EDU Healthcare Blog
IEP Terms to Know...September 1, 2017 10:57 AM
Does your child have an Individualized Education Program (IEP)? If this is a new development, you may run into some language you’re not familiar with. Here are key terms you’ll see and hear as you work with the IEP team.
Accommodation: This is a change to or in your child’s learning environment. Accommodations can help her learn and then show what she’s learned without having her challenges get in the way. For instance, if your child takes longer to answer questions, she might be allowed extra time to take a test. Even with accommodations, kids are expected to learn the same content as their peers.
Annual goals: The IEP document lists the academic and functional (everyday) skills the IEP team thinks your child can achieve by the end of the year. These goals are geared toward helping your child take part in the general education classroom. IEP goals need to be realistic and measurable.
Assistive technology (AT): Any device, equipment or software that helps your child work around her issues. AT can help your child learn, communicate and function better in school. AT ranges from simple tools (like highlighters) to high-tech software (like apps that reads text aloud).
Behavior intervention plan (BIP): A plan designed to teach and reward positive behavior. Typically, the plan uses strategies to prevent and stop problem behaviors. It may also have supports and aids for the child. A BIP is often included as part of an IEP. To get a BIP, a child must have a functional behavioral assessment.
Disability: A condition recognized by the law. To qualify for an IEP, your child must have a disability that is one of the 13 categories listed in the Individuals with Disabilities Education Act. Kids’ learning and attention issues usually fit into one of three categories: (1) specific learning disability, (2) other health impairment (ADHD) and (3) speech or language impairment.
Due process: A formal process for resolving disputes with a school about special education and IEPs. Due process isn’t the only way to resolve a dispute. There are other options, like mediation and filing a state complaint.
Extended school year services (ESY): Some students receive special educationservices outside of the regular school year, such as during the summer or, less commonly, during extended breaks like winter break.
General education curriculum: This is the knowledge and skills that all students throughout a state are expected to master. The curriculum varies from state to state.
Individuals with Disabilities Education Act (IDEA): The nation’s special education law. IDEA is a federal law that guarantees all children with disabilities access to a free and appropriate public education.
Least restrictive environment (LRE): Students with documented disabilities must be taught in the least restrictive environment. This means they must be taught in the same setting as students without documented disabilities as much as possible. The school must offer services and supports to help a child with an IEP succeed in a general education classroom.
Modification: A modification is a change in what a student is expected to learn and demonstrate. For example, a teacher might ask the class to write an essay that analyzes three major battles during a war. A child with a modification may only be asked to write about the basic facts of those battles. Modifications are different from accommodations.
Parent report: This is a letter you write. It’s a good way for you to document your child’s strengths, struggles and success at school, at home and in the community. By sharing the report with your child’s IEP team, you give them a more complete view of your child.
Progress reporting: How a school will report to you on your child’s progress on annual goals. This is specified in the IEP.
Present level of performance (PLOP, PLP, PLAFF, PLAAFP): This is a snapshot of how your child is doing right now. PLOP describes your child’s academic skills (such as reading level) and functional skills (such as making conversation or writing with a pencil). The school prepares this report for the IEP meeting. This is the starting point for setting annual IEP goals.
Standards-based IEP: This alternative to the traditional IEP is only used in some states. A standards-based IEP measures a student’s academic performance against what the state expects of other students in the same grade.
Special education: Specially designed instruction to meet the unique needs of your child. It should be designed to give her access to the general education curriculum. The instruction is provided at no cost to you.
Supplementary aids and services: These are supports to help your child learn in the general education classroom. They can include equipment or assistive technology, like audiobooks or highlighted classroom notes. They may also include training for staff to help them work with your child.
Related services: Any support services your child needs to benefit from special education. One possible example is transportation. Another is occupational therapy.
Transition plan: This part of the IEP lays out what your teen must learn and do in high school in order to succeed as a young adult. She and the IEP team develop the plan together before it kicks in at age 16. The transition plan includes goals and activities that are academic and functional. But they extend beyond school to practical life skills and job training.
What Role Do PT and OT Play in Managing Juvenile Arthritis?...September 1, 2017 8:31 AM
With the growing array of powerhouse medications available to treat juvenile idiopathic arthritis (JIA), it may be easy to overlook the vital part that low-tech exercise, physical therapy (PT) and occupational therapy (OT) can play in your child’s treatment plan.
Used together, the different approaches complement each other. “I think establishing and maintaining a good therapeutic exercise program will definitely add to any benefits that medicine can provide,” says Greg Shahum, OTR/L, director of Rehabilitation at Regency Heights of Stamford in Connecticut. Take the example of a child who comes to their rheumatologist with a swollen knee that has lost range of motion. The physician may decide to inject the joint with a corticosteroid that would decrease the pain and swelling, allowing the child to regain much of the range of motion but possibly not all.
“That’s where a physical therapist can help by providing exercises to regain the range of motion, muscle strength and bulk,” says Susan Klepper, PT, assistant professor of Clinical Physical Therapy at Columbia University in New York City.
Klepper also points to a study that showed that kids with active disease lost some muscle bulk and strength each time they had a flare. When the flare subsided they regained only some of the bulk and strength. So although medications can quiet the inflammation, the only way to completely restore muscle function is by exercise.
Kids typically love to run, play, get involved in sports and other types of exercise. JIA can interfere with those pursuits and in fact research shows that children with JIA are less physically active and less fit than kids without the disease. Dutch researchers found that children with rheumatoid factor positive polyarticular-onset JIA had the greatest deficits in exercise capacity while those with persistent oligoarticular-onset JIA were the least affected. Overall, girls had worse aerobic and anaerobic capacity than boys.
There’s a flip side too. “Looking at the whole group of exercise studies done on children with JIA shows there’s no harm from exercise, kids generally report fewer symptoms such as decreased pain and stiffness after exercise programs, and they can improve their physical fitness,” says Klepper.
PT and OT
Both PT and OT can help facilitate fitness goals and improve a child’s quality of life by enabling them to perform routine daily tasks with greater ease.
After recommendation by a physician for OT and/or PT, the therapist evaluates the child. OT concentrates more on hand function (reach, grasp and manipulation of objects) with an emphasis on activities of daily living such as dressing, bathing and eating. OTs try to determine if children can move through their day the way kids their age without JIA do.
A PT evaluation measures and establishes a baseline for joint range of motion, muscle strength, muscle bulk, physical activity and fitness, coordination, and neuromuscular function. PTs look at activities children do or want to do, identify any physical limitations and try to address those deficits.
Adaptive equipment may be used both in PT and OT including splints which can help keep joints in correct position, relieve pain and help stretch muscles and other soft tissues that have been shortened due to the disease. Assistive devices can help a child with daily activities like eating, dressing, bathing or writing. Custom molded in-shoe orthotics may help to relieve a child’s foot and leg pain while walking.
There are always at home exercises to do with OT and PT and, depending on the child’s condition, regular or periodic direct therapy sessions. For instance Klepper’s home program for a child with moderately active disease and stiffness but good range of motion might include daily range of motion exercises at night during or after a bath and in the morning in bed to offset stiffness. She’d give two or three strengthening activities to do during the day. She’d give older kids straight strengthening exercises while for young kids she’d devise play activities to get the job done.
Range-of-motion exercises keep joints flexible. Strengthening exercises build muscle, strength and endurance plus can help support weak joints. Kids with JIA should also strive to meet health guidelines that recommend an hour of daily moderate physical activity.
Best of Both
The optimum situation occurs when medication and exercise therapy work together to provide the best outcome for the child. “Just as kids with JIA need very specific pharmacologic management, they need specific instruction in exercise to try to get them to a good level of function with the emphasis on leading as normal, healthy, and active a life as possible,” concludes Klepper.
10 Tips for Sticking With the Program
Though it’s clear that PT, OT and exercise are beneficial, getting kids to adhere to a program can be difficult. Klepper and Shahum offer some strategies:
- Go to therapy appointments with your child so you know exactly what she's being asked to do. Request take home illustrations.
- Consider setting up a reward system to build motivation. Perhaps make a sticker board where you give a prize once your child earns a certain number of stickers.
- Have your child set a goal that is important to her with the therapist.
- Make sure the entire family knows of the child’s exercise plan. Family should be the strongest support system.
- Set aside time in your child’s schedule for exercise each day. This way it’s less likely to be pushed aside.
- Have your child keep an exercise log or journal.
- Encourage your child to have a training buddy, whether it’s a sibling, friend or you.
- Change up exercise options to keep things fresh. Take a nature hike, play the Wii or similar game, swim, or walk the mall when it rains.
- Even when your child is sore or achy, stretching is beneficial. Try not to let her completely skip a day.
- If your child likes watching DVDs, ask your therapist to videotape your child doing her exercises. Most kids like watching themselves.
How to Integrate Therapy Goals Into The Curriculum...August 31, 2017 1:32 PM
Curriculum refers to the lessons and materials that students will interact with to reach educational goals. Most elementary and high schools follow a specific curriculum for each subject. In general, a curriculum includes goals, instructional methodology, materials and assessments to measure progress.
Therapy goals can be established to assist students in accessing the curriculum. Using traditional therapy observational skills and assessment, answer questions regarding the student’s skill level in the classroom. Is the student able to participate during all aspects of the curriculum lessons? Skills that are assessed encompass fine motor, gross motor, sensory processing and visual perceptual skills.
Here are a few examples:
- Fine motor skills: manipulation of materials, written output to indicate an understanding of the lesson, etc.
- Gross motor skills: balance, posture, and mobility throughout the lesson
- Sensory processing skills: body awareness and motor planning (formulating a plan to complete the steps of the lesson)
- Visual perceptual skills: visual motor skills for written output, visual tracking skills to understand the material, etc.
Here is an example of a therapy goal addressing fine motor skills to help a student access the English Language Arts (ELA) curriculum using the Common Core Standards for a kindergarten student (CCSS.ELA-Literacy.SL.K.5). GOAL: By June 2018, during speaking and listening tasks the student will independently be able to open/close containers that hold ELA supplies 9 out of 10 trials to create drawings or visual displays when presenting knowledge and ideas.
Here is a sample goal that addresses gross motor and sensory processing skills using the Common Core Standards for Kindergarten ELA CCSS.ELA-Literacy.SL.K.1: GOAL: By June 2018, the student will independently exhibit age appropriate body awareness (i.e. maintaining personal space, keeping hands to self, etc.) 90% of the time when actively engaged in collaborative conversations with diverse partners about kindergarten topics and texts with peers and adults in small and larger groups.
By writing goals that specifically address accessing the curriculum, school based therapists are embracing the educational delivery of service model. Read more about writing SMART goals.
Another option to integrate therapy goals throughout the school day is to use a specific curriculum to address the sensory motor domains. There are various products available that can help you get started. These curriculums will save you hours of prep work!
Hands First for Learning Fine Motor Curriculum and Preschool Units have a unique vision and philosophy that desires to link health and wellness with kindergarten readiness skills to support the academic success of young children. The resources provide educators, therapists, and parents with activities to develop fine motor and gross motor foundational skills in both the general education and special education populations. The Hands First for Learning books are published by two experienced occupational therapists, Laurie Donovan and Alison Hales and Tama L. Hampton, MA, CCC-SLP. With over 25 years experience working in public schools, the authors understand the needs of school systems, parents, teachers, therapists, and children.
The Importance of Emotional Intelligence for Kids With Learn...August 31, 2017 10:59 AM
At a Glance
- Emotional intelligence is the ability to be smart about emotions.
- It can help kids with learning and attention issues manage their challenges.
- There are things you can do to develop your child’s emotional intelligence.
Consider this scenario: Your child is struggling with his math homework. Instead of yelling and giving up, he tells you how frustrated he is and asks for help. Or this one: Your child’s friend gets some upsetting news and cancels their plans to hang out. Your child understands why his friend doesn’t feel like socializing and makes other plans.
These responses might not seem like a big deal. But they’re signs of an important set of skills that make up what’s known as “emotional intelligence” (EI). This type of intelligence isn’t measured by IQ tests. Yet it’s crucial to helping us work through challenges and respond to situations successfully. It also helps us make positive connections with the people around us.
Emotional intelligence can be especially helpful to kids with learning and attention issues. At the same time, certain learning and attention issues make it harder for some kids to develop it. Learn more about EI and how you can help your child build this key ability.
What Emotional Intelligence Is
EI is the ability to be smart about feelings—our own and other people’s. It involves being able to notice, understand and act on emotions in an effective way.
The concept of EI has been around for decades. It was made popular by the 1995 book, Emotional Intelligence: Why It Can Matter More Than IQ. The author, psychologist Daniel Goleman, described EI has having five basic parts.
- Self-Awareness: A person knows what he’s feeling at a particular time. He understands how his moods affect others.
- Self-Regulation: He can control how he responds to his emotions. He considers possible consequences before acting on impulse.
- Motivation: He can accomplish goals in spite of negative or distracting feelings he may be having.
- Empathy: He can understand how others feel.
- Social Skills: He can manage relationships. He knows what kind of behaviors get a positive response from others.
Why EI Is Important for Kids With Learning and Attention Issues
Think about the challenges your child faces every day. Tasks that are easy for his peers may be difficult for him. He may study hard but get poor grades anyway. He may feel embarrassed about his learning issues and afraid to ask for help.
One of the key roles of EI is shaping how we respond to challenges. For a child with learning and attention issues, it’s like a GPS that can help him navigate his way around obstacles and toward success. It allows him to size up situations, put them in perspective and come up with ways to work through them.
The five factors that make up EI come together to help him achieve the best outcome. Here’s how that might play out when he’s struggling with that math homework:
- He realizes he’s getting frustrated.
- He quickly considers the outcome of yelling or throwing his book on the floor.
- He comes up with a better way to respond—explain how he’s feeling.
- He wants to try again, despite being frustrated, because he understands what he’ll gain in the long run.
- He asks for your help.
- You push a little too hard, but he understands it’s because you really care and want to help him find success.
- He says he needs to go at a slower pace and would like to try doing it again by himself.
- The next day, he waits until after class and tells his teacher he’s having trouble understanding.
Without emotional intelligence, the outcome would likely be different. Here’s how the scenario might play out:
- He throws his pencil down in frustration the minute he gets stuck on a problem.
- He yells at you when you come in to help, thinking you’re really just there to nag him.
- He storms out of the room and never comes back to try again. He doesn’t see any point in it.
- In math class the next day he tells the kid sitting next to him that the assignment was stupid.
- When the teacher asks the students to hand in their work, he says he didn’t do it. He doesn’t tell her after class that he was having trouble with it and ask for help.
Why Some Kids Often Struggle With EI
Many kids with learning and attention issues don’t have any trouble with emotional intelligence. Some have particularly high EI, in fact. But trouble with EI can sometimes be an early sign that a child has a learning or attention issue.
A child with ADHD might miss social cues because he’s not paying close enough attention to pick up on them. A child with an auditory processing disorder might misinterpret what others are saying to him. And a child with nonverbal learning disabilities might not pick up on social cues at all.
On the flip side, it’s not uncommon for people with dyslexia to show very high EI. Some researchers think this may be due to their brain’s natural ability to think in the “big picture.”
How You Can Help Your Child
The good news about EI is that it isn’t set—with help and practice your child can develop it over time. That’s true even if he’s weak in this area due to his learning and attention issues. It just might take him longer to get there.
Many school districts offer social and emotional learning (SEL) programs that teach kids to be aware of emotions and act on them effectively.
There are things you can do at home, too:
Talk about challenges. Ask him how he feels when he’s struggling with something. Put a name to his emotions: sad, angry, overwhelmed, etc. Then ask him why he’s feeling the emotion he just named.
Work on strategies. Brainstorm ways he might have done something differently to get a different outcome. Controlling emotions in order to think of solutions is a big part of EI.
Help others. Have your child join you in taking care of people in need as a way to build empathy. You can join a volunteer effort, or just bring him along when you take food to a sick neighbor.
Emotional intelligence is tied into many other key strengths. Learn how you can empower your child by working on his self-esteem and social skills. And discover concrete tips for helping your child develop EI.
- Some kids with learning and attention issues have trouble with emotional intelligence.
- Schools may offer social and emotional learning (SEL) programs to help build EI in kids.
- Talking about challenges and feelings helps build emotional intelligence.
Getting an IEP for Your Teen...August 31, 2017 8:10 AM
At a Glance
- Even high school seniors aren’t too old to get an IEP.
- The process of being evaluated for an IEP can be helpful, even for teenagers.
- IEPs don’t exist in college.
Sometimes a child’s learning issues aren’t uncovered until the teen years. Some kids are able to work around their weaknesses until they face more challenging work in high school. Others may have always struggled, but no one realized it was due to learning or attention issues.
No matter what your teen’s journey has been, he’s eligible to request an IEP through the public school district. According to the Individuals with Disabilities Education Act (IDEA), students who are found eligible can start an Individualized Education Program—and the special education services that come with it—until high school graduation (or a maximum age of 22).
If you or your teen are reluctant to pursue an IEP, thinking it’s too late, consider the benefits:
- An IEP can help teens learn to understand and manage learning and attention issues while still in high school.
- An IEP must include a transition plan to help prepare teens for life after high school. (IEPs don’t exist after high school.)
Teens and the IEP Meeting
IDEA requires that high school students be included in IEP team meetings. Teens are encouraged to take part in and even lead their IEP meetings. Many learn how to advocate for their needs and goals—an important skill for young adults as they head out into the world.
The IEP Transition Plan
With an IEP, your teen will be entitled to a transition plan. Developed by the IEP team with the student, the plan outlines steps needed to prepare for young adulthood.
Transition services can be included as early as age 14 and must be included by the time a student turns 16. Whether your teen wants to attend college or vocational school or go to work right after finishing high school, the transition plan can pave the way. It will specify what courses and other educational experiences he’ll need while in high school so he can pursue his goals after graduation.
The transition plan also addresses the functional skills he’ll need to live independently: managing money and paying bills, using public transportation, staying healthy, and balancing work, study and leisure time.
The IEP team sets clear goals and decides who will assist him in his efforts. This is a unique opportunity to invite members of the community, such as vocational counselors and other mentors, to participate in your child’s transition.
If your child still has an IEP when he officially becomes an adult (age 18 in most states), he becomes legally responsible for consenting to and making requests about his IEP. You’ll pass the baton to him but can continue to give advice and encouragement.
Summary of Performance
Every teen with an IEP leaves high school with a document that lists what he needs to thrive in the future. This is called a Summary of Performance (SOP), and it’s provided by the IEP team. It includes:
- A summary of the student’s academic achievement.
- A summary of the functional skills (such as navigating public transportation) he has or will need to learn to live independently.
- Recommendations to help the student meet his goals.
Some states have additional requirements for what an SOP should contain.
If Your Child Doesn’t Graduate From High School by Age 22
Special education services for a student with an IEP end when he graduates with a regular high school diploma or when he reaches the maximum age for receiving special education services. In most states, the maximum age is 22.
If the student reaches age 22 and still hasn’t graduated from high school, the school district must provide the SOP letter. But the student is no longer eligible for special education services.
Up until that age, your child is allowed to take high school classes. Some older students prefer to take courses at a community college. Your child must receive permission from the school district in this case.
Make the Most of the Resources an IEP Provides
An IEP provides important benefits to teenagers. It can help you and the school district work with your child to meet his current and future needs. Make the most of the resources and opportunities available to your child now. You may see your child make tremendous progress in academics, self-confidence and planning his future.
Sensory Strategies for the School Based OT...August 30, 2017 3:29 PM
This is a great article written on sensory integration practices in the school setting. It includes the clinical reasoning and practices that go along with sensory practice in the school. Of interest are sensory screening and evaluation recommendations for school settings, sensory intervention and treatment delivery options, and recommendations. Also included is a table with approaches and sensory strategies for Occupational Therapy intervention in the classroom or school setting. Case studies include IEP goal ideas related to sensory processing interventions.
Assessments for sensory needs can include direct observation of the child’s performance in the school setting. Observing a variety of tasks during the school day can be helpful to analyze the demands of specific activities, including needs and strengths in tool use, fatigue, sequencing, spatial concepts, social interactions, physical requirements, cognitive abilities, etc. A child transitions through a variety of settings during a school day and is challenged in various environments which might present differing needs or abilities. The school-based OT should assess a student's sensory and neuromuscular functioning in these various environments.
Many students who struggle with sensory challenges benefit from a sensory diet during the school day. This specialized diet of sensory activities and input should be designed by an occupational therapist who assesses and identifies the student's particular needs and strengths or interests. Sensory diets in the school can include many different tools, not limited to fidget tools, specialized seating, movement breaks, weighted lap pads or vests, calming scents, limited or structured visual adjustments, chewing tools, or other activities.
Fidgeting Tools for the Classroom
Fidgeting with items can help with attention, regulation, and focus.
Adapted Seating in the Classroom
Adapted seating can be a sensory strategy that helps with fidgeting as well. Sensory needs can overflow to wiggling, poor posture, slouching, and decreased focus. An altered seating system is sometimes used to address a weak core strength and resulting inefficient posture as well. Try these sensory-based seating ideas:
- Movement seats like a disk cushion are great for allowing movement for improved attention.
- Wobble Seat uses the idea of a therapy or stability ball in the form of a stool. This is great for classroom use because the giant therapy balls tend to roll away from desks.
- Special cushions
- Bean bags
- Therapy balls
- Wedge seats
- Support added to the seat
Self-Regulation in the Classroom
For the child who struggles with sensory processing disorder or is challenged with impaired responsiveness, interventions in regulation can be used in the classroom:
- Impulse control is a big struggle in the classroom or school environment.
- A quiet space or corner of the classroom can be a strategy that addresses many sensory needs.
- The Alert Program is a guide to teach and promote self-regulation.
- Zones of Regulation is a curriculum designed to help students recognize and address self-regulation needs.
Sensory-Based Interventions for the School Based OT
Here on The OT Toolbox site, we have a huge collection of sensory-based play and sensory experiences that meet various needs.
Sensory Integration Approach to School Based OT
A sensory integrative approach is based on the work of A. Jean Ayres, PhD, OTR, and identified as Ayres Sensory Integration. For school-based practice, sensory integration and praxis needs are addressed by assessment and interventions occurring in natural sensory-rich spaces. A sensory integration approach utilizes interactions between the OT and the student in a sensory-rich environment in a playful approach that allows for adaptation to novel challenges addressing reactivity, postural skills, praxis, and perceptual skills.
Chewing Tools for Classroom Sensory Needs
- Pencil Topper Chews come in a variety of textures and toughness to meet sensory needs.
- Chewable jewelry is often times appropriate for the classroom, because the variety of necklace or bracelet styles on the market are discreet while meeting sensory needs.
Push In or Pull Out OT Services in the School
Sensory needs can be addressed by strategies from the school based OT both in and out of the classroom. For the child who receives occupational therapy services at school, therapy can occur in any aspect of the child's day where needs are limiting educational abilities.
OT services completed with a "push in" model allow the therapist to identify needs in the classroom. Therapists can then intervene, and provide adaptations, modifications, and tools during classroom activities. Consultation with teachers and professionals can occur right in the classroom during daily tasks and in a natural setting. Sensory strategies can easily be a collaborative nature with teachers and paraprofessionals when performed right in the classroom and in the natural environment of the child's day.
Therapy being competed in a "pull out" model can address sensory diet needs and development that is then utilized throughout and within the student's daily activities at school. Specific skill assessment and development can occur in pull out services.
Is Free Play Essential for Learning?...August 30, 2017 11:17 AM
In this month's Atlantic, there is an article about how play is incorporated into the school day in Finland's schools: "How Finland Keeps Kids Focused Through Free Play." In Finland, giving students the opportunity for free play is thought to be essential in helping children learn. School children in Finland are given a 15-minute break for every 45 minutes of instruction. During the break, children are free to go outside to play and socialize with their classmates. Teachers in Finland find that after their breaks, students are actually more focused on their lessons.
Anthony Pelligrini, author of Recess: Its Role in Education and Development, and emeritus professor of educational psychology at the University of Minnesota has praised this approach to education for more than a decade. Pelligrini noticed that after short recesses, students appeared to be more attentive in the classroom.
The Atlantic article reports: "Pellegrini and his colleagues ran a series of experiments at a public elementary school to explore the relationship between recess timing and attentiveness in the classroom. In every one of the experiments, students were more attentive after a break than before a break. They also found that the children were less attentive when the timing of the break was delayed— or in other words, when the lesson dragged on."
But what about winter days, when snow covers the school playground? According to Pellegrini, breaks don’t have to be held outdoors to be beneficial. In one of his experiments at a public elementary school, "students had their recess times inside the school and the results matched those of other experiments where students took their breaks outside: After their breaks, the children were more attentive in class." It's not a matter of whether the breaks are indoors or outdoors. It's the fact that the play is free and unstructored. Kids need time to make their own choices about how they will use their recess time.
When a child is deprived of the opportunity for free creative play, there can be both psychological and educational consequences. Psychologist Alice Miller, author of The Drama of the Gifted Child, says that when a child is restricted to goal-oriented tasks instead of being allowed to aimlessly play, the child's world is overthrown. For healthy development, Miller says that children need free play.
Faced with budget cuts, too many American schools are cutting recess, free play, and physical education, keeping their focus on traditional core subjects like reading, writing, and arithmetic. This is not the best way to help children learn.
There is even research that suggests that the physical exercise children get from just walking to and from school can improve these kids' ability to focus in the classroom.
Update: Today's Washington Post article makes a similar argument for the importance of play in a child's day: "Fidgeting is a real problem. It is a strong indicator that children are not getting enough movement throughout the day. We need to fix the underlying issue. Recess times need to be extended and kids should be playing outside as soon as they get home from school. Twenty minutes of movement a day is not enough! They need hours of play outdoors in order to establish a healthy sensory system and to support higher-level attention and learning in the classroom."
More Businesses Embracing Inclusion...August 30, 2017 8:08 AM
Corporate America is increasingly working to include people with disabilities with a new report finding that a growing number of companies are actively recruiting from this population.
In a survey of 110 companies that collectively account for 5 percent of the nation’s workforce, 95 percent reported that they have recruitment efforts in place specifically aimed at hiring people with disabilities.
That’s an increase of 11 percentage points since 2014.
The finding is part of the 2017 Disability Equality Index, an annual report from the American Association of People with Disabilities and the U.S. Business Leadership Network released this week.
Corporations choose to self-report their disability policies and practices for the index, which scores each business on their efforts at disability inclusion.
Since a pilot survey was first conducted in 2013-2014, the number of companies participating has more than doubled. This year’s index includes businesses from 21 industries including companies like Starbucks, Walgreens, AT&T, Microsoft, Boeing, Aetna and Bank of America.
Of the 110 companies that were scored, 68 received the highest rating of 100.
Overall, the report found that 88 percent of the employers had a disability-focused resource group or organization and 86 percent had a senior executive working to champion or sponsor the effort.
Still the report noted that only about half of companies recognize disability in their supplier diversity programs. And, many businesses have room for improvement in ensuring that potential employees are offered interview accommodations and that both internal and external websites are accessible, the index found.
“On the heels of the 27th anniversary of the passage of the Americans with Disabilities Act, we should celebrate our achievements but also reflect on the fact that employment outcomes for Americans with disabilities have remained unchanged,” said Helena Berger, president and CEO of AAPD. “Working together, we can help ensure no one is left behind or unable to pursue their dream because of a disability.”
Children With Autism May be Over-Diagnosed With ADHD, New St...August 28, 2017 1:41 PM
A well-established screening tool used to assess children for attention-deficit hyperactivity disorder (ADHD) may be less accurate when a child has an autism spectrum disorder (ASD). Pediatric researchers report that children with ASD may mistakenly be diagnosed with ADHD because they have autism-related social impairments rather than problems with attention. This is important for understanding what are the right services and treatments for a child.
The study team, including one of the psychologists who developed the ADHD screening tool, concludes that the tool needs to be refined to better identify the correct disorder, and that clinicians should supplement the screening tool with careful clinical interviews.
"One of our best current screening measures for ADHD may be over-diagnosing ADHD in children with autism," said study leader Benjamin E. Yerys, PhD, a researcher in the Center for Autism Research at Children's Hospital of Philadelphia (CHOP). "This is important because medications that work for ADHD may be less effective for a child on the autism spectrum." Scale scores are used in recommending school-based services as well as treatment options.
The study, from researchers at CHOP, the Perelman School of Medicine at the University of Pennsylvania, and Baylor University, appeared online Oct. 13 in the Journal of Autism and Developmental Disorders.
One complicating factor is comorbidity -- an estimated 30 percent or more of children with ASD also have ADHD. The researchers suggest that the tool they analyzed, the ADHD Rating Scale Fourth Edition (ADHD-RS-IV), while well-validated in assessing ADHD in a general population of children, may overestimate ADHD in children with ASD. The scale asks parents and teachers to provide numerical ratings in reply to 18 items about a child's behavior: nine items on inattention and nine on hyperactivity and impulsivity.
Study co-author Thomas J. Power, PhD, director of CHOP's Center for Management of ADHD, developed ADHD-RS-IV in the 1990s (An updated version, the fifth edition, was published earlier this year, but not used in the current study). "I'm excited to be involved in this study, and in efforts to refine our screening tools," he said, "especially since few researchers have previously investigated using this scale in children with ASD. Our research raises questions not only about this rating tool, but all such measures that rely on parent and teacher ratings to assess ADHD in children with ASD."
The current study analyzed ratings of 386 children, aged 7 to 17, who had ASD without intellectual disability. To test whether the ADHD rating scale was valid in children on the autism spectrum, the research team used a procedure called factor analysis. They found that some questions on the ADHD rating scale were high for children with ASD instead of being high just for the subset of children who had significant ADHD symptoms.
"One underlying problem," said Yerys, "may be in how we ask these questions." For example, he explained, parents and teachers are asked "Does the child respond when spoken to directly?" However, supplying a yes or no answer to this question doesn't distinguish between actual inattention (a symptom of ADHD) and a child's lack of understanding about how to behave in a social situation in responding to another person -- a social impairment often found in ASD. Similarly, other questions focus on how well a child stays on task with play activity. ADHD may cause a child to be easily distracted from an activity, but another child may instead stop playing because of ASD-related difficulties with social play.
The study team recommends modifying the rating scale to better minimize the influence of ASD on ratings of target ADHD behaviors. Moreover, until a more nuanced rating scale is available, clinicians need to combine the ratings with a follow-up interview with parents to better understand whether a child's behaviors stem from ADHD symptoms or social impairments.
Ideally, said Yerys, a clinician should be experienced in evaluating both ADHD and ASD. Large pediatric facilities such as CHOP are particularly well positioned to provide such evaluations, having premier clinical and research centers in both conditions. Yerys added that, as precision medicine efforts expand, differentiating ADHD from ASD will be essential in providing safer and more effective treatments based on a child's specific condition.
"Until we're able to develop and validate a new rating scale that takes symptoms of autism into account, parents who are concerned should seek out clinicians who are conducting evaluations for ADHD and are also taking into account the possibility of autism," added Yerys.
Going forward, concluded Power, it will be important to strengthen local resources by improving training for community-based providers such as pediatricians and school psychologists in recognizing key distinctions in diagnosing and treating both ADHD and ASD.
Handling the Transfer to Secondary School for Children with ...August 28, 2017 10:44 AM
Based on personal experience, the transfer to secondary education can be an anxious time and planning ahead can help. My granddaughter is 9 years old and in Year 4 at a local primary school and we have already started looking round the secondary schools. I am aware that the advice usually given to parents is to start this process in Year 5 however, we were advised by the head of the primary school to begin a year earlier and I now know why!
What do you want?
This is a complicated question to answer and the answers will vary with every child and every family but let me try to help you to think it through. Do you want your child in mainstream secondary education or in a special school? Would you like to consider private education? Look at your child's needs and your view of what you want to get out of a secondary education. Do you want an academic education or a good, well-rounded social education? Has your child any special abilities or interests? Choosing the right school for your child entails striking a balance between what you need, what you want and what is available.
Do you want your child to be included in the school, working with peers or do you want appropriate withdrawal for teaching to meet specific needs? Would you be happy with your child being educated in a unit attached to a school? If so, consider the needs of the pupils within the unit; consider the class size and the staffing ratio. On what occasions are pupils from the unit included in mainstream lessons? How much inclusion takes place? Is it decided upon to meet the needs of the individual child or is it for other reasons?
Make a list
By this point, you may want to start a list of your conclusions. What do you really want and what are you willing to compromise on? Your decisions will inform the questions that you will ask when visiting the schools and the answers you will receive will inform your choice of school.
Consider your child. This may sound obvious but if your child were to transfer to the same school as the majority of children in the primary setting how many of the peer group would be in the same class? It may be fewer than you think if the secondary school is large. If your child enjoys performing arts, there may be a school that specialises in this area. Does your child need a secure environment? Does your child escape at the first opportunity and have no realisation of the dangers that may follow such behaviour? Can your child communicate effectively or does effective communication depend upon the use of Makaton or another sign system? In which case you will have to ensure that this is used within the school.
"Do you want an academic education or a good, well-rounded social education? Has your child any special abilities or interests?"
How would your child cope with break and lunch times? Is there a base or centre within the school, which is always open and staffed, to which children may retreat at such times if they do not want to go outside? Would it be possible for them to eat their lunch in such a place if the hustle and bustle of the dining-room is too much for them? Could they be withdrawn to such a place for individual or small group teaching when appropriate?
Support and communication
How does the school use its support staff? Your child may be used to individual support from one Teaching Assistant (TA) this may not be the practice in a secondary school. The secondary school may allocate several TAs to each child with a statement or they may allocate TAs to departments. Support is organised in many different ways within the secondary system.
How will the school communicate with you and how will you communicate with the school? Who do you contact if there is a problem or something of which the school should be aware? Are there a variety of channels of communication used regularly or is the annual review, open evenings and the school report all that is offered? Are notes sent home with the child, are home/school books used, will someone ring if there is an issue and if so, who is it likely to be?
With regard to communication, my daughter has expressed that as a parent you want to know everything which is happening at school. In the 'junior' years, you need to know less than the infant years and by the time children reach secondary school one hopes that this 'need to know' will decline further still, as your child becomes more independent.
"How does the school use its support staff? Your child may be used to individual support from one Teaching Assistant this may not be the practice in a secondary school."
As a teacher, a mother and a grandmother of a child with a SEN (Special Educational Needs) I can understand her feelings entirely, but from a practical point of view, as a teacher, my opinion is slightly different. The 'need to know' was expressed to me by an educational psychologist in our area as follows: if it is an issue that the school would usually deal with without informing the parent, there is no need to inform the parents of a child who has the SEN label.
You are almost ready to visit the schools!
By now you should have thought through the issues and have your list of questions.
I suggest that you discuss these issues with the SENCo (Special Educational Needs Coordinator). You will be visiting the schools with the parents of children in the current Year 6. You do not need to take your child with you at this point, but you do need to know the details of your statement, if you have one.
Your initial visit
Take note of how the school 'feels' when you visit. What does your 'gut instinct' tell you? One of the schools which my daughter liked, I visited about three years ago and instantly felt that it was a 'happy' school where perhaps my granddaughter might eventually fit in. Does the school feel welcoming?
You may be shown around the school by existing pupils, use this opportunity to talk to your guides. You may know members of staff, or parents of pupils, talk to them all. Talk to the head-teacher of your child's primary school, they cannot recommend a school but they will often give you very useful advice. Talk to your educational psychologist, they know your child and the schools.
My daughter and I came up with the following attributes for a SENCo: enthusiastic, excited at the prospect of having your child at the school, vibrant, welcoming, approachable, a problem solver, empathetic, willing to listen and not over protective. We also agreed that the school has to be inclusive, that all the staff should be aware of the child, their needs and any potential problems. There should also be a willingness to share knowledge and expertise, to enable everyone to contribute to managing any issues which arise.
Make an initial visit to all the schools in your area armed with your list of questions. Visit the special school, even though this may not be the type of education which you feel appropriate. After your initial visit discuss your findings with the primary head if they are willing. You may find it necessary to make more than one visit to several schools. Make sure that you visit again when the school is in session. The schools which you are considering should make you feel welcome to visit as many times as is necessary for you to be as sure as possible that you are making the correct choice. Take someone with you, perhaps the parent of a child who has similar problems, perhaps a friend who works in special needs, anyone who you can think of who may be willing and able to help. A second person may bring a new perspective to what you are seeing and being told and it is always good to have someone to 'bounce your ideas off'.
You will be able to register your preferred school with the LEA in Y5 but this is not binding, you are free to change your mind later. The choice of secondary schools is usually made at the beginning of Y6, but registering your choice early makes it possible to ensure a smooth transition. It gives time for the SENCo from the receiving school to visit the primary school for annual reviews, it also gives plenty of time for the child to visit the school to meet the staff and explore the layout. An early start will ensure that you have time to reflect on your choice and that there will be the time to prepare for a smooth transition.
Visiting the school
My daughter went armed with the list of issues that she wanted to raise with the Special Needs Co-ordinator (SENCo). Possibly the most important amongst these was the issue of security; my granddaughter Megan is a child who, if not closely supervised, will vanish. A second issue is her difficulty with communication; she has oral dyspraxia and still depends upon signing if she is having difficulty expressing her thoughts. Amongst the remaining issues were encouraging her independence, support and home/school communication.
Five schools were visited, all mainstream secondary whose number of pupils varied between 500 and 1200. What follows is a short account of the replies which were given by the SENCos and information gathered from talking to teachers, pupils and parents.
The smallest school had only one exit which was covered by CCTV. A member of staff monitored children who had a history of escaping, at break times. Movement within the school was based on using a 'buddy system,' but a Teaching Assistant (TA) would follow, at a distance, when moving from one side of the school to the other. All staff knew of the children, their needs and issues which may arise. Support was available within each class, and there was one key TA for each child who was statemented; this TA was responsible for the paperwork for the child. School Based Addition Tuition (SBAT) was available as they had their own full time, specialist teacher.
A visual timetable was given to the child, and communication on issues arising during the school day were discussed with the parents by phone. The aim of their support was to encourage independence and encourage the child to seek assistance when needed. At a later date it was discovered that this school is to be rebuilt on a nearby site. The new school will take in half of the pupils from a local secondary, which is to be closed, thereby almost doubling the intake. We were made to feel welcome, and encouraged to revisit the school, when it was in session, on as many occasions as we felt was necessary.
At the second school, which was one of the largest schools, the children with SEN were taught in a separate unit. They joined their own class for registration, PE and Personal and Social Education. It was admitted that they had "never had a child who was so disabled" and that it would "be a brand new learning curve" for them. We were assured that a TA would set the child a task and then the child would work independently. When asked what would happen if the child could not read worksheets, the reply was that they had never experienced that problem. The support within the unit was one TA to 14 children. A SBAT teacher was employed to teach English and Maths to groups in Year 8. We were assured that children do not escape from the school.
When asked if it would be possible to arrange additional visits to the school for the child we were told that this had never happened. The one visit with the primary school was sufficient, and the SENCo asked if we were asking for additional visits because the child was shy. The meeting closed at this point.
Things can only get better, or can they? The third school was a split site and children and staff walked from one site to the other through the middle of town. A result of this was that there was a reduction of staff on site at break times and lunch times, and the school day was extended. There was no form of security, such as CCTV, and the pupils had access to the car park and the main road outside the school.
The unprofessional behaviour of the SENCo, who kept doing impressions of other SENCos in the local schools, and who obviously was more interested in discussing the other schools which we had visited, left us with a negative impression.
The next school had an equally odd SENCo, who considered that the main "selling feature" of the school was the heating system and the lack of draughts. When asked about support we were told that we could have whatever we wanted. When enquiring about an IEP, we could also have one if we wanted. The school had 50% of the pupils on the SEN register and there was not a learning support base. The SENCo could envisage no problems in having our grand daughter in the school as she was "extremely experienced with special needs." Extra visits to the school could be arranged, and the TA from the primary school could accompany our grand daughter to show her round. It did occur to us that the primary TA might not know the school.
By this point disbelief and despair were beginning to set in, but the final school restored some belief in the possibility of finding a suitable school. This was one of the larger schools, but had a safe base where the pupils could go at break times or lunch times. It could even be arranged that they could have their lunch in the base. The base was open throughout the school day to be used as and when needed.
Three TAs would be allocated to each child and would work on a rota. Children would be taken to reception on arrival at school, and would be collected from there by a TA who would accompany them to the base. Spot checks were made on children who were 'known' escapees and everyone would be informed of their 'habit' to ensure their security. If the child chose to go outside at lunchtime support would be allocated.
The SENCo would attend the annual review in Year 5 and Year 6, whereas all other SENCos had indicated that they would attend the Y6 review. The SENCo would visit the primary school in Y6 to talk to the SENCo and the class teacher, but not to the TA, as it was felt that a 'clean break' was desirable. As many visits as were needed would be arranged for the child. On the first visit, a TA would take the child around the school and they would use a digital camera to help make a visual map of the school and a book. Parents were welcome to go to the school, when it was in session, as often as they wished.
Forms of communication would be discussed at a later date and a package would be designed to meet the requirements for each child. All forms of communication would be considered. As with one other school it was emphasised that the aim was to make the child independent.
Following these visits and prolonged discussions with my daughter, it was agreed that in the summer term we would both visit two of the schools, when they were in session. My daughter has also decided to visit the special school, but we have been told that they use one of the schools, that we have rejected, as a link school. The other option, which is still to be explored, is private education. All we need to do next is to work out what issues we have not yet covered!
For those of you who have been following the ongoing tale of finding a suitable secondary school for our grand daughter we have good news, we have succeeded - well almost!
Initially my daughter and her husband visited five schools and later visited the special school and re-visited the local secondary school. When visiting the special school we were advised to look for a child whose needs resembled those of our grand daughter and then if we could not find one to talk to the head of the school. There was not a child in the special school who remotely resembled our grand daughter when we considered her needs. When this was discussed with the head of the school he stated that he thought that she should be in a mainstream school.
My daughter re-visited the local secondary as she had been advised that she had painted an 'unrealistic picture' which was taken from the information which the school had supplied. Apparently she was not on P levels for everything as we believed. An appointment was booked and my daughter visited the SENCo for the second time. She asked the same questions and much to our surprise was given completely different answers, more positive answers, answers more in line with what we had hope for on the initial visit. However it was reiterated that the school had never had a child with Down syndrome and that it would be a learning curve for them.
The decision, after much discussion, was that it was not the best school to meet our child's needs and the recent Ofsted inspection which had highlighted special needs did nothing to raise our confidence. Things were going to change but we were not willing to put her education in the hands of a school which would be in the process of change and would be learning about Down syndrome through the inclusion of our grand daughter. We felt that it would be a re-run of the learning curve which her primary school experienced and was continuing to go through. None of us had the energy to start again.
We finally chose the two schools which had impressed us the most and took up their invitations to visit the schools whilst they were in session. As I had had all my questions answered in the initial visit I began to panic about what I was looking for. As a teacher who had worked as a SENCo for a number of years and who had also worked with several children who had Down syndrome, as well as teaching dyslexics and working as a befriender for the British Dyslexia Association I felt at a loss; this, after all, was my grand daughter and my daughter was relying on my help and advice.
Fortunately a friend who is an Educational Psychologist was persuaded to join us on the visit. Another pair of eyes and ears and more importantly to me someone who had much more experience of schools working with SEN. We were welcomed to the school by the SENCo who took us around the school explaining things as we discussed the issues and questions arose. We eventually went into the SEN base where several students were working. I immediately felt at home and sat with a small group who with prompts from their teacher explained what they were doing. At the end of the lesson the teacher joined in our discussion. All our questions were answered with honesty, all the children we had met and talked to were very positive and polite. During the change over between lessons we were in the corridor and everyone we saw was behaving very sensibly. I was impressed, we were all impressed.
Our main worry was that the school was to be rehoused and that more children were to be included in the intake once the new building was in use. We were shown the plans and it was explained to us that the school would expand by increasing the intake once they were in the new school. Although there was no date fixed we knew that there would be time for her to become secure in her surroundings and establish new friends before the new school was opened.
The second school which we visited couldn't have been more different. We were shown into the head teacher's room where the SENCo was waiting. My daughter had already met the SENCo and had been round the school and had been impressed by the school and their attitude. It was an obvious choice for a second visit and we had been encouraged by the invitation to visit whilst the school was in session.
The head teacher welcomed us and launched into his speech the gist of which was that he had a good school with an excellent staff and a very good special needs department, but he thought that our child should go to her local school. We replied that we thought it was too big and did not consider it suitable. He continued to tell us that if he allowed people like us to bring in special needs children the balance of needs and the staff would be disturbed. He stopped short of saying we do not want your child but said it in as many ways as he could think of.
My daughter was becoming more upset by the minute but I was fascinated and only interrupted him once to remark that my understanding was that he did not have the last word as to which children with SEN he would allow into his school and that the LEA and the parents did have some input into the decision. He stopped and then blustered and continued to dig himself into a hole.
As a teacher I could see what were his concerns but as an observer and a professional I was appalled by his tirade. When we had thanked him for his time we continued with the SENCo showing us around the school. The SENCo was obviously embarrassed and tried to reassure us that if we chose the school he would do everything in his power to ensure that she had the best education possible. Again we finished our tour in the SEN base and had a long discussion with the SENCo.
The decision had been made for us. We did not want to impose our child on a school, we wanted them to welcome her. My thoughts on leaving the school were that it was so unfortunate that the head teacher did not understand how to communicate his fears to parents with children who has SEN. He let his school and his staff down.
My grand daughter and her parents visited the school which we had chosen on the open night for the new intake. As they approached the head teacher he dropped to his knees to talk to her and tell her that he knew all about her and he had been hoping to meet her. He then spoke to her parents. Every time they passed the head teacher on their walk around the school he smiled and waved at her. In the SEN base a teacher put Wordshark on the computer and they worked together whilst her parents talked to the SENCo.
The formal application has been sent in. The next step is for us to supply three letters from people supporting our application. We will not know if she has a place until all the children in Year 6 have been allocated their secondary school places but we have been reassured by everyone concerned that there should be no problem. The SENCo from the school was to attend the annual review; unfortunately she was ill, but plans are in place for her to visit the primary school in the near future.
Study: Early Intervention Pays Off Quickly...August 25, 2017 3:19 PM
Intensive early intervention for kids with autism can be extremely costly, but new research finds that such treatment can pay for itself in short order.
Children who participated in the Early Start Denver Model — an evidence-based treatment for autism — saw the cost of treatment offset in as little as two years, according to findings published recently in the Journal of the American Academy of Child & Adolescent Psychiatry.
The study relied on data from 48 children with autism between the ages of 18 and 30 months. The kids either took part in the Early Start Denver Model — a specialized two-year program where parents and therapists work together to administer a play-based approach designed to improve development — or they received typical community-based treatment.
Those in the Early Start Denver Model program had health costs that were about $14,000 higher annually than the children who received standard care while they were involved in the intervention.
But, in the two years after the intervention concluded, children who were part of the specialized program used less occupational, physical and speech therapy and fewer intervention services leading to $19,000 in cost savings per year for each child, the study found.
The researchers said they believe that those in the Early Start Denver Model group relied on fewer services because of the developmental gains they made during the intervention.
“Prior studies have found that community-based early intervention costs between $40,000 and $80,000 per year,” said Zuleyha Cidav of the University of Pennsylvania, the study’s lead author. “We found that the high-quality, university-based early intervention delivered in this study costs about $45,580. This suggests that the issue is not how much we spend on early intervention, but rather how we use that money most effectively to scale up such interventions so that they are effective in community settings.”
Cidav said the researchers hope to further examine the economic impact of early intervention and identify whether or not cost savings continue as children go through their school years and enter adulthood.
Learning Through Play-What Can an Occupational Therapy Pract...August 25, 2017 11:32 AM
The act of playing is an important tool that influences a child’s life. The primary goals of childhood are to grow, learn, and play. It is often through play that children learn to make sense of the world around them. It is a child’s "job" or "occupation" to play to develop physical coordination, emotional maturity, social skills to interact with other children, and self-confidence to try new experiences and explore new environments.
Occupational therapists have expertise in evaluating children’s neurological, muscular, and emotional development; and determining the effects of infant and childhood illness on growth and development.
What Can an Occupational Therapy Practitioner do?
• Help adapt toys or modify the environment to provide optimal sensory input without overwhelming the child.
• Recommend toys and play activities that provide the "just right" challenge for the child, so he or she learns while having fun. The occupational therapy practitioner can also recommend ways to build on the child's strengths and abilities.
• Offer play opportunities that encourage turn taking and problem solving. Consider family routines and priorities when recommending play strategies. Observe, identify, and develop play strategies that promote a healthy lifestyle and relationships.
• Suggest toys that will help the child develop particular skills, while having fun. Recommend ways for family members to be more involved in the child's play. Suggest toys and play activities for children of all abilities and ages. Collaborate with educators and caregivers to enhance playtime at home, during recess at school, and during community outings.
• Help determine what toys will be safe, developmentally appropriate, and fun for a particular child, based on an evaluation and in consideration of the child's and family's needs and goals.
What Can Parents and Families Do?
• Encourage sensory rich play by using balls, sand and water toys, slides, swings, finger paints, and magnets. During sensory play, children use their senses to incorporate smell, touch, sound, vision, and movement.
• Encourage manipulative play, such as using play dough, LEGOs, and board games. Toys such as puzzles, pegboards, beads, and lacing cards help improve the child's eye-hand coordination and dexterity.
• Promote imaginative or pretend play with things like dolls and stuffed animals, toy furniture, puppets, and telephones. Pretend play encourages creativity and role playing and provides an opportunity to rehearse social skills.
• Choose toys that are appropriate to the child’s age and/or maturity level. They do not have to be expensive or complicated to be beneficial. Common objects, such as pots and pans, empty boxes, spools of thread, shoelaces, and wooden spoons are readily accessible and encourage children to use their imagination.
• Remember when choosing a toy to consider whether a child must be supervised while playing with it. Toys should not have small parts that break easily or can be swallowed.
Recommended Toys and Activities for Children and Teens
• Infants: Rattles, mobiles, playmats, mirrors, crib toys, infant swings, teething toys, busy boxes, squeeze toys
• Toddlers and Preschoolers: Blocks, stacking rings, pegboards, shape sorters, push and pull toys, balls, books, sand and water toys, large beads, movement games, toy cars and trucks, train sets, musical toys
• School-Aged Children: Building sets, books, bicycles, roller skates, ice skates, board games, checkers, beginning sports
• Middle Schoolers and Adolescents: Athletics, books, hobbies, crafts, electronics
Tutoring & OT for Children with Dyslexia...August 24, 2017 4:57 PM
If your child struggles with reading, we urge you to consult a tutor who specializes in teaching kids with reading difficulties. Even if a child is receiving extra help at school—and especially if there is no extra help in school—working with a great tutor can make a huge difference in your child’s confidence and abilities.
Not sure what you need? Some tutors can evaluate your child to determine if there are problem areas. Sometimes the child is right on track and doesn’t need tutoring at all, but either way it’s very useful information.
What to Expect from Tutoring
First of all, keep in mind that tutoring isn’t a “cure.” Dyslexic kids may always struggle to some degree, but with the help of a specially trained tutor, your child can make great strides toward becoming a self-sufficient learner.
Secondly, as parents we have to understand that tutoring is hard work, especially after a long school day. But it’s well worth the effort when you see your child start to enjoy reading for the first time! So keep up the encouragement.
Finally, tutoring is costly. It might be a struggle to pay for it. But here’s some perspective: what will your child’s future look like if she drops out of school because she can’t read well enough to keep up? It’s a sobering thought.
Types of Reading Instruction for Dyslexic Students
To help parents decide what’s best for their child, here are some different methods of reading instruction that are successful for kids who struggle with reading. A tutor who has a variety of “tools” in his/her toolbox will have the flexibility to tailor the instruction specifically for your child.
- Orton-Gillingham methodology is a multi-sensory strategy used to strengthen decoding through sound/letter(s) association, spelling rules, and sight word memorization.
- Lindamood Bell’s LiPS (Lindamood Phoneme Sequencing program) is very similar, but uses the child’s mouth to help develop stronger phonemic skills. It’s about how the mouth feels and moves to identify specific letter sounds.
- Wilson is another methodology/reading program that has been modified from Orton-Gillingham. This very structured program is easily used in schools. Many tutors use it because of its ease and proven results.
- Fast ForWord Language (from Scientific Learning) is a computer-based program that develops a student’s memory, attention, and sequencing. It has its own phonemic development built within the program. It also addresses processing, which is something that can be difficult for a tutor to work on alone.
- Tutors can offer other programs as supplements to learning: Great Leaps, Reading Assistant, Interactive Metronome, and The Listening Program.
How to Choose a Tutor
- Look for personal referrals. Are any friends currently using a tutor for a child with similar learning issues? Ask them if they’re happy. Check websites that may give support for your child’s struggle (i.e. International Dyslexia Assn., Orton-Gillingham, Autism, Facebook support groups, etc).
- Ask questions. Interview the tutor. Ask about his/her specialty. Does she/he have training in more than one methodology? How long has she/he been working with children? If she/he is new to tutoring, is the tutor being mentored by someone? If she/he has a website, it may help answer even more questions. The more information you can gather from your tutor, the better the connection.
- Does your tutor offer assessments? Not all tutors can provide standardized assessments, but they should be able to do some form of monitoring to understand how best to work with your child. It’s always good to have some form of pre-evaluation so that you’re all on the same page.
- Establish what you want from your tutor. Make sure you and the tutor agree on your goals. Do you want your tutor to give homework between sessions? Some parents can’t handle the additional workload. If that’s you, talk with the tutor or ask for an update via email.
- Do you understand what your tutor is doing? Many parents don’t understand the homework sent home or review sheet from the tutor. Make sure you have the chance to review with the tutor. A good tutor will be able to explain the work to you. If she/he cannot communicate with you regarding these simple tasks, then you might want to re-evaluate your choice of tutor.
- Small group or one-on-one? If you’re investing in tutoring, make sure your child is getting all he/she needs. Small group learning might be more economical, but in my opinion, one-on-one tutoring is more effective. Your child won’t be comparing himself/herself to the others in the group, and the tutor can match the pace to your child.
- Does you tutor communicate with your child’s teachers? The goal is for the child is to be successful in the classroom. If the child’s teachers are willing to work with the tutor, this is a great relationship to develop. This lets the parent and tutor know how things are progressing in school.
- Understand tutoring isn’t always a quick fix. Children who struggle with reading and/or math may have a significant learning challenge. Normal once- or twice-a-week tutoring can span a school year or beyond. Sometimes a tutor can’t specifically state how long tutoring will be required, especially if she/he hasn’t met and/or worked with your child.
- Does the tutor fit your child’s personality? Tutoring will be much more pleasant for your child if he/she likes the tutor and his/her energy level.
- Tutoring is an investment. Kids with significant reading difficulties will likely require certified, qualified tutors who are trained in a specific methodology (such as Orton-Gillingham). These tutors have gone through extensive qualifications, and their specialized skills are expensive. Tutoring costs can range from $60 – $120 per hour, so it’s important to interview the tutor and make sure you have a good fit for your child. If you’re simply looking for a homework helper, your school might be able to connect you with a teacher or an older student to mentor in a specific subject at an affordable rate.
Occupational Therapy (OT)
Occupational therapy is helping people who have difficulty performing everyday life activities because of illness, injury, disability, etc. Occupational therapy is concerned with the person’s physical, cognitive, psychosocial, and sensory-perceptual health, well-being and quality of life.
What Is Occupational Therapy for Kids?
The “occupation” of young children is play (it’s how they learn); for older children, the occupation is school. Some children have disabilities or developmental delays that interfere with their ability to engage in play or learning (or other life activities). An occupational therapist (OT) works with the child to promote independent function in these common areas:
- Fine- and gross-motor skills (running, jumping, holding a pencil, using scissors)
- Visual-motor skills: coordination of eyes and motor skills (like copying from the board)
- Visual-perceptual: making sense of what is seen
- Sensory processing: the way the brain processes and responds to incoming information through the 7 different senses (visual, auditory, tactile, olfactory, gustatory, proprioceptive and vestibular)
- Coordination: the ability to perform graded motor movements in time
- Motor-planning/praxis: the ability of the brain to conceive, organize, and carry out a sequence of unfamiliar actions
- Executive functioning skills: higher-order thinking skills including planning and organizing (both of thoughts and materials), and includes cognitive sequencing, inhibitory (impulse) control, mental shifting, initiation, and emotional control (frustration tolerance).
Private vs. School-Based Occupational Therapy
In private practice, the goal of occupational therapy is for the child to learn to function as independently as possible. An occupational therapist uses standardized testing to determine the child’s ability, then designs an OT program with the goal of bringing the child’s performance up to match the level of his/her abilities.
The role of the OT in a school is more limited. A common role for an OT in the school setting is to develop “accommodation and adaptation” of school tasks.
Accommodations are strategies that allow a task to be performed as designed. Example: a child who struggles with writing might have a letter strip on his desk so he can refer to the correct formation of letters.
Adaptations are changes to the task itself, so that the person can perform it more independently. Example: have the child type or dictate a paragraph instead of writing it by hand.
OTs perform services in schools based on federal guidelines (IDEA and FAPE) that require schools to provide an appropriate education and access to learning for every child. To receive OT services in school the child must have an IEP. The child’s delay or disability must be directly related to his performance on one of his IEP goals. The therapist’s work with the child will focus specifically on achieving the IEP goal(s); once the goals are met, OT services are no longer provided, even if the student is still functioning below his developmental ability. This is different from OT in a private setting, where the goal is for the performance to match the ability.
How Can OT Help Kids with Dyslexia?
OTs can help with numerous symptoms of dyslexia or symptoms that often aggravate dyslexia, including ADHD, dysgraphia, and dyspraxia, all of which can occur in conjunction with dyslexia.
- High in IQ, tests well orally, but not in writing. (possible dysgraphia)
- Trouble with writing or copying; unusual pencil grip; inconsistent or illegible handwriting. (possible issues with fine motor, dysgraphia, visual processing)
- Uses fingers for counting and other tricks; knows answers, but can’t do it on paper. (possible dysgraphia)
- Difficulty sustaining attention; seems “hyper” or “daydreamer”; gets lost easily or loses track of time. (possible ADD, ADHD)
- Confused by letters, numbers, words, sequences. (possible visual perception issues)
- Writing shows repetitions, additions, transpositions, omissions, substitutions, and reversals in letters, numbers and/or words. (possible issues with visual perception and sequencing)
- Complains of feeling or seeing non-existent movement while reading, writing, or copying. (possible visual perception issues)
- Seems to have difficulty with vision, yet eye exams don’t reveal a problem; lacks depth perception and peripheral vision. (possible visual perception issues)
- Has extended hearing; hears things not said or apparent to others; easily distracted by sounds. (possible auditory processing issues)
- Difficulty putting thoughts into words. (possible dysgraphia)
- Clumsy, uncoordinated, poor at ball or team sports; difficulties with fine and/or gross motor skills and tasks; prone to motion-sickness. (possible issues with motor coordination, visual processing, vestibular processing, motor planning)
- Can be ambidextrous, and often confuses left/right, over/under. (possible issues with visual processing, vestibular processing, proprioceptiove processing)
- Poor memory for sequences; difficulty learning sequenced information or tasks, or being on time. (possible sequencing issues)
- Extremely disorderly or compulsively orderly. (possible issues wiht organization, sequencing, executive functioning)
- Had unusually early or late developmental stages (talking, crawling, walking, tying shoes). (possible developmental delay)
- Unusually high or low tolerance for pain. (possible issues with sensory processing)
- Mistakes and symptoms increase dramatically with confusion, time pressure, emotional stress, or poor health. (possible issues with executive functioning (multi-tasking), organization)
Benefit of Physical Activities and Adaptive Sports...August 24, 2017 3:47 PM
It is an undisputed fact that young and old must strive for a healthy lifestyle. This means kids, teens and adults must keep mentally and physically fit. Children with special needs most definitely benefit from having a balance in all aspects of their life: social, physical, and mental. My post today will bring out the benefits of physical activity for a child with special needs and what is available to make this happen.
Your child is not able to take part in regular gym class or team sports? Become informed about all the adaptive sports and adaptive physical activities for children with special needs. Talk to other parents and follow special needs parenting blogs.
Kids with physical disabilities face challenges. Some youth have limited mobility and/or tire more easily than other kids and teens. For some kids with sensory issues, communication challenges or difficulties with social skills, team sports are simply not fun. Kids with side effects from medication, those who are always overtired from lack of quality sleep and youth who are overweight and not physically fit at all will not enjoy many organized activity programs. What is the solution?
Physical Activities for Rural Kids
I was certain when I started researching to write this post that I would find how disadvantaged rural special needs families were in regards to adaptive sports and physical activity. This is still true in many areas especially with sport teams because the special needs community and the support and funding are not there in numbers great enough to make it work. But rural areas have wide open spaces offering ample opportunities for families to enjoy walks, bike rides, horse back riding and lots of unstructured physical activities.
Video Game Systems Designed for Exercising
Surprisingly what IT technology has done to social communication technology it has also opened up a whole new realm of possibilities for helping your child with special needs to exercise right in your home. No real sport equipment is required. No more driving or watching for good weather to play outdoors. No schedules to follow. Furthermore, these new, interactive electronic games/activities can be played with more than one player helping foster social skills.
Each video game has many levels of difficulty so your child will find the one he needs. Read about them and choose the game that best suits your child and the area of development you wish to improve. You can find games that address some of the following areas strength, endurance, gross motor development, balance, coordination, body awareness, hand-eye coordination, timing of movements, following sequences, etc. Choose the game that fits your child’s needs… or start with one that your child will LIKE to play because he is good with that skill. His boost in self-esteem might motivate him to try new skills in a different game.
If families find it too expensive to have these games in their homes, schools and community-based fitness centers and programs, like public gyms or local YMCA’s, already have Wii games and exercise modules in place for the use of their members/students. There are also other such games available and new ones coming out all the time:
- Wii Fit Plus Bundle includes the game software and the Wii Balance Board
- DanceDanceRevolution Bundle Bundle includes game and DDR dance mat controller for Wii
- Wii Spots Tennis, Baseball, Golf, Bowling and Boxing in the comfort of one’s living room
- Kinect Sport Ultimate Sport Collection: two best-selling Kinect™ game wrapped into one – 13 great sporting games – basketball, Soccer, American Football, Bowling, Beach Volleyball, Table Tennis, Boxing, Golf, Tennis, Skiing, Darts, Baseball
My Child Does Not Like Sports or Any Physical Activity
No form of sports or physical exercises interest your child? Promote other activities that involve moving/movements that will almost have the same end results.
- Collecting rocks, leaves, flowers, insects…
- Photographing the objects others would collect or different balconies, unique door knockers, various signs, windows, roofs, birds…
- Gardening…flowers, herbs, vegetables, fruit trees, berry bushes, small green house…
- Watching birds, squirrels, bugs, frogs….
- Playing catch with a dog, throwing a ball back and forth with a friend.
- Sitting on huge balls and keeping your balance.
- Learning to juggle, stacking cups, arm wrestling…
- Flying kites, making huge soap bubbles…
- Using hula hoops, gymnastic ribbons, dancing,
- Skipping ropes, hop scotch games, playing hide and seek
- Bowling, table tennis, swimming pool games
- Enjoying a playground, playing in your back yard on swings, slides…
Steps In Planning Physical Activities for Kids with Special Needs
Do it right and have peace of mind. Meet with your family doctor, pediatric physical therapist or a pediatric occupational therapist and have your child evaluated and find out what sports/physical activity would be suitable for him or her. Be sure you’re aware of any risks your child faces, get familiar with the proper safety precautions needed and familiarize yourself with any equipment needed. Almost any kind of disability can be accommodated with adaptive exercise/sport equipment or certain technique adjustments.
Benefits of Physical Activity for Children with Special Needs
All individuals benefit from regular physical activity and children with special needs especially. We could all gain from these physical, mental and social benefits of being active.
- See improvements in muscle strength, coordination, and flexibility.
- Improve exercise endurance, cardiovascular efficiency, and possibly increased life expectancy.
- Experience better balance, motor skills and body awareness.
- Will show improvement in behavior, academics, self-confidence and building friendships.
- Will have positive changes in their health, quality of life and boost to their self-esteem.
- Gets to experiences a sense of accomplishment and possibly the taste of winning or personal satisfaction.
- Experience increases in attention span, on-task behavior, and level of correct responding.
- Will increase appetite and improve quality of sleep.
- Will see a decrease in secondary health complications like obesity, high blood pressure, low HDL (“good”) cholesterol and diabetes.
- Will find an outlet for their physical energy, will help them cope with stress, anxiety and depression.
Physical Education Programs Available in Schools for Students with Special Needs
Children with Special Needs are children first with the same needs and desires as their peers. The difference is that some of these students need adaptations and extra support.
In the United States to support their ability to learn in school, three Federal laws apply to children with special needs:
• The Individuals with Disabilities Education Act (IDEA) (1975)
• Section 504 of the Rehabilitation Act of 1973
• The Americans with Disabilities Act (ADA) (1990).
PE Central site states: “Special physical education/Adapted Physical Education (APE) is a federally mandated component of special education services [U.S.C.A. 1402 (25)] and ensures that physical education is provided to the student with a disability as part of the child’s special education services.” Physical education involves physical fitness, motor fitness, fundamental motor skills and patterns, aquatics skills, dance skills, individual, group games, and sports (including lifetime sports).
The Individuals with Disabilities Education Act (IDEA), Public Law 108-466 (2004), states that physical education is a required service for children and youth between the ages of 3-21 who qualify for special education services because of a specific disability or developmental delay. A personally designed program will be outlined in the child’s Individual Education Program/Plan (IEP).
Under US federal law, children with special needs are entitled to participate in organized sports, physical education and recreational programs unless their presence puts them or someone else in danger. Many cities and towns now offer adaptive recreation classes and sports such as basketball, baseball, soccer, softball, swimming, bowling, and tennis…Kids with special needs can enroll in summer camps, Scout groups, dance groups, yoga classes…which now cater to all groups of youngsters.
Parents Must Be Role Models
Parents must be role models for an active lifestyle. Lead by example, make it a family affair and best of all have fun! Use your imagination and find fun, clever ways to get your child moving indoors or outdoors.
How do you make sure your child with special needs get his required daily amount of physical exercise?
Identifying Anxiety in Students...August 23, 2017 4:18 PM
Students are often nervous the day of a big test. Teachers may notice students cramming right before class or asking for reassurance about their grade afterward. Students might also feel anxious about speaking or giving a presentation in front of the class. Just being called on to answer questions may make some students uncomfortable.
These feelings of mild anxiety are normal responses and usually do not interfere with students’ abilities to perform well.
Some students, however, will experience and demonstrate more severe distress. They may:
- Worry excessively about failing an exam, leading to impaired performance
- Feel extremely fearful of a disaster or other events out of their control
- Refuse to come to school or make consistent requests to visit the school nurse
- Refuse to eat or use restrooms in school
- Avoid social situations with peers or stay inside at lunch or recess
- Cry often or appear extremely sensitive
- Avoid raising their hands or volunteering in class
- Refrain from participating when assigned to a group project
- Hesitate to get out of the car during drop off (however, it is normal for students to feel nervous during the first two weeks of the school year and a week after returning from breaks)
- Appear distracted or have a hard time paying attention due to their fears and worries
Students who exhibit the above behaviors may have an anxiety disorder, which can interfere with school activities, family and peer relationships, and normal development.
Teachers are important role models in students’ lives. Being aware of anxiety disorders can help teachers recognize students’ distress and provide resources or referrals to help students get treatment and support.
How Teachers and Therapists Work Together to Facilitate Self...August 23, 2017 12:16 PM
It’s back to school time and that means changes in routine for many students with Autism, especially in Early Childhood special education settings. New federal/state regulations and service delivery mandates, budget cuts, and an increasing emphasis on behavior management means that teamwork and collaboration is in, and “pull out” individual therapy in a vacuum is out. New classrooms, new classmates, new teachers, new therapists, and new schedules can all be potential “triggers” that can cause behavioral issues.
“It Takes a Village…”
There’s a saying, “it takes a village to raise a child”. There is truth to this, especially when addressing noncompliance and self regulation in children with social communication deficits. Social communication proficiency is the cornerstone of civilization, characterized by the ability to self regulate i.e. transition from Me to We as needed.
This is a hard concept and skill for youngsters with Autism/special needs to grasp and master, due to underdeveloped Self Concept, Theory of Mind, and comprehension of time passing. This results in “meltdowns” due to fluctuating neuro-cognitive disorientation to person/place/time seen in many of these students. To counteract that, it in increasingly important that teachers and therapists collaborate on treatment.
The Three C’s of Behavior Management
Communicating with the child’s inner landscape to establish rapport
1. Get to know the child
Get to know the child’s likes and dislikes through play interaction first, to get an unbiased impression. Give the child the run of the room initially, in both class/therapy, for a short time, at regular intervals, to see what he/she is drawn to and what he/she avoids. Keep a list.
2. Gather Information
Peruse previous documentation, parental questionnaires (I like to create one to send home to each student’s parents at the end of the first day of school introducing myself, and asking for family photos and a list of favorite toys/snacks/topics of conversation/people etc.
3. Create a Social Story
Therapists can assist teachers in using arts & crafts and/or technology to create a visual, customized, cognitively correlated Social Story, “All About Me”, about the child’s known preferences and proper, more age appropriate responses to unwanted/unanticipated events. This Social Story will showcase targeted vocabulary and the items the child will likely receive/experience instead, in various settings.
The teacher can create/discuss templates in a group activity. The speech therapist can individualize the templates by taking/showing personalized digital photos and discussing/teaching the vocabulary etc. The OT can facilitate muscle memory, to facilitate episodic memory, by coloring/cutting/pasting those photos and templates. The teacher can then have the therapists “push in” to a Circle Time routine with a Show & Tell component, where each child gets to show off/discuss their uniquely created and collaborative Social Story. A copy (either paper or digital) gets sent home for homework and review, and to keep parents “in the loop”.
Clarifying expectations for that child, with that child:
1. Class Rules, Schedules and Rewards
Teachers can use Visual Supports (digital photos, labels, Lesson Pix™ or Mayer- Johnson’s Boardmaker™ software) to create succinct class rules, class schedules (AKA Visual Schedules) , and class rewards charts for good behavior (AKA Reinforcer Rosters). These can be photocopied and sent home with instructions and explanations for review.
2. Reinforcement from therapists
Therapists can help the teachers create these materials and teach the meaning behind them, to students on an individual basis. This can provide an additional “teachable moment”, especially if implemented while using role play with puppets (I recommend the book REPLAYS by Karen Levine and Naomi Chedd) or corresponding iPad Apps featuring those photos/topics/concepts.
3. Use the same materials
Both teachers and therapists can use the same photos, target vocabulary, and speech mannerisms for the Visual Supports, to maintain familiarity and help the child retain/generalize.
Consistently positively reinforcing the child’s compliance i.e. performance/completed tasks:
Teachers can create a Reinforcer Roster (rewards chart) of ALL the special things (to be kept out of reach but not out of sight, until ready for use) in the room available for the child’s use, when he/she earns it (ex: iPod + headphones, favorite snack, skateboard, favorite doll etc.)
2. Mix in the new with the old
Therapists can have duplicated items including some new zingers (ex: special straws or horns, playground equipment, iPad with new Apps, remote control airplane etc.) that are visually depicted and up for negotiation as well.
For those children who can tolerate delayed gratification, therapists can also create a digital or paper calendar to show how often compliance occurs, and that calendar gets shared with the teacher/class and parents at the end of each month, token economy style, for a bigger reinforcer at a later interval.
3. Get on the same page
Both teachers and therapists must agree in advance, in writing (team meeting, IEP Behavior Plan, interoffice Email), HOW to handle the child’s reluctance to comply/complete tasks, in both actions and the language used. Parents must get a copy of the written plan of action, which spells out the designated wording/vocabulary (ex: I like to initially say to the child, “I don’t understand”, or “You don’t seem to be ready” while sometimes showing him/her a mirror to catch his/her expression) and action (ex: setting a timer to ring, removal from others to forestall injury etc.)
Learning to Play Detective
These suggestions, within the framework of the three C’s of behavior management, require both teachers and therapists to play detective and learn about their students’ inner landscapes. They require methodical implementation and documentation of IEP goals within this framework, to facilitate self regulation, and counteract inconsistent, situation specific, splintered performance. Only through careful collaboration, can we really help our students generalize learned skills and learn to more seamlessly transition from being a Me to a We as needed.
Homework Help From Occupational Therapy...August 23, 2017 8:08 AM
Why is homework such an issue? According to school-based occupational therapist Judith Schoonover, MEd, OTR/L, ATP, the main problems children tend to have with homework are organization, working independently, knowing what to do, and turning in the finished product. All sorts of reasons can account for students having trouble in each of these areas, and an occupational therapy practitioner can help to identify them. But addressing two big areas—organization and student accountability—can dramatically help students to “own” their homework and their role in completing it.
To help with organization, a student must first have a schoolbag that is the right size to carry home materials and return the completed work. At home, environments and lifestyles play a big part in how children approach their homework. “They need a safe, orderly, consistent place to do homework,” Schoonover says. “If a home or lifestyle is cluttered, it makes it harder for kids to order themselves. Children crave order and most thrive under schedules. They like going to bed and getting up at a certain time. They might whine about it, but it helps them feel better physically and emotionally when there’s consistency.”
Students also need to be held accountable. Sometimes they struggle with the independence that homework requires because of the amount of support they receive. “A lot of students lack organizational skills and often teachers, teachers’ assistants, or even parents, in an effort to be helpful, do so much for them that the student doesn’t know that these materials or their assignments really belong to them,” Schoonover says. “Oftentimes, someone puts the homework in a student’s folder, takes it out of his or her folder, turns it into the homework box, and writes down the assignments in his or her notebook.”
“I also see a tendency that when children forget their work, parents go and collect it for them,” Schoonover says. “There seems to be a diminished accountability for kids and few opportunities for children to be held responsible. When they are not involved with the [homework] process from start to finish, it is difficult for them to see the relationships between the parts to the whole.”
How Can Occupational Therapy Help Teachers?
In general education, occupational therapy practitioners address student struggles broadly as a classroom consultant by collaborating with teachers. An occupational therapy practitioner might observe the routine of the classroom during the school day; identify potential barriers to turning in homework, such as the homework box being difficult to find; and suggest ways for the teacher to arrange the room to support students’ different learning styles and organizational skills.
Occupational therapy practitioners can also help teachers to make their expectations clear. Often, the written instructions for homework, if there are any, are so obtuse that neither the child nor the parent can figure them out. Occupational therapists can assist the teacher in delineating the sequence of expectations in a manner easily discernible or understandable. A teacher might be so familiar with the content and what is expected that he or she may not realize that the instructions are not sufficient for the student to complete the assignment.
How Can an Occupational Therapy Practitioner Help Individual Students?
For an occupational therapy practitioner to work directly with a student, the student needs to have an individualized education program (IEP), which specifies occupational therapy. If failure to complete homework is adversely affecting educational achievement, an occupational therapy practitioner can identify the reasons why and help the student, teacher, and parents to address them.
“Sometimes, students can’t finish their homework because they don’t have the tools to express what they know. When they get home, they’re not successful because there is nobody to scribe, type, or spell for them,” Schoonover says. “The problem may be a poor match of what is expected and what the student is capable of doing. That’s where an occupational therapy practitioner can help and make suggestions.” For example, a student who cannot write could make a scrapbook that depicts what he or she has learned, use a computer to type, or record an audio response.
What makes occupational therapy practitioners so good at addressing problems with homework? “We have an understanding of the physicality of learning and the emotional components of learning. We understand the effects of medication, and we know what mobility issues may interfere with learning,” Schoonover says.
For example, a student sitting at a desk that is not at the right height might expend too much energy trying to balance, “making it difficult to focus or perform motorically,” Schoonover explains. The student may miss verbal instruction because he or she is paying so much attention to maintaining posture, although the student may not even realize the problem. An occupational therapy practitioner can identify this type of barrier.
Or, if a student is unable to sequence or organize an assignment, it may be because it appears endless or overwhelming to him or her. “The occupational therapy practitioner can make suggestions to the child, teacher, or parent regarding how to break up assignments into manageable parts, circumventing a self-defeating attitude or a homework battle,” Schoonover says.
How Can Parents Help?
Schoonover has some advice for parents to help make homework time less painful. Holding children accountable, she says, is absolutely key, and there are simple ways for kids to learn to take responsibility for themselves. “Parents can assign responsibility [with] consequences. Children need to have chores like making their beds, carrying in the groceries, or raking the lawn. That’s how they learn the work ethic that’s a part of doing homework without being reminded and nagged until it becomes a battle,” Schoonover says.
Daily routines, such as homework, must be consistent; expectations and consequences must be consistent; and the environment for doing homework must be consistent, meaning that the child should do his or work in the same orderly place each day.
Every child is different, and will approach and complete homework in a different way. Occupational therapy practitioners understand and can identify a child’s strengths as well as the underlying causes of why he or she struggles in school. Most importantly, occupational therapy practitioners can give children the tools they need to successfully fulfill their roles as students.
Occupational Therapy & Down Syndrome...August 18, 2017 1:58 PM
If you are a parent reading this website, you likely have a child with Down syndrome, as I do. My intent with this article is to provide you with some information about how an occupational therapist (OT) may be able to help you and your child. Occupational therapists who work with children have education and training in child development, neurology, medical conditions, psychosocial development, and therapeutic techniques. Occupational therapists focus on the child's ability to master skills for independence.
These can include:
- Self care skills (feeding, dressing, grooming, etc.)
- Fine and gross motor skills
- Skills related to school performance (eg: printing, cutting, etc.)
- Play and leisure skills
When your child is an infant, your immediate concerns relate to his health and growth, development of the basic motor milestones, social interaction with you and others, interest in things going on around him, and early speech sounds and responses.
At this stage an OT may become involved to:
- Assist with oral-motor feeding problems (this can also be addressed by Speech Pathologists). Due to hypotonia and weakness of the muscles of the cheeks, tongue and lips, feeding is difficult for some infants with Down syndrome. OTs suggest positioning and feeding techniques, and can be involved in doing feeding studies, if necessary.
- Help facilitate motor milestones, particularly for fine motor skills. Occupational therapists and Physical therapists work closely together to help the young child develop gross motor milestones (eg: sitting, crawling, standing, walking).OTs work with the child at this stage to promote arm and hand movements that lay the foundation for later developing fine motor skills. The low muscle tone and loose ligaments at the joints associated with Down syndrome are real challenges to early motor development and occupational therapy can help your child meet those challenges.
When your child is a toddler and preschooler, she will likely have some independent mobility and will be busy exploring her environment. To assist her development you will want to provide her with many opportunities for learning, you will want to encourage the beginning steps in learning to feed and dress herself, you will want her to learn how to play appropriately with toys and interact with other children, you will be encouraging speech and language skills, and you will continue to provide opportunities for refinement of gross motor skills.
At this stage an OT may become involved to:
Facilitate the development of fine motor skills. This is an important stage in the development of fine motor skills for children with Down syndrome. Now they will be developing the movements in their hands that will allow them to do many things as they get older, but many children need some therapy input to ensure that these movements do develop. Children do this through play; they open and close things, pick up and release toys of varying sizes and shapes, stack and build, manipulate knobs and buttons, experiment with crayons etc. Your child may face more challenges learning fine motor skills because of low muscle tone, decreased strength and joint ligament laxity.
Help you promote the beginning steps of self help skills. An OT can help parents break down the skills so expectations are appropriate, and can suggest positioning or adaptations that might help the child be more independent. For example, a child may have more success feeding herself with a particular type of spoon and dish.
Then your child enters the school system and the focus of your energies changes somewhat again! You help your child adjust to new routines, you attend school meetings to plan your child's educational program, you focus on speech and communication, you help your child practise fine motor skills for school (such as learning to print), you expect your child to develop more independence in self help activities, and you search out extracurricular activities that will expose your child to a variety of social, physical and learning experiences.
At this stage an OT may become involved to:
Facilitate fine motor skill development in the classroom. Many OTs work in the school system and provide programs to help children with Down syndrome learn printing, handwriting, keyboarding, cutting etc. They will also look at physical positioning for optimal performance (eg: desk size etc.) and assist with program adaptations based on the child's physical abilities.
Facilitate self help skills at home and at school. As with all children, our kids with Down syndrome vary in personality, temperament, and motivation to be independent. Some children with Down syndrome have a desire to do things themselves, such as dress and feed themselves. These children may learn these skills by watching others and participating from a young age. Other children may be happy to let others do things for them, and may resist attempts to help them learn these skills. In these cases an OT may be able to help a parent work out these challenges, while helping the child develop better motor skills to be successful in self help skills.
Address any sensory needs your child may have. Sometimes a parent has a concern about things their child does that may relate to the child's sensory development. For example, a child may excessively put toys in her mouth, she may have poor awareness of her body in space, she may squeeze everything too hard or drop things a lot, or she may not tolerate very well some routines like washing and brushing hair. An OT can offer suggestions to help the child and parents deal with these issues.
As parents we must be concerned with the well-being of our child in all respects. We have so many things to think about and keep track of: medical and dental needs, motor and communication needs, educational needs, advocacy, social and behavioral needs : the list seems to go on and on! We need the help of trained professionals to guide us and to work with our children to help them achieve their potential in life. An occupational therapist is one member of the team that we can rely on to provide professional assistance throughout the growth and development of our children.
In the US, OT services can be obtained through Early Childhood Intervention programs, public and private schools, and from private therapists.
Tips For a Successful Inclusion Classroom...August 18, 2017 8:10 AM
Children of all abilities seek the same things: to learn, have friends, feel valued, and experience success. When the demands of a child’s environment are misaligned with his or her social and emotional skills, frustrating and disruptive behaviors occur. To help children succeed—whether they are on the spectrum, have a learning disability, or simply don’t yet have the tools to control their outbursts—the adults in their lives need to help children align their behaviors with their aspirations.
While building relationships and structuring a productive learning environment are the foundation of all successful learning experiences, the importance of classroom management is even greater in inclusion classrooms. Classrooms in which students of all abilities work side-by-side can be supportive settings for both students with challenges and their typically developing peers. Inclusion is not just a change in location, however, and educators need to be adequately prepared and must shift their practices to meet all students’ social and emotional needs in order for any inclusion setting to be successful.
As educators work to reach students of all abilities, here are a few tools to keep in mind that Ramapo for Children uses and teaches to facilitate an inclusive environment:
Build a “home base” or “retreat.” Sometimes the social and emotional demands of the classroom environment are too much for a student. To help remove students from an escalating situation and give them the space and time to cool down, create a place where a student can go to escape the stress of his or her current environment and regain control. This space may begin as a refuge, but be sure to manage it strategically by establishing mutually acceptable rules so the student does not overuse it.
Develop routines and procedures for transition times. Transitions can be challenging for all students, especially those with lagging social and emotional skills, and transitions are often the time when the most disruptive behavior occurs. Be proactive: Engage students in an activity as they enter the class. Plan carefully how to transition students from one activity to another. Be consistent, and make sure that students know what to expect from transitions and when they will occur. Allow time for wrap-up and reflection at the conclusion of each class or lesson.
Use noverbal cues and signals to effectively communicate directions. Many students with behavioral problems also have learning difficulties, especially with processing receptive language. Since so much of behavioral direction in a classroom is verbal, there are often students who thus become frustrated or “turned off” in inclusion classrooms. Nonverbal cues help students understand the sequence of activities, clarify expectations, and forecast what is happening next. Use signs, gestures, picture cues, and visuals to communicate directions to a wide range of learners.
Through its highly regarded adult training programs and direct service youth programs, Ramapo for Children has seen that inclusion is achievable. Though working with a range of students of widely varying abilities may seem daunting, the right behavior management skills can help educators intervene with high-needs students while still ensuring an effective learning environment.
Involving Parents in Child Centered Therapy...August 17, 2017 2:02 PM
When young children, ages 2 to 9, are experiencing emotional and behavioral problems, the usefulness of talk therapy is limited because they often cannot communicate effectively using words. Play therapy continues to gain momentum as a viable approach to work therapeutically with young children because it is based on the premise that children communicate best through their usual way of relating — play. Using play in therapy is the most natural and effective way to help children.
Children are most often referred for play therapy when they demonstrate problems with friends, at home or at school. There are many different approaches to play therapy, but all are structured, theoretically based and developmentally appropriate, allowing young children to communicate and learn in the way that is most natural to them. Play therapy is different from “just” playing. It helps children express their feelings, assume responsibility for their behaviors and develop problem-solving skills. Play therapists are trained mental health practitioners who specialize in helping young children.
As mentioned, a variety of approaches to play therapy exist, but I have found child-centered play therapy, as developed by Garry Landreth, to be particularly effective. Based on the work of Carl Rogers, a basic premise in child-centered play therapy is that children possess an innate force within themselves to grow and heal. Therefore, child-centered play therapists do not direct children on how to resolve their problems or use interpretation with children to promote their growth. Instead, child-centered play therapists relate to children in the playroom in ways that demonstrate a firm belief that children learn the most and heal most effectively when they themselves decide what to do in therapy sessions. Through a supportive and caring relationship with child clients, therapists help these children understand themselves, accept their feelings, assume responsibility for their behaviors in the playroom and learn to control their own behaviors.
Why work with parents?
Although there is consensus among play therapists that effective consultation with parents can maximize beneficial outcomes for children, parental involvement in the process often does not extend beyond the intake session and brief periodic check-ins when parents bring their children to therapy. But effective parent consultation can help parents better understand why play therapy is beneficial for their children, how play therapy interventions are purposeful and that the effectiveness of the interventions can be assessed. In addition, these consultations can provide parents support and hope, both of which help prevent early termination by the parents.
Although play therapists may be aware of the importance of parent consultation in helping children, many therapists are not confident about how to approach consultation with parents. In a national survey in 2008, Tim VanderGast found that play therapists identified consulting with parents as one of their greatest needs in clinical supervision. Because child-centered play therapists focus on the relationship with the child rather than on the presenting problem, they face unique challenges when helping parents understand how this popular theoretical approach helps children with specific goals that are established to assess progress.
The goal of this article is to provide some practical guidelines for therapists as they consult with parents when conducting child-centered play therapy. In addition to describing child-centered play therapy to the parents, these guidelines include:
- Learning about the child and developing a trusting relationship with parents
- Addressing objectives and goals
- Relating established goals to the child-centered approach in the playroom
- Providing ongoing parent consultations
Learn about the child and develop a trusting relationship with the parents
Parenting is often difficult and stressful. When issues create the need to involve a young child in therapy, the counselor’s ability to convey to parents the core conditions (as described by Rogers) of empathy, acceptance and genuineness cannot be overemphasized. It is through these conditions that a strong therapist-parent alliance starts to form. Additionally, consultation meetings provide an opportunity to model the person-centered approach with parents, showing them the power of the basic principles that will be used with their child in child-centered play therapy. To begin building this trusting relationship, I recommend that therapists meet parents for the initial session without any children present.
The first step is listening to the parents’ description of the child. This process results in a better understanding of the parents’ perception of the problem, as well as their worldview and the child’s cultural context. For example, when a mother who had not completed high school described her reasons for bringing her child to play therapy, the therapist sensed the mother felt uncomfortable in the elementary school environment and felt intimidated by her child’s teacher. In this situation, the therapist could demonstrate sensitivity to the mother’s perspective by responding to her feelings of uncertainty and discomfort in that environment. However, I would caution that even as therapists attend to the parents’ concerns, the focus should remain on the child’s issues rather than on the parents’ issues.
Address objectives and goals
Communicating the objectives and establishing specific goals for therapy are important for several reasons. First, the process demonstrates to parents that play therapy interventions are purposeful, which might not be as obvious in child-centered play therapy as it is in talk therapy with older children or adults. In addition, the objectives and goals are useful in evaluating the effectiveness of the play therapy. They become the benchmarks to assess progress during ongoing consultations with parents. Finally, we cannot ignore the fact that outcome goals are required in the managed care environments in which many counselors work.
As described by Landreth in the third edition of his book Play Therapy: The Art of the Relationship, child-centered play therapy adheres to the objectives of helping children become:
- More self-reliant
- More accepting of themselves
- Better problem solvers
- Better able to assume responsibility for their own behaviors
The idea of setting specific goals in addition to those four broad objectives can feel uncomfortable to child-centered play therapists. They may fear that they unconsciously possess some expectations and biases that could inadvertently cause them to direct the child in play therapy or to view the child’s behaviors in the playroom through the lens of the established goals. Awareness of this possibility is important and should be monitored through clinical supervision. However, a combination of broad objectives and specific behavioral goals is optimal for monitoring the effectiveness of therapy.
Focusing on the overarching objectives that can be observed in the playroom and in the child’s life outside of the playroom helps us to recognize broad-based changes. Focusing on more specific goals related to the issues presented by parents ensures that attention is also directed to changes in those behaviors that might not be observed in the playroom. Therefore, using both broad objectives and specific behavioral goals is useful in monitoring the effectiveness of play therapy interventions.
In the initial meeting with the parents, the play therapist strives to establish goals that reflect the family’s cultural context, given that each family has its own expectations and experiences with the meaning of help seeking, mental health and play. During this process, play therapists must be sensitive to the parents’ cultural backgrounds because the parents’ values will influence the types of goals established for their child. For example, in some cultures, compliance with authority, both at school and at home, is highly valued. Thus, the goals that evolve for the child through the therapist-parent interaction could focus on compliance and responsiveness to limits. In other cultures in which children experience more permissive relationships with their parents, the goals for play therapy might include enhancing the child’s self-confidence and ability to make decisions. This collaborative process between parents and therapists will result in a consensus on the goals for play therapy.
Setting goals with parents is hard work, and it takes practice. Goals must be concrete, measurable and observable to ensure that progress can be tracked. In addition, goals that are strength-based and that focus on solutions provide hope for parents.
As parents talk about the reasons they sought play therapy for their child, the work of the play therapist is to help them “translate” their concerns into specific behaviors that can be assessed and to set benchmarks to determine how they will know when their child has changed. For example, a mother brought her 5-year-old son to play therapy because he was “out of control” at home and at school. The therapist asked, “What does ‘out of control’ look like?” With that helpful nudge, the mother was able to elaborate, saying, “When it is time for him to get dressed in the morning, he screams for about 15 minutes and hits himself. He says ‘no’ to every request I make of him. And the teacher sends home a note almost every day about him yelling and hitting other children at school.” Based on this specific description of the boy’s behaviors, it became possible to establish realistic goals.
One question therapists can ask parents is, “How will you know when your child has changed and no longer has this problem?” This information provides the basis for benchmarks for change. In the example above, goals were created that specified how many days each week the child would comply with his mother’s requests, not have a tantrum at home, not hit himself and not receive a report from the teacher about problem behaviors in the classroom. Such clearly stated goals are helpful not only in assessing change but also in managed care environments that require the monitoring of behavioral outcomes for insurance reimbursements.
It cannot be overstated, however, that establishing such goals with parents prior to the start of child-centered therapy does not change the way that play therapists relate to the child in the playroom. There are no predetermined interventions during the counseling sessions that seek to change the child’s behavior. Instead, therapists consistently offer a safe relationship and an environment in which the child is free to be self-directive. In fact, in a chapter for the 1997 book Play Therapy Theory and Practice: A Comparative Presentation, Landreth and Daniel Sweeney recommended that child-centered play therapists continually reflect upon their way of being in clinical supervision to address the issue of inadvertently directing the child’s behavior.
Relate established goals to the child-centered approach the playroom
Perhaps the most challenging part of the initial consultation with parents is explaining how the behaviors of the counselor in the playroom help children achieve both the broad objectives and the established goals of play therapy. Play therapists can help parents by describing how each of the established goals could be addressed in the playroom. Using the earlier example, if a young child is “out of control” at home and school, the play therapist might explain to the parents that through the safe relationship with the therapist, the child will learn to assume responsibility for his decisions in the playroom and will have opportunities to demonstrate self-control if setting limits is necessary in the play therapy session. In this way, parents can recognize that what occurs in the nondirective playroom can be helpful in addressing issues occurring at home and at school.
Provide ongoing consultations
Every four or five sessions, therapists should meet with the parents without the child being present. The purpose of the ongoing consultations is to maintain and foster a strong therapist-parent alliance, allow the parents and play therapist to collaboratively assess the progress toward goals, and further educate parents about child development, parenting skills and community resources.
It is important for child-centered play therapists to maintain case notes to document significant events, attitudes and play themes in the play sessions. In addition, reviewing case notes can be useful when assessing progress toward goals. For example, if a child is experiencing anxiety outside of the playroom, case notes can help identify changes in behavior that indicate anxiety in the playroom as well, such as when making decisions about what to do in the playroom, facing the therapist or interacting with the therapist. For a child presenting with goals related to aggressive behavior outside of the playroom, documentation of play sessions could note changes in the child’s response to limits setting. Case notes can be reviewed to identify play session themes (for example, themes of power, mastery or nurturance) to share with the parents. When meeting with parents, play therapists should remain sensitive to maintaining the child’s confidentiality by not disclosing specific play behaviors or the child’s verbalizations during play sessions.
Maintaining and fostering a strong therapist-parent alliance: A primary goal for these meetings is to foster a warm relationship with the parents. The counselor can do this by acknowledging the parents’ experiences, struggles and feelings and responding with empathy and care. Through listening to the parents, the play therapist is better able to support and educate when it is appropriate.
Assessing progress: If parents share more general concerns about themselves at the beginning of the session, the counselor can focus the session on the child by asking an open-ended question such as “How have things been going with ___?” Using active listening skills at this time ensures shared understanding of what the parents are saying. Play therapists should listen for information related to the stated goals for therapy. If the parents do not address each of the goals identified in the first intake session, the therapist can systematically address the goals not mentioned. It is not uncommon for a review of the original goals to surprise parents. Some parents will have no memory of certain goals because the issues will have resolved themselves.
During these ongoing consultation sessions, the therapist can share themes observed in the play therapy sessions, especially if they relate to the established goals of therapy, such as the child’s ability to control behaviors when limits are set or an increasing ability to assume responsibility for decisions. After reviewing the goals, the therapist and parents collaboratively determine whether the original goals were met, whether they need to be modified or if it is time to terminate the relationship.
Providing education on parenting skills and community resources: If the decision is made to continue play therapy, the therapist and parents set a time for their next meeting. Once it is established that the parents will be returning, the play therapist can also share appropriate parenting skills based on the needs of the parents and child. Most parents are eager to learn new approaches to discipline and highly value the skills of limits setting and choice giving. In addition, teaching the skills of responding to the child’s feelings and returning responsibility to the child has been found to reduce parental stress and create a more positive environment in the home. That outcome can influence the entire family system.
Ongoing meetings with parents also provide opportunities to address other needs the child may have that are not currently being met. The therapist can then provide or recommend appropriate resources. For example, if a child appears to have a learning disability, the play therapist should make an appropriate referral for the child to be assessed for needed services.
Child-centered play therapists focus on the relationship with the child rather than the presenting problem. Thus, therapists face unique challenges in helping parents understand how this theoretical approach supports children in progressing toward specific goals. To demonstrate the effectiveness of their work with children and to respond to the demands of managed care in agency settings, play therapists must skillfully share the objectives of child-centered play therapy, establish behavioral outcome goals and then assess progress toward achieving those goals. The guidelines proposed in this article are specifically designed so that child-centered play therapists can collaborate with parents to more effectively help young children.