Flu Shot is a Sure Shot

Image Credit: Envato 

Dear Melissa,

Should I give my children the flu shot? 

YES! Definitely! Absolutely! Without a doubt! And go ahead and stick in any other affirmative adjectives you can think of, it’s that important!  And by the way, make sure you vaccinate yourself and every member of your family as well.  Here is something that I really don’t understand…Everyone is freaked out about Ebola.  I get it.  It is a foreign disease that has hit US soil for the first time.  And I hear people complaining, where is the vaccine for Ebola?  But what about the flu???  To date, how many people has Ebola killed in the US in the past year, um…one.  How many people die each year in the United States from the flu?  Approximately 23,000!  Last year over 105 of these deaths were children. The recent 2003-04 flu season was particularly lethal with 48,614 deaths recorded in the US alone.  Oh, you are thinking that it is just the elderly who get sick?  Last year, in the 2013-2014 season, the CDC reports that nearly 60% of the flu-associated hospitalizations were in people aged 18-64.  Scared yet?  You should be! 

But wait! We don’t have an App for that, but we do have a vaccine for that! Scared of shots?  Most people can get the vaccine via nasal spray.  Pregnant? Great! The vaccination will help pass along immunity to your unborn child. Don’t have time to go to the doctor?  Most people can get vaccinated at their local pharmacy. With the exception of a handful of medical conditions/allergies that should be discussed with your doctor, there really is no excuse for not receiving some type of flu vaccination!

And I will very briefly address the remainder of the excuses. The resource links below have TONS of information to support the following statements. But here is the “Cliffs Notes” version: 

Flu Vaccination Facts

1)     You can’t get the flu from the flu shot. It takes 2 weeks for the flu shot to take effect, so if you get the flu right after getting the flu shot, you were likely already infected before you got vaccinated. 

2)     Pregnant women are generally encouraged to get the flu shot (talk to your doctor, they generally prefer pregnant women to get the shot rather than the nasal spray). In fact women who are pregnant are much more likely to experience serious complications from the flu (such as hospitalization and pneumonia) than non-pregnant women of the same age. 

3)     Babies under 6 months CANNOT get the flu vaccination.  Therefore, it is even more important for their mothers to get the flu shot while they are still pregnant. It is also vital that all siblings and caregivers for the infant are vaccinated to create a herd immunity. 

4)     The flu vaccine is safe.  It does not cause Autism, influenza, baldness, or any other disorder. There is actually a reporting system to report serious complications of any vaccination.  It is listed below.  The FDA really does have a history of removing any vaccine that has even a hint of being unsafe. 

5)     The flu vaccine works.  True, no vaccination is 100% effective.  However, the CDC reports that the flu shot generally reduces your chance of contracting the flu by 70%-90%.  It is a bit of a guessing game by the researchers to create a vaccine each year that matches up with this year’s flu strains. This accounts for much of the variability. In addition, younger people tend to respond better to the flu vaccination than an older adult, which also contributes to some of the variation. 

6)     It’s never too late to get the flu shot.  You need a new flu vaccine every year. The peak flu season in the US is generally January-February. Even if flu season is in full swing, you can still get vaccinated and be protected within 2 weeks.

I never give advice that I don’t practice myself.  Yes, my children and I have had our flu shots this year, and we get them every year. And dear hubby, this is your first official nagging for you to get your flu vaccination as well.  No Excuses!

Also, if you have a question you would like me to address in my Weekly Blog, send it to share@ChildrensTherapyTEAM.com 

Resources: 

Seasonal Influenza Basics, CDC 

Get your Flu Vaccine, US Department of Health and Human Services 

10 Flu myths, Harvard Health Publications, Harvard Medical School

Woman with flu loses life 3 weeks after losing baby, CNN News

Scarier than Ebola, New York Times

Vaccine Adverse Effect Reporting System, CDC, US Department of Health and Human Services, FDA

Autism vs Asperger's Syndrome

image credit: envato 

Dear Melissa,

I thought my 11-year-old nephew had Asperger’s Syndrome, but now my sister keeps referring to him as “Autistic.” When he was younger, he had frequent tantrums. But now he is a really great “quirky kiddo” who loves to tell his younger cousins all about bugs. Did he get worse, and I just don’t see it?  Did something change?  What is the difference between Autism Spectrum Disorder and Asperger’s Syndrome? 

You have every right to be confused!  The medical/psychological community has been confused about this for decades!  So let's start at the beginning of the Autism/Asperger's story…

Autism was first described by an American child psychiatrist named Leo Kanner in 1943. He used this term to describe 11 children who were highly intelligent, extremely withdrawn and showed an inclination towards “an obsessive insistence on persistent sameness.” In 1944, an Austrian man named Dr. Hans Asperger also was noticing a pattern of social differences in several boys who were highly intelligent, struggled with social interaction and had specific obsessive interests. At first Autism was commonly described as “childhood schizophrenia,” but then “Autism” began to be diagnosed more and more in the 1950s and 1960s in the US.  In 1980, “infantile autism” was listed in the DSM, the Diagnostic and Statistical Manual of Mental Disorders. The DSM is the “recipe book” for the field of psychology. Psychiatrists take the deficits/symptoms and then match these up to the deficits/symptoms associated with various diagnoses in the DSM. The goal here is to provide a patient with the most accurate diagnosis. At first “Autism” was the more common diagnosis in the US, because Kanner wrote his papers describing this disorder in English, and Asperger published in German. (In these pre-internet days, it could take a long while for things to get translated and widely distributed!). In 1994, Asperger’s Syndrome was added to the DSM and was then officially recognized as a diagnosis.  

Over the past 20 years, language delay has emerged as the key differentiator between Autism and Asperger’s Syndromes. Autism was often characterized by a language delay before the age of 3 years, and Asperger’s syndrome was often used to describe children who were hyper-verbal. These children with Asperger’s Syndrome were often referred to as “little professors” or “walking encyclopedias” due to their high language skills but lack of social skills. However, once young children grew into their teen and older adult years, the differences between Asperger’s Syndrome and Higher Functioning Autism were very hard to determine unless you carefully examined the individual’s medical history. Then there were MANY arguments and debates between various practitioners and between the practitioners and parents.  Does this child have Asperger’s? Does he really have Autism? If my child gets therapy and progresses, will his Autism switch to Asperger’s? Confused yet? So were we!

Just five months ago, in May 2014, the DSM came out with their 5^th edition, the DSM-V. In this updated manual, the psychological community determined that Autism, Asperger’s, pervasive developmental disorder and childhood disintegrative disorder should be seen as existing on a spectrum rather than understood as separate diagnoses. Therefore, they placed all of these disorders under the umbrella term “Autism Spectrum Disorder” (or ASD).  You will still hear the term “Asperger’s Syndrome” commonly used for/among individuals with high-functioning Autism. However, the medical community is now using the term ASD to describe all individuals on this spectrum rather than distinguishing between Autism or Asperger’s. 

Does this clear up things a little bit? Is it still “as clear as mud”? I welcome any further questions/comments. I also recommend the resources below for further info. 

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

send it to share@ChildrensTherapyTEAM.com 

Resources:

History of Autism, Parents.com

Diagnostic Criteria for Autism Spectrum Disorder, DSM V

Autism Spectrum DisorderDiagnostic Criteria, DSM-V
Asperger's Syndrome, Autism Society 

Sensory Friendly Halloween

credit: Envato Images

Dear Melissa,

I have a 6-year-old son with Autism. He LOVES the idea of Halloween, but it often ends in a disaster!  He doesn’t like knocking on doors, he won’t say “thank you” after he gets candy, and the costume is always a complete disaster. He likes to pick out a big, expensive outfit at the store, but then he refuses to wear it for more than 5 minutes on Halloween, and we end the evening in a complete meltdown! How do we make Halloween a more enjoyable experience?

Halloween can be a fantastic evening of craziness and fun for most children. However, kids with Autism Spectrum Disorders can have particular trouble enjoying Halloween. With the changes of routine, sensory processing demands and social demands, it can easily cause more trickiness than treats. Here are a few tips to help your child with ASD enjoy a fun evening on Halloween: 

Skip the Store-bought Costume 
They are usually very expensive and can be made of cheap, ill-fitting, scratchy material. Just about any costume, from a princess, to a dinosaur, to a super hero can be created with a little hand stitching and some fabric paint. Simply start with the comfy base of a sweat suit, t-shirt, or leggings and let your imagination run wild! I like this Pinterest site  which offers ideas for sensory friendly Halloween costumes.  

Accessories are Optional  
Most children with ASD or sensory processing disorder have tactile defensiveness towards masks and face paint. If you really want a head accessory, try a bow for girls or a decorated baseball hat for boys. But even these may not be tolerated. 

The Dress Rehearsal
You may want to have your child practice wearing the costume around the house before the big day. Once the costume is more familiar, it won’t be such a change when the big day arrives. For safety, make sure to incorporate glow sticks, lights, or reflective tape in the costume if your child will be trick-or-treating door to door. 

Meeting Social Demands 
There are a lot of social demands associated with trick-or-treating. Allow the child to “practice” with family members, going from bedroom to bedroom, knocking on the door, and saying “trick-or-treat” and “thank you." For children who are nonverbal or especially shy, you can also make a special Halloween sign that says “trick or treat” on the front and “thank you” on the back. Also, consider going to a limited number of friendly, well-known neighbors and repeating these houses over and over. This will help decrease social anxiety. As always, social stories and reading various books on trick-or-treating can decrease social anxiety and help children to understand expectations.

Discuss “Tricks” 
Many children on the Autism Spectrum are very discrete, black-and-white thinkers, and Halloween is a day for fantasy and imagination. It helps to prepare your child ahead of time for the scary masks and haunted houses with books and movies about Halloween. It may also help to take them to the costume aisle at your local store several times before the big day. This way, they can see that it is just a plastic mask or a dress-up costume, and REAL monsters will not be knocking on their door!  

Discuss “The Rules” 
Again, children with ASD tend to be very black-and-white thinkers, and we suddenly change the rules on Halloween. My own son kept saying “Wait, we don’t know those people! We can’t just go knock on their door!” Determine the "special Halloween rules" ahead of time. Discuss them head of time with your child and make sure that he knows that “The rule is…these new rules ONLY apply to Halloween!”

Prepare for dietary issues  
If your child is on a special diet, consider providing stickers or pencils to the houses where you know you will be trick-or-treating so that your child will have an appropriate treat. If you don’t want the candy in the house, some dentist offices will buy the candy back and send it to our troops serving overseas (you can locate these programs online). If your child is allowed to eat candy, only allow 1-2 pieces on Halloween night. In addition, make sure to have a healthy meal before you head out for the door-to-door candy gorge. This will help ensure that their tummies are full of good food, and your kids will be less likely to nibble on mass quantities of candy along the way. 

Keep it short  
Trick-or-treating occurs at the end of the day, around bedtime for most children.  Understand that your child may be too tired at the end of the day and unable to endure a trick-or-treating marathon.This, combined with a sugar rush, is a certain recipe for a meltdown! As much as possible, try to keep a normal bedtime routine on Halloween night, and don’t delay bedtime by more than 30-60 minutes. This will make everyone’s life more enjoyable on Halloween night...and the next day as well!

What tips does your family have to create a fun and safe Halloween?  

Please share your ideas! 

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

send it to share@ChildrensTherapyTEAM.com 

Halloween Tips for Sensory Kids, American Occupational Therapy Association:

Preparing a Child with Sensory Issues for Halloween, Washington Post, 2011

Brushing Debunked

Dear Melissa,

My 4 year old son is having frequent tantrums at preschool. I was browsing a  sensory processing parent support group webpage when I saw several parents discussing “brushing” and how it helps with calming their children. What exactly is it, and would it be appropriate for my child? 

Ahhh…The illusive “brushing” technique. I think I was asked this question in half a dozen different ways over the past month. It seems as if every parent with a child with sensory processing disorder has heard of this technique, but no one is really sure what it is. In addition, many preschool teachers are mentioning it to parents as well. Even after 9 years as an OT, I was not really sure of the true protocol. I tried researching “brushing” in the literature, asking colleagues, browsing then internet, even YouTube, but found few answers. As a last-ditch effort, I searched the term on Wikipedia and found an article riddled with red flags stating that the information provided still needed to be verified. No wonder everyone is confused by “brushing”!

Getting to the Source

I try my very best to be a research-based occupational therapist. I try to focus on those techniques that have been proven both safe and effective. I knew that “brushing” was a technique created by Patricia Wilbarger, M.Ed, OTR, FAOTA.  She has been a leader in the field of occupational therapy for decades and presents training courses along with her daughter Julia Wilbarger PhD, OTR, who is a leader in the field in her own right. So when another OT TEAM member (Katie Gehrki) and I found a 2-day course taught by the Wilbargers themselves, we jumped at the chance to receive training directly from the source.  

The Wilbargers' "Brushing" Program
In the course handout, the Wilbargers described their program as “an advanced treatment program used to specifically treat Sensory Defensiveness. The program uses the consistent and frequent application of Deep Touch Pressure and Proprioception without noxious input such as scratching or tickling. Although research on this technique is limited, clinical experience over many years with a wide range of clinical populations and ages indicates that the it can be very beneficial in reducing or eliminating sensory defensiveness when applied consistently and used within the context of a comprehensive treatment program.” 

Yes, but what is it??? 
In functional practice, the brushing program involves taking a specific brush, very similar to a surgeon’s nail scrubbing brush, and rubbing it firmly on the child’s skin in a particular manner. This is followed by deep pressure to the joints every 2 hours while the child is awake. According to the Wilbarger Protocol this is ideally done 8 to 10 times per day for several weeks. Brushing has been renamed by the Wilbargers as the “Therapressure Program.” However, I have also seen it documented in the past as “The Wilbarger Deep Pressure and Proprioceptive Technique” and “Wilbarger Brushing.” I will continue to use the term “brushing” for this blog for the sake of simplicity.

Is it "All or Nothing"? 
You are probably asking, "What? Do this every 2 hours? That is a HUGE time commitment!  I can barely get my child’s socks on in the morning. I don’t think I can add something to our routine every 2 hours!”  You are absolutely right. Though this technique is very inexpensive, it does take a lot of time. So I asked Patricia Wilbarger herself:  Is it OK to complete the technique less often? Her reply: If you aren’t going to complete the program exactly, don’t do it at all. Simply focus on the sensory input and forget about the brushing.  

The Wilbargers list many do’s and don'ts:
 DO only use the brushing program if you have been directly trained in the Wilbarger Therapressure Program or very closely trained and monitored by an OT who has received this training. 
DO only use the specific brushes designed for the protocol.
DO follow the “every 90-120 minute” protocol strictly.
DO report any adverse reactions to your supervising OT. 
DO NOT brush the stomach or groin area.
DO NOT complete brushing or joint compressions on areas with any injuries such as cuts, scrapes, swelling, bruises, etc.
DO NOT complete with infants under 2 months of age.

My own do's and don'ts: 
I will add a few of my own precautions, as I have seen many parents completing brushing incorrectly and actually causing much more harm than good.
DO only use the brushing technique once properly trained by someone who has been to the course. I have seen many parents brush in the wrong direction, brush the wrong areas of the body, use too light of pressure, lift up and replace the brush with every stroke, etc. All are wrong! Again, completing this technique incorrectly can most definitely exacerbate the situation rather than help it. 
DO NOT apply brushing once a “meltdown” has occurred. Brushing should only be used on the scheduled timeline. Providing brushing when a child is already in "flight-or-fight" mode can just cause the situation to escalate even more.

Does it work?
So, cut to the chase, does it work?  Hmm…maybe?  In reality, I see very few families that are able to make the commitment to brushing every 2 hours, utilizing the correct technique every time. In my own life, this would be impossible, so why would I ask this of another parent? In addition, the Wilbargers themselves report that there is limited research affirming the efficacy of this technique. Therefore, in my own practice I do exactly what Patricia Wilbarger recommends: I focus on providing the other sensory input that is needed by the child to calm his sensory system. But wait! Are you still itching to try it? Come on over. I will be more than happy to teach you! Give my clinic a call. We have several TEAM OTs trained by the Wilbargers in the Therapressure Program.

Have you used brushing in the past with your kiddo? What did you think? I would love to hear feedback from parents who have been in the trenches with the brushing technique! 

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

send it to share@ChildrensTherapyTEAM.com 

Resources:

Therapeutic Brushing Techniques

Therapressure Program (Trademarked) for Treating Sensory Defensiveness – Training Course

What is Sensory Processing Disorder? Monday's with Melissa Blog