National Adoption Awareness Month

Did you know that November is National Adoption Awareness Month? As we have entered the holiday season of thankfulness, it seems only fitting to discuss the importance of family.  

Families can be created in so many different ways. In my work with children, I see many different kinds of families. Yes, there are some families that are the simple Mom, Dad, and 2 biological children. Then there are step parents, half brothers and sisters, foster parents, aunts raising nieces and nephews, grandmas raising grandchildren, domestic adoptions, foreign adoptions, and even more varieties. Each family comes together in its own unique way. And every family that is based on love is beautiful!

November is National Adoption Awareness Month. So, I chose this week's blog to highlight how our TEAM family feels called to support the orphans of the world as they wait to find their “forever families".

TEAMworks International

This branch of TEAMworks is a group of therapists and specialists who travel internationally, seeking to improve the lives and futures of children. Each international team is comprised of various TEAM therapists from multiple disciplines. Currently, we travel to clinics and orphanages in Guatemala, China, and Rwanda. In the past we have also traveled to Ukraine. During these trips, the therapists meet with hundreds of children and and their various caregivers (parents and orphanage staff), offering individualized treatment plans, equipment, and education to improve overall quality of life for these children. By returning to the same clinics/orphanages over and over again, the teams of therapists can build relationships with these communities and create a lasting positive change for these children with special needs.  

Children’s Therapy TEAM Therapists as Mommies & Daddies

Many of our therapists at TEAM have adopted children from foreign countries. Kelly Yates (TEAM Occupational Therapist) recently adopted an adorable 2 year old little girl from China. I asked her a few questions about her perspectives on being a new Mom, as well as the unique considerations involved with being an occupational therapist working with children who have been adopted.

What led to you choose adoption for your family?  

Kelly:  I traveled abroad 5 times as a pediatric occupational therapist, providing assistance at orphanages through our TEAMworks organization. I knew many families, including many coworkers, who had chosen foreign adoption for their families. Each trip abroad broke my heart, seeing those beautiful orphans being cared for in mass by nannies, but never knowing the love of a mommy and daddy. Therefore, my husband and I prayed about and chose adoption. We felt led to love a child, born to a family who could not care for them as their own, knowing that God would place our child in our family as our beautiful daughter. It is an HONOR to be a new Mom to my precious Stella, and we are so, so blessed to make her one less orphan in a sea of many.  

In your opinion, what is one of the hardest things about adopting?

Kelly:  The joy of having Stella is so incredible! But, it remains bittersweet when I think of all the other precious little faces that were in the background of her pre-adoption photos. My daughter has found a forever family full of love. I worry about all the other children who are still in orphanages waiting on for their forever families to come and find them. 

What would you tell other families who are considering adoption?

Kelly: If your heart is being stirred to answer the call to adopt I encourage you to act!!! You will be blessed beyond measure! If adoption is not in the cards for you, consider helping in other ways: fostering, sponsoring, helping to fund others' adoptions, prayer. Borrowed from the great Julie Marvin (another TEAM OT who has adopted internationally):  If you have even the slightest curiosity, pl]lease don't hesitate to ask!  

TEAM therapists in the clinic

Children who have been adopted possess a unique set of strengths and needs that are often different from children in biological families. 

1.  Children who have been in an orphanage often have special needs relating to sensory deprivation in the orphanage. Many babies in orphanages spend the majority of their day in cribs. Likewise, many older children of domestic adoptions come from environments of neglect and sensory deprivation as well. Therefore, when these children are adopted into a loving, sensory-rich environment, it can be a bit overwhelming and scary. Many of these children develop specific sensory sensitivities and sensory processing disorders.  

2.  It is often important to address separation anxiety in children from biological families. However, when a child has come from an orphanage or foster care, the exact opposite approach is taken. Our therapy sessions are used to encourage more bonding with the new parents rather than independence from their parents. 

Both issues with sensory processing and anxieties with bonding with/separating from parents are areas that can be assisted by your occupational therapist.

Did you choose an international or domestic adoption to complete your family?  

Please share your experiences with us! share@childrenstherapyteam.com

Resources: 

TeamWorks

Yates Family Blog 

Adoption.com

Autism & High Prevalence of GI Problems

Dear Melissa,
My 5 year old grandson has Autism, and he has a lot of trouble with constipation. Is this common in the children you treat?

YES! One of the problems with Autism that is not often discussed are chronic issues with the gastrointestinal (GI) system. Constipation, abdominal pain, difficulty toilet training, and severely picky eating are some of the troubles that I see most commonly. When you add in the facts that many children with Autism have low or poor verbal skills AND the fact that many of them have decreased sensitivities to pain, my patients are often in real GI distress before their caregivers realize that there is a problem.

I researched this topic heavily this week so that we could find some real numbers and answers to the topic of Autism and constipation. So lets get started!

Autism & High Prevalence of GI Problems

Frequency
A large meta-analysis study published from Emory University in 2014 looked at previous research on the topic of Autism and gastrointestinal disorders. This study found that individuals with Autism Spectrum Disorder had a greater than 3-fold prevalence of diarrhea and constipation, greater than 2-fold prevalence of abdominal pain, and greater than 5-fold prevalence of “general gastrointestinal concerns” compared to the control population.

When you add food sensitivities into the mix, Virginia Chaidez and fellow researchers at the UC Davis MIND Institute found that individuals with Autism are six-to-eight times more likely to have GI issues than children who are developing typically. In contrast, they found that children with other developmental delays had only a five times more likely to exhibit various GI concerns.

Causes
There are 2 different theories as to why children on the Autism Spectrum tend to have higher rates of constipation and other forms of GI distress:
1. Behavioral: Individuals with Autism are often prone to sub-optimal diets to say the least. Between defensiveness toward taste, smell, and texture, as well as ritualistic behaviors surrounding foods, many people on the Autism Spectrum have extremely limited diets that are generally high in simple carbohydrates, and low in fruits and vegetables. This combined with often having defensiveness surrounding toileting, can be a recipe for chronic constipation.

2. Biological: Preliminary research has also provided some support for such biological factors as altered flora of intestinal microbes, altered patterns of intestinal contractions, food allergies, and gastroesophageal reflux disease. 

Why do we care?
Besides generally wanting to know when our kiddos are not feeling well, why do we care so much that people with Autism have such a high incidence of GI problems? Well…children with Autism often present with “problem behaviors”. Quite frankly, children are often referred to me as an occupational therapist for these negative behaviors long before they are sent to a neuropsychologist for a diagnosis of Autism. But think about it, when your stomach hurts, you generally have poor attention, are irritable, and don’t want to work. Sound familiar? 

Many of my “cranky kids” have negative behaviors that are greatly exasperated by medical causes such as GI distress. Individuals with more severe forms of Autism might also be more likely to engage in self-injury or aggression at times of GI distress as well. AND…When you have low verbal skills, how else do you let those around you that you are in pain?! 

Chaidez's UC-Davis GI Study also found that parents who reported that their child with Autism had abdominal pain, gaseousness/bloating, constipation, and diarrhea also reported significantly more incidences of irritability, social withdrawal, repetitive behavior, and hyperactivity than did those without GI symptoms. As a pediatric occupational therapist dealing with kiddos who have negative behaviors, I always like to rule out medical causes for these negative behaviors such as difficulties with sleep, allergies, or GI distress in combination with my behavioral interventions.

How do you treat it?
If you have concerns that your child has chronic constipation, you should discuss this with your pediatrician, especially if your child is on the Autism Spectrum. While diet modifications alone would be optimal, they are not often effective enough for children with more severe chronic constipation, nor are they practical for children with severe food defensiveness. The recommendations for primary care physicians and pediatricians regarding children with ASD and constipation involve a very complicated algorithm involving medication, diet assessment, behavior therapy, abdominal exam, x-rays, etc, etc., etc. 

Bottom line...chronic constipation in children with ASD is complicated and needs professional help. Don’t hesitate to talk to your child’s pediatrician, and request a pediatric gastrointestinal specialist if you don’t see relief.

Do you have a question you would like me to address? 

Please don't hesitate to share: www.share@childrenstherapyteam.com

If this week's blog didn't answer your questions thoroughly enough, feel free to delve into the matter further with the links below.
Resources
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report, Pediatrics (Jan 2010) 

Gastro Woes More Common in Kids with Autism: Review,WebMD (May 2014)

Children with Autism Spectrum Disorder May Have Increased Rates of Gastrointestinal Symptoms, Jill Jin, News@JAMA, Journal of the American Medical Association (April 2014)
Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis, McElhanon et al, Pediatrics (April 2014)
Children who have autism farm more likely to have tummy troubles, Virginia Chaidez, et al., UC Davis Health System (November 2013), summarized in the UC Davis News (2013)

Management of Constipation in Children and Adolescents with Autism Spectrum Disorders, Pediatrics (November 2012)

Inexpensive Sensory Toy Ideas

Dear Melissa,
Do you have any sensory toy ideas for things that are a bit more affordable?

OF COURSE! Some of the best sensory toys are some of the cheapest. Many are even found in the dollar section of your local Wal-Mart or Target store. Others can be found on Amazon. And yes, these are TOYS, not “therapy equipment” so they are fun for everyone, whether you have sensory processing disorder or not. (And really, don’t we all have a some degree of SPD at times??? I know I do!) Most of my picks below are in the $5 and under range and NOTHING is over $10. I will admit, I tried to limit myself to 10 items. However, I found so many great items that I had to finally stop myself at 12. This proves that you don’t need to break the bank to find some fantastic sensory toys!

Inexpensive Sensory Toy Ideas

1. Koosh balls: The classic. Enough said. 

2. Chew necklaces: OK, so this one is a bit more “therapy” than toy. But I know I personally am lost if I am not wearing a sturdy necklace to fidget with throughout the day. I specifically chose the chew necklaces below because they looked more “fun” rather than “therapeutic”. The idea is that the kiddo just gets a cool necklace in his stocking, and doesn’t realize that it is purposefully meant to be sturdy enough for fidgeting and chewing. Pick a shark tooth, kitty cat, dog tags, Legos…whatever floats your child’s boat! Simply search for “chew necklaces” on Amazon and find what your child will LOVE!

3. Slinky: This has quickly become a favorite in my sensory box at work. And I found mine in the dollar section at Target!

4. Silly putty or Theraputty (Amazon): Take this squishy goodness and add beads or pennies to create “hidden treasures”!

5. Water Wiggles: I love how kiddos gravitate toward these squishy things!

6. Water timers: The great thing about these little gems is that they can be used to help with timing brushing, etc, as well as being visually stim-a-rific!

7. Light up toys: This is another favorite in my sensory box. They also often come in a variety of cartoon characters and are often found in the dollar section at Target and Toys-R-Us.

8. Wind up toys: Yes, these wind up toys tend to be fragile, but they also work on fine motor skills as well. Win, Win!

9. Pin Art boards: These can be prickly or soft, depending on how you touch them. Double fun!

10. Etch-a-sketch: OK, I know this is a bit “old school” but my son just got one of these, and it has turned into hours of fun! It is the ultimate fidget toy between the twisty knobs and then shaking for erasing. Bonus? Our ½ sized Etch-a-sketch fits nicely in my purse so it works perfectly for restaurants and road trips.

11. Pop tubes: I will admit it. I don’t get the appeal of these guys. But my sensory kiddos just gravitate toward them! And, at a couple bucks a piece, I don’t really have to understand it!

12. Glitter wand tubes: These water and glitter filled tubes are definitely stim-a-rific. In our family they also double for pretend play as we regularly switch from fairy godmothers to Harry Potter characters. The fun is endless!

Disclaimer: The pictures above are simply examples. In this post I'm not reviewing the quality of actual brands. Feel free to read reviews and choose similar or alternate items. All product images in this post are those shared by Amazon.com.

For ideas for larger toys, checkout my Post on Christmas Gift Ideas for Children with Autism. 

Do you have a question you would like me to address? 

Please don't hesitate to share: www.share@childrenstherapyteam.com

Christmas Gift Ideas for Children with Autism

Dear Melissa,

Christmas is approaching. Do you have any FUN sensory toy ideas for my 4 year old grandson with Autism?

I love the Holiday Season! Eleven months of the year, I try to make my recommendations to parents as cheap as possible. I love to try to “make due”, get creative, and make equipment with what people might already have on hand. But…when Christmas or a Birthday is approaching, I love to share ideas about sensory therapy toys that may be a little pricy to purchase “just because”, but may be worth splurging on if wrapped up with a shiny bow.  

The items I have recommended are NOT “therapy equipment”. They are TOYS! Yes, each and every one serves a specific therapeutic purpose. However, each of the items was selected because they are simply FUN! Whether your child has sensory processing difficulties or not, many children would love receiving the items below under the tree!

Christmas Gift Ideas for Children with Autism

I have taken a Twelve days of Christmas approach in recommending the 12 items below. 

1. A Mini Trampoline ($50)  

A mini trampoline is my #1 go-to for sensory input.  They can slide under a bed perfectly, so they don’t take up much space and are WAY less dangerous than a standard trampoline. (I do not recommend standard trampolines. Even with nets and other safety precautions, they just are not safe for the little sensory seeker!)

2. Tent ($30)  

Throw in a few old pillows, bean bags, or blankets and you have the perfect “positive time out” space. Tents can be fantastic for calming. They are great for pretend play, and combine with a bucket of fidget toys and your child with have the ultimate calming retreat. 

3. Hippity hop ($25) 

I love these things!  Kids can gain some strong vestibular and proprioceptive input from bouncing on hippity hop balls. In addition, it provides strong exercise which helps with attention to task as well as provides a good cardio workout. 

4. Scooter board ($20)  

Find a hallway, grab some empty 2 liter bottles and go kiddo bowling with a scooter board! Whether sitting on the board or laying on their tummies on the board, kids again can gain a great cardio workout as well as gain sensory input from one relatively inexpensive item. 

5. Body sock ($40)  

Kids love the compression from a body sock's stretchy fabric! It can be used passively while snuggling up and watching a movie, or can be used more actively around the house while pretending to be monsters. 

6. Vibrating animal massager ($10)  

I will be honest, my son asks for one of these every time we see one. Kids tend to either gravitate toward or avoid vibration greatly. If your youngster is one who loves to put his hand on the clothes dryer or chew on a vibrating toothbrush, then a vibrating animal massager is a must have gift! 

7. Gel water scene ($40)  

Ok, ok. This is one that I had given to me, handmade, by a loving intern. She used hair gel and a zip lock baggie. And my homemade one IS super cool, but as someone who is obsessed with sea creatures…this one is WAY cool! Let your future creature-explorer enjoy this gel water scene with its captivating sensory world. It also works as a wonderfully quiet hand fidget. 

8. Doorway Swings ($230 each) 

The doorway swing pictured comes with the doorway bar, sling swing, and trapeze bar. It is listed as appropriate for ages 3-10 years of age.

9. Crash Pads ($175 each)  

This crash pad is huge at 5 feet x 5 feet and is perfect for jumping, crashing, cuddling, and even napping. Perfect for the little “crasher” in your life who may not be safe with a mini trampoline. 

10. Hammock  ($150)  

OK, so I don’t really think of hammocks in the winter either, but you will be glad you have it come spring. Even better that you can crawl in the hammock with your little one and enjoy a good snuggle together! 

11. Bubble light tube ($110)  

At Children's Therapy TEAM our bubble light tube is probably the most popular items in the clinic! The one I have linked to is a large 3ft floor model, but you can gain similar effects with much cheaper lava lamps. Fantastic for calming your wound up child! 

12. Office Chair ($125)

This may seem like an odd choice, but spinning provides strong vestibular input that so many children crave, and it also provides a comfy place for you to get work done too. Win, Win! The prices are really all over the place for an office chair, the one pictured is just an example, but you definitely want one with arms. Feel free to hunt around for the one that looks best to you. 

As a disclaimer, I provided a rough price, website link, and picture for each item above. These are simply examples and generally not actual brands of items that I have tried. Feel free to read the reviews and choose similar or alternate items. In this post, all the product links I have provided are from Amazon.com. All product images in this post are those shared by Amazon.com.

Flu Shot vs Nasal Spray Mist

Dear Melissa, 
I know you advocate the importance of getting the flu shot, but should I give my 2 year old son the Flu mist nasal spray or the traditional flu shot?

 

Flu Shot vs Nasal Spray Mist

Thanks for the question! This is something many parents will have to consider soon. The decision between a flu shot and the nasal spray is something that varies from person to person and should be discussed with your family physician. Personally, my kiddos are terrified of shots (like most kids). Therefore, I make sure to track down the sometimes elusive vaccination nasal spray to make the process much less stressful. Whichever you choose, there are pros and cons to consider.

Considerations according to R. Morgan Griffen 

(WebMD writer reviewed by Jennifer Robinson, MD)

Pros and Cons of the Flu Shot 

The shot involves an injection into the upper arm with a vaccination containing a dead virus. (1)
PROs: Can be given to a wide range of individuals, beginning at age 6 months and in my experience is easier to obtain than the Nasal Spray Mist.
CONs: Many people don’t like shots. The most common side effect is soreness at the injection site. Much less common reactions include a mild fever and achiness. (1)

Pros and Cons of the Nasal Mist 
This vaccine is sprayed into the nose. It is made from a live virus that has been weakened and can NOT cause the flu.(1)
PROs: Does not involve an injection. In addition, the CDC reports that the FluMist might actually provide better protection than the traditional shots for children ages 2-8.
CONs: Possible side effects include: slightly stronger flu-like symptoms than the shot, such as runny nose, headache, sore throat or cough. In children, side effects can also include wheezing, vomiting, fever, and muscle aches. The mist can only be given to individuals between the ages of 2 and 49 years who are generally healthy and not pregnant.(1) In addition, young children need to be able to breathe in through their nose on command in order to take the dose. In my experience, it is good to “practice” this with young children before entering the doctor’s office.

Other thoughts to consider:
As I noted before, it has been my practical experience that the flu shot is easier to obtain. Many chain pharmacies, as well as local pharmacies, offer flu shots. In addition, many employers provide flu shots. It literally can take less than 5 minutes of your time to save yourself the risk of a week in bed. On the other hand, last year I had to call several different clinics to find one who had the Mist in stock. Then I had to make an appointment and wait in the waiting room in order to obtain the Mist for my daughter and myself. But again, much better to deal with this at my convenience than a week sick in bed for either me or my daughter.

U.S. Center for Disease Control Recommendations:
Children receiving the flu vaccination for the first time will need TWO doses. Children, ages 6 months through 8 years, who need two doses of the vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart. (Again, my personal recommendation is to talk to your physician.)
The CDC recommends “All persons aged 6 months and older are recommended for annual vaccination (against the flu) with rare exception." Those exceptions include individuals who:
1) Have had Guillain-Barré Syndrome OR
2) Are allergic to any components of the vaccine (such as egg)(3)

Those in particular who should receive the flu vaccination include the following:
1) Children aged 6 months to 18 years
2) Adults 50 years and older
3) People with chronic illness
4)Women who are pregnant during flu season
5) Health-care workers
6) Caregivers/family members for individuals younger than 5 years or older than 50 years
7) Caregivers for infants younger than 6 months of age (due to the inability for young infants to be vaccinated themselves).(2)

We mamas don’t have time for the flu! We don't want our children to be miserable in bed for a week, nor do we want to spend the following week sick ourselves because our child gave us the flu. So, don't just vaccinate your child, but vaccinate yourself, your spouse, and anyone else you can coerce into getting the vaccination as well. Yes, I can give you all of the scary statistics on how dangerous and even deadly the flu can be, but you can find these in last year’s blog, Flu Shot is a Sure Shot.

Want more information? Check out the resources below:
1. Flu Shot or Nasal Spray? R. Morgan Griffen, WebMD, July 16, 2015
2. Vaccination: Who Should Do It, Who Should Take Precautions, Center for Disease Control and Prevention
3. What you should know for the 2015-2016 Influenza Season, Center for Disease Control and Prevention