Reflex Integration and Development

 There are two forms of reflexes that exist in the human body. “Primitive Reflexes” begin to develop in utero and should only be displayed during the child’s first year of life. During normal development, these primitive reflexes integrate or “disappear” so that our lifelong reflexes can begin to emerge. Our lifelong reflexes are called “Postural Reflexes” and are normal through all years of life because they help us to control our balance, movement, and sensory motor development.

However, when a child’s primitive reflexes are retained and can be seen beyond early stages of life, it can result in developmental delays, sensory processing issues, learning difficulties, and poor gross and fine motor skills. Sustained primitive reflexes can also be the cause of poor coordination, clumsiness, decreased energy levels, depression, poor impulse control, and many social and emotional difficulties.

What causes these primitive reflexes to retain? There are many reasons why your child may still have these reflexes after the first year of life. One key factor that leads to persistent primitive reflexes is a traumatic birthing process such as an emergency C-section, pre-eclampsia, or pre-mature birth. Skipping tummy-time as a baby, a traumatic injury or insult to the body, no creeping or crawling, head trauma, or infections are also reasons that can delay the integration of the early reflexes.

Below is a chart containing all of the primitive reflexes within our body and problems that may be seen if they are not fully integrated (source: Brain Balance Achievement Center)

You can learn more about reflexes within the following resources:

ü  http://www.team4kids.com/primitive-reflex-integration-for-successful-learning-and-development/

ü  https://masgutovamethod.com/learn-more/articles

If you feel your child has persistent primitive reflexes that may be causing developmental delays and functional difficulties in their daily lives, occupational therapists and physical therapists are a great resource for more information! They can also perform tests to take a closer look on what reflexes your child may still have and ideas on fun and playful ways you can help with successful reflex integration at home!

Picture Exchange Communication System (PECS)

Speech Pathologists at Therapyland are trained in the Picture Exchange Communication System (PECS). PECS is a teaching protocol based on behavior analysis that focuses on functional communication. It was developed by Lori Frost, MS, CCC-SLP and Andy Bondy, PhD. PECS is taught in phases. In the first phase, children are taught to request by exchanging a picture with a communication partner. Children are taught to initiate the interaction independently, not wait for their communication partner to start the interaction. In later phases, they request using more complex phrases, pair vocalizations with the requests, ask questions, and make comments. PECS can be used with children with a variety of disabilities. Current evidence indicates that PECS does not inhibit speech, but may increase speech production in some children. Some children who use this system later transition to a speech generating device.

For more information on PECS

Occupational Therapy Home Activities

The Inspired Treehouse is a great resource for parents and families that was developed by two pediatric occupational and physical therapists.  It serves as an outlet for professionals to share information, tips, and strategies to help address developmental roadblocks that may come up for kids.  Here you can find information on topics such as sensory processing and developmental milestones. Also, don’t forget to check out their fun and creative home activities that help address fine motor, visual motor, and gross motor skills!

Click Here to Find More Info

An ABA Therapist's Perspective

What does a day in the life of an ABA therapist look like? Follow the link to find out!

"What does that look like?"

I play: I play with your child, on their level. I make sure I am the most fun person they have ever met. I am the giver of all things: iPads, m&ms, bubbles, trains, tickles, hugs; you name it, I probably have it in my fanny pack. I play with your child to foster social interactions that can lead to communication, play, and imitative progress. I play with your child because they are amazing, fun and I want them to share their interests with me.

I push: I push your child. I do not let them give up. I may make your child angry, I may make them frustrated, I may make them hit me, or bite me, or scream at me. I encourage them and I support them. I continue to work on one skill until I am confident that it can be repeated with anyone, anywhere. I am aware of the limited time frame for language development and social skills acquisition. I acknowledge the incredibly valuable time and money that you spend for your child and do not allow it to go to waste. I push myself, to be a better therapist for your child, to always try something new in a session and to always be transparent with you.

I praise: I praise your child. I give parties like you haven't seen since 1999, and I can say that as I am one of the older therapists that was actually, cognitively aware during that time. I praise all things, big or small, I am indiscriminate. I give random dance parties because I have found that your child loves jazz music or Frozen, techno-remixes. I act ridiculous, I have come up with faces, silly noises, and words with no meaning; just because it motivates your child and I can make them smile.

I worry: I worry for your child. I worry for you. I worry that I will not be effective, that I will not teach your child a skill in such a way, that they can achieve their highest level of awesomeness. I worry that the behaviors they engage in will isolate them, or hurt them, or hurt you. I worry that my being honest about the difficulties we faced in our session today will come across as rude or insensitive; uncaring to you. When in actuality, it was a sharing of truth, and a respect for your position as a caregiver to continue to keep you updated on the reality of your child's progress.

I respect: I respect your child. I always treat them with the dignity they deserve and hold them in the highest regard. I respect you, you are so incredibly important. You are your child's protector, cheerleader, advocate, mother, father, grandparent, sibling, friend, and teacher. You are their safety net. I respect your right to say no. I respect your ability to be the best source of information in regards to your child.

I love: I love your child. I love their hugs, their laughs, their smiles, their sounds, and their happiness. I love making them happy. I look forward to seeing them each morning or afternoon. I cannot wait to experience their next accomplishment in therapy and to share that progress with you.

Applied Behavioral Analysis can often attract negative statements of: clinical, robotic, or cold. That is not the way I experience or implement ABA therapy. It is instead, liberally laced with joy, hope, and lots upon lots of coffee. 

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Written by Kate Butler

PROMPT: Prompts for Restructuring Oral Muscular Phonetic Targets

Here at Therapyland our Speech Language Pathologists are trained in PROMPT. They frequently utilize this technique with the varying children they treat.  

PROMPT was developed by Deborah Hayden. She began manipulating the oro-motor structures to help adults and children with varying speech disorders to produce sounds that could be shaped for verbal interaction with others. PROMPT therapy is a physical-sensory approach that integrates all domains and systems toward effective communication outcome. Children with various disabilities such as: developmental delays, phonological impairments, apraxia of speech, speech disorders, Autistic Spectrum Disorders (ASD), hearing impairment, dysfluencies, etc., can benefit from PROMPT therapy. PROMPT may be used on all speech production disorders from approximately 6 months of age and up. By using this program it assists in developing motor skills in development of language for interaction - it has an emphasis on vowels, consonants and diphthongs through tactile cueing. 

For more information on PROMPT check out their website: PROMPT website

Why You Should Avoid Teaching “More,” “Please,” and “Thank You” to Children with Autism.

Check out why you should avoid teaching children with autism how to communicate "more", "please" and "thank you". In summary, teaching vocabulary for nouns and verbs first are more beneficial for children with autism in order for them to communicate their specific wants and needs.

Click here for link to article

THE BIG PICTURE: Focusing intervention for autism

Gail J. Richard, PhD, CCC-SLP, a former chair, professor emeritus and director of The Autism Center at Eastern Illinois University, emphasizes the importance of incorporating all aspects of development when targeting treatment - including not only the speech profile but also social, sensory, and motor. These separate factors all play different imperative roles throughout the child’s life; roles that may affect how they function in the real world. For example, furthered education may be effected by a decreased ability to perform executive functions tasks (initiate, plan, organize materials, and manage time and academic expectations). As stated by Richard, “their strong intellectual potential cannot be realized without an infrastructure to facilitate their success.” (Richard G.J., 2017). By assessing all aspects of development, therapists can focus their intervention on the big picture and gain the best results possible. At Therapyland, all areas of discipline approach their treatment goals with this theory in mind. Whether it’s physical, occupational, language, speech, feeding or behavioral, the target is consistent with the ‘big picture’ – generalizing skills with each child’s unique ‘real world’ factor in mind. The vast collaboration amongst disciplines further facilitates this objective.

To dive more into this educational read, check out the full article ASHA leader published in their latest magazine: http://leader.pubs.asha.org/article.aspx?articleid=2615520&resultClick=3

Pediatric Feeding News by Krisi Brackett MS CCC/SLP

Check out Krisi Brackett's blog where you can find an abundance of information on pediatric feeding difficulties. Her most recent blog post is about how stress may explain digestive issues in kids with Autism. Carly Morris at Therapyland follows many of her principles and believes in a medical, motor and behavioral approach to feeding. For more questions regarding feeding therapy and what it can do for you, please contact her at carly@therapyland.net.

Pediatric Feeding News

More about ABA...by Sandi Rivers, M.Ed. BCBA

What About When Behaviors Occur? CONSEQUENTIAL STRATEGIES


* Refer back to the Functions (EATS). Do your best to gauge the function so a pay- off is minimized for their problem behavior.
* Planned ignoring – to ignore minor problem behaviors “junk behaviors” and respond then to first appropriate behavior, i.e. being quiet, sitting nicely, etc. Then give them the words they may use to get attention or a desired item they want if possible.
* Pivoting – providing attention to other peers for appropriate behavior while using planned ignoring for another child’s problem behavior. Pivot back to child with problem behavior upon first appropriate behavior and provide praise, reinf., etc.
* Best Practice is to NOT tell the child what NOT to do, yet tell them what TO DO. For example, tell a child to fold their hands or sit down instead of telling them to “stop,” “don’t run,” “no, that hurts,” etc.



* NO Rationalizing during problem behavior, this is attention. This is why IF/THEN Boards are important to set expectations. Your words go away not visuals.

There is nothing wrong with talking to the child at a separate time or once calm to address the problem behaviors and expectations.

* IF a demand has been placed, use 3 step prompting thus eliminating verbal attention.
1. TELL WHAT TO DO,
2. GESTURE OR MINIMAL ASSIST FOR WHAT TO DO,
3. PHYSICALLY PROMPT FOR WHAT TO DO.
However, you may need to wait the child out for when you are unable to physically prompt.
* IF a child needs to be removed due to sensory overload or more intense behaviors, do your best to NOT provide preferred items/activities until calm, displays some form of compliance, i.e. clap your hands, pick up an item, sit in a chair, etc. then provide the communication for the child to get what they want using their words.
* Behavior Momentum / Redirection – Many times you can redirect a child starting to engage in problem behavior by using simple directions, i.e. clap your hands, high five, touch your nose, etc. then reinforce.
* You need to give strategies approximately 3 weeks before you rule out that they are not working.

"It's FINE to work on OT skills at home"

5 Simple Ways to Help Kids Develop Fine Motor Skills at Home

http://mamaot.com/5-simple-ways-to-help-kids-develop-fine-motor-skills-at-home/

What is ABA? continued by Sandi Rivers, M.Ed. BCBA

III. The Building Blocks

A: Antecedent-the environment, the events or the behavior that precedes the Behavior of Interest, or Target Behavior. Also known as the "Setting Event," the antecedent is anything that might contribute to the behavior. It may be a request from a teacher, it might be the presence of another person or student, or even a change in the environment.

B: Behavior-what the student does. This is sometimes referred to as "the behavior of interest" or "target behavior.” It is the behavior that you are focusing on, that is either pivotal (leads to other undesirable behavior, or contributes to other undesirable behaviors) a problem behavior that creates danger for the student or others, or a distracting behavior, that removes the child from the instructional setting or prevents other students from receiving instruction.

C: Consequence. It is the outcome that is reinforcing for the child (the FUNCTION / EATS), so it in turn reinforces the problem behavior. Is the consequence that the child is placed in time out, therefore avoiding a task? Does the parent give the child a preferred item or food, in order to stop the behavior?

IV. So Now What? ANTECEDENT STRATEGIES

* Pairing is MOST IMPORTANT!! RAPPORT has to be built and the child should desire to come to the staff member and/or place. Special Reinforcing boxes with preferred items for the child can be presented immediately upon drop off.

* May be helpful to interview the parents in re: to what the child’s preferences are and to send in favorite items with their child.
* Reward Systems to set expectations. Token boards or reinforcing on a schedule.
* Seating priority for easier redirection and to provide more frequent reinforcement.
* Visual spot to sit on or in for a chair, i.e. special carpet piece, rubber circle, bubble seat, sit spots, yoga ball to sit on.
* A fidget to hold or for putting in mouth so hands are busy (amazon and ARK therapeutic)
* Choice making – empowers the child, i.e. do you want to sit in the blue or red chair, etc.
* If/then visual supports (premack principle or grandma’s rule)

* Timers for how long to participate or before receiving a desired item 
* Reinforcer choice boards, easily made on google images.
* Visual Schedules for what the morning will look like, actually great for all students too.

* Other students telling child vs adult directions or holding their hand to walk
* Lap weights for sensory feedback (fill tube socks with corn or rice)
* Noise canceling headphones
* Tents or sheet over table for calm area with a pillow inside
* Being allowed to roam or hold a preferred item noncontingently during activities
* Painters tape on carpet for giving boundaries or places to sit
* During group activities, try to have some part hands on such as puppets
* Intersperse the time with various activities to provide preventative sensory activities, i.e. carry a heavy box or chair to their seat or next location, wear ankle or wrist weights, pull self on scooter board to next location, jump on a yoga ball or jump hard prior to next activity, wheel barrel walk, etc. These are easy to do during transitions to embed sensory preventative activities.
* Communication – Teach them prior to the behavior what words to use, i.e. break, lets walk, go, ipad, tap on shoulder, etc. Goal is to have them communicate prior to using problem behavior.