Why does my Therapist want to observe my Child at School?

There are many benefits for therapists that are permitted to observe their clients in the classroom. These observations, when schoolappropriate, are beneficial not only to the therapist, but to the teacher, family and child as well. These observations provide the therapist with additional insight into your child’s school day, as well as promote collaboration with teachers; constant and open communication within your child’s “team” (including their doctors, therapists, teacher, etc.) is vital to his/her success in reaching his or her goals.

Below are 5 reasons to why an in-school observation is important to help your child reach his or her full potential in the classroom:

  1. By observing a child in the school environment, a therapist can make recommendations and modifications specific to that child in his or her classroom environment. Important environmental factors include classroom set-up, structure, size and possible distractions (such as noise or visual distractions). For example, should the student have his or her seat located in a more optimal area? Is there something that is distracting the child, such as a certain poster?
  2. Provide realistic and practical recommendations. Without seeing the child’s classroom, it may be difficult for a therapist to provide recommendations that are feasible for each student and teacher to follow. For example, for middle school students, it would be important to know the distance from his/her locker to the homeroom class or how much time they have between classes to get from one class to another. For an elementary student, learning about the classroom “jobs” can be important for the therapist to know.
  3. Update and create treatment plans and goals for therapy. Not only can your therapist provide the classroom teacher with recommendations for their classroom, but by being able to observe a child in their own classroom environment, a therapist can appropriately update treatment plans and goals to optimize your child’s success in the classroom.
  4. Collaboration between your therapist and teacher is a very important part of the therapeutic process, especially when your child is having a difficult time within the classroom. By meeting the teacher in-person and other staff members within the building, a relationship and “team” is formed with the shared interest of helping your child succeed.
  5. Visiting a classroom provides a therapist with an opportune time to advocate for their students as well as provide information to teachers regarding their students and the challenges that the students may be facing, which can make the learning and school process difficult.

Following a school visit, therapists will provide the parent with feedback, including observations of their child’s functioning in the classroom and a list of recommendations. For more information on school observations, please consult your child’s therapist to discuss if an observation is deemed necessary and appropriate.

“I Don’t know!”: How to Communicate with your Teen

What do you do when you ask your child a question and they respond with “I don’t know”? This 3-word phrase can be used in a varietymother and teen daughter talking of situations to evade sharing information or avoid diving in deeper into a topic. So, the real question at hand is how to get your teen to open up the lines of communication in a non-threatening and informative way. School-aged children are familiar with plug-and-chug in terms of math equations and the same can be transformed into a mode for communication. “I Feel” statements are explicit, concrete and allow the teen to filter out what is going on, why it is going on, how it makes them feel and how they can work towards resolution.

The equation is as follows:

  • I feel:
  • When you:
  • Because:
  • In the future:

Instead of acting out or keeping their emotions inside due to confusion or perceived lack of support for their self-expression, the “I feel” statement helps them to understand the situation that is triggering their emotion, how they interpret the event and allows them to provide a solution so that they can avoid the same problem in the future.

For example, your teen explodes when you ask them to do their homework. Upon completion of an “I feel” statement, you might come to find out the following:

  • I feel: frustrated
  • When you: nag me to do my homework
  • Because: it makes me feel as though you don’t trust me to do it on my own
  • In the future: can you trust that I will do my homework when you ask me one time

Whether or not you are aware of the stimulating event, “I feel” statements can be used in times to activate emotions or as a tool to help your teen unload during non-threatening times.

Brain Injury in Children

Traumatic brain injuries that occur in children are quite common and are often associated with significant cognitive, academic and brainsocial/emotional concerns. Studies have indicated that brain injuries occur in approximately 180 out of every 100,000 children.

Transportation-related injuries are the most common cause of brain injuries in children as well as adolescents. Studies have indicated that motor vehicle accidents and bicycle falls account for upwards of 80% of all brain injuries in children. The causal factor for brain injuries is varied based upon the age of the child. Specifically, infants and young children are more likely to sustain a brain injury through falls while older children are more likely to sustain a brain injury from a sports injury, bicycle accident or motor vehicle accident.

Traumatic brain injury is the leading cause of death amongst children and adolescents. Data has indicated that about 40-50% of deaths of children and adolescents are associated with brain injuries. The mortality rate associated with a brain injury is related to the severity of the injury. Children with mild brain injuries almost always survive the injury.

The majority of brain injuries are mild and mostchildren and adolescents will usually survive the injury; however, there is often a wide range of neurobehavioral and cognitive concerns associated with the injury. Issues with attentional regulation, slow speed of processing and concerns with executive functioning are often associated with a brain injury. In addition, \children and adolescents that experience brain injuries often exhibit concerns in regard to their social and emotional functioning.

It is often that these children require significant interventions and accommodations within both a clinic setting and academic setting. The specific interventions and accommodations that the child needs must be individually determined based upon the specific areas of strength and weakness that are observed. The interventions may often consist of pharmacological intervention, social work support, academic accommodations (as part of an Individual Education Plan) and supplemental environmental accommodations.

Promoting Bilateral Coordination of the Hands

When people initially think of coordination, physical activities (such as running, skipping, and playing sports) are usually the pb b and jfirst things that come to mind. In the therapy world, however, coordination can refer to several different things. In general, bilateral coordination is the ability to use both sides of your body together in order to perform an activity. Occupational therapists tend to think about bilateral coordination as both gross motor skills and fine motor skills. Bilateral coordination of the hands is required to perform most fine motor tasks.

Here are four examples of the way we use our hands together:

  1. Stabilizing the paper with one hand while writing or drawing with the other hand.
  2. Cutting paper with one hand and manipulating/turning the paper with your other hand.
  3. Using one hand to hold one side of you coat while zipping it up with the other hand.
  4. Tying shoes.

If your child is having difficulty using both hands together to perform fine motor tasks, here are some activities to have him/her practice in order to better develop the coordination of the hands:

  • Screwing on lids of jars and opening and closing Tupperware lids.
  • Scooping objects (e.g., rice or beans) with a cup with one hand and holding the bucket while pouring them inside.
  • Hand games, such as “Miss Mary Mack”.
  • Folding paper into paper airplanes or making fortune tellers.
  • Putting together and taking apart Legos.
  • Making a peanut butter and jelly sandwich.
  • Stirring ingredients in a bowl while holding onto the bowl with one hand.
  • Rolling play-doh into a snake, flattening it into a pancake and rolling it into a ball.
  • Playing a card game, including shuffling the cards, dealing the cards and holding the fanned out cards with one hand.
  • Making a beaded bracelet by threading beads onto a string.

These are just some of the many ways you can encourage your child to use both hands while at home and at school. Improving the coordination of both hands will set your child up for success for fine motor activities that are important for your child’s educational success and independence with everyday skills.

Recreational Activities to Promote Gross Motor Skills

It is often that parents ask me for recommendations for suitable physical extracurricular activities for their children that will also help to gymnasticsfacilitate the gross motor skills we work on in therapy. Extracurricular activities are a great way for your child to socialize with his or her peers and physical activities are the perfect way to make sure your child is getting sufficient exercise each day. I strongly recommend any activity that your child is interested in because the best results occur when your child is invested in what he or she is doing.

On the other hand, if your child does not have any preference or is open to trying new things, there are 2 extracurricular activities that I strongly recommend families to look into:

  • Gymnastics– This is a great activity for a variety of reasons. For example, gymnastics focuses greatly on a variety of gross motor skills, such as balance and jumping in a variety of different positions and on a variety of different surfaces. This helps your child generalize these skills so he/she will perform better in our constantly changing environment. Gymnastics also helps with core, arm and leg strengthening and works on coordination between different body parts.
  • Swimming– Swimming is another great activity that targets core and arm and leg strengthening. Along with strengthening, swimming is helpful for working on your child’s bilateral coordination. A majority of swimming strokes require different movements from the arms and legs simultaneously as well as at  different times.

Regardless of what recreational activity your child chooses to participate in, they all are positive for your child’s physical and social development. On the other hand, if you have concerns about your child’s physical functioning, please contact a physical therapist at North Shore Pediatric Therapy.

5 Ways To Prevent Meltdowns After School

Oftentimes, after-school hours and times of transition can be extremely difficult for children, especially for children with sensory processing disorder (SPD)boy tantrum. Children may often perform well throughout the school day, but then quickly meltdown after they get home. Meltdowns occur because the child will often take in a high amount of sensory experiences (e.g. noisy lunchroom) and has many demands placed on him/her throughout the school day. Once the school day is finished, the child is usually exhausted upon arriving at home, therefore, it is vital for parents to overly-prepare their children for what is expected of them after school (e.g. extracurricular activities, homework, bath time, relaxation time, and bedtime) so that the entire family can have a more positive end to the school and work day.

5 Ways To Prevent Meltdowns After School:

  1. Over exaggerate expectations:  It may feel silly at first, but it is extremely beneficial to talk aloud with your child about
    what is expected of him/her and what the day’s schedule will look like. This becomes even more important during the weekends when there is not as much structure within the day. Overall, children crave rules, directions, structure and routines, therefore, it is crucial for parents to be clear and consistent and provide fair and obtainable expectations for their children.
  2. Picture/visual schedule:  These tools can be incredibly helpful for younger children and/or those children who are particularly visual learners.  Picture/visual schedules help the child see what the schedule is (e.g. first snack, then homework, and last television time).  Similarly, when one of the tasks is completed, the child can put an “X” through the task or remove it from the schedule (e.g. if it is Velcro). This provides the child with independence and a feeling of accomplishment.  Ideally, this prevents the parents from having to ‘nag’ the child too frequently.
  3. Timer:  Both visual timers and auditory timers can provide a child with structure and with a reasonable goal to work towards (e.g. We’re going to practice your spelling words for 15 minutes and when the timer goes off, you can take a 5-minute movement break before moving onto the next piece of homework).  A timer helps the child know that there is an end in sight.  Similarly, for older children, a timer can help them to become more independent with time management.
  4. Calendar/Assignment notebook:  These tools can help promote responsibility and time management. In addition, they can also help  provide a visual cue.  Similarly, these tools can serve as a ‘to-do’ list and it can be a great motivator to cross something off of the ‘to-do’ list as it provides a sense of accomplishment and completion.  Try making it a habit to look over your child’s calendar/assignment notebook with him/her each morning. This will help both of you stay on the same page and so that you may successfully plan ahead together.  Ideally, this will instill good habits for the child down the road as well.
  5. Write a note:  Who doesn’t love receiving a thoughtful note or card?  Try leaving your child some encouragement throughout his/her week (e.g. Before her big math test tomorrow, leave her a note the morning before, near her spot at the breakfast table.  Remind your child that you know he/she has a big test tomorrow and that you are happy to help her study tonight. In addition, remind her to just take one day at a time and encourage him/her to just try her best). Having a positive support system can  help your child feel less pressure and less stress, even during difficult times.
Overall, structure and over-communication are the keys to your child’s reduction in meltdowns after getting home from a long school day.   Keep in mind that even adults crave structure and consistency throughout the day.  Feel free to ask your child which one of the strategies above would be most helpful for him/her- children are often more aware and knowledgeable than we usually give them credit for. In fact, they will most likely have input as to what works best for their body!  Please reach out to an occupational therapist or behavior therapist if you require more individualized ideas for your own child regarding after-school meltdowns.

Omega 3s: Do we need to supplement?

We have all received the message that Omega 3s are really important to one’s personal nutrition. We should eat more fish or include Omega 3fish oil supplements to our diets. Fish oil may be recommended by a doctor in order to help lower cholesterol or reduce inflammation in the body. Why are Omega 3’s lacking in our diet and why do we seem to need so much of it?

What is Omega 3?

To answer these questions, we must first understand what an Omega 3 is. Omega 3s are a type of long chain of fatty acid molecules. These fatty acids serve as important functions to the body. They are used for tissues in the brain, eyes and cell membranes. These fatty acids compose some of the most important parts of the human body. This is why pregnant woman are encouraged to take Omega 3s (or DHA supplements- a type of Omega 3). Similarly, breast milk is naturally high in Omega 3s and infant formulas are now being fortified with DHA and EPA (another type of Omega 3, both found naturally in breast milk).

When Omega 3 fatty acids are broken down in the body, they make Cytokines. Cytokines promote anti-inflammatory cell signals. In contrast, when Omega 6 or Omega 9 fatty acids are broken down, they produce pro-inflammatory cell signals. There are two key things to understand about this process. Firstly, there is an imbalance of the ratio of Omega 3s,Omega 6s and 9s in our modern day food supply. Omega 6s and Omega 9s are found in refined vegetable oils, such as soybean, safflower and corn oil. These oils are used in many processed foods. In addition, because animals are commonly fed corn, their fatty tissues are higher in these pro-inflammatory fats. Animals who are grass-fed and/or eat their natural diet have higher levels of Omega 3s as well as a better ratio of Omega 3s to Omega 6s and 9s. Another important thing to remember is that many chronic diseases and ailments are caused by or exacerbated by inflammation. These include cardiovascular disease, cancer, asthma, allergies, arthritis and more.

How can Omega 3’s benefit us?

Based on this provided information, Omega 3’s can help prevent and/or alleviate many chronic health problems. One way to reap the nutritional benefits of Omega 3’s would be to eat a diet that is low in processed foods and higher in whole foods, including animal products from animals that are fed their natural diet (meat, eggs, dairy products).

These foods are also naturally high in Omega 3’s:

  • Cold water fish, such as salmon, halibut, and sardines
  • Walnuts
  • Chia seeds and flax seeds
  • Dark leafy greens
  • Canola oil

To learn more about an anti-inflammatory diet or how your family’s diet may be impacting their health, schedule an appointment to see one of our registered dietitians. They can help you modify your pantry and kitchen to help prevent or alleviate inflammatory diseases.

10 Ways to Increase Your Toddler’s Language Using Communication Temptations

These communication temptations were adapted from Warren & Yoder (1998) to facilitate a child’s need to communicate in a variety mom and child with a ballof contexts. For example, the goals of the following exercises are to convey emotion, initiate conversation, make requests, make comments and ask questions.

Making Requests & Asking Questions:

  1. Withholding food/toys: Eat a desirable food and wait to give to your child until he makes a request (e.g. “more”) and/or give him/her the desirable food in small quantities (e.g. sip of juice, bite of a cracker) so that he/she is motivated to ask for more. The same strategy works during play. For example, give the child one block at a time when building a tower, blow one bubble at a time and close the jar, blow up a balloon and deflate it, etc. and wait to give “more” until the child requests.
  2. Initiate a familiar game, play it until the child expresses joy, then pause. Allow the child time to make a request for more. If the child does not respond, look expectantly at the child and ask, “What do you want?” For example, if you are rolling a ball back and forth,
    prompt the child to produce “ball” or “more ball”.
  3. Put a desirable object in view, but out of reach (e.g. on a nearby shelf, table or holding a toy out of reach). Prompt your child to “use his/her words” to request a toy.
  4. Pay less attention than usual to the child (e.g. back away or turn your back during an ongoing game). Wait for the child to elicit your attention.
  5. Place a desired toy in a clear container with an airtight lid (or a container the child cannot open). Give the container and wait. Prompt the child to ask for the desired toy.

Making Comments and Conveying Emotion:

  1. Give the child the run of the room for a few minutes- allow him/her time to direct your attention to something the child finds interesting.
  2. Roll a ball back and forth for several turns, then substitute for a different object (e.g. toy car). The goal is for the child to make a comment about the switch in toys. Consider how an adult responds to something unexpected!
  3. Bring the child a new toy or initiate a silly or unusual event (e.g. wear a clown nose). Wait for the child to react (including gestures, facial expressions, etc.).
  4. Place a toy that makes noise in an opaque bag. Shake the bag and hold it up to the child. Wait for the child to comment (e.g. “Whoa!”) or make a request (e.g. “open,” or “open bag”).
  5. Put the child’s hand in a cold, wet, or sticky substance (e.g. water, pudding, paste, play-doh). Wait for the child to comment on the sensory qualities (e.g. hot, cold, sticky, wet, etc).

Warren, S., & Yoder, D. (1998). Facilitating the transition from pre-intentional communication to intentional communication. In Paul, (2007) Language Disorders form Infancy through Adolescence (p.248)

How to Help with Homework

Homework time is one of the most difficult parts of a parent and child’s day, especially if your child has difficulty with the tasks Homework Helprequested of them. We are often asked how to give the help needed without “doing homework” for him/her. We understand, , that as a parent, you want your child to succeed in school; however, you don’t want to fight a battle every night watching your child struggle.

5 tips to make homework time a little easier:

  1. Remove all distractions: turn off electronics, clear the desk/table of extraneous items and provide enough light. It might also be helpful to provide a snack and ask them to use to restroom shortly before starting homework to minimize disruptions.
  2. Create a schedule: determine how much homework your child needs to complete that night. Allow your child to choose which activity he/she wishes to complete first, next and last. Choices are a great option to allow your child to retain some control during required activities. If a break is necessary mid-way through an activity, schedule that activity as well with a time allotment (e.g., “Okay, after your spelling words, you can have five minutes with your action figures before we start the math problems”). If your child would prefer a visual schedule, pictures can be utilized for the schedule instead of a written one.
  3. Make it fun: the best part about kids is that, in their world, everything is funny. Try practicing spelling words in funny voices. Use goofy items to count math problems. Practice handwriting with homemade mad-libs. Make up jokes and creative plays to practice new lessons. Emotions are contagious – if your child sees you having fun, they will too.
  4. Providing help: Children should never fail more than they succeed. In fact, they should succeed almost every time. If not, do what you can to make the task easier. Pick one aspect/goal for your child to focus on and you do the rest until they have mastered the task. For example, your child is required to write 10 sentences using new vocabulary words and both writing and sentence construction is very difficult for your child. Have him/her form ten sentences using a vocabulary word and have him/her say them aloud while YOU write them down. Once you have written the sentences, your child can copy your sentences by practicing their nice handwriting without the stress of making up a sentence. This will ultimately make homework time less stressful and boost a child’s sense of success and accomplishment, which are crucial to mental well-being.
  5. Use resources: Schools and libraries often have resources to provide suggestions for completing homework.

Remember, homework is an important tool that allows your child to keep up with their peers in the classroom; it should not be so time-consuming and difficult that it ultimately impacts you or your child’s home life and anxiety levels. If you have any questions, concerns or desire suggestions, feel free to contact us.

Warning Signs of a Learning Disability

Prevalence rates of Learning Disabilities have an average range of 2-10%. While we aware of the negative impact that learning learning disability girldisabilities may have on achievement, when identified early, your child can be given the opportunity to meet their potential.

Below are 7 signs that may suggest that further evaluation may be needed:

  1. Uneven delays in development that persist to school age
  2. Inconsistency in your child’s performance and retaining of information
  3. Your child seems to need extra time to process information, learn concepts and complete work.
  4. You notice an increasing, strong dislike for school
  5. Your child routinely avoids academic tasks
  6. There is a sudden drop in achievement or a consistent pattern of under-achievement
  7. You recognize a change from your child’s typical behavior or mood presentation (e.g. opposition, anger, sadness, anxiety, inattention or negative self-statements)

It is important to know that children with learning disabilities are not lazy. The opposite is more often the case; they are highly motivated and want to learn.

What can you do if you suspect learning difficulties?

  • Bring your concerns to your child’s teacher. Develop a plan that will implement interventions and monitor your child’s response.
  • If problems persist, request that an evaluation to be conducted. This evaluation can be done through the school, but it may take several months to complete. Parents may wish to seek a private evaluation for faster results.
  • Closely monitor the progress your child is making with any strategies that are put into place.
  • A final and very important point is to provide opportunities for your child to be successful everyday. This will help them feel a sense of mastery and achievement that all children require.

1.Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. (2000). American Psychiatric Association: Washington, D.C.