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 2^nd 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.

LD Made Easy: Sensory Assessments As Part of a Unified Early Lea...

LD Made Easy: Sensory Assessments As Part of a Unified Early Lea...: "School based screenings for young children are common, but what do they test, and are they enough? They are usually generalized for fine a..."

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.

18. 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

18. 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.

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

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.

________________________________OTR/L._________________________date

SELF CARE __Problems taking on/off coat __Cannot tie shoes __Cannot manipulate buttons, snaps, zippers __Unkempt __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 __Other__________________________
MOTOR SKILLS __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/ designs __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) __Other__________________________
TASK BEHAVIORS __Difficulty staying focused __Disorganized __Over-organized __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 __Other__________________________
SOCIAL __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 __Argumentative __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 __Other_________________________

©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.