Advanced Pediatric Therapies

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October is Sensory Awareness Month!

The STAR Institute for Sensory Processing Disorder has launched a campaign for Sensory Processing Disorder (SPD) awareness this month.  SPD tends to get lumped into autism because kids with autism often have sensory processing problems, but not everyone who has SPD has autism.  This distinction is very important in getting SPD recognized as a disorder all on it’s own.  You can help out by talking to your friends, your pediatrician or posting a link on your social media.  It can be hard to explain, but the STAR Institute’s website is very helpful for you to use and a great place to refer others.  Get the word out this month!

 

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APT Hosts NDT Course

Despite slippery roads and kids home for an unexpected snow day, the course went off without a hitch.  Our course instructors were Gail Ritchie and Brenda Lindsay.

NDT stands for Neuro-developmental treamtment.  From the website:  NDT is a holistic and interdisciplinary clinical practice model informed by current and evolving research that emphasizes individualized therapeutic handling based on movement analysis for habilitation and rehabilitation of individuals with neurological pathophysiology.

Gail Ritchie is an occupational therapist who became an NDTA instructor in 1996.  Her career, spanning 25 years, focuses on supporting children and their families.  Brenda is skilled in a variety of areas including sensory processing disorder, but her focus is to also increase awareness of development and and facilitation of movement through handling in particular for children with autism.

Brenda Lindsay is a physical therapist who was certified in NDT in 1993 and went on to become an instructor in 2010.  Both she and Gail have extensive clinical experience in pediatrics and the autism population.  Both saw a need to bring developmental treatment into autism treatment and created the course to educate therapists about its powerful effects on this particular group of kids.

Members of the OT and PT community gathered over a couple snowy and icy days to take in their knowledge and observe treatment.  All of us came away with a better understanding and appreciation of NDT-based treatment with the kids we serve.  It was a fantastic course.

 

 

 

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The Amazing Auditory System

Picture

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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Parenting the Highly Sensitive Child

sensitive

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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The Power of Play in ADHD

from the University of Vermont website

from the University of Vermont website

It’s no surprise that kids with ADHD like to move.  But the University of Vermont has recently done a study that shows kids who exercise prior to school in the mornings were better able to sharpen their focusing skills and help them follow instructions better even later in the day.  What was the plan?  Researchers had parents provide 31 minutes of exercise to their kids in the morning before school.  The exercise included but wasn’t limited to tag, follow the leader and dancing.  There were 5 different activities included over the course of the 31 minutes.  Another group of kids was given seated craft-oriented tasks for 31 minutes.  The kids who exercised demonstrated better attention and lower impulsivity.  What’s remarkable is that the ADHD group had even better outcomes than kids without ADHD.  The next step in the research is to determine whether exercise can stimulate the release of brain chemicals involved in learning.  Pretty cool!

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Tracy Stackhouse visits APT!

We were thrilled to welcome Tracy Stackhouse to our Portland clinic on March 6 and 7th.  Tracy spoke about her STEP-SI  model.  The model helps practitioners use clinical reasoning to understand our clients better and plan treatment with a deeper understanding of the impact of sensory processing, relationships, environments, arousal level, predictability and tasks.  Tracy’s work is deeply embedded in the research of Jean Ayres  who pioneered sensory integration as we know it today.  Tracy’s fun and information-packed lectures gave us lots to think about and discuss during that weekend and all our workdays since!

FullSizeRender (27)

Thank you Tracy for an incredibly informative and dynamic weekend!

 

 

Tracy StackhouseTracy Murnan Stackhouse, MA, OTR
Tracy, a Colorado native, is president and co-founder of Developmental FX. She is a leading pediatric occupational therapist (OT) involved in clinical treatment, research, mentoring, and training regarding OT intervention for persons with neurodevelopmental disorders, especially Fragile X Syndrome and autism. She received her undergraduate degree in occupational therapy from Colorado State University and a a master’s degree in developmental psychology from the University of Denver. She received her NDT training with Lois Bly. She is SIPT Certified (Sensory Integration and Praxis Test). and was the clinical specialist in sensory integration at The Children’s Hospital in Denver as well as the OT for the Fragile X Research and Treatment Center. Tracy continued her clinical and research work with Dr. Randi Hagerman at the UC Davis M.I.N.D. Institute during its start-up year. Tracy has written several book chapters on sensory integration and neurodevelopmental disorders, and teaches and consults nationally and internationally on sensory integration, Fragile X and related topics. Tracy and her husband have two children.

*from the website for Developmental Fx.

 

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Executive Function: What does it mean?

The skills that make up executive functioning are strong indicators of future life success.

The skills that make up executive functioning are strong indicators of future life success.

Executive Functioning is the latest buzzword that parents have been hearing lately.  EF is made up of many smaller skills that make up the bigger picture.  In the illustration above, from a recent Parents magazine article, you can see how these skills are imperative to being able to get along with other kids, follow through with an idea, become familiar with rules and expectations, self monitor behavior and stay focused on the task at hand.  Phew!  Takes a lot of energy.  Some kids have difficulty with these skills for a variety of reasons including having a diagnosis of autism or ADHD or even dyslexia.  Children (and adults) who don’t have a formal diagnosis can still struggle with EF, and it’s the therapist’s and parent’s work to help bridge the gap.

When your child is in preschool, their brains are developing executive functioning simply by playing with other kids.  For young kids, EF is learned and integrated when kids are able to “use their words” or utilize language when dealing with a problem.  If they have a problem which they can’t solve, they get adult help.  Or they figure out that the game the other kids are playing looks just as fun as the one that was just snatched up by an unwelcoming group.  When a child acts out under these conditions or alternately retreats, then they made need some assistance developing EF skills.

“Executive Functioning is the brain wrestling with it’s emotions.” –  Walter Gilliam, PhD.  Yale University

When a child is mastering executive functioning, they are simultaneously learning to deal with emotions which can make for an explosive mix.  Because studies suggest that self regulation can be a better indicator of future success than SAT’s, it’s worthwhile to invest time in some proactive strategies.  The following ideas are some which have been taken from a variety of sources, but check with your healthcare provider if you have questions.

Choose a school that emphasizes executive function in their curriculum

Look for words like “child centered” and “play based” when selecting a school.  For older kids, look for teachers that see themselves less as dictators and more as facilitators of the process.  Good schools know that emotions and behavior are part of learning just as numbers and facts are.

Tell stories

Kids who listen to stories, make up their own or even listen to an audiobook aren’t relying on visual material.  They have to rely on their memory and how they feel about the story to hold it in mind and keep engaged.

Be a good role model

Ask questions when you don’t understand, talk out loud when attempting to solve a problem.  Go to yoga when you are stressed, then come home and say how the silence helped you figure something out.

Point out an accomplishment

Let your child know when you see them controlling their impulses.  Your preschooler is about to throw the remote when she is told she can’t watch her favorite show.  But instead, she puts it down and starts playing something else.  Tell her she made a good choice.

Patience is a virtue…

When your child learns to wait, something often tough to do in our culture, they are also stopping themselves from doing something else that could be negative.  Like, stomping their feet, yelling or running away.  Modeling patience is helpful too.  Remember that the next time you are stuck in traffic…

Discipline and perseverence

We can learn these skills by doing them.  Over and over and over again.  Just like that episode of Sesame Street that they watched a thousand times.  Younger kids love repetition.  Older kids need a bit more novelty, but repetition is needed nonetheless.

Executive Function isn’t really anything new, although it’s experiencing a resurgence in the media right now.  Ask your OT if there’s anything particular to your child that you can do at home.

photo from Parents Magazine

 

 

 

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“Auditory Processing:” What does it mean?

Auditory processing is more than just hearing.

Auditory processing is more than just hearing.

What does “auditory” mean?  Is that the same as “hearing”?

Auditory simply means related to hearing.  The inner ear has two major organs that contribute to our sense of sound.  Very simply speaking, the cochlea is responsible for defining the sound that is heard (like a car horn) and the vestibule is responsible for the sound making its way to the brain so that the brain can produce a movement based response (get out of the way).  The vestibular system, also housed in the inner ear with it’s partner the hearing system,  helps us achieve more complex responses like balance.  It’s a complex symphony that results in coordinated movement in response to sound.  The music of this symphony is auditory processing.

 

Kids who have a healthy and functioning auditory system…

* are able to turn their heads toward you when their name is called.

*are able to filter out sounds which they don’t need to pay attention to like the refrigerator turning on, or a baby crying in church or their brother kicking a chair during dinner.  Those noises are background.

*can follow directions that are given verbally from you or a teacher without problem.

*can catch the vast majority of words spoken to them without missing a word.

*aren’t distracted by sounds which may be familiar or unfamiliar

*know what to do when they hear a certain sound like the bell to change classes.

 

Kids who have problems with auditory processing…

*may miss small parts of direction, which can affect how they respond.

*may be hyposensitive, which means they are underresponsive, or aren’t able to clue into important sounds around them.  They may talk to themselves a lot or make a lot of sounds.  They may not accurately respond to a direction because they may not have heard it accurately.

*may be hypersensitve, which means that they are overstimulated by noisy environments.  They may seem controlling or avoid these types of environments.  They may cover their ears, or act like they want to run away.  Sounds may seem actually painful to them.

*may seem very distracted and unable to follow your directions.

 

Ways you can help…

Sing songs with them.  Read with them and ask questions about what they have read.

Use verbal cues like “Are you ready?”

You may find it helpful to say something a different way.  After asking a child to pick up his shoes a couple times, you might want to say:  “your shoes belong in the closet.”

For older kids, voice recorders on smart phones can help them remember details from classes.  Younger kids can also benefit from visual components like videos.

Outlines, study guides, personal organizers can all help.

Noise cancelling headphones can be helpful.

Therapeutic Listening- as prescribed by your OT.

Talk to your occupational therapist about the specifics related to your unique circumstances and your child.  We can help find ways to reduce their frustration- and yours.

Other websites to check out:

The American Speech-Language Association– a detailed article about auditory processing.

This website has ideas from parents.

These videos are descriptions of brain pathways related to the senses.

Ideas for the classroom.

Nice blog written by therapist related to auditory processing.

 

 

 

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