Advanced Pediatric Therapies


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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Homework Part 2: Useful Printables

Homework Planning Sheet

Homework Planning Sheet

This is a great worksheet to use after school for your student.  It helps organize their time at home and school.  Feel free to share with your child’s teacher.  Download it here: homework-planning-sheet.

If-then worksheet

If-then worksheet

With this worksheet, you can help your child who has anxiety around homework or who just doesn’t know where to start.  A great way to think about end-product with homework.  Download it here:  if-then-planning-bubbles.

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This worksheet is a great place to start for thinking about after school time.  It works for sensory diets and for helping your child organize their time.  Download it here:  weekly-after-school-time-map.


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Eye See: Visual Perceptual vs Eyesight

This week I was going to write about this exact topic. It was written well for Starfish therapies so I am sharing it here>

Starfish Therapies


Occupational therapists are frequently asked what the difference between visual perception and eyesight is. Vision plays a significant role in the way we interact with our environment and how we learn.

Visual acuity refers to how clearly a person sees. Vision is more than just eye sight and how clearly we see. A person can have “20/20” vision but also have difficulty with visual perceptual skills.

Visual perception refers to the brains ability to make sense of what the eyes see. All of the body’s sensory experiences contribute to visual perception including sight, sound, touch, smell, balance, movement and muscle control contribute to visual perception. Visual perception is important for many different school tasks including reading, writing, cutting, copying from the board, visualizing past experiences, giving/getting directions, navigating the playground, and eye-hand coordination. The sub-areas of visual perception include the following:


Visual discrimination: The ability to see differences and…

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Autism Explained- by a 13 year old boy

photo (31)

The book “The Reason I Jump” is written by 13 year old Naoki Higashida.  Diagnosed with autism, this mostly nonverbal young man used an alphabet grid to write the book.  It’s incredibly honest and both heartwarming and heartbreaking.  The book is broken up into snippets with headings like, Why don’t you make eye contact when you are talking to people?  or Why can you never sit still?  The author describes feeling scared, overwhelmed and losing his “sense of gravity” often and that is the reason he jumps.  It’s a powerful and thought provoking read, as you can see from all the sticky notes sticking out of my copy.  It will change the way you see and think about someone you love with autism.

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What’s all this talk about Engines?

The Alert Program for Self Regulation is also known as "How Does Your Engine Run?"

The Alert Program for Self Regulation is also known as “How Does Your Engine Run?”

The Alert Program was created by Mary Sue Williams, OTR/L and Sherry Shellengberger, OTR/L to help kids learn to self-regulate.  What does it mean to self-regulate?  It means our ability to change our behaviors based on expectations and societal demands in light of our own emotions, beliefs or motivation. In other words, it’s how we go to work even when we are exhausted, talk calmly to our children even when they are driving us crazy and how kids go to school and make friends even when they are anxious.

According to Williams and Shellenberger, this skill is particularly difficult for kids with sensory processing issues.  The arousal level of kids needs to be guided by a skilled occupational therapist to get them to a “just right” point where they are able to have better able to control over their behavior and reactions to unexpected and feared situations.  In order to do this, kids have to first be able to identify their arousal state right now.  Optimal arousal means alert and ready to respond.

The beauty of the AP is that it is simple and easy for kids to understand.  There are different stages of the AP.  The first is identifying engine speeds, then experimenting with ways to change engine speeds then finally regulating engine speeds.  Ways to change engine speeds include:  putting something in your mouth like gum or sipping through a straw, moving like doing yoga, touching like playing with a necklace or fidget toy and looking like watching fish in a tank or dimming the lights.  Kids find out what works for them at what times.

If you’d like to find out more, talk to your therapist or check out our copy of “How Does Your Engine Run?  The Alert Program for Self Regulation.”  Until then, use the language of the AP in your own life.  For example, if you are tired and drained at the end of a long day, tell your kids your engine is in low.  You’re going to pop some popcorn and get ready to help them with homework to get your engine just right.  If you start using the words, your kids will too.

The manual for the Alert Program.

The manual for the Alert Program.

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Fitness & Exercise

This is a post from Anthony Miriello on fitness training he is doing at APT. Check it out!

I am now offering Developmental Fitness Training on Saturdays to teens and young adults. Click on the flyer below:

SpectrumShare Flyer Fitness

Fitness and exercise has always been an integral part of my life. I have long believed in the healing and regulating power of exercise, especially in helping those who struggle with anxiety and depression. Many new and interesting studies and articles are popping up all over the web and in scientific journals substantiating the claim that exercise not only makes us physically healthier, but also emotionally healthier.
Aside from the therapeutic benefits of exercise, we also need to consider the more widely known physical health benefits. Dropping levels of physical activity and a sharp increase in sedentary behavioral (video/computer games, television, etc) are quickly becoming behavioral norms for children, teens, and young adults. As a result, late onset adult conditions are now being found in children. According to the Center for…

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SPD Foundation Responds to Adam Lanza and Newtown Tragedy

The following comments are from the SPD Foundation, a great resource for parents and therapists alike:

Sensory Processing Disorder Foundation Comments on Adam Lanza and the Newtown Tragedy

Reports that Adam Lanza did not feel pain indicates he likely experienced Sensory Under-Responsivity, one of the six forms of Sensory Processing Disorder (SPD), found in virtually all children with an autism spectrum disorder. SPD often goes undiagnosed, but affects at least 1 in 20 children.

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Quote startOur hearts go out to the families impacted by the tragedy in Newtown, Connecticut.Quote end

Denver, CO (PRWEB) December 20, 2012

Dr. Lucy Jane Miller, Ph.D., founder and research director of the Sensory Processing Disorder Foundation, comments on how the reported symptoms in the shooter, Adam Lanza, are a classic indicator of a form of Sensory Processing Disorder (SPD).

“Our hearts go out to the families impacted by the tragedy in Newtown, Connecticut. Reports that Adam Lanza did not feel pain indicates he likely experienced Sensory Under-Responsivity, one of the six forms of SPD, found in virtually all children with an autism spectrum disorder. The suggestion that Lanza suffered a rare and exotic condition reflects the widespread unawareness of SPD. In reality, SPD is a common neurological condition that affects at least 1 in 20 children.

“SPD is not included in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV), published in 1994, which is typically used by health care providers to diagnose and prescribe treatment options. Unless identified in a diagnostic manual, like the DSM, children rarely get the help they need.

“When diagnosed and treated early, children with SPD are able to function well in society. Typically, treatment for SPD involves occupational therapy with a sensory approach. Unfortunately, lack of a diagnostic code means that treatment is not covered by insurance.

“Without treatment, children with SPD are at high risk for many emotional, social, and educational problems, including the inability to make friends or be a part of a group, poor self-concept, academic failure, and being labeled clumsy, uncooperative, belligerent, disruptive, or out of control. Anxiety, depression, aggression, or other behavior problems can follow.

“Earlier this month, the American Psychiatric Association (APA) announced changes being made for the upcoming fifth edition of the Diagnostic and Statistical Manual (DSM-5). Despite an overwhelming amount of rigorous data, the APA did not include SPD in DSM-5. There was no explanation given for the decision. The next edition of the DSM is not scheduled until 2025 at the earliest.”

The SPD Foundation, in addition to forty-nine scientists from Harvard, Yale, Duke, and many other institutions, has been conducting and publishing research on the prevalence, etiology, phenotypes, treatment, and diagnostic markers of SPD.

For symptoms, treatment options, and recent research, visit

Dr. Miller is available for media interviews. To schedule an interview, contact Caraly at (303) 865-7636 or caraly (at) SPDFoundation (dot) net.

The Sensory Processing Disorder (SPD) Foundation, a Colorado 501(c)(3), offers educational programs, conducts SPD research, and provides resources for parents worldwide. Dr. Lucy Jane Miller, widely recognized as a leader in SPD research worldwide, founded the SPD Foundation in 1979. For more information, visit or call (303) 794-1182.

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Asperger’s and the Newtown Connecticut tragedy

Shared from Sensory Spectum

Shared from

We all watched with sadness and despair as the Connecticut shootings unfolded.  We were more disturbed, however, to find the term “Asperger’s” floated around as a a possible reason for the shooter’s violence.  As we already know, kids with Asperger’s are more likely to be victims of violence than the perpetrators of violence themselves.  The Autism Self Advocacy Network put out a statement on Friday that helps educate others on autism.  Please give it a read and share it.

We join with all other Americans in putting  forth an effort to make sure our country unites around this unspeakable tragedy.  Consider Ann Curry’s call to action with your family as a way to deal with sadness and fear related to Newtown.

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Welcome to the Advanced Pediatric Therapies blog!

Welcome to the new Advanced Pediatric Therapies blog!  Please refer to our website for information on our clinic including our staff, location and how to find out if APT is right for your child.  Our goal is to provide a forum that not only tells who we are and what we do, but also allows for fun, community and active engagement.  Please let us know if there is a topic you would like covered in the blog.  We want you to be part of it’s development.

So let’s get started!

We thought we’d tell you about the phenomenal weekend we spent with Patty Oetter.  Patty comes to us from a private consulting practice in California and is well known to OT’s as the founder of the MORE (acronym for motor components, oral organization, respiratory demands and elements of toys that can be used to promote all of them) program.  She has an easy and natural way with kids that makes them feel instantly comfortable.  It may seem unusual, but Patty tells us that the mouth is the starting point of development throughout the rest of the body.  We spent the weekend with not only all of us at APT but other local OT’s who gathered to hear Patty’s pearls of wisdom.  We all came out rejuvenated and ready to share our knowledge with all of you!  We want to thank the families who brought their children in to us for Patty to treat and also all our OT friends who came and helped make the weekend such a fun and educational one.

Patty helps EJ jump from the platform for the very first time!

The OT’s are the ones watching for a change…

Patty is the author of “M.O.R.E. Integrating the Mouth with Sensory and Postural Functions” which has a companion DVD.  At the course, we learned techniques for use of oral motor intervention strategies, respiratory strategies and postural development.  We also were reminded about the healing power of touch and the importance of the energy we feel from each other in the therapeutic process.   Ask your therapist for more information.  The most important thing we learned from Patty is that you have to work from where you are and not try to jump ahead too quickly.  That way all kids are able to feel successful.

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