Wednesday, January 26, 2011

Crawling to Victory

The stronger and more coordinated your child's body, the easier it will be for him in school and in life.  The ability to sit and attend is made so much easier when the child has a stable base of support.

Crawling, which typically occurs when the child is about six or seven months old, is a critical stage in a child's development.  The action of crawling, among other things, sets up the pelvis for walking, strengthens the spine, shoulders, neck, and arms, integrates the two halves of the brain and the body to coordinate together, fine tunes vision and perception, and separates the thumb out of the palm, so that it can work strongly and independently for fine motor control.  Children who don't crawl, but go directly to upright, or who have unusual patterns of mobility such as habitually scooting on their backs or bottoms, are at risk for problems later on.

Many of the children I treat for sensory processing issues have not crawled at all, but have gone directly to standing and walking.  Thus they skip developmental stages that are crucial to the integration of the central nervous system.  They don't acquire age appropriate strength, coordination, and balance as a result, and it affects their ability to function at school and in life.

It is possible to replicate these activities which are so necessary to the child's neurological development, even after the child has long since outgrown them.  By incorporating games into his day that require him to crawl, play on all fours, or use his arms and legs against resistance, you can give your child a better foundation for learning.

You can try playing some of these games to supplement your child's occupational therapy program.  Here are some things I do with children when I don't have suspended equipment to work with:

Set up a couple of collapsible tunnels  into a little obstacle course.  You can drape them over piled up couch cushions or rolled up blankets to make it more challenging. {If you have room at home, you can buy a big bag of foam scraps for cheap at a futon store, which you can place in an inexpensive comforter cover, and use that.}  Put puzzle pieces inside for the child to retrieve and put together, or have the child play Superman and rescue toys or animals that are trapped inside.

 Have the child push objects, like a medicine ball or a large stuffed animal, through the tunnel.

Hold up one end of a length of tube fabric and have the child crawl through while pushing a large ball in front of him.  You can tie a knot in one end of the fabric and fill the resulting bag with colorful balls for the child to crawl through.  Hide things among them for the child to find.  This is a great sensory activity.

Set up a race track on the floor in a figure eight pattern and have the child race a car along the track on his hands and knees.

Give the child piggy back rides and don't hold on to  him.  Force him to grip you with his arms and legs.  Put some music on and dance. Lean to one side and the other, forward and back, and spin around.  Keep track of how long he can hang on and always try to beat the last record.  I stop counting the moment I feel his legs start to let go.

If you're strong enough, and the child is young enough,  have the child  lie on the floor on his back, wrap his arms and legs around a very sturdy stick {a French pin is ideal for this} and see if you can lift him up as he hangs on.  I call this "Marsupial."  "Extreme Marsupial" is having the child hang on while you swing the broomstick.  {Do this over a couch or some cushions.}

Play leapfrog.

Take turns pretending you're a series of four legged animals, and mimic their actions  in the forest or in the jungle while going about their day: hunting other animals, hiding, eating, playing/fighting, walking about.

Have family plank contests, sit up contests and push up contests.

Make up games that involve getting down on the floor on hands and knees, like rescuing animals from under furniture. Set up obstacle courses that require the child to crawl under and around chairs and tables.  Have the child balance an object on his back while crawling through the obstacle course, and see how long he can keep it there.

Play memory match game on the floor.  Spread the cards out wide so that you have to crawl to get them.

Have the child grip a large ball between his arms and legs and try to pull it away from him.  See if he can get strong enough so that you can actually lift him up along with the ball. {Don't do this if you think you can't do it safely.  It requires excellent body mechanics.}

Get down on the floor and wrestle.  Keep it low to the ground.  Let him pin you, but make him work hard for it.

Wheelbarrow walk:  Pick up your child's legs, and have him walk across the floor on his hands.

Pretend you are soldiers in the jungle and have to crawl on your bellies through the brush.  Have the child rescue stuffed animals and bring them back to base camp.  Or have belly crawling races.

The old fashioned game of marbles, which is played on all fours, is superb for developing hand eye coordination and sportsmanship.  The video in the link shows the children flicking marbles into a hole in the floor, but if you don't have a hole in your floor, you can make a circle out of string instead.  Tiddly winks is also a good game to be played on the floor.

Added bonus:  crawling is very good for bad backs.  I have had several parents tell me that their sore backs felt great after crawling with their children!

Wednesday, January 19, 2011

Why is My Child So Rigid and Controlling?

If your child has a hard time coping with everyday life and has to have his own way all the time, it could be a symptom of sensory processing difficulties. 

In the sensory gym where I have my OT practice, there is a room with a zip cord.  The children climb up a platform, hold on to a plastic handle that runs along a wire suspended over the room, fly through the air and crash down into a ball pit, sending little colored plastic balls flying all over.  I like to use the zip line as a way to begin with a new little friend, by studying his reaction to it.  Some children confidently race up to the top of the platform, catch the handle as I send it flying across the room, and zip across into the pit as if they had been doing it forever.

 Other children take one look at it and run out of the room screaming.  Recently, I had one of those.  It was his first day of occupational therapy and I invited him to try it.  He took one look at it and flatly refused, telling me in no uncertain terms that he would never go near it.

Here is the art of the therapist:  within about five minutes, he was zipping like a pro, having a wonderful time, and asking me if there was any way to make it more challenging.

I had little conversation afterwards with his mother, who was present during the entire treatment, and was frankly amazed at how quickly he had changed.  She had known for a long time that there was something wrong with the way her son was interacting with the world, but had no idea how to help him until someone referred them to me for occupational therapy. We talked about what she could expect to see in the coming weeks.

 She said that she could see how his handwriting would get better, but that there were certain aspects of his personality that she was afraid would never change.

I knew instantly that she was referring to how stubborn and controlling he could be.  He was often quite rigid, refusing to socialize, try new foods or to have new experiences.  He was anxious when life was not predictable.  He had to have everything his way, in a well ordered routine, or he just couldn't cope.  A small change in plans was often enough to send him into a full meltdown.

 Instead of meeting novelty and challenges with enthusiasm and confidence, the way that this child's nervous system was functioning was forcing him to respond to most of what came his way with "NO!" and "I can't."

Why is that?

His skin, mouth, eyes, nose, and ears are overly sensitive, so everything that crosses his path is too bright, too loud, too stinky, and too scratchy.  He has low muscle tone, impaired motor planning, and his balance is poor.

Ergo: much of what he encounters is painful or uncomfortable or feels threatening, he can't rely on his body to do what he tells it to do, his relationship to gravity is uncertain, and he is prone to falling.

 So he responds by being controlling and rigid, trying to keep  danger at bay and to protect his fragile equilibrium.

{When you're at the end of your rope, don't you get a little like that yourself?}

I explained to his mother that the work we were doing would indeed help him be less controlling and learn to be more flexible.  As he gained control over his insides, he would be less driven to control everything that happened on the outside.

In the sensory gym, we work to normalize the way that the child takes in and processes sensory information, by neutralizing and overriding inappropriate perceptions from the eyes, ears, skin, and muscles that inform the child of danger when there is no danger present.  Working on the suspended equipment improves balance, coordination, and motor planning, so that the child knows that his body will do what he tells it to do.

When a child is not feeling threatened by danger signals, nor made uncomfortable by normal sounds and sensations, the need to control is greatly reduced.   When he  develops a sense of mastery over his environment, his confidence increases.   Along with this comes the ability to be more mentally and emotionally flexible, as things don't seem so threatening or insurmountable.

Wednesday, January 12, 2011

Teach Your Children Well

A woman I used to know a long time ago once called me to tell me about a day with her six year old that had gone wrong. It had started out with him coming to the breakfast table with a small water balloon in his hand. There was a glass of orange juice set at his place. His mother saw him eying the glass and said, "Don't you dare even think of putting that balloon in your orange juice." So of course, he did. To which she responded, "Just for that, you can't go swimming with your father after dinner." This was a weekly ritual that they both looked forward to doing together. He had a screaming tantrum, and she sent him to his room. He slammed his door shut and proceeded to trash everything within reach.

So instead of having a lovely evening alone reading romance novels and drinking red wine , she was stuck with a furious, resentful husband, an out of control six year old, and a big mess to clean up. She was proud of herself, however, that she had imposed consequences after he had behaved badly.
She made the mistake of calling me and telling me all about it, expecting me commiserate and to praise her for how she had handled things.

"There are so many things wrong here that I hardly know where to begin," I said. "What on earth were you thinking, letting him come to the table with a water balloon in the first place? And here's a news flash about six year old boys: 'Don't you dare' is the exact equivalent of 'I dare you'. You were telling him to go right ahead. What self respecting male can resist any kind of dare? That was a total set up. Then, without any warning, he got a huge consequence. He was denied an activity that was necessary to his physical and mental health, and rare quality time with his father. Plus, consequences have to be immediate to be effective. Ten hours to a child that age is forever. He won't remember that he did anything wrong such a long time later, and he'll just think you're mean and unreasonable to deny him his special date with his dad."

When I was in social situations with this woman, I could tell from how she spoke to him that she didn't really expect her son to listen to her, and so he never did. Consequently, his behavior became more and more problematic as he lost his respect for the adults who had no idea how to contain him, help him gain control of himself, or make him feel secure. He was so unmanageable at school that he had to attend a program for special needs children.

Eventually, I lost track of them, but not before an occupational therapy colleague who was treating her son lost his patience with both of them, because the little boy would hide under a table and refuse to come out when it was time to sit and work on academic tasks like handwriting. She wouldn't allow the therapist, who was very skilled and could have imposed some much needed authority, to discipline him or insist that the child follow his direction.

This woman had grown up with parents who had very little idea of how to relate to their children aside from yelling, hitting, shaming, and essentially squashing their spirits. She didn't want to repeat those mistakes with her own child, but in my view, what she was doing, which was basically allowing him to run the show, was just as bad. I recall being at her home when he was in kindergarten, and choosing to cut short our visit because he was throwing things at me, being aggressive to the point where I was beginning to fear for my safety, and she did nothing to stop it.

In order to feel safe, children need to know that the grown ups are in charge. This little boy knew that he was more powerful than his mother, because she gave in to him constantly, didn't expect him to obey her, and rarely reined him in.  Because she did not provide much external structure, he was not able form an internal structure, and could not control his behavior at home or at school.  I believe that she thought that he wouldn't love her if she disciplined him. He had to push the envelope harder and harder to find out where the limits were.

Children whose parents set the bar high, who lovingly expect and demand the best from them, are the ones who want to challenge and push themselves, and the ones who are best equipped to navigate the complicated world of school and playground.

Wednesday, January 5, 2011

Why Can't My Child Get His Work Done at School?

Grownups, please do some detective work if your child {or student} is struggling in the classroom.  You  may be expecting him to function under circumstances that you would be unable to tolerate yourself.

I recently evaluated a little boy whose teacher reported that he was unable to produce much, if any, written work during morning writing time.  He would sit quietly,  not bothering anyone, but not getting anything done,  either.

The first thing I saw, when I walked into his classroom, was that my little friend, who is a bit small for his age, was sitting in a chair that was so low that the height of the table came up to the top of his chest.

What's the big deal?  You say.  Furniture is furniture, what's the difference?

  OK.  Go get a footstool and pull it up to the desk where your computer is sitting. Now go ahead and do some work.  I'll wait for you.

Back so soon? How was it?  Couldn't stay that way for long, could you?  Pretty uncomfortable, I bet.  Could you even see your keyboard?

If you were assigned a desk at work that came up to the height of your chest, after your initial fit of indignation at being so mistreated by the imbeciles in management, who had no concept of what constituted proper seating  -- how did they expect you to get anything done with such a poorly designed work space?  The idiots! --  you'd be on the phone with human services first thing, demanding office furniture that was calibrated to fit you, so that you could do your work.

When a desk is so high that it comes up to your chest,  you can't see anything on it. Raising your arms up above  your chest to try and write or type would tire you out instantly and make your back ache almost immediately.

But the grownups were expecting this little boy to sit there for hours and hours and do his work like that, day after day, and then getting on his case {quite loudly and exasperatedly, from what I saw in class} because he wasn't producing much.

As bad as it was, this wasn't the only thing with which the poor boy was contending. He was chronically stuffy, according to his parents.   He had indeed sniffled and snuffled his way through the evaluation, blowing his nose frequently, and breathing through his mouth.  

How are your critical thinking skills, attention span, and alertness levels when your sinuses are blocked and your nose is so stuffed that you can't breathe?  How does your throat feel, when you breathe through your mouth all day?

I also saw that this child was highly sensitive to sound and movement, which made him  hypervigilant.  In contrast to most of the other children, who were sitting and writing through the occasional interruption of the teacher's voice as she spoke to individual students,  he alerted and attended to everything that happened around him.  Each time the teacher, or another child, spoke or moved, he watched and listened to the entire interaction.   He was sitting with his back directly against the door, so that every time anyone had to come or go, they had to pass directly behind him, further disrupting his already tenuous ability to concentrate.

The children in this little boy's classroom, who were six and seven years old, were required to sit still for 90 minutes and write independently every single day.  I was there for about the first 40 minutes of writing time, and as I was getting ready to leave, the teacher was already doing a lot of shushing, reprimanding, and ordering children to stop moving, stop talking, and get back to work.

How realistic is it to expect six and seven year olds, even neurotypically developing ones, to sit for 90 minutes and write without a break?  I personally can't do it myself -- even when I am having a great time with my thoughts and genius is burning, I top out at about 40 minutes of sitting at my computer before I need to get up and move around, or do something else, like visit another website or play a quick game of Scrabble Blast, before I can concentrate again.

Those were the obvious things.  The less obvious ones were the child's weak eye muscles, which made reading and copying from the board difficult, his low extensor tone, which made sitting for long periods extra effortful, his impaired fine motor planning, which made manipulating his pencil a struggle,  and his weak tongue, which made eating less than pleasurable, {because it was much effort to chew his food, and to keep it away from the back of his throat before he was ready to swallow}  so that he limited himself to bland, soft, highly processed foods, and wasn't getting the nutrition he needed to fuel his brain and body.  He also had very poor habits of letter formation, since the school did not formally teach handwriting.  He hesitated before writing many of his letters, which meant that he was still struggling to recall how to make them, and when he did manage to get something down on paper, it was messy, poorly organized, and in no way reflected this child's abilities, which were considerable.

If your child is having a hard time functioning in school, what are some of the practical considerations, like poorly fitting furniture and not enough recess, that are holding him back?

Please also remember that children do not have the verbal sophistication to tell us what is wrong.  All the child knows is that he can't do what the grownups expect him to do, and so he feels inadequate.  He is unhappy, lost, confused, often highly uncomfortable, and no one is stepping in to help him; quite the opposite, they are nagging him to do things that he just is not able to do.

You can also find some more ideas and information about helping the child who is struggling to succeed in school here and here.