OT what is it??

OT what is it??
Kids learning through doing!!

Friday, December 24, 2010

Therapy "vacations" are generally NOT a good idea

As this is time off time, I want you all to think about yourself and medication.

Would you take time off from blood pressure medication just because you have time off of work?

Would you stop a specialized diet for diabetes just because this time of year there are too many goodies to resist?

If you are logical, the answer would be "of course not"!

Well the same goes for your child.

A sensory skewed child, one with learning challenges, behavior issues, may find that time out from school is the IDEAL time to have therapy.  No homework to compete with, no after school programs, no tutoring to go to--just a down time with a purpose.

An extended therapy time may be just the thing for your child to stay on track and be on track when school starts back up again.  I am not saying everyday, but 1-2 times during the vacation can be an ideal time to address sensitive areas of competence at a stress-free time.

For those children with social issues, you might ask if they could bring a friend to work on a project in OT together, getting in fine motor, task design and social skills!!

Instead of therapy being something to take a vacation from, think of OT during vacations as something to enhance and enrich the time off!!

Should a teacher diagnose your child!!---NO!!

Too often I hear that “…Tommy’s 2nd grade teacher told me he has ADD so I went to the pediatrician and he prescribed_______”….. HOLD the phone!!~

Stop the presses!!!  Freeze and do not defrost!!

Teachers cannot diagnose!!  And too many are taking the “squirmy kid” and giving him or her a label!

And shame on the pediatrician who goes on the teachers’ say so!

ADD can be seen on a PET or MRI of the brain. It can also be diagnosed through comparative checklists filled out by parents, teachers, and others who interact with the child.  These checklists are them interpreted by a developmental pediatrician or and psychologist.  NOT a TEACHER.

I have nothing against teachers; I was one years ago before becoming an OTR.  But nothing I learned in a top 25-education college ever taught me about brain function.  And ADD/ADHD is a disregulation of brain functional capacities.  It can be treated both chemically and with occupational therapy teaching the child strategies for coping and self-calming, etc.

So before you head down that path think about where the information comes from.  ADD/ADHD can look like an attention problem when it is really a sensory integration issue.  Sensory information not processed correctly can throw off a child’s ability to know where their body is in space (so the wander), make touch uncomfortable (squirmy in their clothes), or make reactions to sound extreme, to mention only a few of the issues that may present in the “inattentive child”.

Sensory issues can present as under-reactive (low affect, slow to respond, sluggish child), over-reactive (highly emotional, always on the go, poor adaptability to changes, etc.) or that it looks like ADD but is not.

And then there is the sensory seeking child.  Ants in the pants, always touching, cannot keep his/her hands off of anything, has no fear, and is moving too fast to easily respond and or react to verbal directions. They need lots of repetition to learn new tasks.  NOT because they are not paying attention, but because their mind is moving like a firefly and cannot land long enough in a “comfort zone” to relax to learn.

These children generally do not respond to medication.  So the “give him a pill” knee jerk of too many unqualified individuals is often to the detriment of the child.

So before you walk that path, talk to a pediatric occupational therapist for a full evaluation, a developmental pediatrician and interface that with information from the teacher.  It really does take a “village” to diagnose a child properly.

Friday, November 12, 2010

Thursday, November 11, 2010

Autism/PDD or a Sensory Issue: suggestions for making a clinical decision

Autism as a sensory issue is very tricky, so many things over lap and intertwine. The classic indicators seem to almost be the same.
In fact, I really hold to the opinion, that the two diagnoses are irrevocably meshed.
Having said that , however, there nonetheless remains a need to differentiate between these two distinct issues.

The two lists offered here are to help illustrate just how careful we need to be in suggesting parents further investigate clinically observed behaviors. I also suggest that clinicians use these lists as informal checklists as part of their parent in-take process or in the course of therapy as needed.  I advise making this into one list but keeping the items separated, and then note which items from the two categories are most noted.

The suggested items* for each issue is listed below: (*complied from various sources)

Sensory Integrative issues may be characterized by:

1.     Either be in constant motion or fatigue easily or go back and forth between the two.
2.     Withdraw when being touched.
3.     Refuse to eat certain foods because of how the foods feel when chewed.
4.     Be oversensitive to odors.
5.     Be hypersensitive to certain fabrics and only wear clothes that are soft or those they find pleasing.
6.     Dislike getting his or her hands dirty.
7.     Be uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator.
8.     Have difficulty calming him or her after exercise or after becoming upset.
9.     Jump, swing, and spin excessively.
10.  Appear clumsy, trip easily, or have poor balance; odd posture
11.  Social skill issues/authority issues.
12.  Tantrums
13.  Overly sensitive to criticism
14.  Either always on the go or very sedentary
15.  Memory difficulties and/or problems following directions
16.  Have difficulty handling small objects such as buttons or snaps.
17.  Be overly sensitive to sound. Vacuum cleaners, lawn mowers, hair dryers, leaf blowers, or sirens may upset your child.
  1. Lack creativity and variety in play. For instance, your child may play with the same toys in the same manner over and over or prefer only to watch TV or videos.

While Autism and or PDD issues may be characterized by:

1.     Insistence on sameness; resistance to change
2.     Difficulty in expressing needs; uses gestures or pointing instead of words
3.     Repeating words or phrases in place of normal, responsive language
4.     Laughing, crying, showing distress for reasons not apparent to others
5.     Prefers to be alone; aloof manner
6.     Tantrums
7.     Difficulty in mixing with others
8.     May not want to cuddle or be cuddled
9.     Little or no eye contact
10.  Unresponsive to normal teaching methods
11.  Sustained odd play
12.  Spins objects
13.  Inappropriate attachments to objects
14.  Apparent over-sensitivity or under-sensitivity to pain
15.  No real fears of danger 
16.  Noticeable physical over-activity or extreme under-activity
17.  Uneven gross/fine motor skills
  1. Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

And, as illustrated here, it is easy to see, especially in very young child (ages 2-6) how these behaviors can be dismissed as “they’re young, they’ll grow out of it.” And making broad statements, suggestions of referrals to other sources, etc.,  may be very frightening to parents, especially if they have been trying to tell themselves that the nagging feelings they have been experiencing is due to being an “over-protective mother”.

A psychologist who refers to my practice once counseled me about informing parents of issues with their children. She said, “…the first person to tell them gets shot, the second shoved and the third gets listened to. Try to be number 3.”

In our position as occupational therapists, we are often put in the role of being “number one”. Being the resource person in the schools, the first referral source of pediatrician, the person known in the community for what we do, etc. puts us in the precarious position of saying first to a parent, “there is something that needs to be investigated”.  I hope that the use of these lists when converted into a check- list will help guide both our families and us in the quest to provide empathic quality care.

Susan N. Schriber Orloff, OTR/L is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA.  She can be reached through her website at www.childrens-services.com or at sorloffotr@aol.com.

Doodling..is GOOD for your Brain!!

Doodling:  bane to teachers—a boost to the brain

I went to “teacher school”; even was one for a while.  And I have to say unequivocally that there was no information about how a child learns—just what they should learn.

I guess that is why I became an occupational therapist.  I needed to know what was going on “inside” not just the outside—looks as they say, can be deceiving.

And so it is the case of “doodlers”.  Admonished for “not paying attention” they are often made to feel belittled and self-conscious about something they really do on “auto-pilot”.

Recent research has shown that doodling actually helps learning!!  The child may not look like he or she is paying attention but science says otherwise.   In findings published in Applied Cognitive Psychology (2009) test subjects who doodled while listening to recorded messages had a 29% better recall than those who didn’t.

The article goes no to state that, "If someone is doing a boring task, like listening to a dull telephone conversation, they may start to daydream," study researcher Professor Jackie Andrade, of the School of Psychology at the University of Plymouth, said in a news release issued by the journal's publisher. "Daydreaming distracts them from the task, resulting in poorer performance. A simple task, like doodling, may be sufficient to stop daydreaming without affecting performance on the main task."

Various articles on associative memory contend that doodling can boost retention up to 50% for immediate recall.  In other articles there is information that doodling actually helps the learner “opt-IN” to discussions by enhancing recall invigorating multiple neural pathways.

Science is giving a new slant on doodlers, fidgeters, and, Heaven forbid—whisperers!!  Reprimands from teachers (and even bosses) may soon be a thing of shame to them NOT to the “culprit”.  “Pay attention”, “Are you listening, I will not repeat myself” and “Am I bothering you?” and similar phrases are more than inappropriate, demeaning and harsh—they scientifically wrong.

TIME Magazine (Feb. 2009) states a study that defines the benefits of doodling very simply.  It prevents daydreaming.  Daydreaming tends to trigger the brain to recruit other networks that shift your attention to other things so you cannot focus on the tasks at hand. Doodling does just the opposite; it keeps the motor running so the brain can focus. And historically we have had some rather impressive doodlers:  Winston Churchill, John F. Kennedy, Franklin D Roosevelt, John Keats and Bill Gates to name a few.

Other studies support that doodlers tend to be more organized than their non-doodler counterparts. Doodling, it is reported, actually helps clear the mind by relieving stress and aiding in relaxation. So what is the problem?  Obviously with the people that doodling seems to upset. (Teachers??)  “Paying attention” in class usually means sitting up straight, feet on the floor, not touching anyone else and eyes on your work or the teacher.

Research has a different slant on doodling. Similar to the analysis of dreams, the inspection of doodles can actually create a better understanding of how a mind works. It is the connection between the conscious and unconscious and that is where we learn. Rather than a distraction, doodling can assist in triggering many major routes for us to store information into long-term memory.

Margaret Livingstone, a Harvard University neurophysiologist writes in her book, “Vision and Art: the Biology of Seeing” that art is a “spin-off” of our brains visual system and this connection cues neurons.  Not only does it help us pay attention, it also helps our mind wander into unimagined areas stimulating associative thinking aiding in symbolic expression.

What is known about doodling is that it increases arousal in the brain and forces it to use up just enough energy to STOP it from daydreaming.  Doodling seems to stimulate the right side of the brain that mediates visualizations (reading and writing) leaving the left side (information gathering) to relax and absorb information more readily.  Both sides together allow the person to synthesize the total concept being presented.

Encouraging doodling may be a route to increasing attention in class.  Wouldn’t it be amazing if  “Increase doodling while listening” became an IEP goal?

Susan N. Schriber Orloff, OTR/L, is the author of Learning Re-enabled, a guide for parents, teachers and therapists and Write Incredibly Now™ 12 hours to better handwriting.  She is the Executive Director of Children’s Special Services, LLC, in Atlanta, GA. She can be reached on the Web at www.childrens-services.com  Her WIN™ program is available through YourTherapySource.com.

Sunday, November 7, 2010

How to pick a preschool and why

For some very young children, preschool is NOT the answer.  Some kids just belong at home a little longer.

Now as an "always" working mother, I more than "get" that you have to go to work and the kids have to be somewhere and not everyone can afford in-home care.

But keep in mind that the early learning experience can have long-range impact on the young child. Because this is often the first time that they have been away from home without a parent, finding the right experience is crucial.

Choices for this are often chosen for reasons ranging from: geographical convenience, social (this is where my friends take their children), religious, cost, physical appearance.

While all of these issues are important the list needs to also include:
  1. Experience of the teachers
  2. School certifications
  3. Philosophy of the school
  4. Size of the classrooms
  5. Number of classes per age group (are there smaller classes for children that might need modifications in the general program)
  6. On-going continuing education for the teachers
  7. Frame of reference for age/class specific curriculums
  8. Structure of the school (level of classroom structure and flexibility, is it experiential, etc.)
  9. Classroom facilities
  10. Extra-curricular experiences available (foreign language)
  11. Outside consultants (OT/Speech, Nutritionist, psychologist)
  12. Accommodations and modifications for the child with early learning needs

These issues become even more important when you are selecting a school for a child with special learning concerns.  This is where the occupational therapist is often engaged to help the parent make specific decisions that are essential for a successful early learning experience.

Helping find the right place is two-fold: it must fit the child and it must fit the parents.
Evaluating the home philosophy is as important as the evaluation of the child.   A child from a family that is "democratic" may not do well in a structured school. And conversely a child from a very structured home may be lost in a loosely defined atmosphere.

If your child has been asked to leave a preschool setting the first impulse is to be defensive. But step back a minute and think, "was this really a good match?" Usually the answer will be "no".  Figure out why before picking the next setting.  

Maybe some testing might help you get to the right decision.  Or maybe an alternative setting might be just the "ticket".  For more information log onto "The Modified Developmental Preschool" at www.childrens-services.com

Sunday, October 3, 2010

Sensory Assessments As Part of a Unified Early Learning Testing Protocol

School based screenings for young children are common, but what do they test, and are they enough?  They are usually generalized for fine and gross motor, basic perception and social/emotional development.

All of this information is important and very valuable, but for some children essential insights into the quality of a specific performance are not addressed in what “TOTEMS”* used to call “quick and dirty” overviews. (TOTEMS and AOTA program Training Occupational Therapists for Educational Management Systems).

Some children just seem to be missing the ability to “stay with the group”.  (That is what I hear a lot of when parents call about their young children.) Discovering “why” often falls to the OT doing a specialized assessment.

Many preschool and lower school directors respond to these children by suggesting facilitators who stay with the child during school.  While in many cases these individuals do an excellent job, they are also expensive and make the child “stand out” from their peers within the classroom.

Screening for developmental issues can help both the parent and the school administrator decide on the best placement for the child.  While the majority of early learners do very well in traditional typical programs, the ones that do not suffer in the same situation.  That is when seeking an alternative modified program may be advised.

Learning should never hurt, and early learning should be joyous. For the child with sensory developmental issues school can be a scary place.  Try to think about going to the same place everyday but not being able to recognize it as familiar.  Think about going to a familiar place but finding noise, smells or light noxious.  Put yourself in the “shoes” of a child with postural instability and asking them to sit a table for any length of time.

Knowing these things before the child enters the classroom can make the difference success or failure for these young learners.  It is also good information for both parents and teachers to have on all children.  Therefore a unified assessment process should include a parent checklist and an admissions or early in the school year assessment.

The parent checklist should include items that address self-care, family participation, self-calming and interests as well as the standard motor/task areas. A sample of such a checklist is offered below.

Children's Special Services, LLC Parent In Take Checklist©

Dear Parent: Your child ________________________has been referred for an occupational therapy assessment/screening. As part of this process, you are being asked to please fill out this checklist and return it to the school prior to the screening. Thank you.


__Problems taking on/off coat
__Cannot tie shoes
__Cannot manipulate buttons, snaps, zippers
__Rejects going to the bathroom
__Cannot use utensils easily
__Spills drink often
__Needs reminders to keep track of belongings
__Rejects certain fabrics
__Resists toilet training
__Messy eater
__Picky eater (explain)
__Always wears socks, long sleeves even in warm weather
__Habituates wearing 1-2 specific outfits


__Poor motor learning (new skills)
__Mixed and/or no hand preference
__Does not attempt to initiate writing first name
__Does not like to (or never liked to) scribble
__Does not like to draw/write
__Frustrated with fine motor tasks
__Difficulty when trying to copy simple shapes
__Poor gross motor (Running, jumping, skipping)
__Looses place when looking at a book that is being read to him/her
__Walked early did not spend a lot of time crawling
__Poor grasp (awkward use of pencil/crayon)
__Poor writing pressure
__Motor performances seem unusually slow
__Cannot color inside the lines as needed
__Poor reproduction of shapes/forms/
__Poor cutting skills
__Shows no preference for his/her right and left handedness
__Holds back with gross motor games
__Rejects tasks that have multiple parts (figure-ground perception)


__Difficulty staying focused
__Overly dependent on teacher/parent
__Does not seem to hear when instructions are given
__Poor (task) sequencing skills
__Sloppy work areas
__Easily distracted
__Difficulty initiating tasks
__Difficulty transitioning from one skill/task to another
__Needs instructions repeated
__Gets confused easily
__Cannot sit easily in “circle time”
__Restless when riding in a car
__Work pace is much slower than peers
__Difficulty with instructions that are more than 1-2 familiar steps


__Not many or few friends
__Complains that “someone hit” them
__Difficulty with cooperative tasks
__Multiple somatic (physical) complaints
__Poor eye contact when speaking to peers, adults, new acquaintances (circle one)
__Seems fearful of new situations/places
__Difficulty with self-calming when upset
__Hangs of people or things
__Cannot tolerate things out of “place”
__Difficulty demonstrating affection
__Wants to but is hesitant to interact with peers
__Prefers to play alone rather than with peers
__Difficulty discerning personal space
__Poor verbal expression of thought, ideas, and feelings
__Overly sensitive to corrective remarks (criticisms)
__Avoids talking out in class, and/or participating in discussions
__Easily frustrated in social situations
__Not understand jokes
__Difficulty reading body language or facial expressions
__Uses oral language that is less mature than peers
__Does not wait to ask for help if an adult is talking
©Children’s Special Services, LLC 2006 revised 2010 (May be used with copyright designation only)

The teacher would also be asked to fill out this checklist and the results compared.  It is important to (gently) explain to the parent that life on “Planet Home” is very different than life on “Planet School”*.  It is often hard for parent to get that they have been “trained” by their children to anticipate areas that may be stressful for them and thus circumventing challenging situations.  This is particularly difficult if the child in question is number one! (*From Learning Re-Enabled, Mosby/Elsevier Books)

Parents of young children are often focused on are they “having fun” and are they “happy”, while teachers are focused on the physical, intellectual, emotional and the neurological actions and reactions impacting learning.  Unfairly, teachers are often deemed “unfriendly” by parents or having a “personality conflict” when issues are revealed. 

The Occupational Therapist can play a pivotal role in the assessment and learning environment by explaining development to the parent and the teacher so that increased understanding can be attained.  The OT can also help explain the crucial importance of early intervention and discouraging the “wait and see” attitude many parents may choose if they do not fully understand the issues. 

And we all can be reminded of the famous quote by Mel Levine, MD author of One Mind at a Time, “children do not outgrow anything but their clothes.”

As Occupational Therapists one of our many roles with children is to make sure they grow with their clothes.

Tuesday, September 21, 2010

You and Your Willful Toddler

Your little one just won’t listen.

She gets upset at changes.

She will not follow routines.

It feels like she is sabotaging you and the whole family.

Everything revolves around her and her potential to explode.

You are just plain worn out, and you are beginning to not like you.  You should love and adore this child, and somehow it has become an adversarial relationship; not at all the one you envisioned with her when she was a baby.

Well, you do love and adore her. But daily routine has become more about control than nurturing and you both have to get back on track.

What could possibly be the matter?  How to spin what seems like a negative spiral into a positive trajectory?

Toddlers are by nature defiant.  So first off, DO NOT TAKE IT PERSONALLY.

Think how you would feel, if you knew what you wanted but could not say it right, could not move as quickly as you wanted and felt constantly frustrated.  How would you act?

Mmmmm….bet not too different.  Early on it is best to let your "budding" individuals “own” their own feelings and behaviors.

Natural consequences seem to be an automatic teacher, but so do consistent limits and boundaries.  Those boundaries when consistently applied provide the structure that gives rise to feelings of both security and safety.

Nothing trumps love, attention, praise and ROUTINE.  So first off if you say you are counting to 3 and then the toy disappears for example, then it disappears. Not doing so teaches the child that crying gets the toy back.  By going back on the limit you set, you are just letting yourself in for a more forceful exhibition the next time.

The Mayo Clinic stresses love and acceptance and structure that is constant is key for helping toddlers mature.  However their research does address tantrums and behaviors that may indicate developmental issues.
“….Sometimes, however, temper tantrums can indicate an underlying issue, such as:
      Developmental delay
      Attention-deficit/hyperactivity disorder (ADHD)
Rarely, temper tantrums may indicate a more serious condition, such as Asperger's syndrome.
To determine whether your son's temper tantrums are cause for concern or simply an age-appropriate response to frustration, ask yourself these questions:
      How often and in what settings do the temper tantrums occur?
      Is your son's speech development on track?
      Are your son's motor abilities and curiosity normal for his age?
      Are you able to manage the tantrums?
Has your son ever injured himself or others during a tantrum?....”

Here are some parenting tips for raising toddlers:
  1. Love and accept your child for who she or he is
  2. Limit rules at first and keep it to those that are for protection and safety and then add others later.
  3. Childproof your home and try to remove temptations
  4. A strong willed child has perseverance, give the child challenging toys, let them learn problem solving but not to the point of frustration.
  5. Understand your child’s limits and as much as possible do not push it. 
  6. Make sure your child understands what you asking him or her to do and be sure they can do it.  Asking them to do something beyond their skills is a fodder for an outburst due to frustration.
  7. Do not command but use a friendly tone.
  8. Do not over-react when your toddler says “no”—just repeat the request—friendly but firmly.
  9. PICK YOUR BATTLES—say no because you have to –do not make it a power play, toddlers do not think about that, they just want what they want when they want it.  It is not about you.
  10. Do not make “deals” it teaches your child that there are ways they can break rules and that is not what you want.
  11. Stick to schedules and pre-set—known—limits –“no you may not run in the parking lot –ever”
  12. Offer choices when possible, if helps with the child learning self-control and decision making skills.  Keep the choices to 2, not an array of items.  i.e. the blue or the green pajamas?
  13. Try to find “alone time” when it is just the two of you and let your toddler plan the time—we have a whole afternoon, what should we do first?
  14. Encourage using words, baby talk is cute but it can be a real deterrent to effective communication.
  15. Enforce consequences—neither you or your child is a “saint” and sometimes rules get broken and limits must be enforced.  So if it is a time out, withholding privileges, etc. follow through on that consequence.
  16. After the consequence has been given engage your child in a positive activity and reinforce that he is “good” but the choice was not.

Nobody said parenting was easy, however, my willful daughter now 36 called me long-distance the other day to complain about her ‘adorable son’ who just would not listen and was being totally ‘contrary’.  “This parenting thing is harder than it looks”, she said. 
“Mmmmmmm”, I said, smiling.

Saturday, August 14, 2010

When it comes to challenges..especially with handwriting tasks listen to your child's complaints...carefully

Sense-able feelings—when learning new skills

In addition to individual therapy, I also provide therapy camps and groups. These groups help children with sensory processing (Play YOUR Way to Sensory-motor Success), handwriting (Write Incredibly Now WIN™) and social skills (Personal Options and Preferences POP™) in a supportive peer/task environment.

And inevitably every now and then there is at least one or two kids who drop out because (as reported by mom), ‘their feelings got hurt’.

On a closer look these were the kids that really needed the groups! The ones that cracked at even minor frustrations, were over-sensitive to unintentional “slights” by the other children, who had difficulty following a one-step direction in a 1-1 setting and/or whose short term memory was almost non-existent.

As therapists we are doing our job when we challenge a child to make choices that change old, non-productive patterns. The disconnect happens when the child complains (often tearfully) to the parent that “everyone is mean to me in the ___________group”.

I have thought long and hard about how to circumvent this and I think I have a solution I want to share. By providing parents a before group syllabus and letting them know what we are doing in advance they can support the child at home and ask the appropriate questions to counter the complaints. I use the following chart form.

Using handwriting as a sample (from my WIN™ program)* I offer this example:

What activities


Anticipated (child) Responses* (all activities are new to the children and have never been tried before)

Functional Goal

Sliding a straw between three fingers

In hand translation skills

Awkward motor skills-some frustration

Increased in hand fluency

Paper cup button catch

Visual tracking


Competition with peers

Some possible frustration

Increase in-hand timing and visual tracking

Paper cup shell game

Visual memory

Visual tracking

Visual spatial organization

Acting silly

Reluctant to try (some)

Peer helpers

Increased visual skills with constancy and movement

Water bottle rock turning

Increase palmar “apple hand” position

Increase finger individuation

Increase wrist stability

Fun to make

Hands get tired

Decrease wrist rotation

Hard to keep wrist steady

My fingers won’t move “right”

Making choices

Estimating skills (when bottle is “heavy enough”

Prepositional understandings with movement

Increase isolated finger movements

Wikki-Stix relief rubbing

Increase tactile awareness

Increase kinesthetic skills

Automatic pride in being able to make a complex form

Learning shapes automatically without vision a foundation skill of automatic writing


To systematically introduce formation and fluency

Hesitant at first

May rush through to get it done

May not want to correct self

Learning that to do it right is more important than to do it fast

Pride in a job well done

Self-measure progress

*This is only a partial list

Now that the parent is aware of what is going on in the class, it is also important to let the parent know when all this is going to happen. A timeline of what to expect can be very helpful for the parent to help the child through frustrations and expectations. Using the WIN™ program again as an example, I often tell parents that this is a 12-hour program offered (usually in 4 3-hour days) so here is what you can expect:

§ Day One—NO writing we will spend the whole day playing with our hands and bodies and learning how they move and how we can be “in charge of them” instead of them being in charge of us!

§ Day Two—tracing, nonsense shape making, chalkboard activities, blindfolded “writing”, gross and fine motor fluency activities, and initial workbook activities.

§ Day Three—All of the above and new games and crafts to put in our end of session take-home bags, putting our bodies together games using fine and gross motor patterns within one activity, continue in our workbook

§ Day Four—finish the workbook, and do Mad-Glad-Grab Sentences to learn about writing paragraphs with the T-E-C System (Topic Embellishers and Conclusions)—both trademarks of the WIN™ handwriting system.

Now the parent knows what and when and has some really useful tools when talking to their child about their feelings about writing, making new friends or tolerating unfamiliar situations.

But that still leaves us with the issue of how to help the emotionally fragile child. This is the child for whom everything is upsetting. The very act of walking into an unfamiliar place can be so upsetting that they need what I call a “first day shadow”, or a special “transition toy” that they can have with them the whole time. For these children creating trust is often synonymous with safety and both must be in place before learning can occur.

Even with all this in place, there will often be that “one child” for whom group therapy settings are just too much. The chaos of the group, the noise level, the stimulation of people moving, the inability to know how to ask for help, etc. can all be influences that impact a child’s ability to benefit from a given program.

So above all else, make sure that the parent knows that you are available to them by phone, email, written note, whatever works for the both of you. And YOU want to know how their child is reacting before they take action to remove him from the group. Letting the parent know that their child’s success is your only objective puts you both focused on the same goal—a happier more functionally secure child.

Monday, August 9, 2010

School is starting...translation...worksheets and homework!!

Handwriting: Why is something so "simple" so hard?

The controversy over handwriting is clear evidence that computers have not “killed” it.

Handwriting is more than pen to paper.  The lack of the ability to write has a diagnosis: dysgraphia. Dysgraphia is “…a learning disability resulting from the difficulty in expressing thoughts in writing and graphing. It generally refers to extremely poor handwriting.” (Medical Dictionary definition)

Keith E. Berry, Ph.D., author of the Developmental Test of Visual-Motor Integration, known as the VMI, is a “gold-standard” standardized test often used by psychologists, occupational therapists and other professionals to evaluate educational abilities. He addresses the issue of handwriting, citing that is a “natural vehicle for teaching” and that it is “frequently an indicator of children’s mental and social foundations.” This visible, graphic, tangible illustration of performance is a powerful reinforcement that can be either positive or negative. 

Dr. Berry writes, “Because it is so visible (in contrast to spoken language), poor handwriting often operates as a self-fulling prophesy. If a child is allowed to continuously portray his mental and social inadequacies graphically, he may come to increasingly believe that he is an inferior person and to behave accordingly.” 

Concurring with Dr. Berry, Jeanette Farmer, and pediatric handwriting expert in Denver, Colorado states that “handwriting is as important in the development of other intellectual faculties.”

In other words, what your child produces is how he or she sees themselves and that translates into a major influence on how he or she behaves. It is also important not to underestimate the influence of peer appraisals. The kid sitting next to your child probably has more influence over their self-esteem than you
(i.e. parent, teacher therapist) do. Pride in one’s work and feeling peer competitive is at the foundation of solid social and emotional well-being.

There are other concerns as well. Sensory-motor development is intrinsically linked to ones’ fine motor ability to being able to successfully manipulate environmental elements. Handwriting is the constant thread that links these various fine motor demands. A child can have difficulty dressing, but that happens at home, in private, no one really knows. A child has difficulty writing, that happens in school and everyone can see it. Poor handwriting cannot be hidden, ignored, or avoided. It is “in the face’ of the child for the entire school day. No wonder homework becomes a fight. They cannot fight the teacher; but Mom and Dad are easy targets for their frustrations and fears.

Learning issues are often reflected in motor performance, and the most visible school-based motor performance is handwriting. Handwriting is the task of putting something on paper. Handwriting difficulties graphically confront the child with his/her inadequate abilities. This graphic confrontation is often emotionally bruising.

Children with LD “look” like they understand, they are smart, and yet they seemingly, willfully, just don’t do their homework and if they do, it is often messy.

There are real neuro-motor reasons for handwriting difficulties that cannot be out-grown and that will not self-resolve. Understanding this neuro-motor system is key to teaching handwriting to children who find handwriting difficult and painful.

Sloppy papers are not on purpose. Addressing these issues frustrates teachers and parents; but most of all it impact the child in many negative ways. Punishment does not help.  Often the (younger) student misses recess and the older student gets detention. And still, the homework remains messy, late and incomplete. 

The student is subsequently labeled lazy, uncaring, willful, and the list goes on.

The child seems to be lost in a sea of unattainable expectations.

While no assisted device should be discounted, it is important to note that computers, Alphasmarts®, and the like cannot eliminate handwriting.  Therefore the appropriate teaching of handwriting must be addressed for all children, and especially for the LD child experiencing developmental sensory-motor issues.

With Occupational Therapists and teachers, working closely together, can embed  regular classroom tasks with simple everyday activities and techniques that can help children write more securely, getting their thoughts, ideas and feelings down on paper readily.  Related handwriting skills also teach how to visually scan and copy, thus helping the student express his/her full potential and to be more peer competitive.

Resolving the homework issues is often resolved when handwriting is remediated.  Knowing how to write must be paired within knowing what to write.  And knowing what to write must be taught with an understanding of the obstacles to the actual task of writing.

Understanding and identifying those obstacles are essential for helping children overcome their resistance to both handwriting and homework. It often takes the trained occupational therapist to guide the child through the maze of developmental issues impacting the realm of fine motor issues.

Often children with handwriting difficulties have a real discomfort with pencil in their hand.  We can see these children at a glance in the classroom, they have a “death grip”, a flimsy wobbly pencil, a wrapped hand that hides the pencil, their sitting postures are reflective of their hands, stiff, floppy, squirmy, etc.

Their issues aren’t just happening in their hands, it is happening in their physical bodies, and their emotional beings as well.

Addressing their physio-emotional issues while giving them a structure to assist with their organizational abilities helps them to become more confident in their abilities, thus able to demonstrate their actual competencies.

Those competencies: physical, emotional, neurological and intellectual interact concurrently and constantly in all of us.  For children with LD, facilitating the expressions of these competencies is the essential first step to resolving the handwriting, homework and self-esteem issues.

And changing a child’s handwriting from scribble and scratch...slow and labored...to legible...Can be life-altering.

Can something that is so important really be useless? The argument that doctors have poor handwriting is invalid. They write in a fast coded shorthand for pharmacies, this is not if you ask them, representative of their personal handwritten communications.

Besides, my elementary teacher, Mrs. Buckingham of treasured memory, who insisted on precise formation and penmanship used to stress “we are what we write”. And we are so much better than sloppy papers and defensive excuses.