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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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Expressive Language

Expressive Language: What is it?

Speech and language pathologists may use the term “expressive language” when describing the needs of your child. To better understand expressive language it is important to understand its definition and use.  Expressive language is the output of language to communicate a want, need, thought, or idea.

Expressive language is a combination of one or more of the following features:Expressive Language

  1. What words mean: Language is symbolic by nature, therefore, each word represents an idea, item, verb, emotion, etc. Children first need to understand that when they say the word apple, they are representing the actual object of an apple.
  2. How to put words together: Understanding how to put words together is the next step to acquiring expressive language. In order to communicate more extensive or intricate ideas, children often need to combine words. For example, children learn that by saying “more milk” or “all done” they can relay more complex messages.
  3. How to make new words: Understanding that words can be changed to represent a new idea is another feature of expressive language. For example, children often struggle to properly use past tense of verbs. The word friend can be changed to friendly or unfriendly to represent new concepts.
  4. What word combinations are best for different situations: Children learn that in order to effectively communicate, they need to adjust their use of language depending on their surroundings. For example, children may say, “I want a cookie now!” while at home. However, at a birthday party with an unfamiliar adult children may say, “may I please have a cookie?”. This understanding of the social use of language is critical for children and often takes years to fully develop.

Understanding the use of language is extremely complex and can often be difficult for children. A speech and language pathologist can help assess if your child is struggling to properly learn or utilize the features of language.


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NSPT offers speech and language services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. 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 today!

ABA Posts

Increasing & Decreasing Behavior With ABA

What behaviors does ABA seek to increase or decrease?

Applied behavior analysis (ABA) uses the principles of behavior for increasing and decreasing specific behaviors of social significance. Behaviors to increase or decrease are selected in collaboration with parents. Additionally, it is wise to involve other relevant stakeholders, like extended family or your child’s teacher.

When selecting ABA goals, it’s important to consider:

For challenging behavior, it’s crucial to consider how much is the behavior impacting the child’s functioning, learning, social opportunities, or ability to access the community. If parents cannot take a child to the store because of tantrums, it can impact a family significantly. (e.g., decreased access to social skills, difficulty completing common routines, or cost of childcare so the parent can go to the store). Similarly, if a child cannot communicate his or her wants or needs, this may cause problems for the family system as a whole.

It is important to consider the following points for increasing skills:

* What should the child be doing?

* How far outside of typical development is this behavior?

* Typically, what should a child this age be doing or expected to do?

* In what manner are these skills pivotal to future areas of development?

Small steps may lead to a larger goal

All goals should be prioritized based on some of the questions listed above. It is also essential to consider prerequisite skills and look at the larger picture. It may be that before you get to the big point of concern that there are other smaller goals to meet along the way. If your child cannot wait at home for five minutes, then waiting at a store for a toy may be more difficult. First, work on the smaller skills to build to the larger ones. With patience and practice, your child will be on their way to achieving their goals.

ABA therapy can be implemented in different environments, like home, our clinics, or in the classroom.

At NSPT, your child will receive 1:1 therapy along with the ongoing analysis of his/her progress to ensure he/she is continuing to progress and succeed.

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