What Parents Need to Know About Feeding Therapy

There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like Feeding Therapyeating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.

The following are reasons why a child may have feeding difficulties:

  • Sensory processing issues
  • Picky eating
  • Food allergies or severe reflux
  • Autism
  • Developmental delays
  • Complex post-op recovery course
  • Transition from feeding tube to oral nutrition

Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech-language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician.

A speech-language pathologist will approach feeding in a comprehensive manner, looking at the actual physical swallow mechanism as well as the sensory aspect of feeding. Before beginning a more structured feeding treatment approach, it is key to rule out any medical reasons that a child is not safe to be taking food or drink orally. If there are concerns regarding vomiting, choking, gagging, etc. then the family should seek further guidance from their pediatrician who may recommend a modified barium swallow study. This test looks at the actual swallow mechanism in real time using x-ray to determine whether or not food or liquids are being aspirated (i.e., food items may slip into the lungs rather than where it is supposed to go). If a child is aspirating, physical symptoms may or may not include choking, wet/gurgly voice, and refusal to eat. Feeding therapy can move forward once it has been determined that a child is safe to take food by the mouth.

In addition to safety concerns, therapists will also look at the various chewing and swallowing stages to see if there is a breakdown in this complex process, once food is in the mouth. There is a developmental sequence of chewing for a child as well as development of independent feeding, first using hands and then moving to use of utensils. Each child will have different needs and a feeding therapy plan should be developed that is unique to your child. One approach to feeding therapy that has high success and is evidenced based is the Sequential Oral Sensory Approach to Feeding.

The Sequential Oral Sensory Approach to Feeding is a therapeutic intervention developed by Dr. Kay Toomey. Certification by Dr. Toomey and her associates through a training course is required for therapists to utilize this technique. Once certified, occupational therapists, speech language pathologists, dieticians, social workers and other health care professionals can intervene using the SOS approach. Under this approach, children are exposed to a variety of foods to increase their comfortability with a range of foods, focusing on exploration of the foods using all the senses: sight, sound, touch, smell, and taste.

Each week, the therapist will send the family a list of 8-14 foods based on sensory characteristics that will help the child experience foods that he/she might never have tried before. The family then brings these foods to the therapy session that week. During the session, the child and therapist (and often the caregiver) engage with the food in a playful manner to move up the “Steps to Eating” with each food, a 32-step process involved in eating developed by Dr. Toomey.  The ultimate goal is for the child to explore a variety of foods and expand the range of foods that he/she tolerates. The goal initially is not for the child to eat the food, rather discover and interact with a variety of foods and develop the skills needed to do so. Parents receive feedback after each session and are given recommendations to continue practicing these techniques at home during the week for ultimate success and generalization across environments. Using this approach, children become more comfortable with and generalize the skills needed to eat a wide variety of foods.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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This blog was co-written with Julie Paskar.

J-PaskarJulie Paskar is a speech-language pathologist, and the Branch Director at the Lincolnwood clinic. She joined North Shore Pediatric Therapy in August of 2012. Julie obtained both her Bachelor of Arts in speech and hearing sciences and her Master of Arts in speech-language pathology at Indiana University in Bloomington, Indiana. She has lived and worked in the Chicago area for the past eleven years. During that time, Julie worked for a pediatric clinic providing Early Intervention services as well as speech-language therapy services to children ages 3-12. She has her Early Intervention credential in speech pathology as both a provider and an evaluator. Julie’s areas of interest include: phonological disorders, motor speech disorders: specifically childhood apraxia of speech, feeding disorders, and expressive language disorders/delays. Julie is a Hanen certified therapist, has also attended both the Introduction to PROMPT and Bridging PROMPT trainings, has attended Picture Exchange Communication System (PECS) Level 1 and Level 2 trainings as well as the Kaufman Speech to Language training. She has been trained in the Orton-Gillingham program which is a treatment program for dyslexia. Julie is a member of the American Speech-Language Hearing Association and is licensed to practice in the state of Illinois. Julie is dedicated to working with children and their families to make communication both fun and functional.

Make the Summer Olympics Come to Life in Your Own Home

With the Summer Olympics just days away, what could be a better time to engage your kids in fun Summer Olympicsactivities to promote physical activity, social interaction, a healthy lifestyle, and improve their overall development? Many kids dream of becoming a gold-medalist in the Olympics and with these activities, you can make your child feel as if they are standing on top of that podium while assisting in their skill development without them even realizing it! There are endless opportunities to promote your child’s well-being. Be creative! Below are a list of easy-to-do Olympic related activities to get you started:

Focus on Fine, Visual, and Gross Motor Skills:

Table time activities

  • Print off Summer Olympic word searches, mazes, and coloring pages.
  • Create the Olympic rings (Cut strips of paper, form them in to circles, and connect them).
  • Olympic torch craft (create an Olympic torch using a paper towel roll, covering it with tin foil, and cutting/taping flames to the roll using red, orange, and yellow tissue paper).
  • Origami Olympic Rings (http://www.activityvillage.co.uk/origami-olympic-rings)
  • Create gold, silver, and bronze medals using paper, clay, tin foil, or paper plates. Then connect them to a string or ribbon to wear during your Olympic games.
  • Write about a favorite sport, Olympian, or your child’s Olympic dream.

Play Sports and Competitive Activities:

  • Basketball, swimming, running, simple gymnastics tricks, volleyball, soccer, hockey, mini-golf, etc.
  • Water balloon toss or ring toss
  • Races (three legged races, sack races, spoon, or relay races)
  • Obstacle course
  • Throwing a ball through a hoop or at a target,
  • Create a long/high jump

Focus on Social-emotional Skills:

  • Model good sportsmanship- Play the Olympic games with family and friends. This gives you the opportunity to model good sportsmanship when losing, working as a team, and how to support/encourage others for your child.
  • Promote social interaction with others, sharing, and taking turns – these are all important for building friendships and play skills.
  • Use positive self-talk– “I can do it,” “I will try my best,” “The more I practice, the better I will get.” Promoting positive self-talk will help improve self-confidence, increase positive thoughts, and will help improve performance during tasks.
  • Create rules for the games to teach direction following and playing fair with others.
  • Celebrate differences– the Olympics are a time of celebration, unity, and peace. Take this time to teach your child about different cultures and countries from around the world and that we accept our differences and treat everyone equally.
  • Promote friendly competition– While playing games, time your child and see how fast they can complete the game. Then see if your child can beat their score every trial. This will promote focus, improve overall attention, and assist in friendly competition with themselves or others.
  • Identify feelings of others– Find pictures of athletes in the Olympics on the internet or in magazines which portray emotions on the athletes faces and ask your kids how they think the athletes are feeling.

Focus on Sensory Processing:

  • Tactile input
    • Create the Olympic rings with finger paint- have the child create a circle with their thumb and index finger and with a paint brush, paint their hand. Then print on to the paper and repeat with the next color (this is a great tactile play activity for the tactile defensive child)
    • Bake cookies and decorate them to look like the Olympic rings, medals, basketballs, etc. Have your child mix the dough with their hands and decorate with frosting, sprinkles, or candies. This way your child is engaging with all different textures.
  • Proprioceptive input with heavy work– Have races, whether it be while pushing a laundry basket, running around a track outside, or animal walk races (these are great activities to help regulate the sensory seeking child or increase arousal levels)
  • Oral and tactile input-Engage with and try different foods from different countries and cultures from around the world- maybe your picky eater will try something you never though they would!

Focus on Speech and Language:

  • Incorporate your child’s target sounds in the context of the Olympics. For example, if your child is working on his or her “L” sound, have them practice saying: Summer Olympics, medal, or basketball.
  • Improve expressive language by describing/explaining as well as answering open ended questions, you can ask you child some of these questions:
    1. How hard do you think the athletes work to be able to compete in the Summer Olympics?
    2. How do you think the athletes feel on the day when they will be competing in the Olympics?
    3. What types of things would you do on that big day to prepare?
    4. How do you think an athlete would feel if they took last place in the Olympic Games?
    5. If you were going to compete in the Summer Olympics, which sport would you chose and why?

Make it even more fun by making a whole day out of it and creating your own Olympic Games! Create an athlete registration table, make teams, dress up, and don’t forget the award ceremonies. Enjoy and may the odds be ever in your favor!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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Activities to Help A Child with Low Tone

Muscle tone refers to the amount of tension present in a muscle. This is different than muscle strength, Low Tonewhich refers to the amount of power a muscle can generate. Low muscle tone means that the muscles are slow to activate and initiate movement, and have decreased endurance for sustaining contractions. A child with low tone may appear weak, floppy, and have poor posture.

If your child has low tone, here are some activities you can try at home:

  1. Yoga poses – Practice a variety of yoga poses each day. Superman pose and plank are good for developing core and upper extremity strength.
  2. Animal walks – Encourage your child to use animal walks around the house. These include bear walking, crab walking, and wheelbarrow walking.
  3. Lying on the belly – Whenever your child is playing a game on the floor, encourage them to play while lying on their stomach. This will support the development of back and neck strength.
  4. Carrying heavy items – Have your child help out around the house by carrying items that are heavy (but not too heavy!) such as a bag of groceries, a basket of laundry, or a watering pot. If it is too challenging for them to carry these items, try having them push them around the house instead.
  5. Climbing and swinging – Any activity that requires the child to lift both feet off the ground at the same time will help develop their core strength. This can include climbing a knotted rope or hanging by their arms from a trapeze swing while kicking a ball.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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The Do’s and Don’ts of Play: A Parent’s Guide to Helping Your Child Develop Better Peer Interactions

Imagine that you go to work in the morning and spend your entire day not knowing how to navigate thePlay Skills parameters of your workplace. You’re unsure of your job description, title, and workplace culture….and no one will give you any answers. By the end of the day, you feel utterly exhausted merely as a result of attempting to navigate a world with no structure or boundaries. Now, imagine you’re a child.  This is how children with limited play skills might feel as they are expected to respond to situations for which they don’t have the skillset each time they come in contact with a peer.

Play is the single most important mechanism children utilize to learn about their universe.  Play provides a framework to explain imaginative and real events in a child’s world. It allows them to learn about independence, manners, and character, as well as build confidence and practice new skills. Yet, some children have difficulty learning how to properly navigate these interactions.

The good news? You can help.

Play at Any Age

Play skills are developed in a progression.  Although there are times in which a child may fluctuate between all levels of play, the following indicates the age-appropriate development of peer interactions.

Solitary play (ages 0-2): Child is completely captivated with play and does not seem to notice other children.

  • Learns through trial and error
  • Copies other children and adults
  • Looks at other children playing but does not join in the play
  • Likes playing with adults as well as by himself/herself

Onlooker play (2-2 ½): Child is interested in other children’s play but does not join in. He/she may ask questions.

Parallel play (2 ½- 3):   Child shares the same space with peers but doesn’t actively engage with them.

  • Begins to use symbols in his play, such as using a stick as a sword
  • Starts to show some reasoning skills… may still learn by trial and error.
  • Copies other children and adults’ behaviors and language

Associative play (3-4): Child is interested in pursuing social interactions with peers while they play.

  • Shows more reasoning skills
  • Begins to ask “why” and “how” questions
  • Plays imaginatively, for instance, dress-up

Cooperative play (4+): Children play in groups of two or more with a common goal in mind; they often adopt roles and act as a group.

  • Shows understanding and uses reason related to experience
  • Begins to understand simple rules in games
  • Plays cooperatively, taking turns

Should I Be Concerned About My Child’s Play Skills?

Typical play:

  • Spontaneous
  • Flexible: child can add onto others’ play schemas*, play story** can change throughout, child does not become distraught if a peer/parent adds their ideas
  • Creative
  • Voluntary
  • Internally Reinforcing
  • Functional
  • Age-Appropriate

Atypical or Disordered Play:

  • Ritualistic: child engages with toy in the same order/manner, every time he/she plays with toy
  • Difficulty with Generalizations: child has difficulty accepting new patterns or rules, attempts to utilize one general rule for all similar events (i.e. “I know the youngest person goes first in Sorry, so I expect that the youngest person goes first in all games.”)
  • Non-functional
  • Repetitive: child performs the same action repetitively with a toy that doesn’t suit its purpose, ie. flipping, stacking, ordering items or repeats the same phrase over & over again while engaging
  • Limited Interests: child frequently finds a way to steer play story to a few favorite interests
  • Rigid: may accept when parents and peers join his/her play schema, but only by child’s rules and with his/her interests
  • Difficulty “bouncing back” from unexpected events in play: may recoil when a peer introduces a dinosaur, for example, when child expected story to progress in a certain direction. May become upset at changes or quit altogether
  • Avoids eye contact, or eye contact may be fleeting
  • Often requires prompting for basic communication, i.e. saying hello when approached by peer
  • Often includes non-reciprocal language: response frequently does not match question
  • Difficult for child to enter into an already-developed play scheme: two peers are pretending to be firemen, third child wants to join but can only talk about/pretend to be a doctor

*Play schema: diagrammatic presentation; a structured framework or plan 

**Play story: the story that is told through the play schema

Parent How-To Guide

If your child has underdeveloped play skills, here are some ways to assist in his/her development to encourage parallel, associative, and cooperative play:

  1. Provide Opportunities
  • Allow your child time for free play with same-aged peers
    • Don’t “helicopter” parent during free play, but provide modeling if necessary
    • Provide plenty of materials to encourage imaginary play, i.e. dress-up clothes, pretend food, cash register
    • Encourage symbolic play: child engages in imaginary play with an item and calls it something else, i.e. uses a banana as a telephone
  1. Model Feelings & Behavior to Encourage Problem-Solving
  • Provide your child with words to explain feelings
    • “Jimmy, it looks like you’re sad because Sally isn’t sharing her toy with you. Let’s tell Sally how you’re feeling together.”
    • If your child is old enough, encourage him to use the words himself. “Jimmy, you can say, ‘Sally, I am sad because I want to play with that toy too.’”
    • Starting your modeling sentences with the phrase “you can say…” is a very powerful way to neutrally provide your child with the words he/she may not know how to express
  • Provide your child with options for independent problem-solving
    • “Jimmy, do you want to wait until Sally is done with the toy or ask her if she can share it with you?”
    • This allows the child to choose between 2 options and learn to find solutions independently
  1. Set Expectations. Especially if your child demonstrates rigid behavior!
  • Be sure to set expectations before engaging in task
    • “Jimmy, we are going to the playground. At the playground, I expect you to play properly with friends. That means sharing the equipment, speaking nicely, and waiting your turn.”
  1. Give Positive Reinforcement
  • Encourage proper behavior and play skills by offering both natural consequences and praise.
    • Consequence, stated before engaging in task: “Jimmy, if you don’t follow the rules we discussed at the playground, we will need to go home immediately.”
    • Praise, stated after task is completed: “Jimmy, way to go! You followed all the rules by taking your turn and speaking nicely to your new friends. I’m proud of you.”

Seek Outside Help

If your child doesn’t seem to improve with these at-home tips, seek the assistance of an occupational or developmental therapist for hands-on support for both you and your child.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

References:

  • Parten, M. (1933). Social play among preschool children. Journal of Abnormal and Social Psychology, 28, 136-147.
  • http://www.child-development-guide.com/stages-of-play-during-child-development.html
  • http://brighttots.com/teaching_playskills.html
  • http://www.erinoakkids.ca/ErinoakKids/media/EOK_Documents/Autism_Resources/Teaching-Play-Skills.pdf
  • http://childdevelopmentinfo.com/child-development/play-work-of-children/pl2/

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Food Milestones: From Mashin’ to Munchin’

Mealtime and achieving food milestones can be a stressful time for many families, especially for those whose kids demonstrate Food Milestonesdifficulty consuming a variety of flavors and textures. Instead of stressing over consuming those calories and pumping on the weight, take time to relax and enjoy a meal. Take away the stressors from your day and use mealtimes as an opportunity to bond with your little one. There is great variety in the development of infants and toddlers due to differences in the rate of physical and mental development as well as how often these skills are promoted by caregivers. As children develop their preferences for different foods (tastes & textures), they learn to accept or reject specific foods, which is OKAY!

The old mother’s tale “you can’t get up until you finish your peas” has proven to be an ineffective way to have children smoothly go through the realm of trying different foods. Instead of “forcing” your child to eat different foods, give them options…”you can eat 5 or 6 peas…you pick!” Give great verbal praise despite how big of a gain the child has made that meal.

Please see the developmental chart below that guides you through a variety of food milestones while providing ideas on how to keep mealtime positive!

Age Strategies and foods that should be introduced Tips and Tricks
Birth-2 months
  • Nipple feeding by breast or bottle
  • Semi-reclined position during feeding

Foods:

  • Breast milk or formula (approx. 18-28 ounces)
  • Sing songs or tell stories while you feed your infant, build a rapport
2-3 months
  • Start forming a consistent schedule

Foods:

  • Breast milk or formula (approx. 25-32 ounces)
  • Make silly faces with your infant, make meal time a reciprocal relationship
3-4 months
  • Infant starts to put hands on bottle during feedings

Foods:

  • Breast milk or formula (approx. 28-39 ounces)
  • ˷4 mo, rice cereal trials
  • Always avoid television or electronics during meal time, practice songs or rhymes
  • Have your infant sitting at the table during adult meal times

 

5-6 months
  • Start to introduce pureed spoon feeds
  • Tongue will continue to “mash” the food to consume

Foods:

  • Breast milk or formula (approx. 27-45 ounces)
  • Overly ripe fruits/vegetables
  • Oatmeal
  • Rice or wheat cereal
  • Puree a food that you are having for dinner to make it easier with food preparation

 

6-9 months
  • Moves to a more upright position during feeds
  • Helps caregiver with moving spoon to mouth

Foods:

  • Breast milk or formula (approx. 24-32 ounces)
  • Sweet potato mash
  • Cottage cheeses
  • Puff cereal bites
  • Encourage infant to hold bottle independently
  • Think of a variety of different flavors to introduce, even mix flavors based off babies preference
  • Take small trials of foods from your plate to give baby to try
9-12 months
  • Progresses from pureed to more textured food
  • Increases finger feeding
  • Introduction of straw based cup or open cup
  • Moves to a more “munching” formation with jaw and tongue

Foods:

  • Breast milk or formula (approx. 24 ounces)
  • Egg-free noodles
  • Variety of fruit/vegetables
  • Mild cheese slices
  • Offer new foods without the expectation of eating the food (he/she can poke, smell, lick, etc)
  • Always offer small portions on a child sized bowl or plate (don’t overwhelm)

 

12-18 months
  • Grasps utensils and self-feeds
  • Complete transfer from bottle to straw based cup or open cup

Foods:

  • White potato mash
  • Chicken
  • Beef
  • Beets
  • Offer foods of different textures: pudding, soup, crackers, mashed sweet potatoes, etc
  • Have child come with you to the store to pick out their “special cup” to encourage discontinued use of nipple based bottle
18-24 months
  • Primarily self-feeding
  • Able to chew different textures and flavors

Foods:

  • Eggs
  • Lentils
  • Beans
  • Cantaloupe
  • Never ask a child “Do you want ____” because you will have to respect if they say “no”
24-36 months
  • Holds open cup independently
  • Eats a wide variety of solid foods

Foods:

  • Cleared to try any food
  • Have your toddler “get messy” with their food, spread the different textures on their hands, face, or even nose
Continuum into childhood
  • Continue to use choices to give your child the “control” during mealtimes
  • Have your child participate in mealtime prep as much as possible

 

Remember, mealtime goals shouldn’t be about consumption, but about a positive experience for the child. Always consult your pediatrician about diet concerns or questions.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

Developmental Stages in infant and Toddler Feeding., Infant & Toddler Forum., 2014.

McCarthy, Jessica., Feeding Infants & Toddlers: Strategies for Safe, Stress-Free Mealtimes. Mosaic Childhood Project, Inc., 2006.

1998, The American Dietetic Association. “Pediatric Manual of Clinical Dietetics”. 1998.

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Encouraging Muscle Development in the Infant Stage

Importance of Tummy Time for Muscle Development

Tummy time is a great way for infants to strengthen their muscles and develop age appropriate motor Muscle Developmentskills. When a baby is born they are in a position referred to as physiological flexion which simply means they are in a “curled up” position. All their back muscles are stretched and their core muscles are tight. By incorporating as much tummy time as possible, babies are allowed to strengthen their back by extending and stretch their tummy and core muscles at the same time. Encouraging floor time is key to developing motor skills such as rolling, sitting, crawling, and eventually walking.

Jumpers, Swings, and Exersaucers

Devices that aid in childcare can be lifesavers, such as when you are taking a shower or cooking, however, they should never replace the benefit that a child receives from floor time. When a baby plays on the floor they are using their entire body to explore their space. On the contrary, when they are in a swing or jumper, something is not being utilized. Excessive use of swings can result in flattening of the skull or a preference to tilt their head to one direction which can then lead to muscle shortening that requires intervention. Jumpers, exersaucers, and bumbo seats can also result in muscle disuse since the hips are frequently placed in unnatural positions and the core is not allowed to rotate as much as when a child is working to navigate the floor. When using devices such as the ones mentioned above, be mindful to limit their use in order to maximize muscle development.

Developmental Red Flags to Be Aware of

Sometimes babies will discover a pattern that is different than what we typically expect. Below are some movement patterns to be aware of and mention to your pediatrician should you notice them.

  • Scooting on their bottom to get around rather than crawling. This does not allow for the proper leg strengthening and cross lateral movement that crawling incorporates.
  • Pulling up to stable surfaces using only hands and not adjusting legs in order to push themselves up.
  • Stiffness in the legs or trunk that is constant and impacting movement; may first become evident with a lack of voluntary rolling.
  • Head position that is not in line with the body or a preference to only look in one direction, roll in one direction, or reach with only one hand.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood,Glenview, Lake BluffDes Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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‘Act First, Think Never’ – Warning Signs That A Child May Have ADHD

In the United States, attention-deficit/hyperactivity disorder (ADHD) has become a very common Blog-ADHD-Red-Flags-Main-Landscapechildhood diagnosis (NIMH, 2015). Parents and teachers may often wonder if their child or student fits the criteria for this diagnosis. There are several common indicative signs and symptoms of ADHD; however, the best way to be sure is to get a proper assessment by a psychologist/neuropsychologist. There are various factors that may influence a child’s behavior, causing them to appear as though they have ADHD. Additionally, anxiety and depression are common mood disorders that resemble ADHD symptoms. Because, ADHD is more complex than inattention and restlessness, it is imperative that an assessment is conducted.

Some red flags that may warrant concern and need for an ADHD assessment are:

  1. Behaviors are frequent and negatively impact quality of life
  2. Behaviors impact school performance and everyday life
  3. Inability to regulate emotions- seeming impulsive and “over reacts”
  4. Short attention span
  5. Talkative
  6. Always moving, running, jumping, and fidgeting
  7. Forgetful- “where?” “What?” Uh?”
  8. Disorganized
  9. Curious- interested in a lot of things but has poor follow through
  10. Cannot wait turn- very impatient
  11. Often loud and struggle to play quietly
  12. Avoids tasks that require mental effort
  13. Makes careless mistakes, and does not seem to work to potential
  14. Difficulty following multiple step directions
  15. Often unaware of time and gets lost easily

It is important to distinguish what is normal childhood behavior from behaviors that are impairing developmental growth and academic performance. There are also gender differences in symptoms. Boys and girls often do not display symptoms in the same manner; boys tend to be more impulsive than girls and equally inattentive.

A standard rule of thumb is that children with ADHD display symptoms three times as much as their peers (NIMH, 2015). If you suspect that a child may have ADHD, it is best to refer for assessment from a qualified professional. Remember to be aware that the child’s behavior can be caused by a host of influential factors, i.e. neurological, psychological, and environmental. Nonetheless, if the behaviors persist and are worsening, thus essentially negatively impacting their quality of life, socially, academically, emotionally, and physically, then it is time to seek help.

References

Hasson, R. & Goldenring Fine, J. (2012). Gender differences among children with ADHD on Continuous Performance Tests A Meta-Analytic Review. Journal of Attention Disorders, 16(3), 190-198.

The National Institute of Mental Health (NIMH). (2015). Attention Deficit Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Self-Care Skills for Children with Autism

Self-care skills such as brushing teeth, washing hands, and dressing are important for children to learn Blog-Self-Care-Skills-Main-Landscapeas they affect their everyday lives. For children diagnosed with Autism, they often experience delays in learning these skills and may need a different way of teaching to acquire them. Using some behavior analytic techniques, these skills can be taught in an appropriate way suitable for your child to be successful.

Is your child ready to perform self-care skills?

  • Component skills: In order to ensure success with the desired self-care skill, make sure that your child can perform the basic skills necessary for the task. For example, for the skill of brushing teeth, this may include: pincer grasps, holding a toothbrush, moving a toothbrush in a back and forth motion, spitting out toothpaste, squeezing toothpaste tube, gargling water.
  • Attending: Can your child pay attention and tolerate the duration of the skill?
  • Complexity of composite skill: Can your child put together the component skills to perform parts of the desired task?

If your child is unable to perform the component skills, attend to the desired self-care task, or combine component skills, work on building up this repertoire before moving forward. Providing help and lots of positive reinforcement with these tasks will make learning the desired skill easier!

Now that your child is ready, how can you teach your child to perform self-care skills?

  • Chaining: This strategy involves breaking down the steps of the skill into multiple pieces. Once the steps are broken up, teaching can occur by linking steps together.
    • The steps can be linked together from the beginning of the skill. For example, brushing teeth can begin with allowing the child to put toothpaste on the tooth brush and run the tooth brush under the water. The rest of the steps of the skill can be prompted by an adult. As the child becomes more independent with the first few steps, more steps can be added for him or her to perform independently as a chain.
    • Steps can also be linked from the end of the skill. For example, for hand washing, you can have the child wipe his or her hands independently on the towel. As the child becomes more independent with that skills, you can also introduce turning off the water to the chain of steps. All the steps prior to those mentioned steps can be prompted by an adult.
  • Social Stories: These stories outline the appropriate way to engage in the desired task. Each page can describe the steps and how to complete the skill. They can be in the form of videos, audio, or written (with pictures). Each child may respond better to one form over another.

What supports can you use with these strategies?

  • Visuals: You can provide visuals of each step of the task posted in the location that the skill will occur in. For example, with hand washing, some pictures can include turning on the sink, hands under the soap dispenser, or rubbing hands with soap. Modeling the skill before the child engages in the skill may also help the child learn by imitating your actions.
  • Physical prompts: You can physically guide your child with your hands on top of theirs to allow them to get used to the motion of the task. Then, you can reduce your physical prompts (e.g., move your hands to their elbows or moving farther away and pointing to the correct step) until they can complete the skill independently.
  • Vocal prompts: You can vocally instruct the child to perform each step as they are performing the skill. Then, you can fade your prompts until they can do the skill independently.

Working on the component skills independently until the child can easily and reliably perform them can greatly increase their success with putting those steps together. A combination of different supports listed above can provide a way for you to teach your child how to engage in complex self-care skills. Providing and fading your physical and vocal prompts can take some practice. It may be beneficial to work with a BCBA to ensure the success of your approach and the acquisition of these skills.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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At Home Speech and Language Games

Who says that practicing speech and language skills can’t be fun? While most games were not created Blog-Speech-and-Language-Games-Main-Portrait (1)with the intent to work on speech and language skills, there are many games that can actually be used for this reason. In fact, you may be targeting these skills at home without even knowing!

The following is a list of games that can be used and various skills that can be targeted for at home speech and language development:

  1. Go Fish
    • F or SH sound – Your child will get a lot of practice when saying “go fish!”
    • Asking questions – Your child will need to think of what card he needs and request the card by asking an appropriate question (e.g. “Do you have a four?”).
  2. Twister
    • Following directions – Your child will need to follow directions that contain three components (right vs. left, body part, color). If three components is too complex, the directions can be modified to have two components by eliminating right vs. left and only using the body part and color. An example containing three components would be “put your right foot on blue” and two components would be “put your foot on blue.”
  3. Hedbanz
    • Asking questions – Your child will work on asking yes/no questions to figure out what picture is on his or her head.
    • Word finding – The game can be altered where one person is describing the picture for someone else to name. When your child describes pictures and names, he or she can work on various word finding techniques such as identifying categories and attributes.
  4. Jenga
    • Jenga can be used to work on numerous speech and language skills by writing target skills on the Jenga blocks.
      • Speech – Any speech sound can be targeted by writing words, phrases, or sentences containing the specific sound(s) on the blocks. When your child removes a Jenga block from the stack, he will practice his sounds by reading what is written on the block.
      • Language – Many language skills can be targeted in the same way by writing various targets on the blocks. For instance, wh- questions (e.g. who, what, where) can be targeted by writing one wh- question on each block. Another language skill that can be targeted is categories. This can be done by writing a category name (e.g. animals) for your child to name or write items that are associated or writing items in the category (e.g. dog, cat, elephant) and having your child name the category.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Best Apps to Reinforce Occupational Therapy Concepts

Within our day and age, technology can be used in many ways to facilitate daily functional skills. In regards to occupational therapy, there are many apps that can be used to facilitate and reinforce occupational therapy concepts at home with your child. The following apps are great for facilitating listening skills, transitions, attending to tasks, self-regulation, body awareness and handwriting skills. Blog-Occupational-Therapy-Concepts-Main-Portrait

These apps are easy to use and can be used anywhere and at any time to reinforce occupational therapy concepts:

Metronome App

  • Importance and benefits of using a metronome:
    • Help develop and improve rhythm
    • Improves listening skills
    • Facilitates the ability to attend over an extended period of time.
  • Population:
    • Any child with difficulties following directions, attention, and rhythm.

ASD Tools

  • Importance and benefits:
    • Helps with transitioning from one activity to another, attending to specific tasks, as well as, following directions.
  • Features:
    • Visual schedule
    • First-then visual
    • Timer with a visual
    • Reward system
  • Population:

Brainworks

  • Importance and benefits:
    • Great and easy way to develop activities for a sensory diet.
  • Features:
    • Organizes all the activities into what would be best for your child.
    • Provides 130 sensory activities with pictures and descriptions.
    • Provides activities that can be completed at home, school, in the community, or at a table or desk.
    • Allows you to choose whether your child is feeling “just right, slow and sluggish, fast and stressed, or fast and hyper”- a list of sensory activities will be provided based on how the child is feeling.
  • Population:

Handwriting Without Tears: Wet-Dry-Try

  • Importance and benefits:
    • Great app that allows children to practice handwriting.
    • Provides multisensory ways to practice correct letter formation.
  • Features:
    • Capital/lower case letters, and numbers on a chalkboard with double lines.
    • Has a left-handed setting.
    • Reports errors for extra guidance.
  • Population:
    • Helpful for children with poor handwriting skills including letter formation and sizing.

Zones of Regulation App

  • Importance and benefits:
    • Great app for developing self-regulation strategies.
    • Helps children develop skills to assist in regulating their bodies, emotions, and behaviors.
    • Helps children acknowledge how they feel and acquire the skills to create strategies to cope with their emotions.
  • Features:
    • Mini games to help facilitate learning the zones of regulation and develop strategies to facilitate emotional control and self-regulation.
  • Population:
    • Helpful for children who have difficulty with emotional control and self-regulation.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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