Holiday Survival Guide

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Dear Melissa,

Any ideas to help make the holidays run smoothly for my son with Sensory Processing Disorder?

Thanksgiving, Hanukkah, Christmas, Kwanzaa, New Year's...the holiday season is upon us!  The holidays are a time of big changes in routine for most families. These changes can be particularly difficult for children with Sensory Processing Disorder. With new foods, new clothes, new smells, new people, new routine…it can be the perfect recipe for a meltdown! Here are a few ideas to help set realistic goals & expectations for this holiday season. 

1. Keep to your standard routine as much as possible.  

Great fluctuations in sleeping habits and meal times can create hungry, cranky, tired children (and adults!). The more you can stay with your typical nap, bedtime, and mealtime routine, the better. If your child tends to sleep well in the car, it may be helpful to plan car trips during nap time or to pack PJs and toothbrush so that your child can complete the bedtime routine at Grandma’s house BEFORE you take the long trip home. It may also be helpful to keep healthy snacks handy if mealtimes get delayed. 

2. Consider clothing requirements with holiday outfits.  

Many children who have tactile defensiveness are defensive toward various textures/styles of clothing.  A child who only wears sweatpants and t-shirts is not suddenly going to be happy wearing a button up shirt tucked in with a belt, just because it is Christmas Eve! Consider choosing holiday outfits with softer fabrics...as close as possible to the style that the child prefers. A happy child in soft khaki pants and a polo-style shirt looks much more appropriate than a child throwing a tantrum in a suit. For girls, consider soft cotton dresses and avoid excess lace, taffeta, tulle, tights, and other scratchy fabrics. If you have a special outfit in mind that you think may be troublesome, try having the child wear the special outfit around the house on a calm afternoon so they can get begin to get used to it in a less stressful environment. Another good idea is to purchase 2-3 appropriate outfits (keeping receipts and tags) and let your son choose his favorite. Again, it is amazing how a bit of control can greatly improve a child’s compliance!

3. Remember special diets and food allergies.  

Make sure you inform all people preparing food of these restrictions so that you can learn ahead of time what your child can/can’t eat, and you can bring additional dishes if needed. No one wants to end up in the ER during the holidays because of a food reaction!

4. Remember your picky eater’s preferences.  

In general, it is good to encourage trying new foods. However, this is NOT the time. Simply dealing with the change in routine of the holidays is enough. Make sure that there is something on the menu that your child will eat, or just bring a lunchbox!

5. Consider alternate traditions surrounding presents.  

Many children with sensory processing disorder love routines and hate surprises. This often makes the idea of opening presents very stressful. Some of these children prefer for presents to not be wrapped.  Other children prefer to unwrap presents at a time other than in the middle of the chaos of the holidays. 

6. Set realistic expectations for social interaction with extended family.  

A child who has social anxiety won’t suddenly warm up to Aunt Susan who the child hasn’t seen in 6 months. This can be a source of hurt feelings for both the parent and the extended family member. If you think this may be a problem, it is important to let Aunt Susan know that her nephew has difficulties with social skills, and this is an area that you all are presently working on. But then actually work on it! Consider having your child practice an appropriate greeting (such as a “high five”) prior to family arriving and role play how he should interact with various family members. 

7. Set realistic expectations surrounding holiday ceremonies.  

Consider how long your child can reasonably sit in one location, the level of noise involved, how crowded the situation will be, what will be your escape strategy, etc. A little planning can help set your child up for success. 

8.  Designate a quiet “safe zone.”  

This can be a quiet closet, inside tent, or bedroom away from all of the hustle and bustle of the holiday. Line the space with blankets, pillows, and stuffed animals and allow for quiet music and soft lights.  Ideally, this is NOT a space for electronics, as they can be too stimulating. More appropriate activities for this space include books, fidget toys, or coloring. Your child should be allowed to go to this space anytime they feel overwhelmed by the chaos of the holidays. (Don’t we all wish we had a space like this!)

9.  Create a social story.  

Your speech therapist or occupational therapist can help with this. A social story is simply a story that you create with your child to describe a setting and/or task of particular difficulty. This story book depicts a situation with your child as the main character and then describes the proper way to act.  These stories work because they help inform the child concerning expectations and proper responses to the situation. The story is stronger if it contains pictures of the child being successful in these situations.

With a little planning and preparation, the holidays 
CAN be an enjoyable time for everyone! 

 What holiday survival tips have worked for your family?  
I would love to hear your tips/ideas!

 You can send questions to share@ChildrensTherapyTEAM.com

Resources:

4 Tips for Preparing your Child with Autism for Holiday Celebrations, Huffington Post

Holiday tips for Children with Autism,Siblings, Psychology Today

Holiday Survival Tips for Families of Children with Special Needs, Mama OT

Mimicking Siblings

Dear Melissa,

I have two boys, ages 3 and 7. My 7-year-old son was diagnosed with Autism when he was 2 years old. My older son has several self-stimming behaviors including flapping his hands, spinning in circles, and rocking. He primarily engages in these behaviors when he is excited. During the past month, I have noticed that my younger “typical” son has also begun to flap his hands when he is excited. Should I be concerned that my 3-year-old has Autism as well?

Any time you see your child mimicking self-stimming behaviors, it can set off a firestorm of emotions. The prospect of a second child with Autism can be very confusing. I have had MANY mamas express this concern to me. Most of this blog is my opinion about sibling mimicking based on many years of working with children with Autism as well as their families and siblings.  

The basics of stimming
Let’s go back to the basics of “stimming.” Stimming is a repetitive, stereotypical behavior that is one of the diagnostic criteria for Autism. Children with Autism engage in these stimming behaviors to calm themselves and help them regulate a sensory system that is often very out-of-sync. Many common stims include flapping hands, rocking, spinning, blinking, random mouth noises, chewing non-food objects, etc. Again, these socially inappropriate activities serve a purpose in helping soothe the individual with Autism. 

Is it just a phase?
Let's not forget that kids do weird stuff. They are kids...that’s what they do! This is what makes them so much fun! If a sibling of a child with Autism begins to spin or flap his hands, I generally don’t get concerned. The behavior itself is NOT the problem. The REASON behind the behavior is more of a concern. If the sibling is truly “neuro-typical”, then he won’t really get anything out of the stimming behavior. It will simply be a quirky act that he engages in for a month or two before moving on to the next quirky behavior. In other words, it’s just a phase. 

When is there cause for concern? 
Though the data is somewhat varied, siblings of children with Autism have a 7-19% increased chance of having Autism themselves. You should contact your child's pediatrician if you: 1) observe that these stimming behaviors continue for more than a couple of months, OR 2) observe a significant regression in your younger child’s language or other developmental milestones lasting more than a couple months. I would also recommend consulting with your older child’s occupational therapist. It is likely that he/she knows your family well and has casually observed the younger sibling on multiple occasions. As someone who has been in this business for over a decade, I have learned to be observant for “red flags” in siblings, often months/years before the parent is aware there may be a problem. 

Do you have a child with Autism? How have you addressed concerns with siblings? 

Or do you have more than one child with a diagnosis of Autism? 

I would love to year your ideas/comments for this question!

You can send questions to share@ChildrensTherapyTEAM.com

Resources:

American Academy of Pediatrics: Siblings of Children with Autism Spectrum Disorders

Web MD: Child’s risk whenolder sibling has Autism

National Institute of Mental Health:  Autism Risk in Younger Siblings 

Melatonin Minute

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Dear Melissa,

My 3 ½ year old daughter has no other medical diagnoses but has the hardest time falling asleep at night! We minimize TV and other electronic devices in the evenings, and we have consistent bedtime and wake-up times throughout the week. We have also tried “reward charts” and other behavior modification techniques. Even when she is “being good,” I can watch her on the video monitor just tossing and turning for an hour, even though her head is on the pillow. I have friends who use Melatonin to help their children fall asleep. Is this a good idea for my daughter? 

Confession...this is actually a question about my own child that I really struggle with! Some commentators praise Melatonin as the greatest thing since sliced bread. It not only helps children and adults fall asleep with minimal/no side effects, but its efficacy is being studied for treating and preventing certain cancers. Others say the complete opposite. Critics accuse parents of taking the “easy way out” and drugging their children to induce sleep, claiming that Melatonin has long-term side effects ranging from dependency to decreased sexual development. What is the truth? 

What is Melatonin?
Melatonin is a hormone found naturally in the body. It is produced in our brain's pineal gland. Melatonin appears to be linked to the body's sleep/wake cycle or circadian rhythm. The release of Melatonin is stimulated by darkness and suppressed by light. The levels of Melatonin in your blood are highest just before you go to sleep. Melatonin used in medicine is usually made synthetically in a laboratory. It is most commonly available over the counter in pill form, but Melatonin is also available in forms that can be placed on the cheek or under the tongue. This allows the Melatonin to be absorbed quickly into the body. 

Effective...Yes!
There are many quality research studies which have deemed Melatonin to be quite effective in helping children fall sleep. Not only children with various disabilities such as ADD/ADHD, Autism, Cerebral Palsy, Cognitive Impairments, and Blindness, but typically developing children as well. In most cases, it is recommended that you administer Melatonin 30-60 minutes before bedtime. It helps a child to fall asleep but is much less effective at helping a child stay asleep. As a whole, I can find little question that Melatonin works. 

It is sold over the counter...but is it safe? 
Many people have commented to me that melatonin (and other supplements) are “all natural” and therefore are safe. To that I reply “Marijuana and psychedelic mushrooms are ‘all natural’ but I would hope that you would not deem THOSE products safe to give to your child!” The problem with “all natural” products is that they are not regulated by the FDA. I like the FDA. I know that there are many conspiracy theorists out there, but it is the job of the FDA to keep us safe. The FDA is in charge of making sure that all drugs are both safe and effective. This includes regulating potency and ensuring there are no added/unreported ingredients. One of the major known problems of taking melatonin is that one can never be completely sure of the dosage. As with all non-FDA approved supplements, there is little outside regulation. Therefore, the consistency, potency and outside contaminants can vary from company to company and from bottle to bottle within the same brand.   

My Recommendations

1. Start with good sleep practices. This includes consistency of bedtime routine, sleep/wake time, minimizing electronics, etc. 

2. Assess your child’s individual sleep needs. Each child is unique. If your child goes to bed later but wakes up on time and thrives during the day, she may need less sleep than her peers. Though annoying, this is OK and causes no need for further intervention. 

3. Add behavior modification techniques when necessary. Think about your personality, your child’s reasons for not sleeping well, and the personality of your child in order to find the best technique for your family.  

4. Use an infant video monitor. This can help you assess what might be contributing to your child’s sleep difficulties. I have found this information to be tremendously valuable as a mama when working with my own children on sleep. Is the child getting up and playing, or is she tossing and turning with her head on the pillow? These two scenarios require different interventions. 

5. Talk to your pediatrician. When you have tried all of the recommendations above and your child is still having sleep difficulties, it is time to take the next step. In my opinion, a “wait and see” approach is not good enough. Work with your pediatrician, teachers, occupational therapist, child psychologist, and other professionals who might be involved in your child’s care to determine the best approach.  

Parent detective work

Don’t forget to be a detective first! This will allow you and your pediatrician to have an informed discussion about the problem. Your doctor's recommendations will rely heavily on your day-to-day observations. Go to your pediatrician equipped with knowledge gleaned from your own observations. For example, be able to answer questions such as the following:    

• Does your child have a problem with falling asleep or staying asleep? 
• Does your child appear restless? 
• Does your child have problems with naps (if they are still necessary) or just at bedtime? 
• Does your child snore? 
• Does your child have nightmares? 
• Does your child have specific fears with falling asleep?   

My final word on Meletonin
Yes many of the sleep medications and supplements have potential negative side effects. However, we KNOW that a sleep-deprived child will have the negative side effects of irritability and decreased attention. In addition, many studies have also linked a lack of sleep with decreased academic performance, obesity, depression, and behavior problems. In general, I tend to embrace non-pharmaceutical approaches first, but don’t hesitate to do what is necessary to help your child achieve the quantity and quality of sleep she needs. 

What are your thoughts on Melatonin?  Have you found it to be a wonder-drug for your family?  Did you or your child have negative side effects? I would love for you to weigh in! In addition, I have posted a TON of resources this week due to the complexity of this issue. Sweet dreams!

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

send it to share@ChildrensTherapyTEAM.com

Resources:

Safety and Efficacy of Melatonin in Children, The Natural Medicine Journal

The Use of Melatonin in Children with SleepDisturbances, MedScape

Melatonin, American Cancer Society

Melatonin, National Institutes of Health

Bedtime Routines for School Aged Children, Healthychildren.org

Melatonin: A 'Magic' Sleeping Pill for Children? Wall Street Journal

Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences, American Academy of Pediatrics

A Practice Pathway for the Identification, Evaluation, and Management of Insomnia in Children and Adolescents With Autism Spectrum Disorders, American Academy of Pediatrics

Sleep Training 101

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Dear Melissa,
I need sleep!  My kids are 3 and 5, and my husband and I have had them in bed with us almost every night for the past 5 years. Every night is a bedtime struggle before we all collapse together around 11 pm. WE ARE DONE! Please help us kick our little birds out of the communal nest and into their own beds!

Oh, the struggle of bedtime! As parents, we think that we will sleep-train our infants at 9 months, then be done with it. But in many cases this process can go on, and on, and on… Some families sleep together in one big bed, not because they enjoy the coziness, but because they are exhausted at the end of the day and don’t have the energy to try to make a change. There is no single magical answer for sleep-training children. (If there were, there would be no need for all of the child-sleep books on Amazon!) When my kiddos weren't sleeping, I think I read just about every sleep-help book out there. In this blog I will share several tips that have worked in my own house and with my kiddos in the clinic. But first, I need to share a few important points.

This may not be for you.
If your family bed works, then it works! If Mom, Dad, sister, brother, little brother and dog all enjoy sleeping together in one huge California King bed while getting a sufficient amount of restful sleep...then great! If grownups are getting 8 hours of restful sleep, and the kids are getting at least 10 hours of restful sleep...don’t let me try to change you. 

Consider the needs of each family member.
In my opinion, the number one consideration is the quantity and quality of sleep that each member of the family receives. Lack of sleep is linked to obesity, driving accidents, hyperactivity, depression, lower academic performance...the list goes on and on. Oftentimes, when families co-sleep, they are unable to meet the needs of each individual family member.  Parents need less sleep than kids.  If the kids are put to bed at 8, but the parents don’t want to go to bed until 10, then one can face a 2-hour struggle as the children struggle to sleep because they are used to having parents in the bed throughout the night with them. 

Sleep training is hard! 

Before sharing sleep-training techniques, I must admit that getting kids to sleep is often HARD! It can take up to 2 weeks to see results. Every child is different, and it may take some trial and error. Don’t give up! Pick a time span of a couple weeks in which the family should have a fairly routine schedule. Also pick times where the parents can afford to lose a bit of sleep (i.e., NOT at the time of scheduled work stresses such as major presentations, meetings, trips, etc). Then, try a technique and stick to it. You should see a turnaround start to occur by day seven.  If no results are seen by day 10-14, abandon the technique and try another one.  

Sticking with it is important!
Every child is different. However, if you start one technique, and by midnight day 3 you abandon it, the sleep patterns will only get worse. The child has just learned that if he throws a big enough tantrum, then he will get what he wants. This is dangerous territory! The negative behaviors surrounding sleep often get worse for a couple days before they get dramatically better. I have learned this as a mama myself. I have used all of these techniques at one time or another with my own children in my own PJs. The key is to match the technique listed with your own temperament and the temperament of your child.  Stick to it, you can do it!

Know when to get help.
If your child consistently does not fall asleep on his own after lying quietly for 15 minutes, it is probably a good idea to discuss this with your child’s pediatrician to rule out other causes for insomnia. 

Sleep Training Techniques 

#1 Create a regular sleep routine 

This means no electronics 30 minutes before bed, going to bed at the same time every night, and having a regular sequence to the evening to help set the child’s circadian rhythm.  I have more information on this in my previous blog (link). 

#2 Keep a consistent environment  
Keep the child’s bed consistent throughout the night. DO NOT allow her to fall asleep in one place, then move her to her own bed in the middle of the night. Everyone wakes up periodically and briefly in the middle of the night. If the environment at midnight is not the same as it was at 8pm, this can cause a child to wake up completely, reassessing the safety of their bedroom situation. This usually involves kids crying, parents comforting and less sleep for everyone!

#3 Help your child create the environment
It often helps to get a preschool child involved with choosing his/her sleep environment. Often a new blanket, stuffed animal, night light, or pillow pet can help create a “big kid bed” that is inviting and personalized for the individual child’s needs. 

#4 Sticker/reward charts  
Children over the age of 3 years generally respond well to sticker/reward chart. First create the chart. Then reward your child with a sticker each morning based on certain night behavior (e.g., her head was on the pillow by a certain time the night before, she stays in bed all night, etc.). After the child earns 5-10 stickers, she can receive a “reward” of a toy, trip to the yogurt shop, movie date, or trip to the park. 

#5 Ferber method

      This is a sleep training technique created by Dr. Richard Ferber. In this method, the parent tucks the child into bed then leaves the room. Then the parent checks back in on the child at set intervals that increase (2, 3, 5, 10, then 20 minutes) until the child is asleep.

#6 Reverse Ferber
I made this name up after listening to a sleep specialist from New York University. It worked wonders on my daughter when she was 3 years old. The basic premise is this: As parents we often let our child practice life skills on their own before we offer to help. For example, we let our children attempt to put on their own shoes/socks before we offer help when we see they are having trouble. This method uses the same premise. 
a) If your child is able to understand, you tell your child you are going to let her practice sleeping before you help.
b) You tuck the child in, then allow the child to “practice” sleeping alone for a few minutes.
c) When the time is up, you lay down in the child’s bed with her until she falls asleep.
d) At first the child “practices” for only a couple minutes. Over time the practice period extends to up to 15 minutes.
e)  If the child is truly laying still in his bed and has had a good sleep routine, she should fall asleep in that amount of time. However, if something else is going on which makes falling asleep difficult, then you are there to comfort her and provide support after that 15 minute period.

#7 "Super Nanny” approach

      OK, I will admit that this one was a disaster in my house, but many people I know swear by it.  In this approach, you tuck your child in, then sit in the room as they go to sleep. If the child gets out of bed, the first time, you say “time for sleep” and put them back into bed. After that you simply put them back to bed with no words or eye contact. In my house, sitting in the same room did not work. However, repeatedly and gently placing the child back to bed without words or eye contact has worked well in my house. 

What sleep tricks have worked in your house? I would love to hear your ideas!

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

send it to share@ChildrensTherapyTEAM.com 

Resources:

The Truth about the Ferber Method

The Super Nanny: Sleep Separation

The Ferber Method – Dr. Ferber’s Sleep Book, Pediatrics.about.com 

Solve Your Child’s Sleep Problems, Dr. Richard Ferber

Healthy Sleep Habits, Happy Child, Dr. Marc Weissbluth

The Happiest Baby on the Block, Dr. Harvey Karp