Advanced Pediatric Therapies


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!

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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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Do You Have a Child That Hates to Lose?

Does this look familiar?

Does this look familiar?

We play a lot of games here at APT, and there are frequently some pretty sad or frustrated faces when a game is lost.  We play games for a variety of reasons including building social awareness, improving self regulation (skills such as handling frustration, managing expectations) auditory or visual skill building, fine motor skill enhancement and so on.  Kids who hate to lose are often called “sore losers,” but it can be taken to the extreme.  Kids will throw tantrums, name-call (to themselves or others), cry, hit or even stop talking.

We suggest first trying to avoid the problem by teaching them how to be good sports.  Parents magazine suggested a couple of the following and also some tried and true methods from the therapists here are included:

  • Play by the rules.  You are your child’s best teacher and you shouldn’t let them win on purpose.  If the game is too hard for them, scale down.  Shake hands whoever the victor is at the end of the game.
  • Encourage self competition.  This means letting your child set their own goals.  If they were able to ride their bike up 1/4 of the hill, maybe their goal can be half the hill next time.  They don’t have to play games all the time to learn some aspects of healthy competition.
  • Encourage “improving” over “winning.”  The game that keeps score may be more difficult for a child to handle than activities that don’t.  Martial arts, dancing and fort building are not scored, but you can show improvement in each.
  • Poor sportsmanship is not okay.  Bragging when they have won or “freaking out” when they have lost:  neither is being a good sport.  Model for your children how to be a good sport.  At the beginning of a game, do a cheer for the opposite team.  Always make sure to say “good game.”  Don’t gloat when you win.  Point out what the other team did well, even if they lost.
  • Acknowledge the effort.  Let them know how hard you see that they tried.  Ask them if they’d like some help getting better at something.
  • Don’t set the bar too high.  If your child is 5, don’t pick out a board game for ages 7 and up. There is a reason for age parameters.  Try to stick to them.
  • Set a new strategy.  When they say “I’m never playing this dumb game again!, ”  you can try to help them become better at the game you were playing.  Ask them what they could have done differently.
  • “How would you feel?”  Ask them how they would feel if a friend quit in the middle of a game that your child was winning.  Ask them these questions when it is no longer game playing time, when the heat of the competition has worn off.
  • Set them up for success.  For our kids, things like lighting, noise and seating can make a huge difference in how well they are able to play.
  • Have a sense of humor!!  When kids get a “skip a turn” card or make a wrong move, they can pick a silly word to say that will express their frustration.  We use words like “Oh Fiddlesticks!” or “Oh Pickles!” Silliness takes the seriousness out of play.  You can also leave the game as it is and go out and throw a ball outside.  Come back later.

For some kids, the emotion of winning or losing may just be too much for now.  On those occasions, play a game where they are part of a team or choose an activity that is non-competitive like an art or science project.

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Have Holiday Travel Planned? Some Tips to Get You There….

The holidays are a busy travel time.

The holidays are a busy travel time.

Traveling these days can be anxiety provoking for anyone, let alone our kids!  Before traveling this year, consider these tips.

  • Prepare, prepare, prepare!  Let your child know when you are leaving, where you are going, who you will be visiting and what you will be doing.  The more they know ahead of time, the less likely the tantrum.
  • As part of the preparation, do an activity.  Have your child make a drawing of their cousins.  Show them pictures of their aunts and uncles if they haven’t seen them in a while.  Or show them photos of your destination.  Even showing them photos of the inside of an airport, security lines, etc.  Let them know!
  • All of us who travel know that it can be a frustrating process.  There may be delays or other unforeseen circumstances.  Have a back up plan like a travel game or photos or a favorite book.  If your child has a “lovey” that’s manageable, let them bring it!
  • Noise reducing headphones, post it notes, usually-not-allowed treats and stickers go a long way to reducing stress when you need it.  During the travel itself, be a little looser with the rules.  It will help everyone breathe a little easier.
  • By all means, if you are staying with friends or relatives, prepare them for your child’s needs and behavior.  If your child requires special seating, let them know you need a special spot.  If your child has special food requirements, pick them up ahead of time or let your family know.  If they know what to expect, your family and friends will be willing to help.
  • If your child’s behavior is an issue, talk to your therapist about how to manage it ahead of time.  This can include using routing planning charts, receiving special buttons for good behavior or other techniques.
  • Don’t plan too much!  Keep sightseeing and activities to a level that allows for rest and time to hang out.
  • Be willing to change the plan if it’s not working.
  • Keep food and other daily expectations as close to what they would have at home as possible.
  • Remember to have fun, connect with your child and enjoy the time away.  Research shows that vacations are the perfect time to work on ridding yourself of bad habits.  Think about that as you give yourself some much needed downtime.
  • If your child’s vestibular processing predisposes them to motion sickness, prepare with some ice cubes, water and perhaps an over the counter remedy.  Some parents we know swear by lavender essential oils to ease motion sickness on a long car trip.

Have a great trip!

photo from

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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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Back to School!

Forgive me!  APT has been hard at work all summer, but your blog writer has taken a brief reprieve to soak up some rays and take some time with her own kiddos.  Rest assured, the blog is not forgotten and welcomes your ideas.

It's Back to School Time!  (photo courtesy of edulicious)

It’s Back to School Time! (photo courtesy of edulicious)

It’s nearly that time:  Back to School!  Based on how your summer has been, you may or not be cheering right now.  We wanted to give you some ideas for how to ease the transition back to school for you and your children.

1.  You know the drill:  Routine, routine, routine!  For the week before or at least a few days before your child goes back to school, keep a good predictable schedule of meals, bath tiime and bedtime.

2.  Let your child take part in purchasing school supplies.  Let them handle the supplies before you buy them and before school starts so they are not distracted by that awesome new folder or that pencil that clicks.  You can go during off times to reduce overload.

3.  Oh those new school clothes!  Kids get so excited about wearing their new duds, but for our kiddos, it may be better to let them wear those new clothes once or twice before school starts in case there are any problems with fit or comfort.

4.  Does your child need an eye exam?  Lots of fine motor or coordination problems can be traced to visual problems.  If you need a referral to a pediatric opthalmologist or developmental optometrist, let us know.

5.  If your child is entering kindergarten or going to a new classroom or has trouble with new teachers, it’s a great idea to to touch base with your child’s school before school even starts.  Many schools have kindergarten prep classes, start-up or other programs to help ease the first day jitters.  Meeting that important new person before the first day can be very helpful.

6.  Parenting for Special Needs has a great form called “Getting to Know My Child” that can help your child’s new teacher learn about your unique child.  Check it out here.

7.  An OT, Lesley Biehl, created a checklist for parents which may help your the classroom staff identify areas which can be adapted for your child.  You can download it here.

As always, you can ask any of the staff at APT for help with back to school transitions.  Encourage your child to be curious, and be open to having fun!


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