The Developmental Progression of Self-Dressing Skills:

The ability to dress oneself is an important fundamental component for participation in an individual’s daily routine. Teaching a child how to dress themselves not only promotes functional independence, but also relieves family stress by decreasing the amount of one-on-one assistance require in the home or out in the community.


The chart below is from The Inspired Treehouse.com and is a great quick reference for the developmental progression of self-dressing skills.

References:

http://mamaot.com/when-do-kids-learn-to-dress-themselves-developmental-progression-of-self-dressing-skills/

https://theinspiredtreehouse.com/child-development-teaching-kids-dress/

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!

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

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/

PT vs OT Who Does What?

Check out the video below to better understand the difference between Physical and Occupational therapy.

What is feeding therapy?

 My son doesn’t like green beans.  According to my husband, it is because he is smart.  But what happens when your child doesn’t like any food that is green…or orange…or too soft…or too hard?  Is your child just a picky eater, or could there be a bigger problem?

According to The American Speech-Language-Hearing Association feeding and swallowing disorders are described as “problems gathering food and getting ready to suck, chew, or swallow it.”  Signs and symptoms of feeding or swallowing disorders include failure to accept different textures of food, long feeding times (over 30 minutes), coughing or gagging during meals, less than normal weight gain or growth, and difficulty chewing.  If you notice these symptoms in your child, it might be time to discuss your concerns with your pediatrician. 

What happens next?  If feeding therapy with a speech-language pathologist is recommended, an evaluation is completed to look at movement and strength of muscles used during eating as well as an observation of eating to examine posture, behavior, and oral movements during chewing and swallowing. If therapy is then recommended, treatment may target increasing strength of mouth, increasing lip and tongue movements, improve chewing ability, accepting a variety of foods, and/or improving ability to drink from a cup or straw.

Our goal is to have happy, healthy kids who are able to enjoy the social and nutritional benefits of meals with families without the stress!

Is Screen Time Affecting Your Child?

Screen Time and the Young Child

Computers and electronic devices are a huge part of our daily lives.  They are a huge part of our kid’s lives as well.  But when should these items become a part of our lives and how often should they be allowed? Babies have a curiosity for the light and sounds of iPads and phones. One-year olds are getting tablets for their birthdays.  The 2013 Zero to Eight study commissioned by Common Sense Media showed that 38 percent of infants younger than age two use mobile devices like smartphones. What does this exposure mean for our little ones?

Recent studies have shown that screen time can have an impact on typical language development in small children.  It showed that the more television children under two watch, the less words they are able to understand and communicate. This includes televisions on as background noise.  Other studies have shown that when technology is used as “play”, the amount of expressive language used by the parent decreases as opposed to when they play using simple toys or books. With that being said, should you completely limit all screen time and media time?  Is that realistic in today’s world?

Up until recently, the American Association of Pediatrics recommended avoidance of screen time for children under 2 and 1-2 hours a day for older children. But they are currently changing their guidelines.  They have stated, “In a world where ‘screen time’ is becoming simply ‘time,’ our policies must evolve or become obsolete.” So what are their recommendations?

Current recommendations include:

·        Setting limits at every age. AAP has said that limited screen time continues to be best for children under 18 months.  FaceTime with Grandma? It is completely fine. For children 18 to 24 months, limit screen time to high-quality programing/aps. Children older than 2 should limit screen time to one hour or less a day.

·        Avoiding displacement.  Strive to maintain time for play, conversation, and creativity.

·        Address digital etiquette.

·        Engage in media use together. Adult interaction continues to be crucial for young children. Discuss what is seen on the screen with your children to model more language and joint attention.

·        Create media-free zones. Take time away from your devices.

·        Model media behaviors. It is amazing what children pick up from just simple observations.

Technology isn’t going away.  We just have to find a balance to help young children learn how to handle technology in their lives as well as encourage social and communicative development.

My Child Has Autism…What Can Physical Therapy Do?

Nicholas S. Kelly, PT, DPT / Thursday, October 20, 2016 / Therapyland, LLC / Alpharetta, GA

“I thought you guys just worked on things like strengthening.”
Contrary to popular belief, pediatric physical therapists (PTs) work on A LOT more than just muscle strengthening for our kids. In fact, Autism Speaks denotes PTs as healthcare professionals who “focus on any problems with movement that cause functional limitations”. These movement compromises can occur in children with cerebral palsy, Downs Syndrome, orthopedic or cardiovascular issues, and even children with Sensory Processing and Autism Spectrum Disorders (ASD), as well as a host of other medical diagnoses.

“Does my child need PT?”
Children with autism frequently have challenges with motor skills such as sitting, walking, running or jumping; however, every child with ASD is different from every other child with ASD. Not every child with ASD will need physical therapy. If PT is found to be medically necessary and the child could benefit from physical therapy services, a program will specifically be designed for his or her needs. If you suspect that your child has problems developing appropriate motor skills or has low muscle tone, contact your child’s pediatrician regarding physical therapy services.

“So, how exactly will the PT help my child with autism?”
A PT will start by evaluating the current developmental level and abilities of the child. Once identifying the individual’s challenges, interventions can be designed and implemented to address the “physical therapy diagnoses” or issues like poor muscle tone, balance issues, and coordination deficits - all common in children with ASD. The Children’s Hospital of Philadelphia Research Institute outlines 4 areas of PT intervention:
● Gross Motor Skills – using large muscles for sitting, standing, walking, running, etc. 
● Balance/Coordination Skills – involves the brain, bones, and muscles in a coordinated effort for smooth movement; for example, as in climbing stairs and jumping.
● Strengthening – building muscles for support and endurance like for walking for a distance without becoming tired. 
● Functional Mobility/Motor Planning – moving through space, day to day, for independence and efficiency; for example, to climb onto the rocking chair and make it rock back and forth.
In addition, extensive collaboration with other professionals from whom your child might receive treatment (i.e., occupational therapists, speech-language pathologists, behavioral therapists, etc.) will help to maximize the child’s potential to reach the highest level of functional independence.

“What will a treatment session look like?”
Since children learn through play, licensed physical therapists use child-friendly, specially chosen toys and activities to motivate and encourage patients to participate in therapy. Typically, you will find balls, swings, puzzles, and slides in our therapy gym. Children are encouraged to have fun while they work hard to accomplish the tasks their therapists set for them. In our clinic, sessions are usually an hour, with frequency determined by the referring physician, parent/caretaker, and PT. The child’s health insurance may also influence the frequency of services. 

For more information, please follow the links provided:
https://www.autismspeaks.org/family-services/tool-kits/100-day-kit/treatments-therapies

https://www.carautismroadmap.org/the-role-of-the-pediatric-physical-therapist-for-children-with-autism-spectrum-disorder/?print=pdf

https://www.carautismroadmap.org/examples-of-outpatient-physical-therapy-activities/?print=pdf

http://www.everydayhealth.com/autism/physical-therapy.aspx

Toddler Talk

Speech is an important milestone in toddlers. Toddlers usually begin using one- two word phrases at this stage. There are several things that parents and caregivers can do to encourage speech.

Toddlers understand and say nouns before other parts of language. Identifying nouns with your child is the best way to start speech. You can build vocabulary in almost everything you do with children, simply by talking to them. While dressing them (or as they are dressing themselves) identify shirt, pants, socks, shoes, say left foot and right foot when putting on their shoes. While at the grocery store, identify common food items, apples, juice, crackers, etc. While driving in the car, ask your child “what do you see?” and model responses such as “I see trees and the road” or “I see a stop sign and a car next to us.” Descriptive words are important when building a vocabulary. When talking with your child, use adjectives. You can say, “I like your green shirt”, “Let’s get in the blue car”, “That tree is tall”, “The kitten is little”, etc.

In addition to working on receptive language, you can encourage talking by modeling words for your child. If they show signs of hunger, model “eat” and try to have them imitate the word. If they want to be picked up, model “up” and try to have them imitate the word.

Typically your child’s first words are simple. At dinnertime, say “Eee” before giving them food, withhold for a moment to encourage them to imitate the sound to request “eat”. When playing with a ball, say “ba” before throwing them the ball. The motivation of playing should encourage them to imitate the sound. Shortening words so that children are able to say them is important. Instead of encouraging them to say “fire truck”, first work on “tuck”. Simplifying words can be helpful so that children can more easily imitate. Shorten sentences as well. Instead of saying, “The baby is crying”, encourage your child to say, “Baby cry”. Instead of asking them to say “pick me up, please”, ask them to say “up peas”. Then follow up with a model of the correct production of the word or sentence.

Finally, reading is a great way to encourage speech and language. While reading books, describe the pictures and ask questions. In addition, ask them to identify and point to pictures in the book. This will keep children engaged during book reading.