All posts by Guest Blogger

Do Gifted But Non-Disabled Children Need Occupational Therapy?

November 15, 2017Occupational TherapyGuest Blogger

School-based occupational therapists are familiar with receiving requests for assessments or interventions for children with delays of all kinds. What happens when the service request is for a child that has been identified as gifted or talented, but has no diagnosed disorders? Will OT treatment help a child whose brain is globally and permanently wired for intense responses?

Some common behavioral characteristics of the gifted often suggest that sensory processing difficulties could be present:

Sensitivity to lighting, fabrics, and other sensory stimulation.
Seeking strong sensory-motor input throughout the day.
Difficulty tolerating school rules such as taking turns or sharing the spotlight in discussions.
Pursues interests in isolation or with adults rather than with peers.
Resistance to complete assigned projects; pursues personal interests.

Theorists such as Kazimierz Dabrowski have attributed these and other behaviors to multiple “overexcitabilites.” He identified five primary areas of over-excitability in gifted individuals: psychomotor, sensory, intellectual, imaginational and emotional. Not considered to be signs of neurological disorders, they are thought to be the result of a brain that is wired differently than children of average abilities. Brain imagining studies suggest that the gifted make faster and more complex associations between stimuli. They perceive experiences and interactions with more depth and intensity than other children, and have an inborn drive to follow their passions.

These brain characteristics are not necessarily problematic for every gifted child. When teachers and parents know how to support children who learn differently, the gifted child can become a positive force and even a leader in the classroom. Although scores on the Sensory Profile or on other sensory-based assessments may suggest an SI diagnosis, there are gifted children that manage successfully in school and at home without intervention. They may even come up with their own sensory diet, having identified activities that provide what they need. For example, a child that seeks sensory input could engage in complex art projects or specific sports activities that provide visual, tactile, vestibular or proprioceptive input. A sensory-sensitive child may happily use an unoccupied corner of the room with indirect light for free reading time.

Some gifted children will have difficulty in class, especially when their behavior is at odds with school routines and social norms. A child that takes over discussions or refuses to work on a group project may disrupt a classroom or be unable to complete assignments even though their academic abilities exceed their peers. A child that refuses to wear a tie or participate in music class may need help to handle the demands of school.

Anne Cronin, OTR, FAOTA has recommended that gifted children can benefit from sensory diets and modulation strategies found in programs such as “How Does Your Engine Run?” It is worth noting that gifted children may be able to comprehend and implement programs at earlier ages and stages than typical children. Children who were reading at 3 or creating complex imaginary civilizations at 5 may learn and incorporate a sensory diet almost immediately on accepting its value. Such students may even improve on your suggested activities with one of their own creation! This is the time to collaborate with them and provide them with the positive feedback they may need in order to try new ways of responding at school and at home.

The same sensory-based equipment that we recommend for other children with sensory processing problems could help gifted children as well. Fluorescent Light Filters effectively dim harsh lighting, and fidgets for feet and hands can be effective tools that don’t disrupt productive work. Because gifted children need to learn to manage and modulate their intense and complex responses, there are many ways that OTs could be helpful to these children.

Gifted children may need a wider variety of tools to give them the desired novelty they crave, or they may reject many ideas rapidly. Always ask for an explanation and be ready with alternatives. A gifted child may be able to project many steps ahead of you and identify roadblocks that you don’t anticipate…yet!

Cathy Collyer, OTR, LMT, PLLC

Cathy Collyer, OTR, LMT has treated children with neurological, orthopedic and sensory processing disorders for over 20 years. She is the author of The Practical Guide To Toilet Training Your Child With Low Muscle Tone. Learn more about her work at tranquilbabies.com.

Helping Little Kids Cut: Set the Stage with Demonstration and Positioning

October 18, 2017Fine MotorGuest Blogger

by Cathy Collyer, OTR, LMT

OT goals on IEPs and IFSPs for young children commonly include some form of scissor use. There is a good reason for this: using scissors independently and safely is an important preschool classroom skill. For OT’s, it is also a benchmark for bilateral control, dissociation of the sides of the hand, and the ability to control and grade force. But what do you do with kids that aren’t interested or prepared to cut?

Many young children are eager to learn to cut with scissors. They are excited to control such a grown-up tool and they like to see the immediate effects of their actions as the paper bits fall to the floor. Not all interest results in a good outcome. At times, they are so enthusiastic that they act in unsafe manner or use scissors in inappropriate ways.

Some kids fear scissors; they are often the children who fear failure and shrink from a challenge. And finally, there are children who have little interest or excitement in participating in any fine motor tasks. Whether due to frustration or a preference to act on their environment with sensory-based or gross motor skills, their behavior suggests that they couldn’t be bothered by learning to use scissors.

Children that struggle to cut can become discouraged and lose their initial excitement for mastery of this important skill. By allowing them to observe and practice pre-training skills before you introduce the act of cutting, you can improve your chances that they will develop and sustain enthusiasm and good safety skills with scissor activities.

There are children over 3 who have never been allowed to use a scissor due to adult safety concerns, lack of appropriate tools/assistance or developmental delays. A child’s initial exposure to scissors can be as simple as directing a child’s visual regard to your use of scissors as part of a therapy activity.

Make sure that you narrate your actions in short phrases with emphasis on action words.
Use an enthusiastic tone and gestures that sustain the child’s attention and interest.
Make practice short: in fact, end practice before a child is frustrated or bored.
Finally, make it clear that you expect that the child will be able to use scissors as they grow and develop more hand skills.

Children benefit from being able to see an adult’s hand movements while cutting. Your students may have been discouraged from being too close to an adult model due to safety concerns. Some adults are unaware that children need exposure to develop interest and excitement in the use of scissors. Use the safest scissors available with impulsive children who may reach for your scissor blades in their eagerness to learn about this exciting tool.

Once interest has developed, you may want to assist children as they open and close the blades. Scissors that are spring-loaded or have finger spaces for an adult can help, or you could place your fingers between the handles to facilitate movement. The sound of the blade movement is fascinating to young children, even without bringing the blades to the paper for cutting. Practicing alternating opening and closing the blades may be your entire activity for the therapy session. By breaking down the actions of scissor use into their precursor parts, you are decreasing a child’s frustration and increasing the likelihood of later success. Hand-over-hand assistance can be helpful when combined with independent scissor use. Gradually fade out this assistance out to allow maximal proprioceptive and kinesthetic input.

Children with hand and wrist weakness or poor sensory registration and discrimination benefit from scissors that provide more support and allow more of their hand to be involved in cutting. Create textured handles with tape on classroom scissors or use Fiskars Total Control Kids Scissors that provide more digital control and encourage activation of intrinsic musculature to support development of the horizontal and vertical arches in the hand while cutting.

Provide additional postural support to children with instability and core activation issues. They may require more proximal stabilization than they appear to need for other tasks. Well-chosen classroom chairs or even a corner sitter may give a child the motor support needed to achieve optimal stability for learning a new motor skill. Beanbag chairs diminish sensory-based distractibility while providing full-body support. Once the new skill is mastered, the degree of support can be decreased gradually.

By focusing more on pre-scissor activities and thereby maintaining a child’s enthusiasm and attention to task, you will increase their ability to persist with practice, and have a more productive therapy session!

Cathy Collyer, OTR, LMT, PLLC

Simple Hacks to Optimize Backpack Safety and Organization

September 20, 2017SensoryGuest Blogger

by Cathy Collyer

One of the essential back-to-school items on every parent’s shopping list is a new backpack. Beginning in preschool and progressing all the way through high school, kids use their backpacks every day. As therapists, we are aware that how that backpack is filled and carried will either create problems for kids or solve them. A pack that is too heavy, so full that it creates perceptual, sensory or cognitive roadblocks to organization, or missing essential tools for kids with special needs, is not doing it’s job. With targeted education and the introduction of simple alternative strategies, we can improve the chances that backpacks end up helping every child perform well during this school year.

Here are some ways to help students manage their backpacks for optimal performance throughout the school year:

Lighten up. Kids tend to make their packs heavier than they need to be. Hypermobile kids, kids with orthopedic issues and kids with low tone may be carrying packs that put them at significant risk for injury. Make sure parents are aware of this issue, and help them by suggesting a review of backpack contents and downsizing the “essentials” whenever possible. Small water bottles, travel sizes of toiletries, and a minimum number of pencils, pens or markers lighten the load. For kids that aren’t aware of the sensory or cognitive overload of an overfilled pack, a backpack checklist or a smaller pack help them manage without an adult assuming responsibility for content management.

Teach kids how to pack and wear their pack. The heaviest items should be carried close to the body and content weight should be distributed equally across the back. Kids should use both straps when wearing their backpack. The one-shoulder carry can be preferred by middle-schoolers wishing to look “cool”. This overweighting of one side of the body puts them off balance and at-risk for injury. It may be hard to change habitual behavior in children at this age. Try identifying the child or children who seem to be admired and copied by their peers. Influencing the kids who are acknowledged social leaders can change class culture quickly. Don’t wait until children report neck and shoulder pain, but remind parents and teachers that the risk of strains, sprains and exacerbations of issues seen in tweens and teens like scoliosis are real.
Frequently used items should be quickly accessible in surface pockets, and items they need for their first class are reachable when they open their pack, not packed under other materials. Laminated photos of pocket contents can help children learn the habits of efficient storage.

Help kids remember to use their sensory tools by having them handy. Tools like Highlighter Strips and the Desk Buddy Multi-Textured Ruler are slim and can be left between pages of a book or workbook, ready to be used. Calming tools like the Wristful Fidget can be worn, not shoved into a pack. Since it looks like a sport wrap, kids aren’t as eager to toss it away when they pack up and go! Kids may need more than one set of tools so that they can leave a set at school and another one at home. Items that do more than one job, like the Desk Buddy Ruler, have an advantage over carrying a bunch of fidgets and then an equal number of classroom tools.

Accept that altering behavior is a long game. Don’t get discouraged if kids only use some of these strategies to improve how they manage their backpacks. Habits change slowly, and as the demands of the school year mount, it may take periodic reviews and revisions to find the right combination of equipment, organization and carrying strategies to make a difference!

Cathy Collyer, OTR, LMT, PLLC