Another Resource for You...

Yesterday I attended a one-day seminar called "Autism, Asperger's, SPD & ADHD," presented by John F. Taylor, Ph.D., which was put on by Summit Professional Education.  I had been to one of Mr. Taylor's presentations before; he is a wealth of information and provides a ton of practical application ideas and tools.  I really couldn't even begin to put even a small amount of the information he covered on this blog, but I will encourage you to check out his web site, ADD Plus at:
http://www.add-plus.com/

Don't let the name of the web site fool you-  obviously there is lots of information regarding ADD/ADHD, but also about many other topics, some of which include:
ADD/ADHD, Allergies, Autism, Nutrition, other related conditions, Parenting and Support and General Health (click on "links" to access information in the above mentioned areas).

Take some time to click around on his page, there are some free downloads, and check out the bookstore.  One thing that I always find impressive is the amount of resources/books etc. that John Taylor has available at his workshops for purchase, some that he himself has written.  I purchased a few things yesterday, but while browsing on his site, I found a book called "Parenting a Child with Sensory Processing Disorder" that he didn't have with him yesterday, and I think I may have to order that one now as well!

One area that John Taylor really goes into detail on in his seminar is nutrition for kids with ADD/ADHD, ASD and sensory processing disorder.  He is a big supporter of checking into the digestive system needs of kids, food allergy elimination, gluten free/casein free diets, encouragement of a protein rich diet, vitamins/minerals, magnesium and zinc, and super blue green algae. 

John Taylor provides his contact information on his web site and at his workshops, and he is serious about getting in touch with him if you have questions (click on "contact us").  He/his website is another  excellent resource for you to use as it applies to you and your child and his/her needs.

"Secrets" to Good Handwriting

A common issue that OTs in the schools are consulted about is improper grasp patterns when using a pencil/marker/crayon.  In fact, if your child is one of the little people that I see, I have several kids on my caseload right now that are at the preschool or kindergarten level that need to work on this very issue.  There are a variety of reasons why kids hold their pencils incorrectly or in an unrefined manner.  One reason can be that they have been "practicing" writing letters and numbers before their hands are developmentally ready to be doing so.  This is often the case as parents are aware that kindergarten has evolved into a tough and more advanced curriculum, and they want their kids to be ready for writing and fine motor activities.  

Being good at handwriting goes beyond just being able to hold a pencil/marker and form letters.  There is a whole foundation of skills that are actually precursors to learning to print and for being developmentally ready to do so. In order to have good fine motor control for pencil use, there needs to be a good fondation to develop from.  The body (trunk), shoulder and arm need to be able to be stable in order for your child to be able to use the muscles of his/her hand efficiently and have control distally (that is, farther away from the body, such as the hand is).  A common observation that we often see is kids drawing or coloring with a pencil/marker or crayon while having their forearm off of the table, moving their whole arm as one unit.  This is a sign that postural/shoulder/upper extremity stability has not been established. That being said, there are several skills that parents should be encouraging even BEFORE expecting their child to be printing his/her letters and numbers. These skills include:

• postural and shoulder stability
• bilateral integration/coordination
• wrist extension stability
• arches of the hand
• thumb opposition/open web space
• separate functions of the 2 sides of the hand
• in hand manipulation skills
• hand and finger strength
• grasp patterns

In the coming weeks, I will address each one of these skills individually, and give activity suggestions to work on and further develop each as well.   Developing all of these skills more will positively affect your child's fine motor skills. Think of these skills as the building blocks of fine motor skills. 

Because the summer is just beginning, I do want to encourage one thing: PLAYING OUTSIDE  :)

Playing on playground equipment- hanging, climbing, swinging, sliding...all of these things will address many of the skills in the bulleted list above.  So, when in doubt about how to encourage these things with your kids, head to the neighborhood playground, park or your backyard swingset!

School Based vs. Private Based OT

Working in the public school system, we sometimes get "referrals" from outside sources, such as a dr.'s office.  Or, we have parents who are under the assumption that because their child qualifies for OT services at an outpatient clinic, they would then also qualify for OT in the school system.  In special education, Occupational Therapy is referred to as a "related service."  What does that mean?  ND DPI defines a related service as follows:

"Related services consist of transportation and any developmental, corrective, or other
supportive services that are required to assist a student with disabilities to benefit from
the educational experience. Related services consist of the support services not
traditionally included in educational programs but which are necessary for some
students in order to make the educational services accessible or meaningful."

Furthermore, according to the Parent Guide to Special Education that is distributed by the ND Department of Public Instruction,

"Related services are defined as transportation and such developmental, corrective,
and other supportive services required to assist a child with a disability to benefit
from special education. Related services include:
• speech-language pathology and audiology services;
• interpreting services;
• psychological services;
• physical and occupational therapy;
• recreation, including therapeutic recreation;
• early identification and assessment of disabilities in children;
• counseling services, including rehabilitation counseling;
• orientation and mobility services; and
• medical services for diagnostic or evaluation purposes.
The term also includes school health services and school nurse services, social
work services in schools, and parent counseling and training." (pg 9)

According to DPI, OT is defined as:
"Occupational Therapy is provided to students who have documented needs in the
area of motor development that are impacting on the ability to engage in meaningful fine
motor tasks and performing functional academic and daily living tasks."

And OT is further described by the Parent Guide to Special Education that is distributed by the ND Department of Public Instruction as follows:

"Occupational Therapy--The use of purposeful activity with individuals who are
limited by physical injury or illness, psychosocial dysfunction, developmental or
learning disabilities, poverty and cultural differences, or the aging process in
order to maximize independence, prevent disability, and maintain health. The
therapy encompasses evaluation, treatment, and consultation." (pg 23)

That being said, there are distinct differences between school based and clinical based OT.  The type of therapy that is carried out by an OT in a clinical setting is not necessarily what an OT session in the school system might look like.  The type of therapy that is carried out in the school setting is based on an educational model vs. a medical model or a rehabilitative model.  What we do in the schools is related to your child being able to benefit from special education and allow for him/her to access their education in the least restrictive way and be successful in the school environment.  That being said, we serve many children who also receive outpatient OT services.  Part of our goal is to look at the whole child and work with their OT clinician outside of the school for the greatest good of your child.  However, there are times when the 2 services may have different objectives/goals based on the child's needs in the 2 environments (school and home/community).  For example, if your child does receive OT in the schools, and is issued a home program or suggestions to be carried out in the school system by their outside OT clinician, this would have to be further evaluated by the multidisciplinary team and school OT and determined to be relevant to their special education needs and/or required in order for him/her to be successful and function in the school environment.  Both services are important to and for your child, but it is important as their parent/caregiver to understand the differences between the education model vs. the medical model.

Ohana Therapy and Activity Center in Leavenworth, WA has a very nice write up about the differences between school based and private community based OT services, which you can read here:

http://www.ohanacenter.com/what-difference-between-school-based-and-private-community-based-occupational-therapy-services

References taken from the following publication:
North Dakota Department of Public Instruction
Parent Guide to Special Education  Special Education in ND
United States Department of Education, Office of Special Education Programs (OSEP)

and from the following website:  http://www.dpi.state.nd.us/

Fun with a Balloon!

**Not for kids with latex allergies**

Playing with a balloon can improve/address the following:
-visual tracking (following an object with your eyes)
-eye hand coordination
-body awareness
-motor planning
-bilateral coordination (using 2 hands together)

Try some of these activities with your child...

1.  For a child who is just learning to bat at a balloon, and requires more control/structure with the activity, tie a string of yarn to the balloon and tape it to a door frame/ceiling, tie it to something on the ceiling.
-Have your child hit the suspended balloon.  It will come back for them to hit again.
-Vary this activity by telling your child which hand to hit the balloon with to work on the concept of left and right.
-Make the string longer so that the balloon is at kicking height.  Practice kicking skills, use the left and right foot, etc.

2.  Have your child try to keep a balloon from hitting the floor.
-Hit the balloon up in the air with one hand, with alternating hands, with both hands together, etc.

3.  Bat a balloon back and forth with your child.
-Vary the activity by having him/her alternate hands when hitting it back and forth with you.
-Call out which hand your child should use to hit it back to you.
-Have him/her hit the balloon with an empty paper towel/wrapping paper roll, bat, a badminton racket, dowel, etc.
-Have him/her bump the balloon back to you with his/her head.
-Have your child try to bat the balloon with a different body part (elbow, knee, foot, etc.)

4.  Have your child catch the balloon when you bat it/toss it to them.
-Encourage your child to catch it with 2 hands.
-Use a smaller balloon to refine catching skills.

Drawing a Person

In OT, we use the activity of drawing a person as a way of teaching body awareness/schema, sequencing, symmetry, and visual motor integration skills.  It is interesting to watch how your child develops these skills over time by observing how his/her drawings get better and more recognizable the more he/she practices.  Drawing recognizable pictures is a skill that is needed as a precursor for learning to print.

In our school district/special services unit, we use the Handwriting Without Tears (HWT) program as a means of handwriting intervention with our preschool through grade school kids.  Check out the link at http://www.hwtears.com/hwt  At the preschool level, this program introduces Mat Man, which is a hands on way of learning how to draw a person, as well as addresses development of body awareness, drawing and counting skills (if you are in our school district or special services region, then your child may have told you about Mat Man already!).

Mat Man  (I can't get the picture to turn vertically!  Sorry!)

If you don't have access to Mat Man materials, though, here are some ways to practice learning to draw a person with your child:

-Draw a picture of a person along side your child i.e.: you draw a head, your child draws a head...you add a face, your child adds a face... you add a body, etc.  This is imitation, and it is a skill that comes before copying or drawing independently.  Make sure you have at least these body parts:  head, eyes, nose, mouth, body, arms, hands, legs, feet.  Also add: ears, hair and later add embellishments such as buttons, a belt, etc.  (If this is too hard, back it up a bit by you drawing it, and have your child tell you what is missing in the picture, or what you need to draw next.  Example:  draw a head, and ask, “What else do we need?”  “How about eyes?”  “A nose?”,  etc.  You could also start the drawing and have them add to it as they answer what needs to be added.).

-Draw a picture of a person, and give it to your child as a model to copy from.  Include the same body parts as mentioned above.  Copying from a model is the skill that comes after imitation.

-Have your child draw a picture of a person independently.  This is the next skill after copying.  If they are having trouble, give them some verbal cues/clues as to what they forgot to draw or add to their person.

These are some drawings from a couple of my little guys-  the one on the left is by a 4 year old, the one on the right was drawn by a 5 year old.

variations:  draw a house, draw a tree, draw a flower.  Use the same techniques as above to teach them how to draw them (imitation, copying, drawing independently).

Summer Reading for Parents...

There are several books that our staff here and I recommend to parents regarding sensory processing...there is a lot of information out there, but not all reading is parent friendly.  Sensory processing terms in general can be confusing and overwhelming, but the bottom line is, what does it all mean and can it help me understand and help my child better?  I have read each of these books, and have found all of them helpful in my practice, but also as a parent, because one of my own children has some significant sensory processing issues.  So, happy reading!


“The Out of Sync Child," by Carol Stock Kranowitz.
This is an excellent resource for learning more about sensory processing problems, geared toward parents and lay people.  I attended a conference by the author, and this lady is a wealth of information!

“The Out of Sync Child Has Fun," by Carol Stock Kranowitz
This book is full of activities to use with kids with sensory processing issues, and for kids in general.

“Sensational Kids,” Hope and Help for Children with Sensory Processing Disorder, by Lucy Jane Miller.
Another book that is just full of useful information for parents and professionals.

“The Sensory Sensitive Child," by Karen A. Smith and Karen R. Gouze

“Too Loud Too Bright Too Fast Too Tight,” by Sharon Heller

“Raising a Sensory Smart Child,”  by Lindsay Biel and Nancy Peske

“Raising Your Spirited Child: A Guide for Parents Whose Child Is More Intense, Sensitive, Perceptive, Persistent, and Energetic,” by Mary Sheedy Kurcinka
This book is not written specifically about sensory processing disorder, but has sections related to it, and has good information for parents for dealing with "intense" children.  There is also a workbook that you can get that goes along with the book.

“10 Things Your Student with Autism Wishes You Knew,” by Ellen Notbohm

“10 Things Every Child with Autism Wishes You Knew,”  by Eleen Notbohm

Here's one that I found to be a very interesting read, I found it by chance at the library, and I highly recommend it:
"Sleepless in America: Is Your Child Misbehaving...or Missing Sleep?" by Mary Sheedy Kurcinka
It is amazing how sleep deprivation can "look like" other issues, and how loss of sleep can affect your child's behavior and sensory processing overall.

Pre Writing Skills

Are you worried that your preschool child is not able to print their name or print numbers and letters?  Don’t be too concerned about this if your child is still in preschool or early kindergarten, especially if he/she has not learned how to copy basic pre writing lines and shapes.  Copying pre writing lines and shapes is a precursor to learning how to print.  The same basic strokes and early developing visual motor integration skills that are needed to learn to copy lines and shapes are required to print letters and numbers.  Trying to learn to print numbers and letters before learning to form basic lines and shapes is like putting the cart before the horse!

Work with your child on the formation of the following basic lines and shapes:
vertical line
horizontal line
circle
cross (+)
diagonal lines ( \ and / )
X
square
rectangle
triangle
diamond

Developing skills emerge in the following manner:  imitation, copying and independent formation.  Imitation-  you draw it,  then your child draws it.  Copying- you give them a model to look at, and they draw it.  Independent formation-  You ask them to draw a shape, and they draw it.

Emphasize direction concepts when drawing.  Encourage “top down” orientation, because this will be important to transfer these skills into learning to print letters and numbers.   Example:  when forming a vertical line, have your child start at the top and draw the line down.  Use the phrase “start at the top” with your child so he/she learns what that means and what that feels like when drawing.  For circles, emphasize starting the circle at the top and going in a counter clockwise motion.  When forming a horizontal line, start at the left and progress to the right.  Use the terms “left” and “right” to help your child learn these concepts.

Learning and practicing prewriting skills also progresses developmentally from a vertical surface to a horizontal surface.  Initially, it may be easier for your child to practice on a chalk board or white board on the wall, or on an easel.  Later, have them transfer these skills to a horizontal surface, like a desk/table top.

You also want your child to develop stability through his/her upper extremities for eventual handwriting.  A good way to do this is by having him or her lie on their tummy on the floor while coloring, so that they are in a weight bearing position through their elbows.  This gives them good input through their muscles and joints and will help them develop a foundation for stability.

Hog Wild for Increasing Hand Strength!

Here’s a fun toy for weak little hands!  I found the Hog Wild Camo Popper for 9.99 at Cabela’s this past weekend, and kids love it!  Squeeze the bear’s tummy, and the ball pops out of his mouth.  The harder you squeeze, the further the ball with go.  If little hands are super weak, you can just lightly push the ball in so that it takes less effort to squeeze.  The amount of pressure that it takes to squeeze can be gradually increased in this manner as strength increases.  To work on eye hand coordination, have your child aim at a target or into a container.  The larger the target or container, the more successful your child will be.  As their aim gets better, decrease the size of the target/container.  It’s also a good toy from a sensory standpoint.  Squeezing makes heavy work (proprioceptive input) for the muscles and joints of the hands.  If your child has trouble grading movement, this toy can help with determining how hard they have to squeeze for the desired result.  The bear does make a mild “popping” sound, which some kids find hilarious, but others with auditory sensitivity might not enjoy (makes very minimal sound, however).  I make rules about not aiming the popper at friends (or me), or the bear has to go away for another time.  There is a little net to keep the balls in, and you can buy an extra package of them for 4.99, too.  This toy also comes as a moose at Cabela’s, but can be found online and there are other animal styles to choose from as well (a cow and a pig, among others).  Now if I can get my own kids to leave it alone so I can use it with my school kids, that would be great...

ZONES OF REGULATION

I attended a workshop on May 1st regarding the “Zones of Regulation,  A Curriculum Designed to Foster Self Regulation and Emotional Control,” written and created by Leah M. Kuypers, MA Ed. OTR/L.   An excerpt taken from the manual states that it is 

“a curriculum geared toward helping students gain skills in consciously regulating their actions, which in turn leads to increased control and problem solving abilities.  Using a cognitive behavior approach, the curriculum’s learning activities are designed to help students recognize when they are in different states called “zones”, with each of the four zones represented by a different color,  In the activities, students also learn how to use strategies or tools to stay in a zone or move from one to another.  Students explore calming techniques, cognitive strategies, and sensory supports so they will have a toolbox of methods to use to move between zones”  (Kuypers, 1).

For those of you familiar with the Alert Program or the Incredible 5 Point Scale, creation of the Zones of Regulation was influenced by these 2 programs.  The manual thoroughly explains the curriculum, and also comes with a CD of full-color ready to print reproducibles (that are PC and Mac friendly).  

Special and regular education teachers, OTs, SLPs, psychologists, counselors, behavior  specialists, social workers, parents or others who work with students who struggle with self regulation can all teach and use this program.  Anyone can benefit from the program’s use, and can be used with students/children as young as preschool age (about 4 yrs old). 

If you are interested in more information, check out the website at http://www.zonesofregulation.com/

Kuypers, Leah M.  Zones of Regulation,  A Curriculum Designed to Foster Self Regulation and Emotional Control.  San Jose, CA: Social Thinking Publishing, 2011.  Print.