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Questions About Medication For Children

For many children, therapy or accommodations are not sufficient to support their needs.  It is often that these children will need child medicationpharmacological intervention to help improve their attentional regulation, impulse control, emotional regulation and/or behavioral self control. Parents should be honest with their pediatrician about medication as well as ask several questions about ensuring the best care.

Questions Parents Should Ask When Determining If Medication Is The Right Choice For Your Child:

  1. What are the side effects of the medication? All medications have side effects and it is important to be aware of what to possibly look out for.
  2. How long should the child be on medication?  It is important to ascertain if the medication is likely a temporarily solution or long-term.
  3. What therapies would be beneficial for the child to participate in while taking medication?  It is often that medication alone is not sufficient. Children will often benefit from specific therapies and interventions to help teach emotional and behavioral regulation.
  4. Who should I tell? My advice about medication is to always inform the academic staff as to when a child starts medication. Many times, the teacher would be able to have a greater watch over the child and monitor whether or not there are experiencing any negative side effects.

Medication is often warranted in a child’s treatment regime. It is always important for parents to ask good questions and work with a treatment team in order to ensure the best success of their child’s social and emotional development.

Family History and Kids with Special Needs

If you have a brother, nephew, uncle or some other member in your family with certain special needs, you will want to be cautious and family tree mindful that many neurodevelopmental conditions have a high genetic component. Recent studies have indicated that genetics account for 70 to 80 percent of the risk of having Attention Deficit Hyperactivity Disorder. A 2004 study indicated that there is considerable evidence that demonstrates that genetics play a major role in the risk of having an anxiety disorder. It is important to realize that the risk factors are high; however, they are not necessarily 100%.  This simply means that just because a parent or relative has a neurodevelopmental disorder, it does not mean that the child will exhibit the condition. What it does indicate is that the child is at a higher risk for the condition.

As a parent, it is important to realize that your child may be at risk for a condition if a relative has that same condition. Do not be alarmed; instead, be aware. Always pay attention to any concerns, seek out advice from your pediatrician, psychologist and/or developmental therapist.

There are numerous possible warning signs for the purpose of this blog;  however, below is what to be on the lookout for:

Anxiety:

• Does the child shy away from peers?
• Does the child have sleep onset  issues?
• Does the child engage in behaviors such as picking, biting nails, pacing, etc.?
• Are there fixed routines that the child engages in?

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ADHD:

• Does the child have difficulty focusing on work?
• Does the child require a lot of redirection and repetition of information?
• Does the child make careless errors with work?
• Does the child always seem to be on-the-go?

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Autism Spectrum:

• Does the child struggle with initiating and sustaining appropriate eye contact?
• Are there language delays?
• Does the child avoid seeking out others for interaction?
• Does the child avoid engaging in nonverbal behaviors such as gesturing?

The information above should not be considered to be a diagnostic check sheet, but rather possible concerns that might require further assessment. Parents, if you know that there is a family history of a neurodevelopmental condition and you see any of the above signs or symptoms expressed in your child, it is then time to seek further guidance.

What is Applied Behavior Analysis (ABA) Therapy?

Applied behavior analysis (ABA) uses the scientific principles of learning and motivation in order to teach effectively. It focuses on theaba therapy idea that the consequences of what we do affect what we learn and what we will do in the future. ABA seeks to improve specific behaviors while demonstrating a reliable relationship between the procedures used as well as the change in that specific behavior. ABA uses positive reinforcement to increase more positive behaviors and social interactions and decrease inappropriate behaviors. Below are a list of some possible ABA teaching methods that may be used when receiving ABA therapy:

ABA Teaching Methods

  • Discrete Trial Training (DTT)
    • DTT teaches a skill by breaking it up into simplified, isolated tasks/steps. By breaking down tasks into short trials and using prompts, DTT uses the overall success rate of learning. DTT utilizes clear beginnings and ends to each trial with specific instructions and
      prompts. The trials are short, permitting several teaching trials and a number of learning opportunities to occur. In addition, using one-to-one teaching allows for individualized programming.
  • Verbal Behavior (VB)
    • VB training uses a structured and one-on-one type of teaching format. This training works to teach language to children by creating and developing connections between a word and its meaning. The following are a list of VB terms that are typically implemented:
      • Echoics occur when a speaker says something aloud and the listener repeats exactly what was said. For example, the therapist says, “Ball pit” and the child will repeat the same phrase, “Ball pit”.
      • Mands can be thought of as commands or demands, in which a person is commanding or demanding something. A mand typically results in the speaker obtaining the item that was spoken. For example, a child asking for a drink of water when he/she is thirsty and then receiving the drink.
      • Tacts can be thought of as labeling an object. When a child sees a dog and then verbally says the word “Dog”, he/she is emitting a tact.
      • Intraverbals are similar to a conversation:  A question is first asked and then an answer is provided.  For example, a therapist asks, “How are you?” and the child responds, “Good!”. Intraverbals can also involve filling in the blank. For example, the therapist says, “Twinkle twinkle little _____” and the child responds with “Star”.
  • Natural Environment Training (NET)
    • NET focuses on practicing and teaching skills within the situations that they would naturally happen. In these situations, the therapist uses naturally occurring opportunities to help children learn.  The therapist might provide a coloring page but withhold the crayons until the child requests them, giving the child an empty cup and waiting for him/her to request juice, or playing a board game but withholding the dice or spinner until the child requests it are all examples of using NET.
  • Pivotal Response Training (PRT)
    • PRT uses the natural environment for teaching opportunities and consequences. PRT focuses on increasing motivation by adding items like having the child make choices/selections, taking turns and providing reinforcement for attempts made.
  • Self-Management Training
    • Self-management training is used to help individuals increase their independence and generalization of skills without always requiring the help from a teacher or parent. This technique results in an individual being able to monitor their own behavior. The individual is taught to self-evaluate their behaviors, keep track and monitor their behaviors, and provide their own type of reinforcement.
  • Video Modeling
    • Video modeling uses repeated presentations of target behaviors so that there is not a lot of change between modeling the target behavior. Video modeling can assist individuals with working social skills, learning self-help/hygiene tasks, and understanding emotions, etc..

ABA therapy is implemented to ensure that each individual’s programs are tailored to that individual’s unique needs. Therapists will often use different assessments (i.e. functional assessment interviews, direct observations, ABLLS, VB-MAPP, etc.) to develop an ABA program that is the ideal match and addresses the individual’s specific needs.

Pragmatic Language: Building Social Skills for Your Child

What is pragmatic language? boy with truck

Pragmatic language refers to the communicative intent, rules and social aspects of language. It is the way in which language is used to communicate in a variety of different contexts, rather than the way language is structured. A major component of pragmatic language is being able to read the cues of the communication partner and following conversational rules.

How will I know if my child has a problem with pragmatic language?

Often times, children who demonstrate challenges regarding pragmatic language will have difficulties sharing, using appropriate eye contact, initiating and maintaining conversations and joining in during structured activities with peers. They may also present weaknesses when participating in “make believe” activities, have a limited variety of language that they use, have poor storytelling skills and prefer to play alone rather than with other children. Some children have trouble understanding emotions and feelings which may negatively impact their interactions with others. This may also lead to challenges with perspective taking (i.e. imagining how someone else feels).

A few ideas to facilitate pragmatic language skills at home:

  • Participate in pretend play activities with your child
  • Play simple games to encourage turn taking
  • Participate in group activities with peers
  • Create stories together
  • Practice making music with different instruments
  • Role play scenarios in which there are problems and solutions (i.e. finding a toy in a story, ordering food in a restaurant)
  • Allow your child to lead during motivating activities
  • Work on greetings with familiar people (i.e. mailman, family friend, grandparents)

Individualized treatment sessions help to encourage appropriate social awareness skills. Children benefit significantly from structured social group activities to help practice appropriate pragmatic language skills as well! For more information on ways to help encourage pragmatic language and social skills, please contact a licensed speech-language pathologist.

What is a Neuropsychologist?

Pediatric neuropsychologists are clinical psychologists who have extensive training in neurodevelopmental conditions.  We focus on learning disabled boythe assessment and diagnosis of such conditions and strive to develop the most effective interventions for a child within both home and school environments.

What types of testing do Neuropsychologists perform?

We conduct very extensive testing.  The focus of the testing is specific and is based upon concerns that parents have presented to us.  We evaluate children for a host of neurodevelopmental conditions, including Attention Deficit Hyperactivity Disorder, Learning Disorders, Autism, Social/Emotional concerns, response to medication, medical issues, etc.

Testing involves the collection of information from a variety of sources, including the parents, teachers, outside therapists, pediatrician/psychiatrist/neurologist as well as quantitative testing, in which the child would participate in a full day evaluation.  The reason why this information is gathered from so many sources is to ensure that the data we receive is consistent throughout all areas of the child’s life. It will also help to identify where the child may be struggling the most.

What happens after a Neuropsychologist performs the testing?

Once the testing is complete, the neuropsychologist will spend time integrating all the information and determine which specific areas of strength and weakness are identified.  With this information, we are able to help work with the family, outside therapists and academic team in order to create the most appropriate accommodations and interventions possible.

It is vital to realize that the neuropsychological evaluation should be an on-going phenomena.  We often request that the children return for brief follow-up evaluations every three to six months in order to track progress from therapy and help to identify whether or not there are changes to be made with the current accommodations and interventions.

Click here to find out how a Neuropsychologist can help your family or to schedule a consultation.

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5 Major Differences between an Individualized Education Plan (IEP) and 504 Plan

Your child has been identified to be falling behind in school in some way. Perhaps they are scoring below expected levels on iep and 504achievement tests or maybe they are exhibiting symptoms of inattention or become easily distracted. These symptoms may be keeping them from learning up to their potential. In another case, they may have an identified medical or emotional disorder that impacts them academically. Children can have a number of challenges that may impact them in the school environment. What can be done about these challenges? There are two formal plans that can be implemented: Individualized Education Plan (IEP) or 504 Plan. Below are five differences between the two plans:

IEP versus 504 Plan:

  1. An IEP is for children who qualify for special education services. To qualify, your child must have a documented learning disability, developmental delay, speech impairment or significant behavioral disturbance. Special education is education that offers an individualized learning format (e.g., small group, pull out, one-on-one). In contrast, a 504 Plan does not include special education services. Instead, a 504 Plan involves classroom accommodations, such as behavioral modification and environmental supports.
  2. An IEP requires a formal evaluation process as well as a multi-person team meeting to construct. A 504 Plan is less formal and usually involves a meeting with the parents and teacher(s). Both plans are documented and recorded.
  3. An IEP outlines specific, measurable goals for each child. These goals are monitored to ensure appropriate gains. A 504 Plan does not contain explicit goals.
  4. An IEP requires more regularly occurring reviews of progress, approximately every 3 months. A 504 Plan is usually reviewed at the beginning of each school year.
  5. A 504 Plan does not cost the school or district any additional money to provide. On the other hand, an IEP requires school funds to construct and execute.

To watch a webinar called: Getting the Most out of an I.E.P, click here.

 

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Does Hand Flapping Mean Autism?

With today’s easy access to the Internet, it is common for many of us to try and diagnose our own symptoms and ailments; however,girl stimming even if your symptoms come to a match, it does not necessarily mean that you have that particular diagnosis that shows up on your computer. The same can be said with children. If you notice what might be a ‘red flag’ in your child, it does not automatically imply that your child has something ‘wrong’ with him/her. One such ‘red flag’ that many parents get overly worried by is the action of hand flapping. It should be noted that hand flapping can occur for many different reasons, and not only in children with Autism.

Hand flapping can occur due to:

  • Excitement
  • Nervousness/Anxiety
  • Fidgeting
  • High engine level/Arousal level
  • Habitual behavior
  • Decreased body awareness (child does not even know he is doing it)

Overall, it is important to keep in mind that every child is unique and reacts to various situations in a different manner as well as with different mannerisms.  Be sure to reach out to your child’s teachers and therapists if you notice that your child using hand flapping behaviors, so that you may all be on the same page in relation to treating this behavior. It is important to monitor when the hand flapping occurs in order to look for trends. If hand flapping does occur with other “red-flag” behaviors, talk to your pediatrician or a Pediatric Therapist.  

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Stay tuned for my next blog on strategies to replace hand flapping behaviors.

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Differential Diagnosis: Autism versus Aspergers

Autism and Asperger’s Disorder are diagnoses which both present with a hallmark feature of social impairment. There are several differences between Asperger's Childthe two diagnoses which help classify the two disorders.

Autism Diagnosis:

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR), which is the diagnostic guidebook published by the American Psychiatric Association, indicates that there are three domains of diagnostic criteria for a diagnosis of Autism. Impairment with social relationships is the first domain which includes impaired nonverbal communication (poor eye contact and lack of gestures), poor peer relationships (lack of social interest when young to one-sided social interactions when older), poor joint attention (lack of pointing to show interest, not bringing items to show parents), and a lack of emotional reciprocity (failure of the child to notice parents and peers emotions). The second area is impairment in language which includes: language delay (not speaking at a year, or not speaking in sentences at two years), inability to carry on a give-and-take conversation, perseverative and repetitive language (repeating lines from television shows or the same thing over and over), and absent or delayed pretend play. The final area of Autism is repetitive behaviors which include: preoccupations or over-interest with favorite objects or topics that are unusual for the child’s age, routines and rituals that cause distress if interrupted, stereotypical movements (rocking, hand flapping, spinning), and interest in parts of objects (playing with only the wheels on a car). According to the DSM-IV, the main differential between the diagnoses of Autism (as described above) versus Asperger’s Disorder is that children with a diagnosis of Aspergers do not evidence impairment in language.

Asperger’s Diagnosis:

Neuropsychological studies have documented that children with Asperger’s Disorder often exhibit relative strength with regard to their verbal skills with deficits in their visual spatial and visual motor ability. Whereas children with Autism will often exhibit the opposite profile; strength with visual spatial and visual motor ability and weakness with verbal skills (Wolf, Fein, Akshoomoff, 2007).

Overall, the diagnoses of Autism and Asperger’s Disorder are quite similar in that they both feature impairment with social relationships and repetitive behaviors. The main exception between the two diagnoses is that children with Asperger’s do not exhibit the concern with language functioning.

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Sensory Strategies and Other Ideas for Kids with Autism

Sensory strategies are associated with a variety of diagnoses and conditions through childhood, adolescence and adulthood.  These strategies are non-invasive accommodations that can be made in any context, to all daily activities in all environments. Sensory strategies are often referred to as “movement breaks,” or other similar titles, but provide the same suggestions and are truly sensory strategies at their core.

These strategies have been found to be very useful for children with Autism who also have sensory processing challenges:

  • Mother plays with childUtilize a visual schedule throughout the day (both at home and at school).  Visual schedules are often easier to understand for a child with autism, or any young child, as there is a pictorial representation of each activity or time of day.  Using a visual schedule more clearly outlines the expectations that you have for the child and gives him/her a sense of control over their day.  A visual schedule may also be used as a tool to develop a morning and bedtime routine and increase independence in self-care activities, such as brushing teeth and getting dressed.
  • Allowing the child to take a 2-3 minute movement break every 10-15 minutes.  This break should involve intense movement when possible, such as jumping jacks, pushups, jumping on a trampoline, etc.  When intense movement is not appropriate, breaks may involve the student walking to the drinking fountain, getting up to sharpen his/her pencil and/or walking to the bathroom.
  • If an assigned task involves intense academic work, such as testing, lengthy projects or problem-solving assignments the child should be given the opportunity to take a longer break (approximately 10 minutes) to allow time for more intense physical exercise.

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  • Utilize a timer during activities and make sure it is visible to the child.  Timers can be either visual, meaning that there is an area of the clock that becomes shaded and as time elapses the shaded area becomes smaller and smaller however there is no noise associated with it, or auditory, in which there is a digital display and an alarm that sounds when the time has fully elapsed.  Using a timer is especially helpful during preferred activities, such as free-play, as it sets a clear limit for the child regarding how long they will have to participate in this designated activity.  This makes the environment and the activity more predictable and eliminates any element of surprise which is present during verbal warnings such as “2 more minutes,” and should make transitions happen more easily.
  • Along with a timer, providing transition warnings and using transition items will help a child with autism move from one activity to the next.  A transition warning can be used in conjunction with a timer to create more clear expectations surrounding transitioning from one activity to the next.  A transition warning involves setting the timer for how long the child will have until moving on to the next activity, as well as verbally or visually communicating that the transition is approaching.  For example, if a child has 5 minutes of free play prior to a structured task, when I set the timer for 5 minutes I would tell him/her “You have 5 minutes to play and then when the timer beeps it is time to go sit at the table.”  Then when there are 2 minutes remaining on the timer I would follow-up with “Look at the timer, you only have 2 more minutes until table time.”  If a child does not yet understand the concept of time, the visual timer would be the better choice for a timer as you can clearly see the shaded or colored area disappearing.
      • A transition item is a physical thing that the child is allowed to bring from one activity to the next.  If a child was playing with blocks and it was time to go to the table for a writing activity, a transition item could be allowing the child to bring a block with to the table.  Or substitute an item, such as allowing him/her to bring an action figure, small doll or ball with him/her from the block area to the table.  Transition items help stop “tantrums” or the feeling that something is being taken away form the child and make the transition smoother.
  • Provide a toy or item for the child to manipulate during solitary work.  These items are often referred to as “fidgets,” and provide the child with an outlet to release their restlessness.  Rather than continuously moving his/her body, the child can move his/her hands quietly in their lap or on their desk while manipulating the fidget.
These sensory strategies can be implemented in the classroom, at home and in most other settings where a child is expected to be able to sit and attend to a task (church, Sunday school, music lessons, camp, etc.).  Incorporating these strategies into particularly difficult parts of the day can also have an immense positive impact on the child; for example, incorporating physical exercise into transitional periods may lessen the stress that these times put on both the child and the adult.  These sensory strategies are not strict rules to abide by, but are general guidelines to be expanded upon or adapted to fit each child’s individual needs.

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Problem Feeders: When Picky Eating is a More Serious Problem

Following my last post about picky eaters, parents should know that there is a more severe level of picky eating, which has been termed problem feeding. In the medical community, it is often diagnosed as “feeding difficulties”.

Problem feeders have the following behaviors:

  • Young infants who refuse bottle or breast, or drink a small Mother feeds a babyamount then refuse. This results in a decreased overall volume consumed, and eventually weight loss and dehydration.
  • Toddlers and children who eat less than 20 foods.
  • Kids who “lose” foods that they once ate, and do not resume eating them even after a few weeks break. Eventually they may be down to 5-10 foods.
  • Kids who refuse certain textures altogether.
  • Kids who scream, cry, and panic over touching, smelling, or tasting a new food.
  • Kids who are unwilling to try almost any new food even after 10+ exposures.

Why do some kids become problem feeders?

There is an underlying reason why they have a strong negative association with eating, to the point where they will starve themselves before consuming foods outside of their repertoire. There is often a medical diagnosis that contributes to the development of a problem feeder, such as:

In these cases, the child forms “oral aversion” associated with the pain and discomfort they feel/felt as a result of eating or swallowing. This association is made very strongly in the young developing brain, and in the case of problem feeders, overrides hunger. Oral aversion becomes a protective mechanism, which is why they panic over eating new foods. Problem feeders can be underweight or overweight as a result of their rigid food choices, depending on what type and how much food they eat.

The big difference between picky eaters and problem feeders:

Eventually, a picky eater will come around to eat some type of food they are presented with outside of their usual repertoire, if they are hungry enough. A problem feeder will not respond to hunger cues to meet their needs with the food options presented to them if it is outside of their “accepted” foods. Problem feeders will go on a food “strike”, even if it results in dehydration and malnutrition.

Problem feeders need assessment and feeding therapy, which can be effectively achieved with a multidisciplinary team, such as at North Shore Pediatric Therapy. NSPT has occupational therapists, speech therapists, and dietitians to work through sensory, oral-motor, and nutritional deficits as well as mealtime behaviors. We also have social workers for additional support and behavior guidance.  If you are concerned that your child is a problem feeder or a picky eater, contact our facility for an evaluation.

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