 
Yes, all children need to learn to remain calm when they hear the dreaded “no,” but I have learned that avoiding “no” as much as possible makes your life so much easier. This does NOT, however, mean that you should give in. It means rather that you learn to get creative with your responses to your child’s requests. I always like to respond to requests with “of course” followed by a qualifier. When the child asks “Can I go outside?” you reply, “Of course you can, when it stops raining.” When a child asks “Can I have a snack?” you reply, “Of course you can, after you pick up your toys.” When a child asks, “Can I watch TV?” you reply, “Of course you can, after school.” When the child asks, “Can I have a private island in the Bahamas?” you reply “Of course you can, when you win the lottery!” You get the idea. 

Keep to a regular schedule.  
Children thrive on structure and routine. The more struggles a child has with impulsivity, attention, and behavior, the stricter the routine needs to be. It may seem cruel to leave a party early in order to respect the bedtime routine, but it really is for the best. Children are just little guys & gals. They don’t know what to expect from their world, and they have little control over it.  The more they can learn to predict their daily routine, the more they can learn to remain calm and not worry about what is happening next. If you notice the schedule posted in any quality preschool classroom, you will find that they have the full day scheduled down to the minute.  Again, this predictability makes life calmer and simpler for everyone. 

Use picture/written schedules.  
This helps to keep things on schedule even more. Depending on the reading abilities of the child, this can either be written out with words, or you can use photographs or drawn pictures.  The “Super Nanny” Jo Frost always created a huge poster board schedule when working with her families on TV, and she had some doozies!  I always use this technique in the clinic and with my own children as well. This helps make a clear picture of the predictable schedule and can be used to prepare a child for any changes in the day (which are bound to happen). If a child needs pictures rather than words, consider taking photos of activities, printing them off, laminating the pics and adding Velcro to the back. This will allow you to create a quick visual schedule each day and easily make changes as needed.

Use a visual/auditory timer.  
This goes back to the fact that kiddos need predictable schedules and structure. Whether utilizing an alarm app on your phone, a wristwatch alarm, a kitchen timer, or a simple sand timer, you can create a definite cue that it is time to move to a different activity.

 Give choices as much as possible.  
OK, this one really does seem like “magic fairy dust,” but hear me out and give it a try. You tell the child to brush his teeth, and she refuses. Then you simply ask if she wants to brush her teeth in the upstairs or the downstairs bathroom. And she magically chooses to brush her teeth upstairs!  I am completely floored that this one actually works.  It seems too simple! Please, give it a try, and let me know. I promise that you will be amazed more often than not!

Avoid the hungry/sleepy/tired situations.  
Simple, right? Wrong! This singular concept will probably be the topic of many future blogs. But in short, respect regular meal and snack times, respect nap times and bedtimes, and always keep a healthy snack on hand for emergencies!

Again, I could go on, and on, and on…These are just my favorites! In addition, these are only tips for setting a child up for success. Yes, sometimes consequences are necessary, but we will save those for another day. My philosophy is that it is much easier to set a child up for success than try to get creative with deciding on appropriate consequences. I would love to hear your favorite tips/tricks to help with difficult behaviors at home. Please share!

If you would like additional tips for addressing behavior difficulties in your child, please explore the following resources: