Squeeze! You’re Under Arrest: Potential Pitfalls of Squeezable Food Pouches

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At a time when fast, convenient, and easy rule the world, it follows that parents would want to minimize hassle and make meal times as efficient as possible. This attitude has brought about foods such as Go-Gurt and GoGo SqueeZ, pouches of yogurt or pureed foods on-the-go, for home and away. These foods allow children to self-feed, reducing the need for direct parent contact (depending on age), and promoting independence amongst toddlers. Sounds great, right?

So, What’s The Problem with Squeezable Food Pouches?

These foods are quick and easy, but no real “work” is required for children to advance their developing
pouches-Portrait oral-motor skills. Sucking is one of the earliest skills a child acquires (e.g., breast/bottle feeding), and these pouches require little or nothing more. Children tend to transition from liquids to pureed foods around six months; however, pureed foods should no longer be the primary form of nutrition (for typically developing children) beyond 12 to 18 months. Purees can be used as snacks, of course, so long as children are eating solids (e.g., chicken nuggets, etc.) during regular mealtimes.

The ideal feeding experience is multisensory. Children often use their fingers (touch) to feed, they are able to smell and see what’s on their plate, and, ultimately, food reaches the lips and mouth (taste). This multisensory cycle promotes development, allowing children to interact with their food and take a more active role in feeding. Using squeezable pouches alone removes the multisensory experience, as children are not seeing food, touching food, or even using their lips to scrape their food off a spoon. Blocking this sensory input can result in difficulties once new textures are introduced (e.g., aversion to crunchy foods, or difficulty with chewing).

What Can Parents Do?

Keep squeezable food consumption to a minimum. There is no question that they are a very convenient option, but as they are encouraging walking and talking skills, parents should also be introducing a variety of textures and foods. There are also ways to make squeezable food pouches a little more challenging in order to further feeding development while still allowing children to self-feed on textures they are comfortable with. Spoon attachments, for example, require that children involve their lips to scrape food off the spoon, allowing for greater sensory input!

Use squeezable pouches with attachments. The three options below offer great additions to squeezable food pouches. These spoon attachments fit onto most squeezable snack pouches, promoting oral-motor development.

The link below is a great alternative to food pouches. This spoon is still a self-feeder, allowing children to control the amount of food squeezed onto the spoon. Parents can fill the spoon with whatever pureed food they desire, either home-made or packaged!

Boon Squirt Spoon

What If Parents Need Help With Feeding?

Speech-language pathologists and occupational therapists are here to help! If children are struggling with a transition from purees to more solid foods, these therapists can educate families on appropriate foods to try, reduce stressors around meal time, and provide direct therapy to children who require it!

Baby Led Weaning

Baby Led Weaning: Is It Right For My Child?

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What is Baby Led Weaning?

Baby Led Weaning (BLW) is a method of transitioning infants from breastfeeding to eating solid foods. It bypasses
baby led weaning use of spoon-feeding or purees and encourages babies to feed themselves starting at 6 months of age. In addition to breast feeding, the infant sits with the family at mealtimes and is given pieces of solid foods to eat with his/her fingers.

Principles of Baby Led Weaning:

  1. Food is offered in its whole form as finger foods rather than pureed
  2. Infants feed themselves by grasping foods, making initial mouth contact and then ingestion through their own actions rather than by spoon-feeding
  3. Infants join in family meals, eating family foods as soon as they start BLW

Potential benefits of Baby Led Weaning:

Gill Rapley, a health visitor and creator of the BLW philosophy, claims the following benefits to her method:

  • Allows babies to explore taste, texture, color and smell
  • Encourages independence and confidence
  • Helps to develop their hand-eye coordination and chewing skills
  • Makes picky eating and mealtime battles less likely

How do I implement BLW?

Gill Rapley provides the following instructions for implementing BLW*:

  1. Sit baby upright, facing table, either on your lap or in a highchair. Ensure baby’s stability so he/she can use hands and arms freely.
  2. Offer baby food: Put it in front of him/her or let him/her take it from your hand.
  3. Start with foods that are easy to pick up: thick sticks or long strips
  4. Include your baby in family mealtimes as often as possible and, so long as it is safe, offer baby the same food that you/your family is eating to promote imitation.
  5. Mealtimes should happen when your baby is NOT tired or hungry so he/she can focus on feeding. During the transition to family foods, the focus of mealtimes is play and learning. Nutritional needs will continue to be met via breast milk.
  6. Continue offering breast/formula feeding, as this is still your baby’s primary source of nutrients until 1 year of age. When your baby requires less breast milk/formula, he/she will reduce feeding herself.
  7. Offer water with your baby’s meals.
  8. Do not rush or distract your baby while he/she is handling food
  9. Do not put food in your baby’s mouth or try to convince your baby to eat more than he/she wants.

*Adapted from http://www.rapleyweaning.com/assets/blwleaflet.pdf

Should I use BLW?

There is no easy answer to this question. As a parent, your decision should be based in an understanding of your baby’s individual nutrition and safety needs. Therefore, consulting with your pediatrician is important before deciding to use Baby Led Weaning. Further complicating your decision-making process is a lack of research investigating the effectiveness, benefits, and hazards of using BLW. Here’s what we know so far:

  • Rapely (2003) observed 5 infants introduced to complementary foods using BLW: All infants were able to self-feed by 6.5 months and showed signs of chewing and swallowing, but the sample was small and no data regarding how much food each infant ingested was provided.
  • Rapely (2006) and Rapeley & Murkett (2008) claim that BLW may decrease food fussiness and allows infant to self-regulate food intake according to appetite; however, there is no empirical evidence to support these claims.
  • In a study including 655 mothers with children between 6 and 12 months of age, participants who used BLW reported little use of spoon-feeding and purees and were more likely to to have breastfed their infants. BLW was associated with later introduction of solid foods, greater infant participation in meal times, greater exposure to family foods, and decreased levels of maternal anxiety regarding infant feeding and weaning.
  • Parents report choosing BLW because they believe that this method is a healthier, less expensive method of introducing solid foods.
  • Thirty percent of mothers using BLW report at least one episode of choking, most commonly while their infant was eating a raw apple.

Preliminary research also suggests a disconnect between mothers using BLW and healthcare professionals. BLW users do not report major concerns and view this weaning method as a healthier, less stressful way to introduce solid foods to their infants. In contrast, healthcare professionals express reluctance to recommend BLW due to the following concerns:

  • Increased choking risk
  • Iron deficiency
  • Inadequate energy intake

All in all, if you do decide to use Baby Led Weaning, or any other weaning method, it is important to follow safety rules. For more information regarding feeding guidelines and safety from the National Institute of Health, please see http://www.nlm.nih.gov/medlineplus/ency/article/002455.htm.

What should I do if I am concerned about my child’s feeding habits?

Contact your pediatrician, speech-language pathologist, or occupational therapist. Ask questions, describe your concerns, and, if needed, request a feeding evaluation.

Sources:

  • Brown, A. & Lee, M. (2010). A descriptive study investigating the use and nature of baby-led weaning in a UK sample of mothers. Maternal & Child Nutrition, 7(1), 34-47.
  • Cameron, S. L., Heath, A.-L. M., & Taylor, R. W. (2012). How Feasible Is Baby-Led Weaning as an Approach to Infant Feeding? A Review of the Evidence. Nutrients, 4(11), 1575–1609. doi:10.3390/nu4111575
  • http://www.rapleyweaning.com/

NSPT offers Nutrition Counseling and Feeding Therapy in Bucktown, Evanston, Highland Park, Lincolnwood (coming soon), Glenview and the Neuropsychology Diagnostic and Testing Center in 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!

Picky Eater

Picking Apart the Picky Eater: 5 Tips to Address Your Child’s Problem Feeding

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In an era with Whole Foods, Paleo diets, and organic produce at our fingertips, how do we improve a child that is a picky eater? Modern day life can be hectic and as the result feeding may reflect fast, convenient options that taste good but are not always the most nutrient-dense. So, how does one correct picky eating to support a more balanced diet?

5 Tips to Address a Picky Eater

  1. Re-create expectations around feeding. Eating does not just have to be about pleasure, it can be about sustenance, nutrition, and a time for social interaction/community. To frame feeding in terms of just for pleasure, we overemphasize the role of taste in our feeding practices; if it doesn’t taste goodPicky Eater or initiate our pleasure receptors, we shouldn’t eat it. Really, we eat for a variety of reasons and taste can be one of them. If we re-create our expectations to encompass eating for nutrition, sustenance, as well as taste it can become easier for your child to engage with non-preferred, more healthful foods.
  2. Motivate compliant behaviors through incentives. Feeding is a behavior just like any other so if you want to target increased compliance with eating certain foods, provide incentives to encourage the desired behavior. For example, if your child refuses to eat vegetables with dinner, create a log that tracks compliance with trying at least 3 bites of the non-preferred food. Upon completion of the bites, the child can get a sticker, equating with a long-term prize at the end of the week for compliant behaviors or result in shorter-term gratification which can look like being served dessert. Identify what may motivate your child the most to get through challenging tasks and work with this to create investment towards a new mode of eating. The 3-bite rule can help the child also determine if this is truly a food they like or not as they engage with it more.
  3. Debunk negative thinking. Chances are your child’s refusal of food is due to negative thoughts around how they perceive the food to taste or impact them. For example, if a child fears that a food will make them gag, taste disgusting, or make them sick, it would make sense that they would want nothing to do with these foods. The fact of the matter is, there may be limited to no evidence supporting these interpretations so it is important to challenge or debunk this negative thinking. If the child asserts that they don’t like broccoli, inquire about what they believe will happen to them if they eat it. Will they gag? Will they dislike the taste? Will it make them sick? Likely, they will report they just won’t like the taste. If that is the reality, this is a small problem that they can overcome with practice, perseverance, and supplemental positive thinking. Thinking that broccoli is just “ok” but nothing bad will come as the result can facilitate easier engagement and consumption with the non-preferred food item.
  4. Pair foods together. No one says that a meal will only consist of just preferred or just non-preferred foods so it is important to teach balance This can look like pairing favored foods with non-favored foods to emphasize this point; incorporating chicken nuggets with vegetables or fruit instead of French fries or dipping peanut butter and apples together can make unpleasant foods more pleasurable.
  5. Model. Model. If you want your children to get healthy foods and interact with a balanced plate so do you! Align with your child and demonstrate for them that these foods are good and good for you.




NSPT offers Sensory Processing Disorder (SPD)  and Nutrition services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview 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!

Boppy Pillow

Boppy Pillows: Multifunctional Uses

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When living in the city, maximizing what space you have and minimizing purchasing frivolous things is the difference between living in a cluttered mess and having an organized abode. Throw a new baby into the mix and their accompanying lists of “must-haves,”  your home can easily change into a cluttered nightmare! To avoid this as much as possible, it is ideal to purchase things with multiple uses.

The boppy pillow is a device that takes up minimal space, but allows for maximal use throughout your child’s first year of life.

Uses for a Boppy Pillow:Boppy Pillow

Shoulder Support for Caregiver During Bottle or Breast- feeding: The boppy pillow, and other nursing pillows, was designed to make newborn feeding an easier process for the caregiver. The device fits around the trunk of the caregiver just above the naval to allow for support of the baby, without causing stress to the shoulder joint.

Introduction to Tummy Time: It has been well documented that by 3 months of age, infants should be spending about 1 hour of total time on their stomachs each day. For an infant who initially is resistant to tummy time, propping them over a boppy  pillow allows them to build up neck strength while gradually increasing tolerance to tummy time.

Independent Sitting Assistance: The boppy pillow can be used several different ways to aid in independent sitting. Once a child has adequate head control to begin sitting exercises, the boppy pillow can be placed around the child’s trunk to give the child some support at the base, while still allowing the core muscles to develop.

Protective Environment when Learning Protective Responses in Sitting: This can be progressed to having the only the ends of the boppy pillow touching the child at the hips, providing increased degrees of freedom at the trunk while creating a protective environment in case of falls. Falls are in important part of the learning process for something called protective responses. A child who has mastered protective responses will outstretch an arm sideways, forwards, or backwards when exhibiting a loss of balance, in order to slow down their body and protect their head.





tongue tie

Tongue-tie (Ankyloglossia): Symptoms and Treatments

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Tongue-tie, or ankyloglossia, is a condition that restricts the tongue’s range of motion. When a child is born with tongue-tie they have an unusually short thick or tight band of tissue (lingual frenulum) tethering the bottom of the tongue to the floor of their mouth.

Symptoms of tongue-tie (ankyloglossia):tongue tie

  • The child may have difficulty sticking out his or her tongue
  • The child may have difficulty lifting their tongue to their upper teeth or moving it from side to side
  • The tongue may look heart shaped when stuck out
  • The child may have difficulty producing t, d, z, s, th, l, and r
  • The child pay have difficulty swallowing
  • The child may have difficulty breast feeding
  • The child may have difficulty eating solid or semi-soft foods

Here are some signs that your baby’s tongue-tie may be causing feeding problems:

  • She repeatedly breaks suction while feeding.
  • She makes clicking noises while feeding.
  • She’s gaining weight too slowly.
  • You experience nipple pain when she nurses. (She may be chewing rather than sucking in her effort to access the milk.)
  • Your milk supply is dwindling.

What your doctor may ask you about your baby:

  • Are you having trouble breast-feeding?
  • Is your child having trouble with their speech?
  • Is a gap developing between your child’s two bottom front teeth?
  • Are you concerned about activities your child is not able to do because of limited tongue movement?

Treatment options for tongue-tie:

  • The lingual frenulum may loosen over time and it may resolve on its own.
  • If tongue tie persists, a simple surgical procedure called a frenotomy may be warranted.
  • In this procedure the doctor numbs the membrane with a topical anesthetic, then snips the frenulum. It takes only a few minutes and doctors say it is less traumatic than ear piercing. Discomfort to your child is minimal during this procedure.

As always, consult with your pediatrician if you have concerns that your child may have a tongue-tie and consult with them for your best treatment options. A speech-language pathologist can help with feeding issues.


6 Ways to Get Your Baby to Take a Bottle

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The American Academy of Pediatrics, as well as many other national and international health organizations, recommend that babies be breastfed exclusively until 6 months of age to ensure adequate nutrition for your baby’s growth and development. However, it is not always possible for a mother to breastfeed, making bottle feeding necessary. If this is the case, and you’re having trouble getting your baby to bottle feed, read on for some helpful tips to get your baby to take a bottle.

6 tips to get your baby to accept a bottle:

  1.  Bottle feed your baby when she shows signs of hunger, rather than on a schedule. Your baby may be hungry if she does any of the following:
    • Attempts to lie back/get into position for nursing
    • Licks her lips
    • Opens and closes her mouth
    • Moves her head quickly from side to side
    • Cries
  2. Stroke baby’s lips from top to bottom with nipple to stimulate rooting response of open mouth. Allow your baby to seek nipple rather than trying to push the nipple in her mouth.
  3. Try using different nipple shapes to see if your baby prefers one over the others.
  4. Make sure the nipple hole is the right size for your baby. Fast flows can cause babies to gag. Slower flows may cause her to suck with too much effort or gulp air.
  5. Burp your baby every 3 to 5 minutes during bottle feedings and hold your baby upright after feedings.
  6. Do not force your baby to finish the bottle. If your baby is falling asleep, remove the nipple before the bottle is empty, as this means she is done.

If you have any questions or concerns regarding your baby’s feeding or nutritional needs, contact your pediatrician or schedule a consultation with a speech language pathologist who specializes in feeding issues.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

Meet-With-A-Speech-Pathologist

texture aversion

Help! My Child Has a Texture Aversion

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“Just take a bite!” “Just try it!” “One bite and you can eat the rest of your food.”

Does this sound all too familiar to you? Do you recognize this battle during mealtime? Your child may have a food texture aversion.

Signs your child may have a texture aversion:

  • Only accepting a narrow range of food choices
  • Extreme preference for certain brands of food
  • Anxiety when faced with a new food item
  • Inability to eat any foods, including foods regularly chosen within the home, when not at home
  • Preference toward avoiding food, often for an entire day, instead of trying something new
  • Difficulty chewing or swallowing
  • Frequent gagging when served certain foods
  • Facial grimacing or spitting out foods
  • Vomiting when new food is introduced
  • Refusal of food is not related to a food allergy
  • Prolonged mealtimes

What you can do to help with a texture aversion:

  • Reactions
    • Keep a journal of the types of foods your child eats and his reactions to these specific foods. This list will be extremely helpful for the speech-language pathologist or occupational therapist when taking your child in for a feeding evaluation.
  • Don’t push
    • Don’t reinforce the food aversion. Many parents believe that withholding favorite foods as punishment will force the child to give in, but this will only worsen the problem. Also, promising rewards for trying disliked foods will also reinforce food aversions.
  • Modeling and fun
    • Model the behavior you want to instill in your child by eating a wide variety of foods. Children will often adopt the behaviors they are exposed to. With positive reinforcement your child will reduce stress around new foods. Also, get your child involved in meal preparation. Make playing with new types of food fun. Learn about foods and where they come from. Teach your child how foods help our bodies. Expose your child to new foods or averted foods in a fun, stress-free environment.
  • Evaluation
    • Take your child for a feeding evaluation with a speech and language pathologist or occupational therapist. These professionals will help you determine if further therapy is necessary and can introduce the concept of food chaining to your child.
      • Food chaining is the systematic process of slowly introducing averted or new foods to your child. This should be done with professional guidance.

If you believe your child may have a texture or food aversion consult with a professional feeding therapist. Remember, take the stress out of eating for your child and make eating foods a fun and exciting activity. The goal is to reduce stress for you and your child.

Crossing the Midline

MORE Activities for Crossing the Midline

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As discussed in last week’s post, crossing the midline is an essential skill that affects a person’s efficiency in many of life’s everyday tasks. By engaging your child in activities that promote this skill, you are helping her to create pathways in her developing brain that can benefit her motor abilities, learning capacity, and behavior.

10 Activities to Promote Crossing the Midline:Crossing the Midline

  1. Dance! Get your child moving to a rhythm with her entire body and you will promote coordination and crossing over midline with big body movements.
  2. Play Twister.
  3. Do karaoke or grapevine walks.
  4. Engage in bimanual activities such as stringing beads, playing Pick Up Sticks, cutting with scissors, creating crafts or other projects with stamps, stickers, glue, etc.
  5. Play clapping games such as pat-a-cake or row, row, row your boat.
  6. Create a secret handshake that involves tapping feet, knees, or elbows to that of the other person.
  7. Involve him in baking! Let him stir the ingredients into a big bowl that he will have to help stabilize with one hand in front of his body, while the other makes big circular motions with the spoon.
  8. Engage him in a sorting game and encourage him to complete rounds of sorting using only one hand at a time.
  9. Play Simon Says. You could even take this up a notch and specify right or left side.
  10. Help with chores! Have her help you wipe off tables, mirrors, dishes, etc.

General recommendations to encourage crossing the midline:

  1. Always encourage children to complete self-care tasks such as dressing, eating, and bathing to the fullest extent they are capable. So many of these everyday tasks require us to spontaneously and purposefully use both hands together and to move one hand to the other side of the body.
  2. Before hand dominance is established, always present utensils (spoons, markers, etc.) at the child’s midline. Encourage the child to complete the task with whichever hand he initiates use of that utensil. Be sure he uses the other hand as the “helper” to stabilize the bowl or paper.
  3. Discourage w-sitting! W-sitting (where a child sits with his knees bent and feet out to either side of his body so that his legs form a “W” shape) has many negative implications. One of these is that the child is unable to cross midline as easily. When engaging in an activity on the floor, help your child sit “criss cross” instead.
  4. When completing work at a table, encourage your child to keep herself in the center of her work rather than scooting herself (or what she’s working on) to the left or right.
  5. Make it fun! Working on the development of midline crossing does not need to be a tedious exercise. As you engage in the fun activities listed here, you will begin to see how easy it is to adapt games and other tasks with this skill in mind. Don’t be afraid to get creative and let us know what you come up with!

Click here for a refresher on the 1st article to promote crossing the midline.

baby finger foods

Finger Foods for Babies

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How many times have you tried to give your baby a bite of his food and he reaches for the spoon, ready to do it himself? Probably just about every time you feed him. When your baby is about 9 months old, he has begun to develop the fine motor skills needed to start feeding himself. This is often a favorite (and very messy) activity for little ones.  It’s important to remember that finger foods for babies don’t have to be bought in the baby food aisle. Many of the things we eat can be adapted for baby! This will reduce your worry about always having something for him to eat as well as expose your baby to a new foods and textures.

Allowing your baby to feed himself as much as possible will help to encourage independent, healthy eating habits. This gives your child some control over what, and how much, they eat. There will be days that he will clean his plate, and there will be days where everything ends up on the floor…but that’s okay! He is learning the process of self-regulation and learning to recognize when his tummy is full.

 Rule number 1: Always try the food first.

Here is your finger foods checklist:

  • Is it soft?
  • Is it cooked enough so that it’s mushy? Overcook those veggies!
  • Does it melt in your mouth? (Think puffs or Ritz crackers)
  • Can you gum it? (i.e. eat it without teeth)
  • Is it cut into small pieces?

Rule number 2: Give your baby a variety of foods.

It can take up to 10 times for a baby to accept a new food into their repertoire. Don’t give up if the avocado ends up on the floor the first 4 (or 7) times.

Rule number 3: let him get messy!

Food play is an important learning experience. You have similar nerve receptors on your tongue and fingers so playing with food will help your baby experience different textures and temperatures.

With those three rules in mind here is a list of great finger foods to try with your little one!

  • Bananas-To make bananas easier to pick up, try dusting them in crushed Cheerios first.
  • Mandarin orange/peach/pear cups.
  • Grapes without the skin
  • Blueberries-If they aren’t small enough, cut them in two.
  • Watermelon (seedless, of course)
  • Cooked veggies: zucchini, carrots, sweet potato, butternut squash, etc.
  • Avocados or guacamole
  • Extra soft pasta
  • Small pieces of slow cooked or ground meats like meatballs, etc.
  • Fish
  • O-shaped cereals
  • Egg yolks-Once your baby is one year, they can have egg whites too.  Try chopping up hard boiled eggs!
  • Rice cakes
  • Cheese-Start with something bland like mozzarella or cheddar.
  • Quesadillas
  • Waffles and pancakes

Remember, now that your baby is eating these foods, the biggest issue to avoid is choking. Make sure your baby is strapped into his high chair and your eyes are on him at all times when starting these finger foods. Don’t give him any foods that could get stuck in his throat: popcorn, raisins, raw veggies, fruit with hard skin, hot dogs, etc.

Have fun with it! Get creative! And, don’t think you can only give him “baby” food!  If you have questions about your baby’s feeding, contact our Speech-Language Pathologists for answers.

Child With Learning Disability

Helpful Homework Tips for Children With Learning Disabilities

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If you are a parent of a child with a learning disability, you know how frustrating homework time can be. Evenings should not be spent tirelessly at the kitchen table. In fact, over involvement in your child’s homework can be counterproductive. If you sit down with your child every day at the kitchen table, who’s homework is it? “Many kids will let you do as much of their work as you’re willing to do.”

The responsibility lines can become blurred over time. Additionally, kids who are always provided a great deal of assistance, may become reliant on it and feel as though they cannot do it on their own, in turn, negatively affecting their academic confidence and self-esteem. Of course you love your child and you want to see them succeed… So what can you do?

Be specific about what kind of help you will provide during your designated homework time. Here are some helpful hints you can try out:

Help with organization:

  •  Checking assignment notebooks
  •  Going over directions and make sure they understand what is being asked of them
  •  Prioritizing tasks

Help Manage time and stay on Task:

Children with learning disabilities tend to underestimate the time it takes to complete tasks

  • Schedule Homework in shorter sessions
  • Allow mini breaks and snacks, if needed
  • Soft music or white noise
  • If you have a squirmy one on your hands, try having them sitting on an exercise ball, chewing gum or squeezing a soft ball while working

Review their work:

Children with a LD tend to prefer to not check their work

  • A child with a visual-perception problem may not be able to spot their errors or maybe it was just boring and they don’t want to see it again!

Know when to ask for help:

Sometimes as the parent you aren’t always the best one to be helping during homework time. Simply providing emotional support and guidance can prove extremely beneficial. Also, utilize your resources, talk with the teacher if your child is having trouble understanding the assignments. Considering a tutor may be an option, as well.

References:

Smith,Corinne (2010). Learning Disabilities: A to Z. New York, NY: Free Press