How Do I Know if My Child Has a Reading Disability?

Reading Disabilities are estimated to occur at a prevalence rate of 5-10%.  A disability, which is a more chronic struggle with reading without early identification and intervention, must be differentiated from the child who demonstrates a slower process in the normal developmental curve of reading development.  A disability will not resolve with repeated practice, extra attention, or the passage of time.  Below are a few clues to help figure out if there really is a disability.

Clues that Indicate Your Child May Have a Reading Disability:

  • Your child has difficulty with basic rhyming.
  • Your child has always been slow to learn the alphabet and maybe even numbers.
  • Your child struggles with sound-letter associations.
  •  Your child’s writing is illegible.
  • Your child likes to be read to but never wants to read.
  • Sight words, despite repeated practice, are easily forgotten by your child.

At times, differentiating between a disability and other factors (e.g., attention, motivation and interest, or behavior) can make accurate identification difficult.  An evaluation can help tease apart any related factors that may be impacting your child’s success.  If you are concerned with your child’s reading development, you can request an evaluation through our Neuropsychology Diagnostic Clinic.  We have clinicians trained in the diagnosis and assessment of reading disabilities and are able to provide efficacious recommendations to best help your child.
Click here to read about signs of a reading disability across grades.


The Rewards of Adaptive Bicycles for Children

Bicycle or tricycle riding is an important component of childhood. For certain children with medical complexities, there are special equipment that enable them to explore the world just like any other child.

When I was working as a physical therapist on the pediatric floor of a rehabilitation hospital, I encountered many children and families impacted by debilitating conditions and circumstances. From cerebral palsy and brain injury, to spinal injury, or cancer, many of the children I met proved that being physically and cognitively limited did not keep them from participating in stimulating play activities.

Adaptive tricycles are designed to provide less able-bodied children a way to exercise their limbs, practice their skills and encourage their participation. 

They often come with various features and accessories such as extra wide frames, trunk reinforcement, head support, leg straps, hand straps, steering assist, etc. They make it possible for children who have low muscle tone, motor control, coordination, or cognitive function to engage in locomotion.

How Can an Adaptive Bicycle Help?

For children with diagnoses that reduce their trunk control, adaptive bikes provide a safe environment where they can work on coordinating their limbs while having their back fully supported or strapped in.  For children who fatigue easily due to their medical conditions, adaptive bikes offer the option of having an adult help steer from behind.  For children who lack the motor control to alternately pedal their legs, foot straps and connected pedals make the reciprocal motion easier by putting muscles and joints through those much needed ranges. Depending on the type of bike, adaptive handles can also accommodate all kinds of grip. So when a child with upper body weakness has a hard time grasping or holding the handlebars to steer a regular bike, an adaptive bike allows them more control of their locomotion.

Durable wheels and a parking brake make adaptive bikes safe for children with a wide range of physical abilities and conditions.  Children with medical complexities who are restricted to a wheelchair can still benefit from rides in an adaptive bike.  Aerobic training and upright posture, as well as limb movements (facilitated or self-initiated), are an essential part of the growth and rehabilitation process for children of all different capabilities. All of this is made easy by special equipment such as the adaptive bike. Being outside and being able to participate in activities with other children promote emotional health and create positive environments for mental and physical growth.

The Rewards of Using Adaptive Bicycles

I have watched many children blossom behind the wheel of an adaptive bicycle. Taking part in that transition is such a rewarding process.  Children who were unable to move certain parts of their bodies after an injury were eventually able to transfer what they learned during cycling to standing and walking tasks. Toddlers who were never able to stand on their own were able to experience, for the first time, limb movements and self-propulsion locomotion. Seeing the smiles on their faces, and hearing the laughter of their parents and siblings… Those moments definitely made my job worthwhile.

5 Ways to Improve Fine Motor Skills with Valentines

It’s that special time of the year again. Bags of candy and cards adorned with hearts and kind messages line the aisles of our local grocery and convenient stores. Our kids wait with great anticipation for their classroom Valentine’s Day parties when they are allowed to pass out and receive cards; play games, and eat delicious sugar-filled treats. While this time of the year can be difficulty to enjoy as we’re trudging through the snow covered streets, try to take time to enjoy the season and help your child to spruce up her fine motor skills!

5 ways to turn Valentine’s Day into a platform for improving fine motor skills:

  1. Cutting: This year, instead of buying pre-made cards from the grocery store, help your children cut their own cards from their favorite colored construction paper. For the younger kids, cutting straight lines for a square or cutting across a piece of paper to create smaller squares is the first place to start. For kiddos who are older (4 ½- 6), try to encourage them to cut simple shapes including circles or hearts. If your child is up for the challenge, encourage her to cut out the shape using a hole-puncher. The resistance that the hole puncher provides and repetitive motion to cut the entire shape will surely improve your child’s hand strength. Cutting is an excellent way to improve hand strength, bilateral coordination, visual motor skills, and fine motor planning.
  2. Writing Name: Making Valentines cards is an excellent way for your child to practice writing her name. Practice and repetition is key in building new foundational skills. What a better way to provide repetition than asking your child to sign a card for all of her classmates? If a child needs more help, try to show her how you would write her name, letter by letter, on a separate piece of paper. In your child’s handwriting skills are advanced, encourage her to write a short message to her best friends. The more she practices, the better her handwriting will become!
  3. Gluing: Gluing is another way to promote fine motor skills and hand strength. If your child chooses to use a glue stick, encourage her to use her dominant hand with the same grasp pattern that she uses for writing and coloring activities with her pencils and markers.
  4. Stickers and Stamps: Placing stickers on cards can also help your child to improve her fine motor control. Bending and manipulating a sheet in order to peel the desired sticker from the page and manipulating the sticker to place it on her Valentine takes a lot of patience, bilateral coordination, and fine motor planning.
  5. Folding: Folding is a very challenging activity for a lot of kiddos. Practicing manipulating paper so that the sides match up while folding and stabilizing the two ends together to create a crease in the middle of the paper requires a lot of visual and fine motor planning.

Valentine’s Day, as with many other holidays, affords children an opportunity to practice their fine motor skills. There should not be any limits to their creativity in making cards for their friends. Encourage them to practice new and emerging fine motor skills this season as they’re creating their cards!

Relaxation Strategies for Children

How do we teach our children to relax and self-soothe in a society that is inundated with constant stimuli? How do we re-frame the evil term “boredom” into an opportunity to make peace with our inner thoughts and feelings and calm our body? Often times, even adults, need prompting to relax and take a load off.

Here are some examples of activities that both you and your children can engage in to “recharge your batteries” and face the world with a more balanced mindset:

1. Mindfulness—Easier said than done. Mindfulness is the practice of connecting the mind and body to enhance attention and focus to the task at hand.  It means living in the moment and quieting out other “noise” to focus your attention moment to moment. This is a nonjudgmental practice that incorporates all the senses to be fully present. Two of my favorite ways to practice mindfulness are when you are eating or bathing.

  • Eating. We commonly eat in transit, in front of the TV, talking with others, or while multitasking. When we don’t focus on just the act of eating we miss a lot of cues such as satiety, flavor, texture, etc. Practice mindfulness when eating. Prepare your food and sit in a quiet space. Before indulging your food notice your body cues about the food. Are you starving, craving salt, is your stomach growling. Still, before consummation, notice the color of your food, the texture of your sandwich, the way the sandwich smells. We are wanting to eat with all our senses. Take a bite. What does it taste like and smell like? How does the meat and cheese and bread feel in your mouth? How many bites does it take to swallow? What does the sandwich feel like in your stomach? You get the picture. When we focus on the experience of eating in the moment we are more attune to how we feel and our mind and body and in connection.
  • Bathing. The same can be said for bathing. Notice how the water feels on your body, the temperature, the texture. Notice the smells of the product and how it feels to massage your scalp full of shampoo. Remember, use your senses to be present in the experience and try and steer clear of other intrusive thoughts that may enter about your upcoming day.

2. Music—Music can be such a relaxing outlet but make sure that the music matches the mood that you are seeking. Kids commonly want to relax to Top 40 hits, Hip Hop, or other high energy music but this in fact does not aid in relaxation as the body will mirror the energy it is hearing. If you truly want to relax, I recommend jazz or classical in addition to natural noises provided by a sound machine (waves crashing, rain falling, rainforest, etc.). Listening to music can help kids relax in times of transition (after school before homework, after homework and before bed) or when they are emotionally triggered.

3. Deep Breathing and Muscle Relaxation—Relaxing the body and calming our breath can enhance relaxation either when someone is emotionally triggered to be upset or anxious, during transitions, or prior to upcoming stressful events. Deep breathing requires breathing in through your nose for 5 seconds, holding the breath for 5 seconds, and exhaling the breath through the mouth for 5 seconds. Repeat this 5 times. Muscle relaxation includes tightening and then releasing various muscle groups. Sit in a chair or lay down in a quiet space. Start from the bottom of the body and work your way up. Squeeze your feet and toes tightly for 10 seconds and then release. Squeeze your calves for 10 seconds and then release. Squeeze your thigh muscles for 10 seconds and then release. Continue up the body. By isolating each individual large muscle group you are calling your attention to that part of the body and scanning it to release any tension or stress. You can use these strategies when you want to relax or you can make these into habits and incorporate them into a daily routine.

Click here for 10 ways to help your child unwind before bed.



What is Co-Treating?

You may have heard your therapist say, “I think a co-treat would be a great option for your child!” But what does that really entail? Will your child still be getting a full treatment session? Will his current and most important goals be worked on? Will he benefit as much as a one-on-one session? When a co-treatment session is appropriate, the answer to all of those questions is…YES!

What is a co-treatment session?

Co-treatment sessions are when two therapists from different disciplines (Speech Therapy (SLP), Occupational Therapy (OT), Physical Therapy (PT), etc.) work together with your child to maximize therapeutic goals and progress.

When is a co-treatment session appropriate?

When the two disciplines share complimentary or similar goals.

EXAMPLE: Maintaining attention to task, executive functioning, pragmatics, etc. Playing a game where the child needs to interact with and attend to multiple people while sitting on a stability ball for balance. [all disciplines]
*When children have difficulty sustaining attention and arousal needed to participate in back-to-back therapy sessions.
EXAMPLE: Working on endurance/strength/coordination while simultaneously addressing language skills. Obstacle courses through the gym while working on verbal sequencing and following directions. [SLP + PT or OT]
*When activities within the co-treatment session can address goals of both disciplines.
EXAMPLE: Art projects can address fine motor functioning as well as language tasks like sequencing, verbal reasoning, and categorizing.
*When a child needs motivations or distractions. [OT + SLP]
EXAMPLE: Research has shown that physical activity increases expressive output. Playing catch while naming items in category or earning “tickets” for the swing by practicing speech sounds.  [PT or OT + SLP]
EXAMPLE: PT’s need distraction for some of their little clients who are working on standing or walking and working on language through play during these activities works well. [PT + SLP]

Why co-treat?

  • Allows therapists to create cohesive treatment plans that work towards both discipline’s goal in a shorter amount of time.
  • Allows for therapists to use similar strategies to encourage participation and good behavior in their one-on-one sessions with the child.
  • Allows for therapists to collaborate and discuss the child’s goals, treatment, and progress throughout the therapy process. Together, they can consistently update and generate plans and goals as the child succeeds.
  • Aids in generalization of skills to different environments, contexts, and communication partners.
  • Allows for problem-solving to take place in the moment. For example, an extra set of hands to teach or demonstrate a skill or utilizing a strategy to address a negative behavior.

Co-treatments sessions can be extremely beneficial for a child. There are endless ways therapists can work together to promote progress and success towards a child’s therapeutic goals.. However, co-treatments may not always be appropriate and are only done when the decision to do so is made collaboratively with the therapists and the parents.

Contact us for more information on the benefits of co-treating in therapy sessions.

Tipper vs. Dipper: How to Produce /S/ and /Z/ Speech Sounds

“Speech” can be thought of as verbal communication. It is the set of sounds that we make (using our voice and our articulators) that comprise syllables, words, and sentences. Speech alone carries no meaning, it is merely sound. Most speech sounds are mastered by 8-9 years old, with different sounds emerging at different ages.

/s/ and /z/ speech sounds can be challenging for many children. This sound is typically mastered close to 5 years old, however some children may continue to struggle past that point. When producing /s/ and /z/, there are 3 main factors to consider: place, manner, and voicing.

Place of Production:

When producing /s/ and /z/ sounds, most people can be categorized as “tippers” or “dippers.” Tippers will bring their tongue tip up to touch their alveolar ridge (the ridge behind our top teeth), whereas dippers will bring their tongue tip down towards their bottom teeth, or anywhere in between. Both placements are correct so long as the tongue stays at midline behind the teeth. Each individual will find which placement works best, however if children struggle with placement an interdental (between the teeth) lisp may result.

Manner of Production:

The /s/ and /z/ sounds are classified as “fricatives,” or pushing air out continuously through a small opening. Many children will have difficulty with the manner of /s/ and /z/ production, and will “lateralize” their airflow, resulting in a lateralized lisp.

Voicing:

/s/ and /z/ place and manner of production are identical, however these two sounds differ when it comes to voicing. /s/ is the voiceless pair to /z/’s voiced sound. For example, when producing an /s/ sound, our vocal chords are off (not vibrating), however when producing a /z/ sound, our vocal chords are on and vibrating. Try it – put your hand on your throat and feel the vibration when producing a /z/, and feel the difference when producing an /s/! Many children will understand the difference between the two sounds but may substitute one for the other.

If your child has difficult producing our “snake” sound (/s/) or our “bee” sound (/z/) a licensed speech-language pathologist can help!

Click here for more blogs on sound production: /m/, /k/ and, /b/ and /p/.

Click here for a list of books to help with specific sound productions.

Baby Food Pouches: Bad for Baby’s Health?

A recent statement from the American Academy of Pediatric Dentistry warns parents of the possible side effects to prolonged usage of baby food pouches. They compare the squeeze pouches to that of giving babies juice in sippy cups and bottles, and they indicate that tooth decay may develop if babies are given frequent access to the pouches.

What Harm Can Baby Food Pouches Cause?

The squeeze pouches, while convenient for families on the go, often contain sugary fruit blends which can reek havoc on developing teeth. Over time, the constant exposure of the foods directly to the teeth may begin to break down tooth enamel. However, further research will determine if there is a true correlation between the squeeze pouches and cavities in young children. It is indicated that if parents do allow for their children to eat from the pouches, that they continue to follow the recommendation  of brushing their children’s teeth 2x per day and giving them water and milk to drink instead of juice.

Should I Allow My Child to Use Baby Food Pouches?

While the jury is still out on the actual effects of the pouches on little teeth, the old adage of “everything in moderation” holds true. Busy parents should not be discouraged from using the pouches in a pinch, but spoon feedings are still preferred. Feeding your child from a spoon not only contributes to functional oral motor development, but increases the social aspects of mealtimes. Parents are able to connect with their children during meals and if children are allowed access to constant drinking from the pouches, they are missing out on opportunities to practice developmental feeding skills when fed via spoon.

Click here to read more about oral motor and feeding difficulties in children.

How to Explain a Language Disorder to a Teacher

Of all the categories available under IDEA law, language impairments are often one of the most difficult to understand. It is not a surface level issue and is often lost in the shuffle. Explaining what a language disorder is and how it will impact your child to a teacher can be tricky. Here are some tips.

How to Explain a Language Disorder to a Teacher:

  1. Language disorders come in a wide variety of cases. Each child will present differently and as an advocate, you need to do your best to describe your child’s needs specifically. Language disorders can impact a child’s ability to verbally express themselves efficiently, effectively and with appropriate grammar. It can result in difficulty understanding sentences, following directions, asking/answering questions or in a number of other impairments.
  2. Enlist the school Speech Language Pathologist. Ask for help in explaining the disorder to the teacher and ask for ideas. Discuss options for adjustments and supports for your child like a visual schedule, repetitions of the directions or having him repeat the direction back to the teacher to ensure comprehension. Many school districts or state programs have materials and resources that can educate teachers on strategies to ensure better classroom learning.
  3. Remind the teacher to notice how your child interacts socially. Teachers will be able to identify a child that is isolating themselves from peers secondary to trouble communicating with them.
  4. Discuss the difference between listening, understanding and attending. One of the biggest complaints of teachers will be “He’s not listening to me!” As often as not, your child does not understand the direction provided and is not complying simply because he does not know what is required of him. It can be very frustrating to have difficulty communicating effectively and patience will go a long way.
  5. Know your child’s IEP or 504 plan and take the opportunity to discuss it with the teacher. Be specific about the types of services and accommodations he will receive and what they will look like in the classroom.

Remember, be proactive and provide as much information up front about your child and his diagnosis to avoid potential difficulties. Refer to this page from the National Dissemination Center for Children with Disabilities for 8 Tips for Teachers who have students with speech and language issues in the classroom.

ADHD and Picky Eating

Attention Deficit Hyperactivity Disorder (ADHD) is a very common diagnosis seen in a pediatric therapy clinic. It is not uncommon for parents to report difficulty with their child with ADHD and picky eating. The most common complaints for parents of children with ADHD who have trouble with mealtimes are distracted eaters, decreased appetites, and picky eaters.

Distracted Eaters

Distracted eaters are attending to external stimuli (e.g., TV, other conversations) or internal stimuli (e.g. lost in own thoughts) during mealtimes. Here are some strategies to help:
  • Decrease the external distractions: Eliminate other distractions like the TV or videogames playing in the background, dogs running around, telephones buzzing, etc. Have your child face other family members and face away from the busy kitchen area to encourage attention in the appropriate direction. Require your child to stay in the room and at the table for the duration of the mealtime.
  • Decrease internal distractions: Use solid placemats, plates, and utensils when eating. Colorful patterns or animated pictures can be distracting. Sometimes having a child engage in motor activities before sitting for a meal can help regulate him to be ready to sit and attend for a period.

Decreased Appetites

An almost universal side effect of stimulant medication used for ADHD is the suppression of appetite. In particular, the dextroamphetamines (e.g., Adderall, Vyvanse) seem to have the highest incidence of suppressing appetite. Here are some tips to manage decreased appetites:

  • Give the morning medication dose after breakfast to ensure an adequate meal is consumed before the side effect of decreased appetite sets in.
  • Provide proteins during lunchtime and small, healthy snacks during the day. Smaller snack-sized portions are often more visually manageable for children than an entire plate of food. Protein shakes are good options during this time.
  • Serve a larger dinner meal at the end of the day when the drug has worn off. Kids will typically make up many of the calories lost during the reduced daytime eating with a larger evening meal.
  • Consider not using the drug on weekends if your child continues to struggle with this side effect. Allowing one or two days of increased calories a week can counteract for a decreased intake during the weekdays.

Picky Eaters

Kids can be picky eaters for a variety of reasons. Evolution dictates children be wary of trying new things in order to survive. They may have a negative association with eating or have sensory issues causing anxiety with certain foods. Cognitive and developmental disorders also may impact the types of food eaten. Similarly, kids with low tone (i.e., decreased strength, coordination, and postural control) may be picky about the foods that are easier for them to eat.

Any of the above issues may co-occur with ADHD.

Here are some strategies to help your picky eaters:

  • Meal Routine: Too much grazing throughout the day may result in a lack of hunger at specific mealtimes. Three meals and two snacks should be offered per day to ensure hormonal balance triggering “hunger”. There should be a beginning, middle, and end to every meal.
  • Exposure: The best role model for food it you! Having family dinners and presenting children to a variety of foods that you, as caregivers, model eating is a critical way to expose your child to the idea that food isn’t scary.
  • Posture: Ideal eating position is hips, knees, and ankles positioned at 90 degree angles. Boosters/chairs should be utilized to ensure the child is at the appropriate table height. If your child has a hard time remaining in a chair, move-and-sit cushions can provide sensory input to help your child stay seated for a longer.
  • Desensitize: For some children, decreasing the sensitivities of the mouth may help with food intake. Using a vibrating tooth brush, a chewy tube or a washcloth tug-o-war are good options to desensitize the child.
  • Get the kids involved: Taking the kids with you when you grocery shop and letting them help pick out the foods will help with compliance. Encourage your child to help with creating the menu, choosing the foods, and preparing the meal are other ways to help your child become involved in mealtimes.

Children with ADHD may have a difficult time with mealtime. Remember to be patient and do the best you can to provide them as many healthy food options as possible. The rest is up to them. For other tips on how to parent a child with ADHD, click here.


Understanding Your Child’s Growth Chart

Growth charts are tools that medical professionals use to track trends in your child’s growth. They are also used to diagnose conditions that indicate growth issues, such as obesity or failure to thrive. For more information about how growth charts are used and interpreted, read on.

Understanding when to use which growth chart:

The Centers for Disease Control and Prevention’s website provides growth charts used for the majority of typically developing kids. It is important that medical professionals use the right growth chart for their patient.

  • For kids < 2 years old:  The growth charts labeled 0-2 years old from the World Health Organization should be used until age two. Recently, growth charts for this age were updated using data that is representative of a wider range of ethnicities and primarily breastfed babies.
  • The “Birth-36 months” growth charts:  These should be used when the child’s length is measured recumbently (lying down). If the practitioner is able to get repeatedly accurate standing height measurements of the child age 24-36 months, then the “2-20 years old” growth chart would be used to plot height and BMI. Weight-for-length is plotted using recumbent length, and BMI is calculated and plotted using standing height.
  • The “2-20” growth charts: These are used for typically developing kids in this age range, and for kids ages 2-3 if their height has been measured standing up. These are also used for kids with special needs or specific diagnoses, such as Down Syndrome and Cerebral Palsy, according to recent recommendations. However, it is imperative that a trained medical professional interpret growth of kids with special needs on standard growth charts. I find it useful to use both standard growth charts and growth charts designed for kids with specific diagnoses as multiple pieces of information in overall growth assessment.

BMI Measurements:

  • Weight for Length and BMI. This single data point is very important, as opposed to the other growth measurements where the overall trend is more important. These growth charts are used diagnostically as follows:
  • Weight-for-length or BMI < 5th percentile. This is considered “underweight”, which means that the infant or child does not have adequate body mass for how long he or she is. Kids who are underweight may be at higher risk for nutrient deficiencies, compromised immune function, lethargy, impaired cognitive development, and more. These cases should be referred to a pediatric dietitian. If underweight status worsens over time or is a chronic issue, the child may be diagnosed failure to thrive.
  • BMI 85th – 94th percentile. This is diagnosed as overweight. Weight loss is not recommended for these kids, but rather weight maintenance. Then as their heightcontinues to increase, the BMI will normalize.
  • BMI > 95th percentile. This is diagnosed as obese. These kids should be referred to a pediatric dietitian for assessment and a weight management plan.
  • Note, children under 2 years old are not diagnosed overweight and obese. This is because growth patterns are very different in infants than older kids. Many factors should be taken into consideration by the trained medical professional for infants who have weight-for-length > 95th percentile before changes to their diet intake are made.

“Within Normal Limits”

This phrase describes the percentiles of the growth chart that are considered to be within a normal range of growth for kids that age. The normal range concept applies mostly to the BMI growth chart and the Weight-for-Length growth chart. BMI is within normal limits if it falls between the 5th and 85th percentiles.

It’s all about the trend.

When it comes to weight and length or height, in most cases, the bigger picture is more important than individual measurements. This means that as long as your child’s growth is “tracking along its usual curve”, his or her growth is probably normal for them. If weight or length/height drop or increase more than two growth channels over a span of 6 months, this is cause for concern and needs further evaluation by the pediatrician and dietitian.

Click here for strategies to talk to your kids about weight and healthy eating.