Advanced Pediatric Therapies


Advocate for Recess!


I remember being in school and the teacher calling this out to us in the lunchroom or class.  It meant (hooray!) it was time to get outside and get all our wiggles out.  Recess means a break from having to sit in one place, use our brains intensely and not having to listen closely to a teacher.  It meant fun, movement and a sort of freedom from the monotony of the school day.  What we didn’t know at the time was that our brains and bodies needed a reset button.  Recess was not a reward, but rather a reserved time just like art, math or lunch.  In our current test-driven educational environment, not only is recess in jeopardy, but it’s value has been called into question.  Recess is not a privilege for kids who are well behaved or get good grades.  Research has shown it to be essential to your child’s development.

Recess in recent years has been limited and even cancelled.  Schools are feeling stress to improve kids’ grades and test scores and the more time spent in the classroom, in their opinion, the better.  Leading educators have been calling this into question more and more in recent years, citing many studies that say that by doing so, we are putting the health of kids at risk.

Research has yet to prove that removing recess with raise test scores, but the following benefits have been proven for kids.  Kids who have recess:

  • Are less fidgety and more on task
  • Have improved memory and more focused attention
  • Develop more brain connections
  • Learn negotiation skills
  • Exercise leadership, teach games, take turns, and learn to resolve conflicts

The American Academy of Pediatrics put out a policy statement in 2013 advocating for the “Crucial Role of Recess” in the development of children.  It is required reading for parents and educators alike.  The paper discusses the cognitive, physical and social benefits of recess in great detail.  In addition, it states that the removal of recess should NEVER be used as punishment.

What can you as a parent do?  The excellent website Peaceful Playgrounds provides handouts, guides and presentations which are easy to download and offer lots of other resources too.  Together, we can take back recess!


from an article I wrote for
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Use Sensory Strategies to Make Mornings Less Hectic

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Chore Ideas for the Summer


Ah summer!  Kids get to revel in their school free days.  They sleep late and play all day (depending on their age…your older kids may be more sedentary).  But kids should also be responsible for helping out around the house as well.  Developmentally, kids of different ages should be given appropriate tasks.  In previous posts, we’ve discussed the benefits of “heavy work” in growing a healthy body in terms of neuromuscular development.  Here’s an age by age guide to help you assign tasks that are doubly beneficial:  Both for your family and for the emotional/physical growth of your child.  For each age group, they can also do all earlier age group chores.

Ages two to three:

  • Make your bed with heavy blankets
  • Pick up and put away clothes
  • Collect dirty clothes and bring them to the laundry room.  (Can use a bag and drag them)
  • Wipe cabinets/tables/baseboards.

*Note to parents:  Please remember that your toddler, preschooler or school age child will not be doing these chores the way you do them (sometimes not even high schoolers!).  They will not be perfect. Don’t allow that to stop you.  It will always be easier to do it yourself.  But by allowing them to do these things themselves, you are showing them how to contribute, how to be part of a team and nurturing skills which will make them more independent in the future.

Ages four to five:

  • Put dirty dishes in dishwasher
  • Vaccuum or dust buster small carpets moving up to larger ones, then furniture cushions etc.
  • Roll out recycling bin and trash bin
  • Set and clear table
  • Roll out dough
  • Weeding the garden
  • Water plants inside and out
  • Carry their own books to the library

Ages six to eight:

  •  Meal prep assistance
  • Wipe down bathroom counters and tub
  • Sweep
  • Hang laundry on the line with clothespins
  • Rake leaves

Ages nine to eleven:

  • Fully clean tub and shower
  • Plan and make a simple meal
  • Clean out frig and freezer, wipe down and replace
  • Wash, dry and fold clothes
  • Clean toilets

Ages twelve and up:

  • Mow the lawn (older kids can ask neighbors to do theirs if they’d like to earn extra money)
  • Fully clean the bathroom
  • Shovel snow
  • Iron clothes
  • Vaccuum all floors, mop all floors
  • Straighten and organize closets

There are all kinds of chore charts and ways to keep track with a simple internet search.  Playtime is incredibly important, but so is being part of a family who all do things to help out.  Let us know if there are other chore ideas you have, the list is endless!


From my article in
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The Amazing Auditory System


Like the other senses we have discussed in previous weeks, listening is much more than the simple sense it appears to be.  A sound is made, we hear it.  Right?  But listening is so much more than that.  It involves a subtle and and delicate dance between the organs involved in hearing and the brain.  It influences so many other areas of our responses and even our behavior.  Let’s take a brief tour of your auditory system and how it relates to how we perceive the world around us.

Sound is first received by the outer ear and then funneled into the tympanic membrane which uses vibration to transmit the signal.  After passing through a series of other intricately designed structures, the fluid-filled inner ear receives the signal into the cochlea.  The cochlea then separates the sound into frequencies, which travel on its basilar membrane.  Hair cells, in turn, convert the sound into an electrical signal which go on to the auditory nerve, then the brainstem.  Auditory information is then interpreted by multiple areas of the brain and on to the auditory cortex.  Here is where the magic happens, where the brain interprets the sound.  All of this happens in a split second!

This is when listening happens.  Listening is a more complex process in that it involves your child’s whole brain and their whole body.  It connects them to the world outside themselves.  Listening forms the groundwork for skills your child will need throughout their lives.  It helps them to interact with you, first by gazing in your direction when you speak or sing to them.  It helps them to learn to speak, after they have models of you, your family, friends and even radio or Sesame Street.  It is the basis for reading as well as writing and thus is the root of communication.  Listening, like the other senses, does not occur in isolation.  It needs them to give a whole body orientation to the world.

Listening begins in the womb.  The movement of the mother is felt through the fetus’ receptors and at the same time, they are hearing her heartbeat and breath.  The muffled sounds of her voice and other sounds such as music are linked with movements from dancing, vacuuming and laughter.  The sounds are conducted and “felt” through the fetus’ bones and joints.  Rhythmic sounds and movement are comforting to the developing fetus.  As the baby develops and after they are born, sounds are a constant motivator to move, whether that be by lifting their head to look at a sibling or crawling their way into the kitchen to find you as you make the noises of making dinner.

What you may not know is that listening is also instrumental in keeping us aware of space.  Think about the last time you played hide and seek. While your eyes were closed, weren’t you also listening for where the person went, and therefore where in the space they were hiding?  Listening also plays a part in arousal, or how well we are able to match our alertness to the task at hand.  Recent studies are pointing to listening to music as a helpful background to homework.  Listening, because of it’s close proximity to the vestibular system, is also involved in keeping us focused and able to concentrate.  The auditory and vestibular systems sit next to each other physically in the inner ear, but are also sidekicks in the neurophysiology of interpreting sound and interpreting the 3 dimensions of space that you and your child inhabit every day (Frick, 2009).

Listening has long been known to have survival value.  When you hear a sound like a siren, your brain interprets that sound, and you slow down and look in your rear view mirror.  If you heard a sound like the roar of a tiger, you would seek shelter!  Although your awareness of the process is subcortical, meaning you don’t have to actively think about it or do it, your auditory system is constantly scanning the environment for threats or sounds which may signal attention is needed (Frick, 2009).  This could be your baby crying or a child calling for help.  When your brain receives these sounds, your whole body responds.  You actively look for your child.  Your body jumps up from a chair.  The expression on your face may even change, reflecting your concern.  For your child, it could be the call of a teacher or the phone ringing or the sound of their favorite video game. Listening enables the body to react.

What you can do to encourage listening in your child: 

  • Dance!  Not only is it a great workout for you, it helps to integrate sound and movement experiences.
  • Play hide and seek.  Don’t be afraid to shout hints so they can localize where you are.
  • Keep instructions simple at first.  Sometimes visual instructions can help assist verbal instructions (make a map for a treasure hunt).
  • Play “telephone” with available props.
  • Simon Says.
  • Read books out loud and act out the scenes.
  • Rock your child while using comforting words when they are upset.
  • When you hear a sound, ask them what to do.  For example, “I hear rain, what should we bring so we stay dry?” or “I hear the bus coming.  Are your shoes on?”  or ” I hear your sister.  Where do you think she is?”

Listening, like all the other senses, connects us from within our bodies to the outside world.  It is a source of joy, of connection, of safety and attention.  I hope this serves as a reminder of just how vital the auditory system is, and helps us all appreciate our ears and our brains a little more.



Listening with the Whole Body:Clinical Concepts and Treatment Guidelines for Therapeutic Listening. Frick, Sheila and Young, Sally.  Vital Links, 2009.



from an article I wrote for kidsmoveandtalk February 2016
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Self Regulation 101

 Here is an article I wrote for about self regulation:


Self regulation is the current buzz term in parent and developmental literature.  We’ve all heard of the famous “marshmallow study” where a marshmallow was placed in front of a child by an adult who also told them not to eat it, then left the room.  In the study, the kids who were able to control their impulses (and thereby earn a second treat) were followed up years later and found to have generally done well in life (think: good SAT scores and a lower body mass index).  The marshmallow study, originally done in the early 1960’s by Walter Mischel, has been called into question for it’s methodology, but it is still often quoted and referenced.  Mischel even recently wrote a follow up book about the study.  But the basic principle holds true through years of research: A child who is able to monitor and control their own behavior builds lifelong skills such as persistence in the face of challenge, ability to deal with anxiety and problem solve in an increasingly complicated world.

In a behavioral context,  self regulation refers to the ability to act in a long term context consistent with your deepest values (Psychology Today).  What does this mean for a child who is still developing a moral compass?  Primarily that they value the power of adults and morally want to please them.  It may also mean that they deeply value candy!  In either case, the child shows a resolute decision to forego the immediate pleasure to attain a greater reward.  In an emotional context, self regulation refers to the ability to calm yourself when upset or even keep yourself from getting upset in a the first place when some sort of trigger arises.  Kids do not have the full cognitive ability to self regulate at all times, their brains simply are not developed enough to do so.  Hence, tantrums occur.  Learning self regulation is a lengthy process that occurs throughout development and can still be learned into adulthood.

Developmentally, even newborns turn their heads away from things they perceive as noxious such as, loud noises or bright lights.  By about age 12 to 18 months, children are able to change their behaviors upon request, if not all the time.  They respond to social and verbal cues from their parents such as “blow kisses”. By about age two, if a known caregiver is not present, they are able to transfer these skills with people they don’t know as well.  From age 3 to 11, these skills continue to grow.  Kids are beginning to learn that they need to wait until mom is off the phone until they can receive that snack they want.  Of course, they are still not able to completely resist impulses at this age, as any parent of a young child will attest!

Older kids and adolescents, while better at self regulating than younger children, may still have problems curbing impulses.  As their brains develop, though,  they are better able to know what works for them and what doesn’t (parents also are learning these things about their own children).  For example, a child may decide to go outside and play when they are angry with a sibling simply because they internally know it will distract them from the upsetting incident.  Similarly, an adolescent may use that same intuition to reach out to a friend to help them calm their nerves before a tough test at school.

What might keep a child from being able to comply with requests or calm themselves down?  Many factors as it turns out.  A child who doesn’t want to play with a certain toy is more likely to help put it away.  Other factors such as fatigue or hunger can affect all of us in being able to keep our emotions in check.  Whatever the situation, kids who buy into the request have an easier time complying than those who don’t agree.  For this reason, it’s recommended to give the request a positive spin rather than a negative.  For example, instead of saying, “You can’t have candy for breakfast!’, say, “How about some delicious eggs for breakfast?” It’s always a good idea to help your child see, in as few words as possible, the positive aspects of a given choice.

The following are also great ways to help your child self regulate as they grow from infants to adolescence: (Gillespie, 2006)

  • Observe:  A baby will tell you she’s hungry by fussing or crying.  But an older child is harder to read.  They may come home from school out of sorts.  You may need to help them to regulate themselves by offering a snack or sitting down to talk with them.  You can also help identify their personal triggers such as crowded spaces or noisy areas.
  • Respond:  Be aware of your child’s particular needs.  Do they need some time and space?  Or do they need tighter routines and order? In the above example, a child may need to move their body to help them reorganize themselves after a busy day or a fight with a friend.
  • Provide structure and predictability:  Let your child know if things may change.  Give them an idea of what’s happening that day or week.  Keep a family calendar.
  • Keep it developmentally appropriate:  You can’t expect a toddler to sit quietly in a waiting room for half an hour.  Bring toys or games to keep them occupied.  For older kids, ask them if they need some space.  Let them know you are there when they need you.
  • Set age appropriate limits:  For younger kids, for example, they need to stay in line so the teacher knows where they are. Explain why teachers have the expectations that they do.  For older kids, develop contracts or agreements to let them know you respect their safety and their space.
  • Show empathy and caring:  For all kids, no matter their age, it’s vitally important that we as parents respect their needs and treat them as people of value.  In the long run, this is what helps them handle strong emotions.
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Parenting the Highly Sensitive Child


We have lots of kids who come through our doors that parents describe as “sensitive.”  What does this mean?  The book The Highly Sensitive Child written by Elaine Aron, defines a sensitive child as… (from website)

A highly sensitive child is one of the fifteen to twenty percent of children born with a nervous system that is highly aware and quick to react to everything. This makes them quick to grasp subtle changes, prefer to reflect deeply before acting, and generally behave conscientiously. They are also easily overwhelmed by high levels of stimulation, sudden changes, and the emotional distress of others. Because children are a blend of a number of temperament traits, some HSCs are fairly difficult–active, emotionally intense, demanding, and persistent–while others are calm, turned inward, and almost too easy to raise except when they are expected to join a group of children they do not know. But outspoken and fussy or reserved and obedient, all HSCs are sensitive to their emotional and physical environment.

Sensitive kids require extra attention and modification from their families.  The best route to effective intervention is to accept them where they are and not try to change them.  You can try to change your approach to your child in some different ways, though, to keep things calmer at home and provide some much needed predictability.  Sensitive kids tend to get “triggered” more easily.  They are more emotional and struggle to not become overwhelmed.

For parents needing some peer support, this series of articles on the blog Scary Mommy is really helpful.  Raising a Sensitive Child and My Imperfect Child give perspective on what it’s like to raise a sensitive kid.  Some additional reading is a book that has been recommended by parents is by Ted Zeff called The Highly Sensitive Boy.

In any event, parents often confront a difficult issue with these sensitive (or “emotional” or “difficult” as frequently labeled) is how exactly to discipline them so as not to break their fragile spirits.  From the book and this article in Creative Child magazine, we have some ideas.

Firstly, there are discipline techniques that should definitely be avoided.  Shaming, by way of name calling and “why can’t you get this?” type of correcting are perceived very negatively by your sensitive child and be potentially very detrimental.  Teasing a sensitive child is bound to provoke their intense emotions and likely will not be felt in the playful nature that was intended.  Best to be direct.  Physical discipline is also devastating to sensitive kids and most childhood developmental specialists warn against using it with any kids.  Time outs likely will be perceived as being sent away by sensitive kids and can take an additional emotional toll.  Finally, being too permissive in an attempt to avoid tears or meltdowns is to be avoided as well.  Loving correction is best.

Discipline Techniques That Work Well:

  • Be careful of your tone.  Loud does not mean you will be listened to any better, and to a sensitive child can be even more harmful.
  • Connect first.  Remind your child you love them and gently tell them what your concerns are.  You don’t want to be perceived as threatening.
  • No time outs.  Instead, take your child someplace that will help them to calm down and peacefully explain what went wrong and what should happen next time.
  • Consequences should be mild.  Most sensitive kids will adjust their behavior based on their ability to see it displeases you and is not acceptable within the family.  Consequences that make them stand out are shaming and to be avoided.
  • Follow up.  Have play time, and use positive language after the discipline has occurred.  This restores connection.

Hope these are useful to you and your family.

Ask any of our OT’s if you have questions or ask about our lending library for resources on sensitive kids.


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Vision and Your Growing Child

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The Amazing Vestibular System

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Hello from the APT book club!

apt photoWe recently met at Tamar’s lovely home to discuss “The Whole Brain Child” by Dan Siegel and Tina Payne Bryson.

The Whole Brain Child provides 12 strategies to “nurture” the child’s mind as they grow and mature.  It’s an extremely user-friendly book that makes the neurology easy to understand and the strategies easy to implement.  We have been using some in the clinic (and with our own kids!) since reading the book, many of us for the 2nd time.  We have been using the Wheel of Awareness, “What would you do?” questions, engage don’t enrage and S.I.F.T. most specifically.  Feel free to ask about the book or borrow one of our copies.  We’re here for you!

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Sensory Processing 101: What does it mean?

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