Motor Skills

What are Motor Skills?

Motor skills are any skills that are associated with muscle activity and which provide the body with Motor Skillsmovement commands. These are learned skills which combine to produce purposeful, efficient action. Motor skills can be broken down as such: fine motor skills are skills that involve the use of smaller muscle groups to produce tasks like cutting and writing; and gross motor skills are skills that involve the use of large muscle groups to produce whole body movements such as crawling, balancing and walking.

How do I know if my child suffers from dysfunctional motor skills?

Dysfunction in motor skills can be caused by a number of issues–a prominent one being nervous system disorders. If your child exhibits clumsy movements, is poorly coordinated or often trips and falls, it may be a result of motor skill dysfunction. When basic muscle tone is too low or too high, one’s motor skills can also become impaired. A baby whose muscular tone is too low (also known as hypotonic) may present a ‘rag doll’ appearance, lacking in movement, body structure and energy. Young children with low muscle tone may often prefer sitting, and may have poor posture–they may also prefer to lean against something, rather than support their own body weight.

By contrast, when muscular tone is too high (also known as hypertonic) children may appear somewhat stiff and may have trouble moving in a natural way. They may also have difficulty demonstrating smooth movements. Children who have difficulty performing certain motor tasks may become discouraged and express their frustration verbally. Parents might consider keeping a closer eye on their child’s reaction to physical activity, and notice if their child uses language like “I hate to draw” or “I hate sports.” This may be a sign of an underlying dysfunction in motor skills.


How do motor skills develop and progress in a child?

Motor skills develop in stages, often first strengthening in the top of the child’s body and working downward. A child first gains eye and face control, followed by the strengthening of neck muscles in order to hold the head up. Once the body establishes neck strength, the shoulders, upper arms and hands begin gaining muscle strength. The torso then strengthens, followed by the hips, pelvis and legs.

How do I treat my child’s dysfunctional motor skills?

Practice and repetition are the most useful tools when helping a child improve his motor skills. Practicing simple tasks such as handwriting and coloring are important. If needed, assistive devices such as pencil grippers or shoe orthotics can help the child along his rehabilitative process. Low-impact athletic activities like swimming, walking and yoga are helpful ways to incorporate exercise into your child’s daily routine.

Our approach to dysfunctional motor skills at North Shore Pediatric Therapy

North Shore Pediatric Therapy uses a multi-disciplinary approach in which both a physical and occupational therapist works with your child if you or your pediatrician suspect a dysfunction in motor skills. A physical and occupational therapy examination usually includes the Bruininks-Osereysky Test of Motor Proficiency (BOT). This is a standardized instrument that is used to measure both gross and fine motor skills in children. Once an assessment is completed, the physical or occupational therapist will create goals and a home exercise program for your child in order to ensure that any newly learned motor skills carry over into the home and school environments as well.


Learning Disability

What does it mean to have a Learning Disability?

A learning disability (which is also referred to as a learning disorder or a learning difficulty) is a general Learning-Disability-Homework-Boyterm which refers to one’s significant difficulty in acquiring and/or using his listening, speaking, reading, writing, reasoning or mathematical abilities. Learning disabilities are neurological disorders that affect the brain’s ability to receive, process, store, and respond to information. The most common area in which a child may develop a learning disability is reading; such a disorder is commonly called dyslexia. Individuals with learning disabilities can be of average or above-average intelligence, but have difficulty utilizing academic skills. With learning disabilities, there is a discrepancy between one’s ability to learn and his level of achievement.

How do I know if my child has a learning disability?Download Your Academic Progress Checklist

You may consider getting your child help if he/she: has trouble performing specific types of activities or completing tasks; is slow to learn new skills; relies heavily on memorization; avoids tasks pertaining to more difficult subjects; works at a slow pace; has repeated struggle and frustration with learning over an extended period of time; poorly grasps abstract concepts; has a history of family learning disabilities.

Symptoms vary with each child and each specific disability.

How will the condition progress if left untreated?

Without the proper support and intervention, children are at risk for continual struggle with academic achievement. The child’s self-confidence can also be negatively affected if he fails to understand that his learning disability is not a reflection of his intelligence, but rather that he simply learns differently from his peers.

How can I help my child overcome a learning disability?

Children with learning disabilities can certainly be taught to overcome their difficulties. Learning and academic successes are achieved through careful identification, specialized instruction, and appropriate accommodations. Because learning disabilities differ for each child, individualized assessments and instructions are necessary to understand the child’s unique challenges and needs. A basic, common approach is to teach the child learning skills by building on the child’s abilities and strengths while simultaneously correcting and compensating for his disabilities and weaknesses. Speech and language therapists and specialists may also prove valuable in helping your child overcome his difficulties.

Our Approach at North Shore Pediatric Therapy:

At North Shore Pediatric Therapy, a neuropsychologist can evaluate your child to provide the most accurate, appropriate, individualized diagnosis. Therapists will work with your child’s school to create an excellent learning environment with potential necessary accommodations. Multi-sensory programs are also available at North Shore Pediatric Therapy, and they are specifically designed to best treat your child, based on his individual needs and specific learning disabilities.

Food Intolerance

What is Food Intolerance?

Food intolerance is an abnormal physiological response to food that does not involve an actual allergy.Food-Intolerance

What are some symptoms of food intolerance?

It can be difficult to determine the offending food causing an intolerant reaction, because if the immune system is involved, the response is likely to be GI-mediated and takes place slowly. Symptoms of food intolerance vary greatly and can be mistaken for the symptoms of a food allergy. Symptoms can affect the skin, respiratory tract, and gastrointestinal tract (GIT), either individually or in combination. Symptoms on the skin may include skin rashes, urticaria (hives), angioedema, dermatitis, eczema. Respiratory tract symptoms can include nasal congestion, sinusitis, pharyngeal irritations, asthma, and an unproductive cough. GIT symptoms include mouth ulcers, abdominal cramp, nausea, gas, intermittent diarrhea, constipation, and irritable bowel syndrome.

How can I help treat my child’s food intolerance?

The prognosis of children diagnosed with food intolerance is good. Patients normally respond to specialized diets eliminating specific food proteins.

Our Approach at North Shore Pediatric Therapy

Our dietitians work with your healthcare team to identify foods that may be causing problems. We start with a basic diet for your child that includes all food groups and teach you how to choose foods that meet your child’s nutritional needs. Food elimination diets are also used to exclude food proteins likely to cause reactions. These elimination diets are not everyday diets but are intended to isolate problem food proteins. Once all food intolerances have been identified, our dietitians can prescribe an appropriate diet for the individual to avoid foods with those proteins that cause the intolerances. We also provide lists of suitable foods that are available from various restaurants and local grocery stores. We will ensure adequate nutrition is achieved with safe and healthy foods!

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Food Allergy

What is a Food Allergy?

A food allergy is an immunological hypersensitivity, which occurs most commonly in response to foodFood-Allergy proteins that are mistaken as harmful: a defense system is created to fight them off. The most common foods which render allergic reactions are: eggs, milk, seafood, shellfish, tree nuts, soy, wheat, and peanuts.

What are some symptoms of a food allergy?

True allergies are associated with a fast-acting immunoglobulin E (IgE) antibody response. These allergic reactions have an acute onset (from seconds to one hour) and may include: soft tissue swelling (usually around the eyelids, face, lips, and tongue), severe swelling of the tongue as well as the larynx (voice box), hives, itching, nausea, vomiting, diarrhea, stomach cramps, nasal congestion, wheezing, shortness of breath, or anaphylactic shock.

How can I help treat my child’s food allergy?

Food allergies are treated by avoidance diets: the allergic person avoids all forms of the food to which they are allergic. For people who are extremely sensitive, this may involve total avoidance of any exposure to the allergen, including touching or inhaling the problematic food or touching any surfaces that may have come into contact with the food.

Our approach to a food allergy at North Shore Pediatric Therapy

Our dietitians work with your healthcare team to identify foods that may be causing problems. We start with a basic diet for your child that includes all food groups, and we teach you how to choose foods that meet your child’s nutritional needs. Food elimination diets are also used to exclude food proteins likely to cause allergic reactions. These elimination diets are not everyday diets but are intended to isolate problem food proteins. Once all food allergies have been identified, our dietitians can prescribe an appropriate diet for the individual to avoid foods with those proteins.   We also provide lists of suitable foods that are available from various restaurants and local grocery stores.  We will ensure adequate nutrition is achieved with safe and healthy foods!

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Childhood Depression

What is Childhood Depression?

All children can experience sadness or moodiness from time to time, but if symptomsChildhood Depression persist or worsen and interfere with school, family relationships, play, and daily life activities, these may be signs of childhood depression.

What are some symptoms of childhood depression?

Symptoms of childhood depression may include:

  • Sadness
  • Irritability or anger
  • Fatigue or low energy level
  • Problems with eating (either loss of appetite or overeating)
  • Problems with sleep
  • Poor self-esteem/loss of confidence
  • Feelings of hopelessness
  • Poor concentration/loss of focusDownload our Childhood Depression Check-List
  • Thoughts of self-harm/death

Does childhood depression represent itself in multiple ways?

There are many variations of childhood depression that include:

  • Major depressive disorder
  • Dysthymia
  • Depressive, anxiety, and mood disorder not otherwise specified
  • Adjustment disorders
  • Bipolar disorder

(Untreated, chronic anxiety disorders can lead to depression, as well).

How can I treat my child’s depression?

Good treatment always starts with solid differential diagnosis. Behaviors and other conditions can sometimes mask, or exist concurrently with, depression. It is critical to pinpoint which condition(s) are observed and which is driving a child’s behavior.

According to research studies, a “best practice” treatment for childhood depression is cognitive behavior therapy, which teaches children to adjust their thinking patterns in order to improve their moods. Skills taught include: thought blocking, reducing thinking errors, positive self-talk, relaxation, and positive visualization methods. If therapy alone is insufficient in improving a child’s mood and functioning, it is important to consult with a psychiatrist for medication management.

Our approach at North Shore Pediatric Therapy

We focus on a cognitive behavior approach. We can supplement this approach, depending on the age, personality, and needs of a child, with play therapy, anger management techniques, social skills training, therapeutic games, and books. Parents are our partners, so we value and encourage communication and family involvement at every stage of the treatment process. We work closely with pediatricians and psychiatrists in order to monitor the efficacy and side effects of medication. We consult and collaborate with schools and other agencies, as appropriate, in order to enhance our clients’ functioning in all areas.

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Central Auditory Processing Disorder

Central Auditory Processing Disorder

What is Central Auditory Processing Disorder?

Auditory processing refers to what we do with the messages that we hear. A Central Auditory Processing Disorder (CAPD) occurs when there is a breakdown in auditory memory, attention, cognition, and hearing. A Central Auditory Processing Disorder can affect children who have normal peripheral hearing but have difficulty coordinating auditory information and synthesizing it accurately and effectively by the central auditory mechanism. Children with a Central Auditory Processing Disorder may co-exist with other difficulties in the central nervous system, including learning disabilities, speech-language disorders, ADHD, and other developmental disorders.

What are some symptoms of Central Auditory Processing Disorder?

Symptoms may include any of the following:

  • Decreased ability to localize sound
  • Poor auditory discrimination
  • Reduced auditory integration
  • Poor auditory sequencing skills
  • Difficulty listening in the presence of background noise
  • Decreased auditory attention
  • Poor auditory memory

Our Approach at North Shore Pediatric Therapy

An initial diagnosis of a Central Auditory Processing Disorder is made following a comprehensive audiological evaluation, which is completed by a licensed and ASHA accredited audiologist. The assessment includes a battery of tests designed to examine how well the skills in the central auditory mechanism in the brain stem are working. The speech-language pathologists at NSPT work closely with the audiologist, following the diagnosis, and collaborate on an ongoing basis. Children with a Central Auditory Processing Disorder benefit from working closely with both speech and language pathologists, as well as occupational therapists. Professionals at North Shore Pediatric Therapy can collaborate with teachers and other professionals and provide formal school observations to help set up a successful learning environment for your child. In addition, compensation strategies can be provided and taught within the context of the classroom. The therapy will include activities to increase auditory closure skills, vocabulary building, discrimination skills, grammatical rules, meta-cognition, and auditory perceptual training.

How can I help treat my child’s Central Auditory Processing Disorder?

Children with CAPD benefit from both direct intervention and remediation techniques aimed at improving auditory skills, assistance in learning compensatory strategies for auditory processing, and making necessary modifications in their environment to make them successful. Classroom and home recommendations can be made by your child’s SLP in order to facilitate improvements with auditory perceptual skills in the school and home environment. Children with CAPD tend to learn well using a multi-sensory approach, and follow through on tasks more consistently when verbal instructions are clear and concise. Listening breaks are also recommended for children, in order to allow them time to process auditory information and to minimize auditory fatigue throughout the day.


Bilateral Coordination

What is Bilateral Coordination?

Bilateral coordination is the use of both sides of the body together to perform a task. This can mean using Bilateral Coordinationthe two sides of the body for the same action (like using a rolling pin) or using alternating movements (like climbing stairs). The practice of using both the right and left sides of the body together is important for activities such as: writing, cutting, typing, throwing and catching a ball, riding a bicycle, and most academic and gross motor activities.

What are some symptoms of poor bilateral coordination?

Poor bilateral coordination skills can include: a child not crawling as a baby, a child beginning to walk at a late age, clumsy motor skills and poor rhythm (not being able to keep a beat). You may also notice a child not establishing a hand dominance (i.e. right-handedness or left-handedness) at 4-5 years of age.

How does poor bilateral coordination affect my child?

Children with poor bilateral coordination are at risk of performing poorly in school activities such as art and other fine motor activities. They also may lag behind in gym class and other sports-related activities. Hence, early intervention is key to achieving success!

How can I help treat my child’s poor bilateral coordination?

Bilateral coordination can be facilitated by any activity that utilizes both the right and left arms and/or legs working together to complete a task. This can include clapping games, playing two-handed musical instruments such as symbols, practicing tearing and cutting objects, galloping, riding a bicycle, and tossing a ball.

Our approach to bilateral coordination at North Shore Pediatric Therapy

We use a multi-disciplinary approach involving both an occupational and physical therapist to meet your child’s needs. With our energetic team of therapists and specialized equipment, we will set up an individualized program to produce results for your child! A home exercise program will also be implemented to allow your child to practice, demonstrate, and utilize his/her newly developed skills at home and school.


Attention Deficit Hyperactivity Disorder (ADHD)

What Is ADHD?

According to the DSM-IV (2000), Attention-Deficit/Hyperactivity Disorder, or ADHD, is characterized by a continual pattern of inattention and/or hyperactivity-impulsivity.  Symptoms occur frequently and are more severe than those typically observed in an individual at a similar developmental level.  According to the DSM-IV, ADHD is prevalent in 3% – 7% of school-age children.  To receive a diagnosis for this condition, symptoms must be present before the age of seven and must have occurred in at least two different settings.  Furthermore, symptoms must significantly impair the individual’s social, academic, or occupational functioning.


What are some symptoms of ADHD?

Symptoms of inattention include: failing to pay attention to details; making careless mistakes in schoolwork, work, or other activities; having difficulty in maintaining attention during tasks or activities; appearing as though not listening when someone is speaking to him or her; inconsistently complying with instructions; having difficulty with organization; having difficulty with tasks or activities that require a heightened mental effort; losing items; becoming easily distracted by stimuli in the environment; and forgetfulness (DSM-IV, 2000).

Symptoms of hyperactivity include: fidgeting with hands or feet; squirming while sitting; leaving a seat when the expectation is to be seated; excessively running about or climbing in situations where it is deemed inappropriate; difficulty in quietly engaging in leisurely activities; described as “on the go”; and talking excessively.

Some examples of symptoms of impulsivity include: giving answers before questions have been completed; having difficulty awaiting one’s turn; and interrupting others.

How might I know if my child is in the early stages of developing ADHD?

Since the onset of ADHD symptoms begin before the age of seven, parents, teachers, and other caregivers may observe excessive motor activity when their child is a toddler.  It is important to distinguish this motor hyperactivity from the activity of a typical toddler.  Typically, a diagnosis of ADHD is made during the elementary years because symptoms may become accentuated when the demands of school are heightened.  As the child enters adolescence, the condition usually remains stable.  For most individuals, symptoms (especially motor hyperactivity) become less pronounced during late adolescence and adulthood (DSM-IV, 2000).

What can I do to help my child?

Behavioral interventions and/or pharmacological interventions are typically used to treat symptoms of ADHD.  Behavioral programs can be developed and individualized according to the individual’s current level of functioning.  Goals are then established in order to maximize the individual’s relationship development, performance at school, or work, and home.  Goals also include decreasing disruptive behaviors and increasing self-esteem and independence.  Stimulant or non-stimulant medication may also be used to facilitate treatment of the symptoms.


Our approach at North Shore Pediatric Therapy

We offer a multi-disciplinary team with a neuropsychologist who can help diagnose ADHD and advocate for proper school support.  Additionally, we have a team of behavior analysts who can develop individualized interventions to help the child reach his/her full potential in all settings (e.g. home, school, extra-curricular activities).  Behavior analysts are available to work in multiple environments so that the child is fully supported.  Our occupational therapists will also help the child develop by addressing his/her self-regulation, providing sensory strategies to better cope with changes in his/her environment.

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Adaptive Behavior

Adaptive Behavior

What is Adaptive Behavior?

Adaptive behavior is behavior that responds appropriately to environmental stimuli.  When planning a program to decrease inappropriate, maladaptive behaviors, it is critical to include objectives to increase replacement, adaptive behaviors.  Behavior analysts consider all elements that may be reinforcing maladaptive behavior in order to determine an adaptive behavior that will serve the same reinforcing function.  For example, in a classroom where a child receives his teacher’s attention by screaming, a behavior analyst would look to decrease the screaming by teaching the child a new adaptive response, such as raising his hand.  This would enable the child to receive the same reinforcing value sought by his screaming—the teacher’s attention.

To learn more about Adaptive Behavior,

We’re happy to answer any questions you have.

Kaufman Method for Childhood Apraxia

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Kaufman Method for Childhood Apraxia

Apraxia of Speech is a motor speech disorder which results in poor coordination of oral-motor movements required to produce and combine speech sounds. Childhood Apraxia of Speech (CAS) is a neurologic motor

speech disorder that is idiopathic in nature and unrelated to muscle weakness or strength. Children with apraxia present with significant difficulty producing sounds, syllables, and words secondary to poor motor planning and sequencing. One of the treatment methodologies used at NSPT is to implement the Kaufman Method. This treatment strategy was developed by Nancy Kaufman, M.A. CCC-SLP, who is a leading expert in the treatment of children with developmental apraxia of speech.

The Kaufman Method varies from traditional articulation and phonological techniques in that it teaches sound approximations using a specific hierarchy. Children are taught word approximations first, in order to help reinforce their ability to successfully increase motor coordination. Once the basic patterns have been mastered, more complex consonants and syllables are introduced. The teaching hierarchy is similar to how children first acquire language, as words are simplified, and more complex consonants and syllables are initially omitted. For example, the word “banana” may first be produced by a young child as “nuh,” then “nuh-nuh,” and “na-nuh.” As they master the ability to sequence more difficult sounds and syllable shapes, the word will eventually sound like the whole word, “banana.” This approach is suitable for children of varying ages and skill levels since it allows them to systematically build upon the approximations they have or are learning in order to begin using true words more consistently. The Kaufman Method also implements specific cues in order to maximize the child’s expressive vocabulary and help increase functional speech sound production.Kaufman Method

Your speech-language pathologist will develop a specific treatment plan for your child, so that your family can help improve functional skills in the home environment and reinforce what is being addressed during the treatment sessions.