Hate Storms?

credit: Envato Images

Dear Melissa,

I have a 7-year-old son with a diagnosis of Autism. He is very sensitive to sounds and HATES thunderstorms. Do you have any tips for helping us cope with the thunder or advice on what to do in case we need to seek shelter during a tornado warning?  

A child’s fear of thunderstorms (astraphobia) can be very difficult for families to navigate. Sound sensitivity or auditory defensiveness is an extremely common occurrence for children with Autism and Sensory Processing Disorders. 

I can always tell which kiddos at a birthday party are auditory defensive because they are the ones that put their hands over their ears during the singing of “Happy Birthday”. 

Thunderstorms are much louder and much less predictable than singing happy birthday. During storms, I generally distract children from their fears while working with them at our Children's Therapy TEAM clinic. However, this technique is likely more difficult at home because home is often quieter than our busy clinic. So, I turned to those who have taught me so much over the years...my clients!

Ideas about how to deal with storms:

Shared by a mom with a boy with Autism (7), a dad with a daughter with Autism (13) and a girl (10) who also has Autism. 

Social stories: 
These little nuggets are truly magical. If you have never heard of these before, I highly recommend them for any anxious situation. You simply make up a story with the child as the main character (write it down and illustrate it). The story should describe the scary situation as well as a proper solution.

Early warning:  
Social stories are a great place to start, but hopefully you will be able to move on to the point that the child just needs some warning that it may be a stormy evening. Don’t we all like to have a heads up about the weather? Simply knowing that there may be a change in the routine that day may be enough for many children to remain calm during the storm. 

iPad:
I have written many blogs explaining why I think screen time should be limited. However, this is a time to break out the iPad and use it as a portable distraction, especially if you have to seek safety in your tornado shelter area.

Blankets/pillows/stuffed animals: 
Often a child can bury himself in pillows and blankets to help muffle the sounds. They are also very useful for providing calming deep pressure. Who knows, your little one may even drift off to sleep!

Headphones: 
One Dad reported that his daughter started out with shooting-range ear protection, then was able to move to music headphones, before stopping them all together. Other items that can help block out the sound of thunder include ear plugs, ear muffs, and pulling up a hoodie or blanket over the head.

Desensitization:  
Your OT can help you with this one. Desensitization involves gradually exposing someone to something that they usually find difficult. Over time, it becomes more tolerable. You may start with more soothing nature sounds such as the ocean or a stream, and you can gradually increase the volume over several exposures. Then, move on to the sounds of a thunderstorm at a very low volume before gradually increasing the volume of that sound over many exposures. 

Fidgets: 
My client in the clinic said that having fidgets (e.g., Koosh balls, slinkies, water timers, stress balls, and squishy rubber animals) during thunderstorms or in tornado shelters helps make her feel much calmer.

Role Play: 
Though tornadoes in Northwest Arkansas are relatively uncommon, they do happen. Identify your “safe place” tornado shelter. Decide what you need to take with you ahead of time, and practice using your sensory techniques while sitting in your shelter. Gradually increase the time spent in your shelter area so that your child can tolerate being in the shelter with you for at least 5-10 minutes at a time (though you will likely be in there much longer for a real tornado warning).

What techniques does your family use to help survive thunderstorm season?  

I would love to get even more ideas from you!

email: share@childrenstherapyteam.com

Additional helpful information:

Explore Helpful Strategies to Ease Child’s Fear of Thunderstorms Chicago Tribune (published May 2013)

Storm Prediction Center: Tornado Safety (downloaded April, 2015)

Weather Worries Children’s Hospitals & Clinics of Minnesota (downloaded 2015)

Tornado Preparedness: Tips for Families Healthychildren.org (downloaded April, 2015)

Heart of an OT?

Dear Melissa,

What's the heart of a good Pediatric OT? 

A common mantra I enjoy is "when you love your job, you never work a day in your life!"  I admit it, I am an Occupational Therapist (OT) that loves the job and I am not alone. What is the heart of a good pediatric OT? He or she has to LOVE their job.That's it! It's simple. However, a more illuminating question might be,"why do you love your job?" In the spirit of recognizing OT month, I reached out to several of my fellow Children's Therapy TEAM OT's to ask this question. They shared the following responses: 

“I love the connections I build with people and helping them reach their own personal goals…whether it be learning to tie shoes, or motor planning to salute a scout leader.”
-Katie Gehrki

"I love being an OT because I love watching kiddos discover and use their unique strengths to develop self-esteem while reaching their goals in therapy and beyond." 
-Bridget Glynn

“I love being able to combine my creativity skills with my understanding of science...child development and brain functioning. Relying on these skills lets me be innovative and helps my kiddos have fun and make great progress.” 
-Allison Schmitz

“I love being an OT because I love working on skills that kids use in their everyday lives!  Plus, we get to have the most fun.”  
-Dana Tolle

“I love being able to help give children the tools to succeed in their daily lives. I love the pride and smile on their face when they meet a goal. And, I love that OT's have a client centered, holistic approach that puts emphasis on working with the families, teachers, and other individuals who impact the child’s life.”  
-Kelly Yates 

“I love seeing the excitement for the parents and kids as they master new skills that they have worked so hard to achieve. Focusing on the child’s ‘occupation’ allows her to succeed with life changing skills.”  
-Kati Bullington

So let me summarize why we LOVE being pediatric occupational therapists, while of course putting in my own two cents!

It Works!  
We wouldn't do this if we didn't see progress. We know how hard our kiddos struggle to meet their goals, and I can’t tell you how many times I have smiled for a full week when a child has met a much anticipated milestone!

Medicine + Creativity = Win, Win.  
Most of us love science and medicine. But we also love problem-solving and creativity. This allows us to live in the best of both worlds!

FUN!  
Um…my “office furniture” consists of a ball pit, trampoline, swings, and a wicked-cool light room. My “office supplies” include play-dough, scooter boards, UNO cards, and glitter glue. Best workplace ever?  Yes, I think so! Take of tour of my clinic and see for yourself. 

It takes a village…
Yes, we are problem solvers, but we are not egotistical problem solvers.  Parents, grandparents, extended family, doctors, other therapists, teachers, even the martial arts instructor…all of these people are in my client’s “village”.  I love having input from all of these loving, caring adults in order to help my kiddo meet his fullest potential. 

Practice, practice, practice. 
I am a mama of 2 young children. I love that I have “work kiddos” that are the same ages as my “biological kiddos”.  Now, I am sure that my biological kiddos hate it, but I have the unique opportunity to practice therapy techniques all day long at work, then all day/weekend long at home. Cool therapy techniques, games, books, TV shows, crafts, books, etc. I am constantly passing these ideas back and forth between my two worlds and I love it!

Do you love being a pediatric OT?  

Are you a parent/child who loves your pediatric OT? Please share! 

email: share@childrenstherapyteam.com

Reference: American Occupational Therapy Association

ADHD Diet & Supplements

Dear Melissa,

My 7 year old son was diagnosed with ADHD, but I don’t want to give him prescription medications to treat it. I have started giving him the supplement from the local natural food market and have taken sugar and red dye out of his diet. What else should I do to treat ADHD “naturally”?

I am asked this question frequently. It is very common for a parent to tell me that they have changed their child’s diet and started them on a natural supplement from the local natural market. However, frequently the parent does not actually know what is in the new supplement. I commend you if you do know what the supplement is made of, you have talked to your child's pediatrician and you understand how the supplement and special diet may interact with your child's body. 

A word of caution

A couple weeks ago, I went to a natural market myself and tried to read the labels of several "natural" supplements. I wanted to better understand what my patients were taking. I couldn't discern heads from tails! This is concerning because certain herbs interact negatively with traditional medications. For example, Ginko biloba should not be taken with aspirin, anticoagulants, or antidepressants (ref: healthychildren.org). Like I always say, psychedelic mushrooms and marijuana are “all natural” but you wouldn’t want to give them to your child!

Mixed Review on "All Natural" Treatments 

There is quite a bit of research on this topic. The following are some “all natural” treatments for ADHD which actually do have some research behind them (with both positive and negative results).

1. Artificial Colors: Mixed Reviews. A few years ago, the United Kingdom and European Union restricted the use of artificial food colorings. Of particular concern are certain red and yellow dyes. Much of this debate started in the 1970’s with the publishing of Dr. Ben F. Feingold's Why Your Child Is Hyperactive. This book touted that half of children on his specialized diet showed improvement. However, the American Academy of Pediatrics3, 4 reports recent studies that “only approximately 2% of children with ADHD on the Feingold diet have shown consistent behavioral improvement when these food dyes are eliminated." 
2. Sugar/Artificial Sweeteners: Probably No Effect. Once more, many studies have looked at the relationship between sugar (both real and artificial) and hyperactivity in both ADHD and neurotypical children. The result? No evidence that sweeteners affect hyperactivity. Furthermore, it is hypothesized that it is actually the lack of structure in the child’s overall household which allows for more sugar, or possibly the sugary event (birthday party anyone?), that causes the increase in hyperactivity rather than the actual sugar/artificial sugar ingestion. 
3. Omega-3 Fatty Acids: Probably Help. 4 Omega-3 Fatty Acids are important for brain health. So it makes since to study the relationship between fatty acids and hyperactivity/impulsivity. The jury is still out on supplementing with Omega-3 Fatty Acids, but the American Academy of Pediatrics states that adding them to your child’s diet is “a reasonable approach” (reference: healthychildren.org.)
4. Megavitamin Therapy: Possibly dangerous. 7 – Some people think that ADHD is caused by deficiencies in the way the body absorbs certain vitamins & minerals. However, studies have shown that megadoses of vitamins can actually cause permanent liver damage. You can have too much of a good thing when it comes to vitamins. 

My Recommendations
When trying to follow the research and try a more natural approach, I recommend the following: 

1. Connect with your Pediatrician. Discuss ALL treatment options, diet changes, and supplements with your child’s pediatrician! Again, some treatments can actually have negative effects on your child. 
2. Embrace a whole-food type of diet and leave processed foods behind. In general, this seems to be the overall nutritional recommendation given by many physicians.8 This means a diet which focuses primarily on fruits & vegetables, adds some fish and other lean protein, and reduces processed foods as much as possible. 
3. Work WITH your child’s “village”. This means the pediatrician, behavioral therapist, occupational therapist, teacher, grandparents, coaches, aunts/uncles… The research clearly shows that a multidisciplinary approach creates the best outcomes. Whether your child ultimately needs prescription medication or not, the bottom line is to make sure that the ADHD symptoms are treated in order to help your child be his best!

Have you tried any of the above treatments?  

Which combination worked best for your child? Please share!

 email: share@childrenstherapyteam.com

Resources:

1. ADHD Treatment: Where do you start? Children's Therapy TEAM Monday's with Melissa Blog, posted February, 2015.
2. Alternatives to Prescription Medications for Treatment of ADHD, Children's Therapy TEAM Monday's with Melissa Blog, posted April 6, 2015.
3. A Research Model for Investigating the Effects of Artificial Food Colorings on Children With ADHD, Pediatrics, American Academy of Pediatrics, Vol. 127, June 1, 2011.
4. The Diet Factor in Attention Deficit/Hyperactivity Disorder, Pediatrics, American Academy of Pediatrics, Vol. 129, February 1, 2012.
5. Relative Effects of Drugs and Diet on Hyperactive Behaviors: An Experimental Study, Pediatrics, American Academy of Pediatrics, Vol. 61, June 1, 1978.
6. ADHD Diets, WebMD, Accessed January 2015.
7. Your Child's Diet: A Cause or a Cure of ADHD, American Academy of Pediatrics, HealthyChildren.org, updated May, 2013, accessed February, 2015.

8. What does the research say about the relationship between food additives and ADHD? John E. Huxsah, Mayo Clinic, updated October, 2014, accessed February, 2015.

Alternatives to Prescription Medications for Treatment of ADHD

credit: Envato Images

Dear Melissa,

My daughter is 7, and her teacher was concerned about her inability to focus in the classroom and generally “not meeting her potential”. I had my daughter evaluated by a child psychiatrist, and the doctor gave her a diagnosis of ADHD. I really don’t want to put her on medication at such a young age. Are there any non-prescription interventions that are proven to help?

I have frequently heard this question from parents. Often parents come and have their child evaluated for occupational therapy because the child is struggling in school, and they want to start the ball rolling to build success...even before the child has a diagnosis of ADHD.  Actually it is not uncommon at all for the psychiatrist to have me, as the OT, provide input from my treatment sessions with the child in order to help the psychiatrist gain a complete picture of the child in multiple settings and make a more accurate diagnosis. 

Prescription medications ARE a fantastic tool for treating ADHD. However, many parents, for various reasons, really want to avoid medications for ADHD. My personal philosophy is that ADHD needs to be treated. Period. No kid wants to be “that kid” who is bouncing off the walls and gets in trouble for not focusing, even when she is trying her best. BUT, I personally don’t like how medication is seen as the first line of defense. I want to see SOMETHING else tried first before we give medication to a young child. Below I have listed some options that are proven to generally help children with ADHD and other mental health disorders. 

Rule out other medical diagnoses.  This should always be first on the list.  Poor attention can be the result of many other medical diagnoses including depression, anxiety, learning disabilities, Autism, dyslexia, visual/hearing problems, insomnia, etc.  All the ADHD treatment/medication in the world won’t do your child a lick of good if there is an untreated underlying cause.  Working with your child’s pediatrician is your best source for ruling out other causes of poor attention. 

Occupational/behavioral therapy.  A therapist who specializes in ADHD and other mental health disorders can work with your child and your family to help find the right techniques to reduce impulsivity, improve social skills, improve listening skills/following directions, and learn to refocus attention.  In addition, occupational therapists can evaluate your child for any developmental “splinter skills” which may have not yet been met as a result of poor attention (ex. handwriting skills, auditory processing skills, self-care skills such as tying shoes, etc). 

Reduce/Eliminate Electronics.  Many years ago, there was a fantastic pediatric neurologist in the area who used to say, “Before you drug, UNPLUG!”  And this was in the days before smart phones and iPads!  Before she would prescribe ADHD medication for a child, the neurologist would require that the child eliminate all TV/video games/computer time for SIX WEEKS.  Research shows that children with more screen time earlier in life have more attention difficulties later in life. In addition, children with more screen time have more sleep problems, which also contributes to poor attention. 

Exercise.  Elementary schools are cutting recess and PE time right and left.  Fortunately, our teachers are finding ways to incorporate brief bursts of exercise into the classroom day to help their children focus. They know it works. For example, one study in Missouri compared three elementary schools using an ABC exercise program with two other schools not using it. Among the findings: Schools that adopted the exercise program for most of the academic year had a 33% decline in ADHD medications used by its students. That compared with a smaller, 7% decline in medication use in the schools not using the program. The side effect? More physically-fit children! Count me in!

Parenting techniques. A study published by the American Academy of Pediatrics in January 2013 showed that Parenting Behavior Training (PBT) was BETTER at improving symptoms of ADHD in preschool children than medication.  In general, children with ADHD (as well as most children) respond well to clear boundaries and structure.  Again, this is where an occupational therapist or behavioral therapist can help recommend techniques which work best for YOUR family. 

Diet. This one is a bit more controversial.  The CDC reports that there is NO link between sugar, artificial sweeteners, food additives (dyes, etc) and ADHD.  However, can it hurt to feed a child more whole foods, more fruits and vegetables, and less processed foods?  Simply go back to the food your grandma ate? Sounds good to me! Personally, if I eat fast food, I can feel my brain just turn down the fire power. That may be fine for a lazy Saturday, but not a great idea for a Monday night when homework needs to get done! Again, the biggest side effect is a child with a healthier diet. It can’t hurt!

Although I think occupational therapy is a valuable tool for treating ADHD, it is not the only option for a first treatment (as you can see above). Maybe the alternative treatment is not 100% effective, but it may help reduce the amount of medication a child may require. Unfortunately, in the American healthcare system (for ALL diagnoses), we are quick to offer pills, but very slow to try other treatments such as diet, lifestyle change, and exercise. In reality, many of these non-pharmaceutical practices actually work BETTER than pills. 

Still not sure?  Next week I will dive into the more controversial area of specific diets and supplements for treatment of ADHD. Send in your questions now, and we will try to get them addressed!

email: share@childrenstherapyteam.com

Resources:

ADHD Treatment: Where do you start? Monday's with Melissa Blog, posted February, 2015

Interventions for Preschool Children at High Risk for ADHD: A Comparative Effectiveness Review, Pediatrics, American Academy of Pediatrics, Vol. 131, May 1, 2013. 

A Research Model for Investigating the Effectsof Artificial Food Colorings on Children With ADHD, Pediatrics, American Academy of Pediatrics, Vol. 127, June 1, 2011.

Relative Effects of Drugs and Diet on Hyperactive Behaviors: An Experimental Study, Pediatrics, American Academy of Pediatrics, Vol. 61, June 1, 1978.

Media Useand Sleep Among Boys With Autism Spectrum Disorder, ADHD, or TypicalDevelopment, Vol. 132, December 1, 2013.

What is ADHD, National Institutes of Health, Accessed April, 2015. 

ADHD, Center for Disease Control & Prevention, Accessed April, 2015.

Why French Kids Don’t Have ADHD, Psychology Today, March 8, 2012.

Exercise Helps Children with ADHD in Study, Wall Street Journal, September, 2014.

Diagnosing ADHD in Children, American Academy of Pediatrics, Healthchildren.org, updated January 9, 2015.