Wednesday, April 28, 2010

Saving the Drama for Broadway

Children with low arousal levels are constantly looking for ways to increase their energy so that they can be more alert. Unfortunately, especially when they're at school and stuck sitting in one place for a long time, we don't allow them to implement many of the strategies that would actually help them get themselves into a just right state, like chewing gum, going outside for a romp in the park, getting up and walking around, etc. So they're stuck trying to do anything instinctive to activate themselves and change their internal chemistry.

What is a really efficient way to get a big rush of adrenaline, if you're a small little person? Do you run out to Starbucks for a venti triple shot half caf low fat extra foam, with a shot of caramel syrup and whipped cream? No. Do you go to the vending machine and chow down on a Snickers bar? No. Do you close the door to your office and take a cat nap, play a quick game of solitaire on the computer, or make a personal phone call? Nope.

None of those strategies, which work well for adults, are available to a small child, nor appropriate for a little one's nervous system. So what are you left with, if you don't have the verbal sophistication to tell people you're out of gas, and no one is letting you run outside and play for a few minutes and you can barely attend for one more second? What requires no special equipment, is one hundred percent guaranteed to get results, and is easy to do?

You do something that makes the grownups mad.

Bingo! Nothing better for producing a big adrenaline rush and increasing your arousal levels than having someone three times your size in your face, yelling at you with an angry expression!

{Who among us has not seen a child sizing her up with a gimlet eye, then deliberately doing something verboten while watching carefully for a reaction? Either the child needs the adrenaline boost that a confrontation would provide, or you are being tested to see how much you are in control of yourself. Which in turn tells the child everything he needs to know about who is really in charge.}

Although it certainly accomplishes the goal, it's not a healthy way for the child to manage either his internal state or his relationships with others. We don't want to encourage it by rewarding the child and providing him with the drama he is unconsciously seeking.

What we can do instead is help low arousal children learn to recognize when they need to activate, and to seek our help in healthier ways.

If you are aware of your own tendencies to zone out when you should be paying attention, or to procrastinate when you don't feel like doing doing something, and to acknowledge how you employ strategies to stay alert and focused like stretching, chewing gum, drinking coffee, and doodling, it's easier to recognize what's happening to the child when his needs are not being met and he begins to act out.

When I see this happening, I say to the child in a very calm voice, "It looks to me as if you need to jump ten times on the trampoline before we continue with our handwriting." {Notice how this is not an open ended invitation to step away from the task. The child jumps, I count. At ten, we're done, and it's time to resume writing.} This often works very well. If the child says no, I will say, "We need to come up with something that will help you focus so that you can do your work. You have a choice between spinning ten times, jumping ten times on the trampoline, or playing 'Head Shoulders Knees and Toes' with me. Which one will work best?" {Note again that this is still not open ended. And I am teaching the child to recognize his state, employ some strategies to activate himself, and go about getting what he needs in a healthier way. Also notice that each strategy I offer is a different form of movement, so that he can begin to think about and choose what will work the best for him.}

If the child doesn't think any of those things will help get him into the "just right" zone, there are other options. If movement won't help, there is music, gum, a lollypop, a drink of water through a straw, a trip to the bathroom. Sometimes I will drop to the floor and we will wrestle for about a minute, I will let the child pin me, and we're back on track.

Of course the trick here is making sure that we are not so depleted ourselves that we can't step back, assess the situation, and respond not out of irritated habit, but using a reasoned choice. What can you do for yourself that will help you? As you sit down and think about what works for your child, how about doing the same for yourself?

{'Cause if mom's not happy, no one is happy.}

Monday, April 26, 2010

Look Homeward, Angel

Why does my child behave out in public, but not at home? 


I remember seeing a movie called "The Tic Code," about a single mother raising a boy with Tourrette's Syndrome. His father, who lived in another city, was very put off by the child's tics, and so the boy used a tremendous amount of effort to stop them during a brief visit. After he said goodbye to his father and was back with his mother, he just exploded with tics. Everything he had suppressed with his father, with whom he felt uneasy, came pouring out all at once when he was someone with whom it was safe to be himself again.

Often parents complain to me that their child is perfectly behaved out in public but becomes the spawn of Satan in private. My response to this is to tell them that they're lucky, especially if their child has sensory issues. A child who works hard to keep his behavior in check and present a good face to the world, and waits to let down the facade until he is home, is a very smart little person. Wouldn't you rather have a child who tries his best to do well in public and save his less adorable behavior for behind closed doors? I tell the parents of the children I treat that it's unfair, because they're doing all the hard work of raising the child while everyone else is getting the benefit of his charm, but it's definitely preferable to having the child acting out all the time in front of others.

By the way, we do this, too. Who hasn't spent a stressful day at work, being polite and accommodating against our will to annoying coworkers, maddening clients, and overly demanding bosses, then come home and been grouchy to loved ones? We know we shouldn't, but we also know that our loved ones will love us anyway, even when we forget to display our party manners.

Children who have sensory issues but present a good face to the world must work very hard at it. When they come home, they are often exhausted, depleted, and unable to cope anymore. Home is where they can allow themselves to express all of the rage, frustration, and misery that build up during a stressful day. Mommy and Daddy are there to help contain them and make them feel safe while they melt down.

It's very challenging for us, as adults, to put on our game faces and go out into the world day after day, and I think it's at least a hundred times more challenging for our little ones, who are not nearly as sophisticated in their ability to navigate and make sense of the increasingly complex and confusing terrain the world has become. Small children have not yet developed the inner resources or emotional flexibility required to be able to handle whatever comes their way with grace, and sensory defensive children are particularly vulnerable. Their internal chemistry is chronically short on the "feel good" neurotransmitters -- dopamine and seratonin -- to be able to allow things to roll off their backs, the way we can when we're on top of our game and can take things in stride.

I was recently consulted by a mother whose preschooler did very well at school but was going through a difficult spate of tantrums and challenging behaviors at home. I asked the mother what had been happening in the child's life and if anything had changed. The mother thought about it and said that she had been spending quite a bit of extra time away from the family in order to resuscitate her high power career in law, which had been dormant since having children. She also realized that they had had several non stop weekends of activities, most of which were very stimulating, and that her son had not had nearly enough down time to regroup. She resolved to spend more time with him, just hanging out and doing nothing in particular. We also talked about my "Don't Ask, Do Tell" approach to communication, and she said that she could see that she was contributing to the problem by being unclear in her expectations of him.

Just making sure that the child gets plenty of sleep, nutritious food, unstructured down time, and opportunities to play outside can help, as well. We need all of those things to stay sane, and they need them even more than we do. Children who are overtired and overscheduled, and therefore overwhelmed, are particularly susceptible to tantrums. Here's another plug for making sure your child gets regular time out of doors: who is more likely to have a lot pent up, frustrated energy: a child who has run around for a few hours on the playground, or a child who has spent the afternoon playing video games?

Wednesday, April 21, 2010

It's a Vision Thing

How well your child performs in school depends a great deal on his ability to process visual information.

When we think of getting our eyes checked, we envision sitting behind the machine with all of the lenses, and the eye doctor turning them and changing them until we can read the small letters on the eye chart easily from a distance. That is called visual acuity; it is the ability of the eyes to see objects clearly.

Vision, on the other hand, encompasses a complex set of skills, and refers to how you interpret and act on your environment, based on what you're seeing. This ability to process visual information in turn is determined not only by your visual acuity, but by the fine motor coordination in the eyes, and the ability of the brain to perceive and interpret that information correctly. Do you ever wonder why some people are terrific drivers, responding immediately and efficiently to changing traffic conditions, demonstrating easy awareness of everything going on around them, keeping the proper distance away from other cars, merging into traffic without a second thought, fitting effortlessly into tight parking places -- while other people just don't have that innate skill? It's because the good drivers have such strong visual processing skills and can coordinate their responses so easily.

When I evaluate a child, I spend quite a lot of time looking at different aspects of the child's vision. I evaluate visual perception, visual motor coordination, and screen for weaknesses in the fine motor movements of the eyes. So much of our functioning depends on having reliable vision. I would venture to guess that most, if not all children who need occupational therapy have some impairment in their visual skills. This is because low trunk tone and poorly integrated postural reflexes affect the fine motor coordination of the eyes. They don't have a stable base of support from which to work.

The muscles of the eyes have certain specific jobs they have to do well in order for a child to be able to read and write:

Convergence is the ability of the eyes to pull in for close work.

Saccades are the movements of the eyes necessary for reading. The eyes must fix at the left side of the page, scan across the correct line of text, jump down to the next line, and fix again at the left.

Accomodation is the ability of the eyes to converge and diverge quickly for copying from the board. They pull in to write, then release out quickly as the child scans the board, then pull back in again as the child looks down at his paper.

If the child's eye muscles are weak and these things are difficult for him, a whole host of problems can result. The first problem is the child's attention for close work. If you're straining to see what you're doing, this is frustrating and exhausting. Your sitting tolerance and attention span are going to be shortened as a result.

Another problem caused by weak eye muscles is reading comprehension. When we first learn a skill, we use the frontal cortex, which is responsible for voluntary control, judgment, and reasoning, to power the muscles involved, until a lower part of the brain, one used for automatic skills, takes over. {Remember learning to type, and laboriously hitting the keys over and over while muttering "QWER UIOP" until all of a sudden, your fingers started to fly and you didn't have to think about it anymore? All that repetition drove it downward, out of the frontal cortex and into the cerebellum.} When the muscles in the eyes are weak and their coordination is poor, the frontal cortex continues to do the work of controlling them, but that is the part of the brain that is supposed to be comprehending, remembering, and synthesizing what is being read. So the child's ability to understand and analyze what he reads is limited, and he is going to find the activity of reading physically and mentally tiring.

If a child does not have the ability to fixate his gaze, not only is he going to have a hard time with reading and writing, he's going to be visually distractible, because any ambient noise or movement is going to cause his eyes to lose their fragile focus.

Children with convergence issues have a tough time on the playground. Many of the boys I treat can throw a ball like Roger Clemens, but they can't catch one to save their lives. Their eyes just don't pull close enough in to keep visual track of a ball as it comes towards them, and sometimes they see two balls and can't decide which one to try to catch.

A child who can't make visual sense of what is going on around him is going to be in a flight or fight state in a chaotic atmosphere, like on the playground or in the cafeteria. He can't figure out what's coming towards him, and so he can't figure out how respond to it. Couple this with tactile defensiveness, a condition that causes the child's nervous system to interpret people coming into his personal space as a threat, and you've got a child who either lashes out and becomes disorganized, or tries to remain invisible, in gym class or on the playground.

If your child complains of headaches, rubs his eyes a lot when it's time to copy from the board or do a lot of sustained close work, turns his head to one side in order to read or write, loses his place when he reads, has a hard time playing games involving fast moving balls or objects, has a short attention span for close work or resists writing or reading, it may be that he's got a vision problem stemming from lack of fine motor control in the eyes.

If I detect motor weakness in the child's eyes on evaluation, I will talk about it with the child's parents, but will not necessarily request that they follow up immediately with another professional. Sometimes a year of work in the sensory gym, strengthening the trunk and doing lots of activities that work the eyes while the child is moving his body against gravity in a variety of positions, is all that is needed to strengthen the eye muscles and improve reading and attention. If the child is still having issues after a course of treatment, then I recommend that he be evaluated by a neurobehavioral optometrist for vision therapy. I do, however, occasionally encounter a child who tells me "I see double all the time," and these children get referred immediately.

A good way to make sure that a developing child's eyes get what they need in order to function optimally is to provide the child with plenty of movement experiences and to make sure that the child spends a lot of time working his head and neck muscles against gravity. This includes lots of tummy time, being carried on a hip or in a backpack, minimal time in front of a television or computer, and lots of time spent outdoors. Craft activities and manipulatives work the hands and eyes together. Bubbles, whistles, and blow toys are also great for synchronizing the eyes, hands, and breath. Playing games like balloon tennis encourage tracking, and tag and hide and go seek encourage the child to scan the environment. I also like books like Where's Waldo, and old fashioned games like Concentration and Memory.

Monday, April 19, 2010

Low Tone

As a therapist, I sometimes forget that civilians don't understand all of the professional jargon that my colleagues and I use to communicate with each other. I try, when I write an evaluation of a child, to explain what each thing I assess means, and most important, how it affects the way the child functions. But when I hand over a 12 page report to a parent, I have to remember that not everything is sinking in all at once, and that the information I'm conveying has to be absorbed, bit by bit, as the parent can integrate it.

"Low tone" is something we occupational therapists talk about quite often. But parents complain to me that they have no idea what that means. Sometimes it's quite obvious -- the mother of one of the children that I treat just had a baby, and she called me to tell me that the baby is so weak and floppy that it can't tighten its fist around an index finger placed in its palm. Other times it's not nearly as apparent, and a child can appear to be quite athletic and still be plagued by all kinds of problems associated with low tone.

Tone is the amount of electricity that courses through the muscles and allows them to do the jobs of extending the body against gravity, contract themselves around joints for balance and stability, and work for long periods of time without undue fatigue. An example of someone with plenty of tone is a professional athlete or dancer. I'll never forget the time I met my favorite baseball player, Dennis Eckersley. He practically crackled, he had so much juice and electricity flowing through his body!

As far as I know, there is no one definitive reason for low tone. Some people believe that it is a nutritional issue, and that for some reason the body is not delivering, {perhaps because of dietary issues or metabolic difficulties} or the muscles are not utilizing, the raw materials needed for maintenance and sustained use. The child's muscles don't develop well, and so they tire easily.

An under responsive vestibular system can be a possible reason for low tone. The vestibular nerve is responsible for many things. It tells us, along with our eyes and muscles, where we are in space. It also responds to how much and what kind of movement we get, and communicates directly with the muscles that extend us against gravity and allow us to be upright. It also talks to the part of the brain that is responsible for alertness, attention, and arousal. If the vestibular nerve is not picking up and processing this information correctly, the result will be insufficient muscle tone and chronic low arousal.

Another issue that interferes with the child's ability to function is delays in the maturation of spinal reflexes. When a child is born, its nervous system is immature, unlike a horse's -- a pony can get up and walk shortly after birth. Humans start out instead with nervous systems that respond by increasing or decreasing muscle tone in response to certain stimulation, and then go on to refine themselves through movement and play until voluntary control is established. Then the reflexes disappear. If they don't disappear and are dominating the nervous system, the child will have difficulty working his body against gravity.

If your child tires easily, complains that he doesn't have any energy, can't sit up while he's writing, is a chronic slumper, or has a hard time sitting still or sitting on the floor, chances are his tone is low, even if he appears to be athletic. I've seen plenty of boys who could pitch a ball like Roger Clemens -- but their core strength was so weak that they couldn't do a single sit up or lift their chests and thighs up off the floor when lying on their bellies.

Children with low muscle tone have an especially difficult time of it in school, because their bodies don't have the effortless uprightness against gravity that allows them to sit still. If they are struggling to stay upright, they're using the mental and physical energy to sit that they should be applying towards attending to the lesson. I once went to school to observe a little boy who acted out a lot, especially during circle time, when all the children had to sit cross legged on the floor. The day I saw him, during circle time, he sat with his legs straight in front of him and his hands behind his back on the floor, using his arms to brace himself. He simply was not able to sit in the traditional "criss cross applesauce" position, and needed the additional support from his arms, and wide base from his extended legs, just to stay upright. I saw immediately that he was so uncomfortable sitting this way, and that it was so much effort, that he couldn't sit on the floor and attend to what was going on at the same time. He didn't have enough sophistication in his language to tell anyone what the problem was. His only recourse was to refuse to stay there for very long, and this was viewed as disruptive behavior. I suggested to his teacher that he either be allowed to sit in a chair or that he be assigned a place against the wall so that he could sit with his back supported. He was much happier after that, and he was much more able to attend.

Low tone affects many aspects of function, which I will address in future posts. Meanwhile, if your child has low tone, no amount of yelling at him to sit up straight will help. Try incorporating activities to strengthen the trunk, like sitting on a therapy ball while doing homework or watching TV, doing sit ups and push ups, wheelbarrow walking, wrestling matches, and playing with whistles, bubbles, and blow toys to your child's daily routine. Spinning is good for vestibular activation, if your child likes to spin. Or take your child outside and play tag or ball, or organize a game of statues or red rover with other children in the neighborhood.

Friday, April 16, 2010

Don't Ask, Do Tell

When I was in OT school, I took a course in group treatment techniques. My classmates and I all took turns leading groups and playing the roles of different types of patients. We pretended that we were elderly women with dementia, stroke survivors, homeless and mentally ill, and drug addicts. One day it was my turn to be the group leader, and my population was a group of alcoholic teenagers. I stood at the front of the room, and nervously asked, "Does everybody want to stand in a big circle?" My professor, who was playing one of the patients, yelled, "NOOOOOOOO!!!!!" and stopped me cold. As I stood there gibbering, she smirked, "Never ask a question unless you're sure you can deal with whatever answer you get."

If there is one thing that I could wave my therapist's wand and change in the behavior of parents, teachers, and nannies, it would be the unfortunate tendency of asking the child if he wants to do something when he really has no choice about it. I hear this all the time: "Do you want to take off your coat?" "Do you want to put on your shoes?" "Loren's ready for you, do you want to go into the gym?" I heard a nanny ask a little boy who was there to see me for the first time to get some help with his handwriting, sitting in the waiting room looking scared and shy, "Would you like to go in with the lady?" {Fortunately, he did. But what if he had said no?}

This used to happen to me when I worked in a school for a year and had a little boy on my caseload who could not happily transition from one activity to the next. I would walk into the room, and the teacher, or the aide, would ask, "Do you want to go to OT?"

Guess what he always said. "NO!!" So then I was stuck! The grownups had given him a choice, and he had clearly expressed his preference. I was then forced into coaxing him, which never worked. The more I cajoled, the less he wanted to interact with me. I would give up and go see another child, whose teacher was not expecting me, and come back. What a waste of time, and how silly of us to leave the decision to come to OT up to him.

When I trained the teacher and the aides to say, "Loren's here. It's time for OT. Bye!" he would get up and go. No muss, no fuss.

A mom who had consulted me because her child was having trouble listening to the teacher at school {and to her at home, as well} told me, I speak to my son like that because I want him to speak to me like that. OK, fair enough. You want him to learn to address you politely. But you are not equals. You, the adult, are in charge. The person in authority tells others what to do, and frankly, the child infinitely prefers it that way. Children know that they are not adults and should not be in charge, and should not be on equal footing with the ones who are in charge.

Children who are being taken care of by grownups who are clearly and kindly in charge feel safe and secure. When they feel safe and secure, that allows them to explore, expand their horizons, and develop freely. You can say please and thank you when you tell him to do something, but it's not a good idea to give him a choice about it when he doesn't actually have one.

Small children are concrete thinkers. If you ask a grown up, "Want to set the table for me?" The grown up will correctly interpret this request as "I need you to set the table now." The young child will not. He thinks he's being given a choice, and will resent you when you force him to do something that he just told you he didn't want to do when you asked if he wanted to do it.

In order to give the child some necessary autonomy, you can present choice embedded within a command. "It's time for lunch. Would you like a sandwich or a bowl of soup?" "Time for homework. Which assignment would you like to work on first?" "Time to get ready for bed. Would you like to start by brushing your teeth or would you rather put on your pajamas?"

If your child is sensory defensive, he will almost automatically say no to anything at first, because he doesn't have the emotional flexibility to be spontaneous. Many young children are like this -- they need some time before they can get used to an idea and will say no until they have a chance to mull something over. So it's extra important not to phrase things in such a way that the child thinks he has a real option of not participating, if he truly does not.

I once heard a father ask his four year old boy, another child who had problems transitioning, if he wanted to go to OT. I had called them with a last minute cancellation and asked if they wanted to come to the clinic for a make up session. The father yelled, "Tommy, want to go to OT?" The little boy yelled back, "NOOOOOOO!!!!!" Although his parents had not intended it that way, he had been given a choice, and he had clearly expressed his preference. They tried to argue him out of it, but he dug in his heels. So he missed the session. He loved OT and would have been very happy to come if the adults had just told him it was time to go and handed him his coat. This child has tons of behavior problems, because his parents can't bring themselves to be in control and set limits. He rules the house, and he knows it. He doesn't feel secure, and is constantly pushing them, behaving more and more outrageously, in an attempt to get them to rein him in.

Another thing I would like to banish forever is asking the child to do something, and then saying, "OK?" at the end of the sentence. Remember, the child is not an abstract thinker yet. "OK?" means "is this OK with you?" to him. "Do your homework, OK?" is just not going to get the job done as efficiently as "Time to do homework."

We unwittingly negate our authority when we do these things. There is a huge difference between being controlling and being in control. We don't need to be controlling; we can offer choices when they are appropriate. Our children feel safe and secure when they know that the grownups are the ones making the important decisions and holding the limits steady.

Thursday, April 15, 2010

Why Can't My Child Pay Attention?

A common reason for attentional difficulties is sensory defensiveness. This means that the child experiences certain sensations that we would either find neutral, or would not even register, as unpleasant or threatening.

A defensive nervous system has a hard time adapting to novelty and filtering out extraneous information. What this means: when you put your shirt on in the morning, you feel it going on, maybe briefly noticing the texture of the silk or wool or cotton, and then your skin adapts to it and the sensation of your shirt on your skin no longer registers in your conscious awareness. Your nervous system is filtering it out, since it is not relevant. This way, your conscious awareness can focus on other things.

A defensive system, on the other hand, would constantly be sending messages: This shirt is itchy! This shirt is bugging me! The label is scratching my neck! The seams on my socks are rubbing my toes and causing huge, oozing, bloody blisters, I just know it! My jeans are too stiff! My underwear is too tight! The label on my panties is poking a hole in my back! My pencil is bugging my thumb! The teacher's voice is drilling a hole in my head! It's too noisy in this cafeteria, I can't eat! The food looks and smells disgusting! Oh, no, someone is getting too close to me, what if he wants to hit me, I'd better do something quick! Oh, no, the teacher is going to use chalk on the blackboard, what if it squeaks! The smell of finger paints is making me sick! The gym teacher is talking, but I can't figure out what she's saying over the rest of the shouting, and it's too loud in here anyway! What's that coming toward me! I hate playing basketball, it's dangerous!

It's challenging to pay attention and participate when your nervous system is constantly bombarding you with messages like that. I liken it to having a fever, when lights are too bright, everything feels scratchy, voices and sounds are too loud, and all you want to do is go home and put a blanket over your head. For a sensory defensive child, every day feels like that. When the sensory information that is bombarding them becomes too much to handle, one way of coping is to just tune out and shut down. If the child's teacher says that the child is often staring out the window, doesn't seem to understand what is being said, can't follow directions, wants to play by herself, hides in the corner, and rarely joins in during groups or at the playground, preferring instead to sit on the sidelines, this may be what is happening.

If a child is a chronic mouth breather or a shallow breather, this can also cause problems with attention and learning. A brain that is starved for oxygen is not one that is primed to pay focused attention. When we are anxious, our breathing tends to become shallow, and when we breathe shallowly, we tend to become anxious. If you don't believe me, try some shallow panting for a minute and notice the chemical reaction that results. An anxious child in chronic low level fight or flight mode is not in an optimal state for learning.

Children who have low trunk tone, are chronic slumpers, or who lay their bodies on their desks and have a hard time sitting up or sitting still, can have attentional problems because they don't have enough strength or energy to sit in one place for a long time. They are using up the energy they should be focusing on the lesson just to stay upright.

Low trunk tone also affects the fine motor coordination of the eyes, because they don't have a stable base of support from which to function. If you are struggling to see what you are doing, it is very difficult to sustain attention to close work.

Imbalances in neurotransmitters and brain chemistry can definitely affect a child's ability to focus. So can structural problems in the body.

Other factors that can affect a child's ability to attend include diet, food sensitivities, sleep patterns, elimination habits, and allergies.

In a future post I'll talk about referrals I make to specialists who treat these issues.

Wednesday, April 14, 2010

Some Crafts I Like to Do With Kids

I'm always on the lookout for craft activities to do with the children I treat, and I encourage parents to do them at home. I find that crafts are helpful in supporting so many of the goals I set for them. They encourage the child to tolerate and work through frustration and improve attention and concentration. Here are some of my favorites that are easily available online or in most large toy stores.

Fuse beads -- Perler beads, or fuse beads, encourage thumb and finger tip opposition, which is critical for writing and all fine motor control. It also requires and encourages patience and precision.

Potholders -- Weaving is a perceptual activity which encourages figure ground discrimination and requires the ability to self correct. The act of weaving is strengthening to the fingers. Make sure you use a metal loom. The plastic ones are too flimsy and frustrating.

Leather Lacing -- I remember lacing a purse and a pair of moccasins when I was in about fifth grade and wearing them proudly. Leather is grounding and soothing and although it is equally appropriate for both sexes, it is an especially good choice for boys, as leather supports masculinity. The action of sewing against resistance is strengthening to the muscles required for writing. Making sure that the stitches don't twist requires patience and coordination.

Critter Bead Animals -- I absolutely love this activity. Beading is wonderful for improving fine motor precision and bilateral coordination. Boys will do this without any complaint {as they would if required to string beads for necklaces} and the results are loved by everyone.

Wooden Models
-- I buy ones at Michael's for a dollar. They're not available online. They are easy to put together and boys from small to large love them. I encourage the children to paint them. I crack the brush so that it's quite tiny and they are forced to hold it between thumb and forefinger, encouraging tip to tip opposition. Michael's also sells wonderful wooden dinosaur puzzles that you crack out of a stencil and put together using a numbered guide.

Felt Sewing Kits: These are especially good for working on bilateral coordination. The kids love the finished product.

Monday, April 12, 2010

Crafting Some Magic

I love doing craft activities with children, although I am not especially crafty by nature. If anyone who knows me now had seen me struggling and cursing during my skilled craft courses in OT school {woodworking class was like entering the twelfth circle of hell every Tuesday and Thursday, but my weaving class was a lot of fun... until we had to warp our looms} or watched me staring in shock and awe as my classmates completed one beautiful, elaborate project after another in crafts lab, while I demolished an entire box of tiles trying over and over to crack just one of them neatly in half for a mosaic, you'd be amazed at me now.

I think what convinced me to continue using craft as a clinician was recognizing how profoundly uncomfortable the emotional struggle was for me when I was faced with something I couldn't do very easily. I grappled hard, both with myself and with the materials at hand, to come out the other side and complete the task. I was so frustrated, so down on myself, so ready to drop out of the program altogether, cowed by my inability to do something that came so easily to everyone else around me. But I was too proud to fail and too invested in completing my schooling at that point to quit, so I dug in, got some help when I needed it, and plowed through. I was thrilled with myself when I managed to finish my projects, and some of them, amazingly enough, received "superior workmanship" grades from the teacher. I also enjoyed the feeling of being as one with my materials as the world faded away and I was totally immersed in creating my project.

What the right craft activity could really accomplish became clear to me when I was a student therapist. I had a patient assigned to me in a rehab unit, a woman who had had a slight stroke. She had good use of her body, but was having perceptual difficulties that made dressing and other self care activities impossible. Despite the fact that she was mobile, she wouldn't have been able to live independently, the way she presented in the unit. She had full use of her arms and legs but couldn't dress or bathe herself without supervision. Her lack of safety awareness and inability to plan and problem solve were worrisome.

Remembering how difficult it was for me to conceptualize and execute a design for my tile mosaic, I asked the therapist who was supervising me if I could give her a tile project for one of her three daily 45 minute OT sessions -- minus the cracking, of course. I thought it might be a good way to get that part of her brain, the one responsible for perceiving her environment, interpreting the data, and making it possible for her to take appropriate action, back in gear.

Just watching her wrestle with the initiation phase was an education for me. She had no idea how to even begin. I sat with her and encouraged her to figure it out, piece by painful piece. It was a challenge for me as well, not to jump in and try to help unless she got so stuck that the frustration was too much. Slowly, painfully, with much trial and error, she managed to design, and began to execute, a simple pattern of tiles, which she proceeded to glue onto a metal dish.

Magically, after a few days of struggle with the project, her clothing ceased to be alien swatches of random fabric, and began to be shirts, socks, and trousers. They once again permitted themselves to be oriented correctly, pulled onto the correct limb, buttoned, zipped, and tucked without too much effort. We went into the clinic kitchen, found some flour and shortening, bowls and spoons, and she mixed and baked some biscuits. Then she took the clinic's sewing kit, threaded a needle, and expertly sewed and knotted a button. This particular task had completely eluded her a couple of weeks earlier during her evaluation; when presented with the sewing kit and the button, she had held them for a few minutes, turning them around in her hands, and then put them back on the table with a sigh.

Of course it wasn't only the craft activity that had made the difference for this woman, but it was quite wonderful to watch how quickly her brain reorganized itself when challenged with the right tasks. After another week of intensive therapy, she went home.

Making things is a high level, powerful activity. When we give our children the opportunity to engage with materials, solve problems, make decisions, struggle with frustration, and ultimately create something uniquely theirs, we are truly giving them the world.

Sunday, April 11, 2010

And Versus But

One of the wisest, most useful pieces of advice I have ever heard about talking to young children, especially children with special needs, was to replace the word "but" with the word "and."

I cannot begin to guess how much emotional trauma this has saved me and my little clients over the years. It works like a charm. There is something so magical that happens when you substitute "and" for "but".  It's the difference between an exchange that causes the child to dig in his heels and refuse to budge, versus providing the child the tools to shift gears gracefully.

The children I treat tend to have difficulty with transitions. They always want to just do one more thing, then one more thing after that, when it's time to go. This has the potential to be nerve wracking because I see children back to back on a tight schedule, the clock is ticking, and the next one is waiting, champing at the bit. Consider this scenario:

Child: "Can I have one more turn on the zip line?"

Me: "But it's time to get going."

Child: "Just one!"

Me: "But it's time put on your shoes."

Child: "NO! I want another zip! WAHHH!"

Here's a different version:

Child: "I want to go one more time on the zip line!"

Me: "I know you do. And now it's time to put on shoes, and we can do it all again next time we play together!"

Child: " Just one?"

Me: " And I know it's hard to stop when you're having so much fun. And we can zip next time! And now it's time for shoes and a prize!"


Me: " Time to sit at the table."

Child: "I don't want to do my handwriting."

Me: "But it's time to write."

Child: " I don't care. I don't want to do it."

Me: "But it's part of what you're here to do."

Child: "But I don't WANNA!"


Child: " I don't want to sit at the table."

Me: "And I know you don't like it, and it's time to sit."

Child: "I hate handwriting!"

Me: "And I know it's hard. And the gym is more fun. And now it's time to sit."

Child: {Miraculously sits down and gets to work, pretty much most of the time.}


Child: " Can I have some candy?"

Parent: "But dinner will be soon."

Child: "I'm hungry now!"

Parent: "But you'll spoil your appetite!"

Child: "But I'm hungry NOW!"

Using "and" instead:

Child: "Can I have a snack?"

Parent: "I know you're hungry, and dinner is very soon."

Child: "But I'm hungry right now!"

Parent: "And it's very hard for you to wait when you're hungry, isn't it? And we will have dinner in a few minutes when daddy gets home!" {And by the way, one of the most important lessons we can teach our children is to learn how to manage their frustration.}

This simple change in language eases the friction and causes much less stress. We are acknowledging that the child finds the situation difficult. Using "and" moves the child away from the negative experience of having his request denied, towards something positive to think about.

{Thanks to Colleen Hacker, OT extraordinaire.}

Friday, April 9, 2010

It's So Simple

A visit to a sensory gym during treatment hours looks like an indoor playground, with children climbing, swinging, jumping, navigating obstacle courses, throwing stuff at targets, yelling and laughing, getting messy, and, if they are working with me, making craft projects. I'm sure that it seems as if the children are just playing. How could it possibly be therapeutic? Isn't therapy supposed to be all complicated and scientific?

I'll never forget the comment of a mother whose son was graduating after coming once a week for the duration of the school year. His issues had largely cleared up, he was confident and happy, had great handwriting, and was easily keeping up with all of the academic demands of second grade. She said it seemed unbelievable that OT could make such a difference, because everything I had done for him all year was so simple. We played in the gym, we worked on handwriting, and we did craft projects. It was simple, and it was just what he needed.

A skilled therapist working in a sensory setting can determine what activities a child needs to do to in order to improve, among other things, visual motor coordination, motor planning, trunk strength, and balance, and make it fun and rewarding in the process by turning it all into a game. These skills are the underpinnings of the ability to sit for long periods, to sustain attention, and to support and power the hands and eyes for reading and writing.

My personal bias is to throw some craft into the mix. Over the years, I've seen magic happen when the right craft is put into someone's hands. Working on crafts teaches patience, sequencing, problem solving, visual motor coordination, and the ability to handle frustration. It builds sitting tolerance, improves attention, sharpens and develops visual perception, and develops fine motor control.

The occupational therapists who graduated from OT programs before I joined the profession {I began school in the mid 80's} were rigorously trained to be competent at a wide range of craft activities. They could throw pots, make furniture, knit, crochet, quilt, tat, and weave, make baskets, bind books, crack and grout tiles for mosaics, and do leather, bead and metal work. I remember someone telling me that when he was a child in the early 50's and had to be hospitalized for a long time due to a bone infection, the occupational therapists there taught him how to work leather -- how to cut it, dye it, tool it, turn it into useful things. He got so skilled that he went on to earn his living making and selling belts and purses at craft fairs, and put himself through college with the money.

Unfortunately today's OT curriculum does not have the same emphasis on craft and working with the hands. I think this is a real loss to the profession. Up until very recently, people were required to do all kinds of crafts for survival. We had to make pots, and quilts, and clothes, and canoes, and baskets, and furniture. Humans have an inherent need to engage in purposeful activity, and we also have the need to feel competent, which making things provides in abundance.

One summer I spent three weeks with a friend and four of her children up in the mountains, without a television or computer. We brought lots of craft activities and we spent the afternoons sitting on the porch making projects together and chatting. It was a wonderful time.

I suggest having a stash of craft projects and materials handy for your child. If, like me, you're not a natural at making things, you can buy some wonderful structured craft projects, all materials included, in many toy stores. If you're lucky enough to live near an Amazing Savings or Family Dollar, they often have a fun selection of little kits to choose from. Just examine them carefully and make sure that whatever strikes your fancy that day doesn't look too cheap or cheesy, or you'll have frustration instead of success. I've had good luck with little felt and foam sewing projects and wooden models to paint and put together from those stores.

There is now a Michael's in Manhattan and I've been in there several times. Recently I stopped in because an older child wanted me to teach her how to knit. I hadn't done it in years, but when I bought the needles and yarn and began to practice, I instantly remembered how absorbing, grounding, and relaxing it is.

We had a lot of fun together the day I showed her how. She picked it up fairly quickly, and was so very proud of herself when she got home from OT that evening and showed her mother what she could do. She went on to teach several of her siblings what she had learned and became the knitting teacher in residence. This child was a bit backward in a home full of superstars, so being able to teach them something and be their consultant was just wonderful for her self confidence.

In future posts I'll talk about the kinds of craft activities I use in the clinic.

Wednesday, April 7, 2010

Learning to Write

I wrote this piece over ten years ago for a website that never happened, and thought this would be a good place for it.

Have you ever watched a very young child at play, and marveled at the ease, freedom, and flexibility with which she moves, how she squats effortlessly when playing, and how upright and straight she sits and stands? Have you had the experience of watching your school age children lose their good posture, and begin to slump and develop poor ways of using their bodies?

F M Alexander, who developed the Alexander Technique in response to problems that he experienced with the coordination of his breathing and vocal mechanism, felt that coordination, so perfect in very young children, was corrupted at about the time that children began formal schooling. He thought that sitting for hours in chairs, learning how to read and write, and the educational process in general, was a disruptive influence on the integrity of childrens’ use of their bodies.

As a certified teacher of the Alexander Technique, a method for learning to improve one’s coordination and overall well being by replacing unconscious, harmful movement and postural habits with beneficial, conscious choices, and a pediatric occupational therapist specializing in school related issues and handwriting, I wholeheartedly agree with Alexander’s theories regarding education. Invariably, when I meet a child for the first time, and ask her to write, I am struck by the physical strain, contortion, and tension she feels she must impose on herself, in order to form even a few letters.

Reading and writing are often taught nowadays before children are ready. Schools used to begin teaching children to read and write when they were six years old, the age when gross motor skills are largely in place, and fine motor skills, visual perception, and cognition are developed enough to handle pencil and paper activities. The current trend is to begin to teach reading and writing before the age of five. In my clinical opinion, many children simply do not possess the trunk and shoulder strength, fine motor coordination in the eyes and fingers, or adequate attention span to perform all the sub skills required to do such high level tasks. Little attention is paid in school to the means by which the children are supposed to achieve the goals imposed upon them. Consequently, the integrity of the child’s coordination suffers. Frequently, it also means that the child’s handwriting suffers as well.

Here are some suggestions for preserving coordination and good use while your child is learning to write.

•If at all possible, do not start the child writing formally until the age of six, when the necessary sub skills are in place.

•Don’t start children on paper and pencil activities too soon. Giving them markers and fat crayons before they are developmentally ready to hold them correctly is just an invitation to develop an awkward, dysfunctional grasp. Provide one inch pieces of chalk and crayon instead. The use of such small pieces promotes pinch strength, and will not cause problems that will have to be corrected later.

•Make sure that the furniture the child is using is a good fit! The correct way to sit while writing is to have the feet flat on the floor, hips and knees bent at ninety degrees, arms and hands resting comfortably on the table. Never allow legs to dangle.

•Buy the child a blackboard or easel, and have him practice writing, and have fun painting, coloring, and drawing, in standing. There is less opportunity for slumping. Working in upright also strengthens and stabilizes the arm, wrist, and shoulder muscles.

•Another excellent way to strengthen neck and shoulder muscles is to have the child play and draw lying belly down on the floor, supported by the elbows.

•Provide gum, hard candy, a lollypop, a piece of licorice, a boxed juice drink with a straw, or a chewy toy while the child is writing. Working the jaw promotes concentration, and encourages upright posture. Sucking is also helpful for tasks requiring close vision.

•Allow frequent breaks, and encourage the child to do something vigorous, like running or jumping in place, as a way of improving concentration. A good time to call a break is when you observe the child slumping!

• Provide whistles, blow toys, and bubbles for your child to play with. Vigorous exhalation strengthens the postural muscles, and improves breathing.

•Craft projects promote fine motor coordination, attention, concentration, motivation, problem solving skills, and tolerance for frustration. All of these skills are critical to successful handwriting. Try fuse bead projects, painting, {crack the handle of the brush so that it's very short} putting together wooden models, weaving potholders, building things with modeling clay, cutting straws into small lengths and stringing them to make necklaces or tree decorations, gluing macaroni shapes and beans onto boxes or thick paper and painting them, stringing beads, leather lacing, etc.

• If your child consistently hunches or slumps over the paper, or holds his head far to one side, a visual problem may be present, and should be evaluated.

•Writing on a slanted surface can be helpful. An easy slant topped surface can be made by duct taping together two rigid ring binders.

•Copying or reading from a vertical surface is easier visually, and
encourages upright posture. Vertical document holders are available at office and computer supply stores.

•If your child has a hard time sitting still, sitting on a therapy ball, or a special cushion designed to allow children to wiggle, may be helpful.

•Experiment with different music to energize a droopy child. The theme music from “Star Wars” or “Rocky”, for example, can be invigorating and refreshing.

According to Jan Olsen, the author of Handwriting Without Tears, writing is a physical skill, akin to learning how to play a musical instrument. Attention must be paid to posture and use, and practice must be mindful, in order to develop the necessary automatic skills. It is better to write a few letters beautifully, than many times, badly. I tell the children who study handwriting with me that they don't have to work for more than five minutes at a time, but that it should be a concentrated five minutes.

Friday, April 2, 2010

How Do I Know My Child is in the Right School?

I should preface this by saying that one of my colleagues told me that as long as I live and practice in Manhattan, where the applications process begins at conception, that I should never, ever suggest to a mother that her child is in the wrong school, unless I enjoy causing and coping with full blown panic attacks.

In a city with many private schools, like Manhattan, there is an abundance of choice in terms of educational philosophies, and there is quite a bit of diversity in terms of how learning and social development are approached and fostered. There are the well known classics, like Waldorf and Montessori, but every single school, whether it is articulated or not, has its own peculiar culture, philosophy and methodology. I've seen how a child can thrive in an environment that plays to his strengths and bolsters his weaknesses, and I've also seen how the wrong school can make a child feel like a failure.

For instance, I evaluated a little girl who was floundering in her public school kindergarten class, which was a highly structured, rigorously academic program that had the children reading and writing for a large portion of the day. This child was five years old and was functioning over a year behind in her fine and gross motor skills acquisition, her visual perception, and her eye hand coordination.

According to Piaget, reading and writing should not be taught before the age of six, because the body simply has not had the time to acquire the strength and stability to support the fine motor coordination of the hands and eyes required for the task. So, all day long, this child was being required to do things that were two years ahead of where she was developmentally. No wonder she was floundering! She was a sweet child, creative, social, and fanciful, and would have thrived in a setting where the children were encouraged to play and be creative, to explore, and to develop their coordination and prewriting skills through movement and craft activities before settling down to the rigors of academics.

Another little boy I treated was in a school where the youngest children were required to spend a large portion of their day collaborating on elaborate block structures with each other, building pretend cities and negotiating the architecture of their work in small groups. All that block building was simply nothing that appealed to him, nor did he have any talent or use for it. I could sympathize with his plight. I have the same problem, since operating in the physical world is often quite a challenge for me. I have often wondered about how I would have functioned in his situation. If the grown ups, who knew best, had required me to spend a large portion of every day doing something for which I simply had no interest or aptitude, I would have concluded that I was inept and stupid.

Although he had a sibling who was thriving in the same setting, the culture and methodology in that place were all wrong for this child. He was quite sensitive to noise, and the block building tended to get chaotic, with the frequent sounds of the wooden blocks crashing onto the hard linoleum, and the children's voices rising to a higher and higher pitch. He was required to sit on the floor a lot, which he didn't have the trunk strength to do easily, and this forced him to contend with struggling to remain upright in addition to dealing with the noise. I could tell when I observed him in his classroom that the block building was bewildering to him. He could not initiate any ideas about it on his own, and the social skills necessary to negotiate the group dynamics were not yet available to him, since his expressive language was somewhat delayed. He did not have the mid range control in his hands and arms to arrange the blocks into elaborate structures without them toppling over, and since spatial skills were not his strong suit, he didn't know how to envision a structure and then build it.

Understandably, this child preferred to play on his own or wander about the classroom, looking at what the other children were doing. When he was redirected back to the blocks, the cycle would begin again. Consequently, his behavior became more and more defiant as he was required to navigate an atmosphere that was making him feel inadequate, confused, and miserable.

Another little boy who was struggling in his environment was a student at a wonderful school with a strong child centered philosophy. Their lower school curriculum emphasizes creativity and critical thinking, fostering motor skills through dance, movement, and craft, empathy for others, and spirituality. The school is full of light, beautifully decorated, and the teachers are sensitive, committed, and highly cultured. The food in their cafeteria is organic, healthy, and delicious. I would send a child there in a heartbeat.

Unfortunately, this little boy was not at all thriving in his classroom, which had a loose structure and a soft spoken teacher. He was an alpha male who required a firm leader, a high amount of structure, and clearly defined expectations to help keep him steady. He was the type of child who needed to challenge every adult in his life in order to feel contained, and the culture of the school and his teacher's personality could not help him. Believing that there was no one really in charge, he repeatedly attempted to take control of the classroom. His behavior escalated to the point where he caused some serious harm to a classmate. He would have been much more successful in an environment with a strong, rigid hierarchy, high academic and behavioral expectations, and powerful, strict teachers. The atmosphere in such a setting would have easily contained him, whereas his school expected for the children to be able to manage their own behavior. He and the little girl in the highly structured academic classroom could probably have happily changed places!

If you love the philosophy of a school but your child is not thriving there, it's important to analyze why the situation isn't working. It's possible that the child would do better in a different environment. This is especially important when looking for placements for children who have sensory and learning problems.

Why Do Children Have to Sit Still, Anyway?

Why Do Children Have to Sit Still, Anyway?
Have you ever wondered why on earth your child can't sit still?

Let me ask you this: Why should children have to sit still? Why are we preventing them from moving instead of encouraging it?

I find it highly sad and ironic that children, who need to move in order to activate their nervous systems, to develop their coordination and visual skills, and to just plain be healthy, are forced to sit for increasingly long periods with less and less outdoor time or recess, to take the bus home from school, and then sit cooped up in homes and apartments, and then have to sit still even more for hours of {often unnecessary} homework and dinner.

A few weeks ago, I observed two different children being admonished by their nannies to sit still when they were being quizzed for their school assignments. There actually was no earthly reason that they needed to sit, as they weren't being required to write. They were just annoying the grown ups! One little girl even said, "But it helps me to think!" Her babysitter automatically replied, "No it doesn't!" I intervened and suggested that they be allowed to move at will if they were working on assignments that called for memorization.

We should be encouraging children to move, not discouraging them. If your child habitually seeks out movement, for example jumping or spinning, the best thing to do is to provide safe outlets for the child to provide what his nervous system requires. For instance, someone I know has a little boy who was so driven to jump and crash that he would smash into his classmates at school, and climb up and jump off of an eight foot wall near his home at every opportunity. His mother was at her wits' end. I suggested that instead of trying to get him to stop jumping, he be given a trampoline. His parents, bless them, went right out and bought him a 15 footer.

The first night, instead of his usual drawn out night time routine, he went right to sleep, didn't wake up once, and slept for an hour longer than usual.

I suggested that his mother send him out for 15 minutes of jumping before homework, and she was astonished at how much better he could focus. The trampoline had the added benefit of being a draw for the neighborhood children, and much socialization, which was lacking in this boy's life due to his school issues, was now taking place.

It's important to remember that children are not miniature adults and just don't have the same skill sets as we do. They're not as patient, they don't tolerate frustration as well, and they can't sit still for nearly as long. Building more movement into their day will help them accomplish everything that we require of them.

Thursday, April 1, 2010

Homework, Yuck!

Bonus points for knowing the theater reference in the title of this post. And in yesterday's, too.

I once asked a colleague what it was like to have both of his children in the Gifted and Talented program at school, and he sighed and said plaintively, "I have sooo much homework!"

Personally, I think homework is unnecessary and pointless, but I'm swimming upstream here. I find it cruel and unusual that children, who need to move their bodies in order to mature and develop, are forced to sit all day long, and then forced to sit for a couple of more hours at night, too. And in the end, what does it accomplish? I'm not sure I'm a better person for having done homework in grammar school, or high school either, for that matter. No matter how much algebra I managed to muddle through outside of class, it never stuck anyway.

Every parent who comes through my door has problems getting their children to focus on schoolwork at home. Plus, if you work yourself, the last thing you want to do is sit down and do a couple of hours of math and geography with a kid who doesn't want to be there. But it must be done.

Try to precede homework with some time outdoors, if possible. The best time to do it, of course, is when the child is fresh and alert. So putting it off until after dinner doesn't help, especially if there's a lot of it. Give the child a protein rich snack first. Make sure she is adequately hydrated. Have her drink some water before you start.

Go through your child's assignments and figure out together how long it will take to get it all done. Have the child review each assignment and estimate how long each one will require. Break the work up into discrete segments. Tell the child, we will work for five minutes, then get up and have quick break. Give her a brief choice of break activities. Some favorites include singing "Head Shoulders Knees and Toes" with accompanying movements {making sure to invert the head when touching toes, which is alerting} getting on the floor and wrestling {let the child pin you, but make her work hard for it!} jumping jacks, hopping across the room, or doing somersaults over the arm of the couch.

If your child can function better by doing a bit of each task and moving between them instead of plowing all the way through one before tackling the next, allow him to choose that option. This is especially wise if the child gets stuck and can't master something. Leave it, let it percolate, and come back to it in a bit.

Kids need to move, so a good option for moving while sitting still is either a therapy ball or a Disc-O-Sit.

If you have an office chair that spins, and your child enjoys it, spin him. Ten times ought to do the trick.

Make sure that the height of the table is good for writing. Your child's feet should touch the floor, and the table should be low enough so that his arms are not reaching up to write.

I always offer the child a lollypop or a piece of gum when it's time to work on handwriting or fine motor skills. Grown ups use gum and candy to stay alert, so why shouldn't children? This is especially true if your child is a habitual chewer and destroys pencils and shirt collars. Sucking on lollypops has the additional advantage of pulling the muscles of the eyes inward, which makes reading and all close work easier.

As I have stated earlier, children who are too young to work on their own need a grown up nearby.

I would welcome more tips from readers: any other strategies you have found useful?

Attention Must be Paid

Something I've noticed that never fails to intrigue me is how much children require, and thrive on, the focused attention of grownups. I once had a job working in a clinic in Brooklyn with children who came from very large families, and I sometimes think that the most therapeutic thing I did was give those children a whole grown up all to themselves for an hour once a week. For many of them, this was a serious luxury, and I received quite a bit of affection and adulation that I may not have necessarily deserved. In my Manhattan practice, of course, the families are much smaller. I notice, though, especially with very young children, that even if I give them a task that they could do independently, they do much better if I am sitting next to them watching intently. I don't have to speak or interact in any way, but the child will immediately sense if my attention has wandered, and lose focus.

I once treated a lovely little boy who was having some minor problems in school with his handwriting. He was seven years old, and in second grade. His mother, who was equally lovely, was worried that he had ADD. He didn't seem to have any out of the ordinary attentional problems to me, so I asked her why she thought so. She said that he couldn't do his homework. I asked how she handled it, and she said that she expected him to go to his room, shut the door, and do his homework until he was done. He had the usual crop of toys, books and video games in his room, so understandably, he'd be in there for about five minutes and then get distracted by something much more interesting than geography or fractions. So she concluded that he was distractible.

"Why doesn't he do his homework at the kitchen table while you're making dinner?" I asked.

It had just never occurred to this mother, who was a graphic designer and willingly worked at a desk in a tiny little office with bad lighting all day, that her seven year old son wasn't mature enough yet to sit all alone in his room and do a bunch of dull homework all by himself. So she moved his homework spot to the kitchen table and made herself available while she cooked, and sat with him when he needed something more. Problem solved, and I wish they were all so easy.

Small children simply don't have the ability or the inclination to work independently, especially on things that are not motivating, for long stretches of time, and we shouldn't expect them to be able to do so. The calm, focused energy of an adult nearby is sometimes all they need to be able to organize themselves internally.

And don't forget a reward. I highly recommend a little something-something, to be doled out on completion of a job well done, to help get that inner drive in gear! What, you don't believe in bribes? Why do you go to work every day? So someone will give you money! That's your reward. What should be theirs? A star on a chart, a little toy, a sticker, a piece of candy, half an hour of TV. It's all good.

Great Expectations

Here's a secret: children love it when parents and teachers have very high standards for comportment and expect their children to meet them. They love it when adults are calm, strict and fair, and they especially love it when the adults in their lives are clear in their expectations and strong in their boundaries. If a child perceives that he is in charge, and more powerful than the grownups who are supposed to be protecting, guiding, and supporting him, he can’t feel secure.

I have a friend who studies Jiu Jitsu at a dojo near her home on Long Island. One weekend while I was visiting, she asked me if I would mind stopping over there. We walked in during the middle of a children's class. There was the sensei, sitting on her heels on the mat, surrounded by fifteen or so seven year olds, all sitting on their heels. She was helping one of the students with his belt, while the rest of the children sat very still, completely silent, all eyes trained on her. I commented on how they were so focused on their teacher, and how even though the discipline in the room was intense, the energy was so upbeat, and the children appeared vibrant and happy. She laughed and said that there used to be a very, very strict martial arts teacher in town, and that his classes were completely overbooked.

A friend recently commented to me that her daughter enjoys pushing the envelope and testing her by doing things she knows she is not supposed to be doing and waiting for her mother's reaction. My friend observed that her daughter is always happy and comforted when her mother stops her. Every time her daughter challenges her authority and my friend demonstrates, calmly, that she, the grown up, can prevent her child from going beyond what is allowed, she is proving over and over to her child that she can keep her daughter safe, contained, and protected.

When I think back on the teachers that had the greatest influence on me, it's always the ones who swept into the classroom on the first day and let us know that they were powerful beings who were going to demand greatness from us. Very often, we delivered, and we became proud of ourselves and motivated to continue to succeed. I try to keep this in mind when I am treating the children who come to me for help. If I demand greatness from them, they will in turn demand great things of themselves.