Pediatric Occupational Therapy, Teaneck, Bergen County, Englewood

3 Ways to Survive Homework Time

carol — Fri, 03 Feb 2012 19:17:17 +0000

Homework is a dreaded time of day in most homes. By the time homework rolls around, you and your child have already had a long, tiring day. For a child with sensory challenges, coming home after an exhausting day and facing homework is especially difficult. Whether your child is overly active or completely wiped after the school day, using sensory strategies to your advantage will make the afternoon and evening hours go much more smoothly in your home.

Some children are so worn out by the effort of sitting in class and keeping their behavior in check all day that they are bouncing off the walls when they come off the bus. If your child fits that description, incorporate resistive activities (“heavy work”) that are calming and organizing into your after-school routine. Spend 15-20 minutes engaged in these activities to ease the transition to homework. Assign specific chores to your child as great way to integrate these activities into the day seamlessly. An added benefit is that having your child perform these chores will lessen your work load!

Raking leaves
Shoveling the snow
Pushing a loaded shopping cart around the supermarket
Unloading groceries at home

Many children are exhausted when they come home from school. They need up-regulating activities in order to shake off their sluggishness. Strong movement (vestibular) activities will help your child stay alert and focused for homework.

Trampoline
Jumping jacks
Jumping rope
Hula-hoop

Once you have employed one of the above-mentioned sensory strategies to help your child achieve a calm, alert state for homework, use rhythm to keep him/her on task for longer. A heavy rhythm is very grounding and organizing, making it a highly effective tool for homework time. A few simple ways of incorporating rhythm into the day are listed below:

Having your child chew a large piece of (sugar free) gum before beginning his/her school work.
Listen to music that has a strong beat. Consider playing the music over headphones if the workspace is shared and could be a distraction to other family members.
Keep a sports-top water bottle at your child’s work station and encourage him/her to take sips regularly.

Blog by Dr. Chaye Lamm Warburg, DPS, OTR 1/30/12

3 Steps to making your child’s morning easier

carol — Wed, 04 Jan 2012 15:45:39 +0000

Mornings are a particularly challenging time of day for children with sensory processing disorder. Children need to get up, dressed, backpacks and lunches must be packed . . . and all before the bus comes! That is stressful under the best of circumstances, but if you are dealing with a child’s sensory sensitivities in addition, the challenge can seem daunting. It may appear that the slightest thing can send your child into a tailspin. Your best line of defense is to be proactive, stick to your routine, and be an advocate for your child’s sensory needs.

1. Be proactive:

• Avoid anything that is difficult for your child to part from (e.g., TV), to ease the transition.

• If your child is hyper-sensitive to touch and dislikes hair and tooth brushing, here are some suggestions to make it more palatable:

o Use a vibrating toothbrush

o Allow your child to choose the flavor of the toothpaste, or try Tom’s of Maine unflavored

o Always brush in the same pattern (e.g., top teeth first) to establish some predictability

o Desensitize the scalp before brushing by massaging the head

o Use a soft bristled brush

o Heavily condition the hair when bathing and use a detangling spray before brushing

• Use your (limited) time wisely:

o If your child is sluggish and slow to get-going, use sensory activities that are alerting, such as jumping jacks, stride jumps, hopping, or skipping to get around the house.

o If your child is overly excited in the morning, use calming sensory activities while waiting for the bus, such as blowing bubbles, jumping rope, pedaling a car or tricycle, or playing catch with a weighted ball.

• For useful tips on helping your tactile defensive child get dressed, check out our previous blog, “The Morning Rush: How to get your hyper-sensitive child dressed in the morning” from October 2010.

• For additional suggestions on how to use music to get going and how to keep your child on track, check out our blog from September 2009, “Keeping it simple: Establishing morning routines for the sensory challenged”.

2. Routine is reassuring:

• Create a pictorial step-by-step Velcro schedule to help your child manage his/her morning routine independently. Take pictures of your child performing each step of the morning routine, such making the bed, getting dressed, brushing teeth, eating breakfast, etc. and put a Velcro dot on the back of each. Place a long strip of Velcro, or Velcro dots on a piece of cardboard or poster board. Arrange the pictures in sequence together with your child. Having your child organize the pictures will give him/her practice with the morning routine (or any other schedule), and serve as a pictorial guide each day. Allowing her to change the sequence with you on days that will be different, such as the weekend or a vacation, will give him/her a measure of predictability and control and smooth over potentially rocky transitions

• Make a “Things to Bring to School Checklist” for your child that includes general materials, such as pens, pencils, and highlighters, as well as notebooks or textbooks for individual subjects, and display it in an obvious location where he/she packs his/her backpack.

• Discuss changes in plans or after-school activities before they happen. Rehearse them out loud.

3. Advocate for your child’s sensory needs:

• If your child is sensitive to loud noises or is tactile defensive:

o Request a permanent seat on the front of the bus

o Make sure that he/she is not starting the school day in a noisy, crowded multi-purpose room that will ignite your child’s “fight or flight” reaction

• If your child’s occupational therapist has designed a sensory diet for school, check in regularly with the teacher so that it can tweaked to best suit your child’s needs in the classroom

• Power breaks are beneficial for most students. For children who have difficulty with sensory processing, “keeping it together” for the whole day can be exceedingly difficult. Intermittent power breaks that involve movement and stretching will allow your child’s “batteries” to re-charge.

“Popcorn Maker”: Sit in a chair with your feet flat on the floor. Put your hands on the chair at your sides. Slowly begin to bounce up and down like a piece of popcorn in the microwave. Use your hands and feet to help push you up and down. Go faster and faster as the popcorn begins to pop. When it is almost all popped, start to slow down and then stop.
Jump, hop, or skip while transitioning from one activity to the next or lining up.
“Wall push-ups”: Place open hands, shoulder width apart, against a wall with elbows straight. Push as hard as possible against the wall to “make the room bigger”.

Aviva Goldwasser, MS, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

What scissors work well for children who are learning to cut?

carol — Fri, 23 Dec 2011 14:19:14 +0000

For children who have difficulty diving right in to children’s Fiskars scissors there are several options.

We highly recommend the Benbow scissors, invented by occupational therapist, Mary Benbow. They are uniquely designed with small finger loops, making them easier for small hands to control. The loops are coated in vinyl to prevent them from slipping off the fingers. Right-handed and left-handed scissors are both available.

A cutting kit can be purchased along with the scissors to gradually build up your child’s skills in a developmentally sound sequence.

Mini Loop Scissors, also known as “squizzors” are a good choice for children who seem unsure about where to place their fingers and have difficulty maintaining a mature scissors grasp. The whole hand surrounds the handles, thumbs-up to squeeze as a unit, compared to traditional scissors that require more refined control of the small muscles of the hand. The scissors automatically re-opens upon release of the handle, and require less pressure than traditional scissors. Use squizzors to practice smoothly opening and closing the scissors and develop the eye-hand coordination necessary to cut on the line, without demanding refined control of individual fingers.

The double loop on the Dual Controlled Training Scissors makes them ideal for a beginner who needs to get the idea of the cutting motion. They are designed to have an adult and child hold them together. The first set of loops is for the adult’s fingers and the back set are for the child. From the front, the adult generates the strength, coordination and control necessary to cut. From the back, the child senses the cutting motion, and can begin to develop the motor plan for cutting, without placing demands on grasp and fine motor control.

All 3 scissors and a variety of scissors activity kits are available for purchase at www.therapro.com

Blog by:

Aviva Goldwasser, MA, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

Cutting to perfection

carol — Fri, 16 Dec 2011 19:57:12 +0000

What is a proper scissors grasp?

There are several key elements to achieving a proper scissors grasp. First, the hand must be placed in a thumb-up position. The thumb goes in the “top loop” and the middle finger goes in the “bottom loop” and the scissors should rest on the index finger. The fourth and fifth fingers should be tucked into the palm to provide stability for the hand as it opens and closes.

What activities can be done to help a child maintain that frequently elusive thumbs-up position?

Dropping and catching: With the elbow bent at a 90° angle palm-down, drop a small object, such as a ball or bean bag into the lower hand, which is cupped palm up. Alternate hands. Gradually increase the weight of the object once the skill has been mastered with a light object
Scoop flour, sugar, beans, rice, etc.
Melon baller
Carry a ping pong ball or marble at arm’s length on a long-handled spoon. A first hold the handle close to the bowl of the spoon. Work your way to the end as skill increases.
Carry a tray from the bottom to play house or restaurant. Position hands palms up, upper arms in contact with trunk, and elbows at a 90° angle
Board games that require turning pieces over, e.g. Lucky Ducks, Squiggly Worms and Lotto
Slinky: Shift the slinky back and forth between hands, palms up, elbows bent
Bounce a ball on a racket (face up or face down)
Throw a ball underhand
Lock and key toys

How do you begin to teach children to cut with scissors?

Learning to grasp a pair of scissors correctly requires practice and a good pair of scissors. Children’s Fiskars are great starting scissors. Difficulty maintaining a thumbs-up position is an indication of poor elbow control. Here are some activities to help strengthen elbow control:

First practice cutting on card stock, or plastic coffee stirrers because they are stiff, easier to cut, and require only one snip.
Save all of those annoying subscription cards that fall out of magazines, and pre-cut them into ½” strips. Have your beginning scissors-user cut them into pieces. This is an easy and almost always gratifying activity. If you have an incomplete collection of paying cards, those work equally well.
You can use the straw and card stock snippets to create a collage. Next, have your child cut fringes at the bottom of a piece of card stock. This should require only one snip per fringe.
When the hands are working well together, draw some shorter and longer lines on the card stock with a thick black Sharpie or a highlighter and have your child practice stopping at the end of the line. This will begin to place demands on sequential opening and closing, and facilitate awareness of the line, and introduce control. Finally, ask him/her to cut longer strips lengthwise on cardstock progressing to widthwise on construction paper to practice opening and closing the scissors 4 or 5 times in a row.

See our next blog to learn about different kinds of scissors to boost your child’s cutting skills.

Aviva Goldwasser, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

12/16/11

Toy review: Feed the animals game

carol — Tue, 13 Dec 2011 15:34:39 +0000

These games are a great choice if you are in search of a game to boost the fine motor skills of your 3-5 year old child. You can purchase all 3 together, or choose the animal that is most appealing to your child. Each game comes with a pair of large tongs that will be used to “feed” treats to the animal. The pretend food treats are an appropriate size, making it challenging, but not exceedingly difficult to pick up. The larger mouths of the animals are conveniently designed to make it a “just right challenge” for young children to get the treats inside.

After having played the game, I have listed below a couple of pointers and adaptations to maximize the fine motor benefits accrued while playing:

Place a piece of colored tape around the tongs exactly where your child should hold them (approximately two-thirds of the way down the tongs) so that he/she automatically knows where to place his/her fingers.

Each game comes with 30 treats. By taking turns with your child, you will keep the small muscles of the hand from fatiguing quickly.

Quality counts! If you notice that your child is struggling to hold the tongs, or is beginning to use the entire hand to grasp them, discontinue the game or alter the game play to pick up the treats using fingers only.

Aviva Goldwasser, OTR/L

Dr. Chaye Lamm Warburg, OTR/L

Toy review: Spot-it!

carol — Wed, 07 Dec 2011 20:06:50 +0000

TOY REVIEW: SPOT-IT!

Holiday season has arrived! As you shop for the ideal gifts, keep in mind that games are a great vehicle for developing your child’s skills. Use this gift giving opportunity to buy a game that will challenge your child’s perceptual skills in a fun, creative, and interactive way.

How do you play?

Each Spot-It! card contains 8 symbols out of a bank of 50 universal symbols. Two cards are drawn at the same time, and placed face up. The object of the game is to find one matching symbol between the two cards. Be the first player to call out the name of the matching symbol.

Therapeutically, this game challenges visual perception skills. It requires accurate visual scanning of the symbols on each card and solid figure-ground discrimination to pick out the relevant symbol from the whole array. It also demands good matching, visual memory, and visual discrimination skills in order to locate the one match between the cards. Players must be able to recognize and identify the matching symbol, even though the symbol may be a different size or in different orientation, tapping into visual form constancy.

For detailed explanations of all of the visual perception terms, click on the “Glossary” tab on the left column of our potsot.com website.

Who can play?

The game is intended for 2-8 players, ages 7+. Because the symbols are universally recognized, such as hearts, ladybugs, snowflakes, and simple words such as Stop, Art, and Ok, accurate reading skills are not critical to play the game, and we have used it successfully with 6 year olds.

What’s included?

Spot-It! includes 55 cards neatly packed in a tin container. Its small size makes it easy to store and ideal for travel. The game is relatively inexpensive and in addition to the regular game, there are 5 mini-games, each with its own set of rules and objectives, making the game more versatile and interesting.

Aviva Goldwasser, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

Updated Recommendations About Limiting TV for Children

carol — Wed, 26 Oct 2011 18:19:16 +0000

Do not be fooled by advertisements claiming that TV programs or video games are “educational”. About two years behind the French, the American Academy of Pediatrics has just released new warnings about allowing young children to watch TV. “Screen time”, time spent in front of TVs, computers, and video games, offers no educational value to children under the age of 2. On the contrary, it detracts from the children’s ability to engage in age appropriate play and explore the environment.

The Numbers:

On October 18, 2011, the New York Times reported that a recent survey found that 90% of parents reportedly allow their children under the age of 2 to watch some form of media.

The Risk:

A recent publication in the journal Pediatrics estimated that for every 1 hour a child is exposed to media, 50 minutes less is spent playing with a parent, and 10% less time engaged in play.

Note that children under the age of 2 are in the midst of a critical period of language development. Children pick up and understand language best when it comes from another person, face-to-face. They do not learn language from videos and TV.

The Recommendation:

While the American Academy of Pediatrics acknowledged that media is ubiquitous nowadays and many parents rely on screen time for a much-needed break throughout the day, it is incumbent upon parents to limit the amount of screen time children will be permitted.

Furthermore, parents are cautioned against leaving the TV on in the background, since it has been found that it is overly distracting to both children and parents.

Fidget Fun

carol — Mon, 17 Oct 2011 20:49:00 +0000

Everyone seeks sensory input throughout the day to remain alert and attentive. As adults, we allow ourselves many opportunities to “recharge our batteries”. For example, many of us drink coffee, chew gum, tap our fingers or feet, doodle, etc. Yet, our children are often not afforded those same opportunities in the classroom to help them stay focused. Some children may be able to suppress those needs until given the chance to move freely during scheduled times of the day, such as recess, physical education, lunch, and snack. However, for children with sensory challenges, the need to satisfy the body’s craving may be so intense that they are unable to focus on anything else until that need has been met.

While some sensory strategies can be difficult (or impossible) to implement in a classroom, providing finger fidgets can be highly effective for children who crave tactile input and need to have something in their hands. Keeping their hands busy will open their minds for learning and concentration.

There are a wide range of fidgets that are available in stores and online. Consult your child’s occupational therapist to help you select what will best suit your child’s needs. For example, if your child craves proprioceptive input, look for stretchy toys and stress balls. If your child craves tactile stimulation, look for fidgets that are textured.

For the classroom, we typically recommend fidgets that do not make noise or light up so that they can remain inconspicuous. In addition, we strongly recommend fidgets that can be placed on a keychain or carabineer to minimize the likelihood of them getting lost, becoming a projectile, or serving as a visual distraction.

Check out the following websites for fidgets:

A closer look: The process of creating an IEP

carol — Wed, 21 Sep 2011 16:10:51 +0000

The process of developing an IEP (Individual Education Plan) can be highly complex and overwhelming. Listed below is a breakdown of the steps involved in the creation of an IEP.

Step 1: Identification

A student is identified as needing an evaluation by either a school professional or a parent. The referral can be in the form of a written or verbal request. Parental consent is required for an evaluation.

Step 2: Evaluation

The purpose of the evaluation is to determine whether the child has a disability according to IDEA, whether special education is required, and which services are needed for the child to succeed academically. Evaluations are conducted by a multidisciplinary team consisting of professionals who have expertise in each of the identified areas of concern. For example, if there are concerns regarding fine motor skills or sensory processing, an occupational therapist would be involved. If there were concerns about the child’s hearing, and audiologist would evaluate). Parents can submit an independent evaluation that was done privately by a professional with no relationship to the school system. In most cases, this would be paid for by the parents.

Results of the evaluation will determine the child’s eligibility for special education and related services according to IDEA. If the child’s parents disagree with the findings, they can request an Independent Educational Evaluation (IEE) and ask that the school system pay for it.

Step 3: Eligibility Meeting

Based on the results of the evaluation, a group of professionals, including those who evaluated the child, and the child’s parents attend a meeting to determine the child’s eligibility for services under the IDEA. If the child’s parents disagree with the outcome of the meeting they can request a hearing to challenge the results.

Step 4: Eligibility for Services

If the child is found to be a “child with a disability”, he/she becomes eligible for special education and related services, such as occupational, physical, and speech-language therapies. The IEP team has 30 calendar days (even during the summer months and vacations) from the date that eligibility was determined to meet regarding the writing of an IEP.

Step 5: Scheduling an IEP meeting

The school must contact the participants for the meeting. By law, the following people must be involved in the IEP team: (1) student, if appropriate (2) parents (3) regular education teacher (4) special education teacher/service provider (5) school system representative, often from the child study team (6) for students of transition age, a representative from the transition services agency (7) an individual to interpret results of the evaluation (8) individual(s) with additional knowledge/expertise about the child. A team member may fill more than one role (e.g the school representative can also be designated to interpret the evaluation results, if qualified to do so).

Everyone must be informed of the time, place, purpose of the meeting and attendees expected, with ample notice. Scheduling must take place at a time and place that is reasonable for both the school and parents. Parents may bring elct individuals to the meetings who have knowledge and expertise about their child. This can be highly beneficial in attaining a true understanding of the child’s capabilities and needs.

Step 6: IEP Meeting

The team, including the child (if appropriate) and parents, meet to formulate the IEP. If parents give their consent for special education and related services, the services are supposed to go into effect immediately. If the parents disagree, a discussion should be attempted to resolve the differences between the parents and the Board of Education (BOE). If the team cannot come to a consensus, mediation can be attempted. Parents have the option of filing a complaint with the state education agency and request a “due process hearing”, at which time mediation must be available.

A due process hearing is a legal proceeding conducted by a third party, independent of both the school system and the parent(s). Arguments are presented by both parties before the hearing officer, who writes a decision. Either party can appeal the decision to state or federal court. If the hearing officer finds in favor of the parent(s), it is possible (under certain conditions) to recover legal fees.

Step 7: Services are provided

The school is responsible for the implementation of the IEP. Parents, teachers, and service providers are all given copies of the IEP and it is the responsibility of the teachers and providers to address the treatment goals, and ensure that the accommodations and modifications specified in the document are in effect.

Step 8: Progress Measured

Parents are provided with progress reports at least as often as students in regular education, regarding their child’s progress toward the annual goals in the IEP.

Step 9: IEP Review

A meeting is conducted at least once a year to make any changes or revisions to the IEP. If necessary, the IEP can be reviewed and revised more frequently, based on the parents or school system request. Parents are included in this process. At an IEP review there may be a determination for additional testing or an independent evaluation. If the child’s parents disagree, mediation or a due process hearing can be requested.

Step 10: Re-evaluation

The child is re-evaluated at least every three years on a “triennial” basis. This is done to determine continued eligibility and educational needs.

Please note that this is a general guideline. Different states and school districts may have different policies. If you need additional guidance, consider discussing your concerns with your local child study team or an advocate or an attorney specializing in special education law.

Blog by:

Aviva Goldwasser, MS, OTR/L

Dr. Chaye Lamm Warburg, DPS, OTR/L

Demystifying IEP’s & 504 Plans

carol — Fri, 09 Sep 2011 13:29:34 +0000

Thanks to revolutionary laws such as the IDEA (Individuals with Disabilities Education Act) more children with disabilities attend their local schools than ever before. While this has opened many doors to children with varying abilities and offers many social opportunities, it is incumbent on schools to provide each student access to an educational program that suites his/her needs and maximizes his/her potential for academic success.

In the coming weeks, we will take a closer look at IEP’s and 504 accommodations to help you understand what these documents are, how they are generated, who is involved in creating them, how they are implemented, and what rights you have as a parent.

What is the difference between an IEP and a 504 Plan?

An IEP (Individual Education Plan) is a legal document that is created for students who receive special education and related services. Each IEP is unique and specific to that student. The goal of an IEP is to delineate the supports and services that will be in place for the child with a disability.

A 504 Plan is for students with disabilities who require “reasonable accommodations” only. It is a document that spells out the modifications, adaptations and accommodations that will be put into place for a specific student to ensure that he/she has an equal opportunity to succeed academically.

There are two key differences between IEP’s and 504 Plans. An IEP is completed in accordance with the IDEA, which is a federally funded mandate. While a 504 Plan is subsumed under the Federal Rehabilitation Act of 1973 Section 504, funding is not federally mandated and adherence is monitored by the Office of Civil Rights. Additionally, IEP’s are designed to include special education services, and related services may be provided in order to enable a student to benefit from his/her special education program. They are generally more involved than a 504 Plan.

Are there similarities between the two types of plans?

There are many similarities between an IEP and a 504 Plan, including:

Both plans are written and implemented by the school
The documents are developed by designated professionals that may include school administrators, teachers, related service providers and family members
Both plans are updated annually in order to remain relevant
Each document is unique and specific to the student
Students can receive the same types of services, accommodations, and modifications in order to maximize their potential for academic success

Which is a better fit for your child?

It can be difficult to determine which plan is more suitable for your child. In general, students requiring special education services will have an IEP to support the child’s ability to benefit from those special education services. 504 Plans are most relevant for students who are in regular education classes and require “reasonable accommodations” to address their needs, but do not require special education.

How can my child’s private occupational therapist (OT) be involved in the planning process?

It can be highly beneficial to have your child’s private occupational therapist’s input when planning for and creating an IEP and 504 Plan. Here are some ways to do that:

Provide the school with any written evaluations that were done
If the evaluation was not recent, have the OT submit a progress report indicating your child’s current level of functioning
Consider bringing your child’s OT to the IEP meeting
Have your child’s OT read, review, and amend your child’s current level of functioning and the occupational therapy goals that are included in the IEP, to ensure that all the goals are appropriate for your child
If your child will be getting OT both in school and privately, be sure to include a statement in the IEP that the therapists must be in regular contact

What all parents should know before attending a meeting:

Be prepared: Get copies of reports and evaluations prior to the meeting

Know your rights
Be involved in the process. Be clear about your priorities and state them unambiguously
Know your child, his/her needs and what kinds of accommodations, modifications, and services you would like implemented
Be certain that the plan addresses the needs you have identified and is a good fit for your child. Prior experimentation with modifications that seem to work should guide you
If there is a behavioral plan, be sure that you are comfortable with it
Get input from professionals who know your child well. A school visit by a professional on your team prior to the meeting might be invaluable
Make sure that modifications and accommodations are highly specific
Listen carefully and take notes
Understand the proceedings. If you do not adequately comprehend what is being said in education jargon, ask that it be restated in a way that you understand
It is worthwhile for both parents to attend the meeting. If not, the parent attending can bring a grandparent or an outside professional for support. It often takes two to grasp the proceedings and take in all of the information being presented
Do not feel compelled to agree to anything, or sign anything on the spot, especially if your spouse is not with you. Be sure to thank all those present for their interest in and support of your child. Then state that you want to put as much thought into the plan as school personnel did, so you would like to take the document home and study it and get back to the school in a timely manner

Blog written by:

Aviva Goldwasser, MS, OTR

Dr. Chaye Lamm Warburg, DPS, OTR

September 9, 2011

References:

www.ed.gov/parents/needs/speced/iepguide/index.html

http://www.greatschools.org/