Why Crossing Midline is Important for Development

As babies grow and develop certain milestones are often celebrated, such as rolling, sitting, crawling, and walking. As a pediatric occupational therapist, one of the milestones I always celebrate might not be visible to the untrained eye. Crossing midline, defined as the ability to reach across the body’s invisible midline with your arms or legs to perform tasks on the opposite side of the body, is a required skill for many higher level coordination activities. Blog Crossing Midline Main-Landscape

This skill typically develops around 18 months of age. Oftentimes when children are referred for occupational therapy due to poor fine motor skills, handwriting, or coordination, they are not crossing midline efficiently.

Some ways to observe whether or not your child is crossing midline efficiently include:

  • Watching to see if your child switches hands during drawing tasks. Do they switch from left hand to right hand to avoid their arm crossing over when drawing lines across paper?
  • Evaluating hand dominance: by age 6, children should have developed a hand dominance. Children with poor midline integration may not yet have developed a hand dominance.
  • Tracking an object across midline: this can be observed during reading, as decreased midline integration can lead to poor ocular motor skill development required for scanning.
  • Observing ball skills: children who are not yet crossing midline may have a difficult time crossing their dominant leg over their non-dominant leg to kick a ball forward.
  • Assessing self-care skills: putting on socks, shoes, and belts may be extremely difficult as these are activities that require one hand to cross over to assist the other in the process.

Children who have difficulty crossing midline may not be able to keep up with their peers, which may cause increased frustration during participation at school and in social situations. In addition, crossing midline is a required skill needed in order to complete more challenging bilateral coordination activities, such as cutting with scissors, using a fork and knife to cut food, tying shoe laces, writing out the alphabet, and engaging in sports.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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How to Help a Child Who is Struggling with Self-Esteem

As children get older and start spending more time with peers, it is natural that they begin comparing themselves to others. It’s healthy for children to want to excel and do their best, but itBlog-Self-Esteem-Main-Landscape becomes problematic when it comes at the expense of their self-esteem. Self-esteem can take time to develop and strengthen, but there are some things you can do to help enhance it during the earlier years.

What to Look for in a Child with Low Self-Esteem

If you notice your child making a lot of negative self-statements, this is indicative that he or she may be struggling with self-esteem. Negative self-statements are self-deprecating and tend to represent black and white thinking patterns. An example of a negative self-statement would be “I am dumb” or “I will never be good at this.”

It is very healthy for children to develop interests or hobbies and to spend time around others who enjoy similar things. Explore a variety of activities with your child and try to provide him/her with options. Whether it’s a cooking class or swimming lessons, your child is bound to show interest in something. Listen to your child and give him/her the autonomy to choose something that really interests him/her. Check out your local park district or community center to see what programs they offer. The Chicago Park District has dozens of wonderful programs and activities that may interest your child.

Each child has their own strengths, talents, and qualities that make them unique. That being said, it is great to point them out when you notice them! It is human nature to enjoy hearing that others are noticing the things we are doing well. At the same time, it is important to help your child understand that they are not defined by their achievements. Think about some adjectives that describe your child (i.e. compassionate, kind, caring). These intrinsic qualities are really what makes someone special – not the amount of trophies or ribbons on their shelf. Plant Love Grow is a wonderful website that has lots of self-esteem boosting activities that you and your child can do together.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

Social Work

10 Red Flags for Poor Sensory Registration

When most people hear Sensory Processing Disorder (SPD), they tend to think of the child who cannot tolerate tags on clothes, covers their ears and screams at parades, and who pulls away from hugs at family parties. While these are all behaviors associated with SPD, they only align with one type. Blog-Sensory Registration-Main-Landscape

Hypersensitivity, or sensory defensiveness, occurs when a child has difficulty filtering unnecessary sensory input and therefore gets bombarded with a waterfall of input, overflowing his or her regulatory system. However, there is another side to the story that often surprises parents that I work with. Just like a child may be over-sensitive, they may also be under. Poor sensory registration, or hypo-sensitivity, is another common classification of sensory processing disorder and applies to children who do not absorb, or register, all of the input entering their body. They are therefore “missing out” on crucial information from their own body and the environment, which is used to make adaptive responses and learn.

Imagine a giant waterfall, filling a pool at the bottom to the “just right” level. Now imagine that waterfall has a giant strainer at the bottom, causing a tiny fraction of the water to pass through and barely filling the pool. While typically processing children naturally and efficiently take in information from the environment through their many sensory receptors and use this information to make adaptive responses, this is much more difficult for children who miss some of the information coming in. Using the waterfall metaphor again, think how much more water you would need to send through the strainer to fill up the pool. This explains why poor sensory registration is often (but not always!) associated with “sensory seeking” behaviors, as children attempt to obtain additional input so that they may better absorb it. These seeking behaviors can often be misperceived as having difficulty following directions or misbehaving, while children may actually be trying to “fill their pool.” Another possible presentation is that children might appear to “be in la la land” and are likely not noticing or absorbing the cues they need to respond appropriately.

While it is very important to identify poor sensory registration, it can be difficult to identify at times.

Below you will find 10 red flags for poor sensory registration, organized by sensory system, to help you identify potential sensory processing deficits in your child:

Touch (Tactile) Processing:

  1. Your child does not notice when his or her face has food, toothpaste, or other materials on it. He or she may not be registering that input and will not notice unless pointed out by someone else or by looking in a mirror.

Auditory Processing:

  1. Your child does not respond quickly when you call his or her name or needs to hear directions several times to respond. If a child does not have actual hearing impairment, being less responsive to auditory input can be a sign of poor registration of sound input.

Visual Processing:

  1. Your child has a particular difficulty finding objects in a drawer, toy box, or other storage space, even when the object is very visible. They may have visual perceptual deficits related to poor registration of visual information.
  2. Your child may perform writing, coloring, or other visual motor tasks in a way that appears careless and not notice their errors unless specifically pointed out. They may be having difficulty noticing the difference between good work and poor work.

Body Awareness (Proprioceptive Processing):

  1. Your child may have difficulty navigating through hallways without leaning against or rubbing their hands against the walls. This may be their way of compensating for decreased body awareness to help them understand where their body is in space.
  2. Your child may have difficulty maintaining upright posture, whether slouching in a chair, w-sitting on the floor, or leaning against a wall when standing.
  3. Your child may use excessive force when giving hugs or using objects (e.g. breaks crayons, throws balls too hard).
  4. Your child may prefer sleeping with very heavy blankets or prefer to keep their coat on indoors. This input gives them the weight he or she needs to better perceive where his or her body is.

Movement/Gravitational (Vestibular) Processing:

  1. Your child loves intense movement (i.e. spinning, rolling, or going upside down) and can do so for a significant period of time without getting dizzy or nauseous.
  2. Your child may appear clumsy when moving about and lose his or her balance unexpectedly.

Of course, as with any set of red flags, one or two red flags does not qualify for a sensory processing disorder. However, if quite a few of the sensory registration items above resonate with you, and if any of these items significantly interfere with your child’s daily functioning, it would be helpful to set up an evaluation with an occupational therapist.

Occupational therapists are specially trained to identify sensory processing disorder through parent interviewing and clinical observation of your child. If a disorder is identified, an occupational therapist can work with you to create a sensory diet, or prescribed set of sensory activities, to help your child get the input he or she needs to feel organized and calm to better learn and grow. They may also teach you strategies to help your child better attend to the input that is entering their body.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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Help for Defiance

Life can already be busy enough making sure your child gets through all of the tasks he or she needs each day. The last thing you need is your child refusing to follow directions. Here are some proactive and reactive strategies for when you need help with defiance. Blog-Defiance-Help-Main-Portrait

Preventative Strategies for Defiance

Clear Directions/Expectations

When asking your child to complete a task, make sure you are crystal clear with the directions. For example, if you ask your child to clean their room, your child may go pick up their clothes off of the floor and then say they are all done. When you go to check the room you say, “Your room is not clean.” This may cause an argument/conflict. To your child, a clean room means there are no clothes on the ground. To you, a clean room is a made bed, clothes folded and put away, and a clean desk. Clearly state your expectations to leave no room for confusion and make success more achievable for your child.

Offer Choices

Sometimes, your child may get overwhelmed and become defiant if they have numerous tasks to complete. Giving them the option to choose what tasks they need to complete each day may make them more compliant and successful. For example, give your child the option of making the bed or cleaning the clothes off the ground. Another example is giving your child the option of which homework assignment they would like to complete first.

Shortening Tasks

I know many teachers who use this tip when working with students who refuse to do their work. For example, they might give a student a math worksheet of 20 problems and ask them to complete 15. Another way to use this tip is asking them to work on one problem or one part of the task and then increasing the number of problems/parts of the task over time. Following strategies like this may feel like you are giving in to them, but in the end they are still completing part of the task, as opposed to refusing to address it at all.

Offer Rewards

Many children are motivated by rewards. When stating your expectations, ask them what they would like to earn after they complete the task or give them options of what they can earn. You want to make sure you do this while stating the expectations. If you do not, and your child engages in defiant behavior and you then offer the reward, it becomes a bribe. Bribes are dangerous for growth because they teach children that if they refuse to do something at first, they will eventually get something extra. We want them to learn that they get a reward by complying with the task.  For example, “What do you want to earn when you complete your chores? You can get 15 minutes on the iPad or a candy bar.” Make sure the rewards are activities or items that your child enjoys and will motivate them. If earning a reward is not enough, you can also present the consequences of what will happen if they refuse to do the task.

Reactive Strategies for Defiance

Reassess Motivation

After the child decides what they want to earn, they still may not complete the task. Their behavior shows that the reward may not be motivating enough for them. You can offer new choices or remind them what they are earning if they complete the task.

Stay Calm

When your child is engaging in defiant behaviors you want to stay calm. Use a neutral tone when you speak to them and make sure your facial expressions stay neutral, too.

Stay Consistent and Follow Through on Expectations

If you offer your child a reward after they complete a task, make sure you give it to them immediately. If you do not, your child may not be motivated by rewards because they will become skeptical. Additionally, you can’t give them the reward at a later time if they do not complete the task.

Deliver Verbal Praise for Appropriate Behaviors

When your child is being compliant instead of showing defiance, please deliver verbal praise!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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How Do I Find a Special Needs Planning Lawyer?

This guest post is from Benjamin Rubin.

Let me begin by asking you a question. If you needed heart surgery, would you go to a general practitioner or an internist? Of course you would not entrust your heart surgery to anyone but an Blog-Special-Needs-Lawyer-Main-Landscapeexperienced heart surgeon. Likewise, when you need special needs planning, you shouldn’t be considering a general practitioner, or even a general estate planning attorney.

So, what is special needs planning?

The attorney should be experienced not only in drafting the two kinds of Special Needs Trusts, but also be experienced dealing with the Social Security Administration and the state when they review the trusts upon application for SSI and Medicaid, or upon redeterminations. The attorney should also be familiar with guardianship and the alternatives to guardianship, as well as how to navigate successfully the state’s children and adult services system for individuals with special needs including intellectual and/or developmental disabilities, mental illness, or those with significant physical disabilities. We often refer to it as the Illinois “maze” for services.

In addition, you want an attorney who will know, and advise you promptly, when new laws, rules, or procedures occur that impact your planning. You want to find an attorney or firm that can assist you, with compassion and understanding. Many special needs planning attorneys are themselves parents or siblings of individuals with special needs and “get it.”

I suggest that the first place to visit is www.specialneedsalliance.org, The Special Needs Alliance (SNA) is a national, not-for-profit, association of experienced special needs planning attorneys, a majority of whom are fellow parents or siblings. Membership is by invitation. I was honored last year to be invited as one of the youngest members to ever be invited to join the SNA and my father is honored to serve as President-Elect of that national organization. In fact, three of the four attorneys in our office are invited SNA Member Attorneys, and the fourth is an Affiliate SNA Member attorney.

Another source is www.specialneedsplanners.com. The Academy of Special Needs Planners (ASNP), a national group, is owned by three attorneys and is open to all attorneys, regardless of experience. My father was a charter member of that group and I remain a member of this group. There are many excellent special needs planning attorneys that are members of ASNP.

However, if you are considering an attorney who is not a member of Special Needs Alliance, I suggest you ask some questions such as:

  1. How many “third party special needs trusts” have you prepared in the past month? Six months?
  2. How many “first party special needs trusts” have you prepared in the past month? Six months?
  3. If the Social Security Administration or the State of Illinois has questions about the trust(s) you drafted, will you “handle” those questions without any additional cost/fees?
  4. How many adult guardianships have you handled and powers of attorney have you drafted for individuals with special needs in the past year?
  5. What other areas of practice does that attorney handle (check his or her web site)? That is, are they also doing business law, traffic, divorce, bankruptcy, personal injury, etc.? If they are practicing in other areas of law, then they will not be able to adequately stay current with the constant changes that take place in the area of special needs planning.

Finally, you are not just looking for someone to draft a document, but you are looking for a relationship with a firm that will be going down that road to peace of mind with you for many years.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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bnrbarmjrBenjamin Rubin limits his law practice, as does the firm of Rubin Law, to Special Needs Legal and Future Planning for his fellow families of individuals with special needs. Benji serves as Vice-Chair of the American Bar Association’s Special Needs Planning Committee, is a member of both the Academy of Special Needs Planners and, by invitation, the Special Needs Alliance, the national not-for-profit association of special needs planning attorneys, is President of SIBS (Supporting Illinois Brothers and Sisters), the Illinois chapter of the national Sibling Leadership Network, which is an organization of adult siblings of individuals with intellectual disabilities, developmental Disabilities, mental illness, among other special needs, is a member of the Board of Directors of The Arc of Illinois, is a member of the Clearbrook Associate Board (Clearbrook is an agency serving over 7,000 children and adults with intellectual and developmental disabilities, one of whom is Benji’s brother Mitchell), is a member of the SEDOL (Special Education District of Lake County) Foundation Board of Directors, and serves on the Advisory Council of Encompass a joint venture that in partnership with Jewish Child & Family Services, Jewish United Fund, JVS Chicago, JCC Chicago, Keshet, and The Center for Enriched Living and Center for Independent Futures, seeks to provide adults with I/DD a full array of financially sustainable, community-based services and supports.Having Mitchell as a brother profoundly shaped who Benji is today, and thus the type of law he chose to practice. His personal experiences as a sibling offer a unique perspective into the responsibilities that come with caring for a sibling with special needs. Now, as an adult, those sometimes present and future responsibilities he will share with his older sister regarding his brother’s care, are a concern that he shares with all brothers and sisters of individuals with special needs.

How to Get Your Baby Talking

A baby typically starts babbling, using speech-like sounds, between four to six months of age. Usually, the sounds p, b, and m are the first to develop. Additionally, in this age range, a baby is more Blog-Baby-Talking-Main-Landscapeinteractive with the parent or caregiver, laughing and vocalizing displeasure or excitement. Between seven months to a year of age, communication will expand and most babies are producing repetitive consonant-vowel combinations such as baba or dada, using gestures for communication, using vocalization to gain and maintain attention, and by one year of age a baby typically has one or two words or word approximations.

A parent or caregiver can support their baby’s language development or “talking” by encouraging all communication, interacting on their baby’s level, and making communication opportunities.

  • Match your child’s communications and interaction attempts, including repeating his/her vocalizations and gestures. By matching your baby’s vocalizations, you are communicating on a level that allows them to maintain communication turn-taking. Additionally target speech games and songs such as itsy-bitsy spider, peek-a-boo, and gestures such as clapping, blowing kisses, and waving hi/bye.
  • Talk through daily routines such as bath time, bedtime, get dressed, and feedings. You are providing your baby with the associated language during these daily routines. Talk through the plan for the day, what will you be doing, where you are going, who are they seeing, etc.
  • Teach your child gestures and signs to support language development.
  • Teach your child animal sounds (e.g., moo, baa) and environmental sounds (e.g., vroom, beep).
  • Spend time reading to your child and labeling pictures in books.
  • Reinforce your baby’s communication attempts by giving them eye contact and interacting with him or her.
  • Simplify your language during communication interactions with your baby.
  • Make communication opportunities within routines and daily activities.
  • Limit your baby’s exposure to television and/or videos. A 1:1 interaction between a parent and child is preferable to support turn-taking communication.

Remember there is a range of typical development. Not all babies will have their first words around one year of age!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Separation Anxiety and School

It’s normal for children to sometimes feel worried or upset when separating from their main attachment figures. Although it can be difficult for parents and the child, it’s a normal stage of blog-separation-anxiety-main-landscapedevelopment.

Kids will often cry, whine, refuse to part or be overly clingy when it’s time to separate. Usually, these behaviors decrease with age, but sometimes, some kid’s reactions are extreme, and they interfere with their functioning in different areas of their lives. These kids may be suffering from Separation Anxiety Disorder. Kids who suffer from Separation Anxiety Disorder have a persistent fear of possible harm occurring to close attachment figures or excessive fear that they will leave and not return.

Some common behaviors related to separation anxiety include:

  • School refusal
  • Frequent somatic complaints (headaches, stomach aches, nausea)
  • Recurrent nightmares
  • Crying or having temper tantrums
  • Avoiding going to new places
  • Refusal to be alone

A common place where these behaviors occur is at school. For some kids, they might refuse to go to school, or they might have a hard time when being dropped off. No matter what type of anxiety the child is dealing with, it’s important to educate and teach your child about anxiety.

If your child is having anxiety about separating from you, here are some recommendations to consider:

  • Do not allow your child to stay home from school. This only worsens the symptoms over time and doesn’t allow them the opportunity to face their fear.
  • Do not ignore or deny the child’s worries. Teach your child about anxiety and its impacts.
  • Keep calm during separations. If your child sees you staying calm and cool, they are more likely to do so as well. When it’s time to say goodbye, make sure not to sneak out. This will only make the child more afraid.
  • Once your child makes it to school, identify a safe place for them if they are having a hard time. You can work with teachers or school counselors in identifying what would be appropriate.
  • Allow your child to pack a comfort item from school (favorite blanket or animal or a picture) that they can use when they feel homesick.
  • Create a goodbye ritual- maybe a special handshake or goodbye which can help the child feel more secure during the transition.
  • Praise your child’s efforts. Reward brave behaviors, however small they are!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Social Work

Why is Toe Walking Bad?

Idiopathic toe walking is a type of walking pattern that occurs when children walk on their tip-toes instead of using the more “typical” heel first pattern. Idiopathic is a term that refers to the fact that this toe walking occurs spontaneously, usually out of habit, and is not due to another medical cause. blog-toe walking-main-landscape

A non-idiopathic cause may be cerebral palsy, autism, sensory processing disorder, muscular dystrophy or brain injury. As children learn to walk, some toe walking is to be expected. When this becomes a strong habit that they do not grow out of, or the predominant pattern as they are new walkers, then several issues can arise.

The following are negative consequences of toe walking:

  • Tight ankles or contractures can develop
  • Poor balance reactions, frequent falling
  • Muscle imbalances “up the chain” meaning decreased hip or core strength due to the different postural alignment
  • Difficulty with body mechanics including squatting or performing stairs, secondary to tight calve muscles
  • Inability to stand with heels flat on the ground
  • Pain in ankles, knees or hips due to faulty mechanics
  • Surgery, casting, night splinting or daily bracing may be necessary

While some toe walking should not be alarming, the earlier you intervene, the better. Discuss this with your pediatrician or see a physical therapist who can provide early strategies to stop the cascade of effects that can be seen later.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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Why Are Occupational Therapy Screens Necessary for Schools?

Occupational therapists are skilled in assessing how a child’s sensory processing abilities, fine motor skills, visual motor skills and gross motor skills impact performance and function in daily life including self-care, play and academics. Proficient skills in these areas are imperative for children to be successful in the classroom environment.blog-occupational-therapy-screenings-main-landscape

  • Sensory processing skills support a child’s ability to learn. A child who is unable to process environmental stimuli effectively and efficiently will be unavailable to learn. Children with sensory processing dysfunction may have difficulty sitting still for an extended period of time in their desks or during circle time, they may be unable to pay attention when others around them are talking or they may have difficulty standing in line without touching, or hanging on a friend in front of them. These behaviors are a result of poor processing of the vestibular, auditory and proprioceptive systems, respectively.
  • Efficient fine motor skills are necessary to complete academic work. From writing to cutting with scissors and keyboarding to making crafts, fluid fine motor skills help children complete classroom activities and homework.
  • Efficient visual motor skills provide a foundation for writing and copying from the board as well as completing math work.
  • Efficient gross motor skills are important within the school environment for moving safely throughout the school and classroom, engaging with peers on the playground or during gym, and sustaining appropriate posture while sitting at a desk to complete work.

When a child struggles in any of these areas, it may not always be obvious. Oftentimes, sensory processing difficulties go unnoticed for many years and the child is left with academic or behavioral challenges. Therefore, occupational therapy screens are essential for schools.  An occupational therapist’s knowledge of child development, and its impact on daily functioning, can help identify children who would benefit from therapy services.

The screens can also be used as a preventative measure to ensure that a child’s development is on track and the child will have the foundational skills necessary to be available to learn. Occupational therapy screens also allow the opportunity for OTs to educate and collaborate with teachers and educators to provide suggestions that they can share with families and use in the classroom.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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