The ability to independently complete essential daily living tasks becomes increasingly more important as individuals near the pre-teen and teen years. For teens with diverse learning profiles the ability to master these critical skills can be challenging. However, there are readily available tools that can help promote independence! In this post we are covering a few low to mid tech solutions that can be a game changer for teens struggling with the ability to independently complete critical self care tasks.
Elastic Shoe Laces. There is nothing more frustrating than a loose shoe or tripping over untied laces but asking for help can be even harder. The good news is there is a simple solution, elastic shoe laces! Simply replace standard shoe laces with elastic shoe laces. Once in place, secure with a double knot and standard bow. The elastic shoe laces provide enough stretch to simply slip on and slip out of shoes, eliminating the need for tying.
Schedules & Time Cues. Remembering when to do something or remembering the correct sequence of a task can be difficult for teens who struggling with executive function deficits. These teens often rely on a support person to provide prompts for task initiation and sequencing which decreases their overall independence. The good news is there is a variety of readily available assistive technology tools that can support a teen’s ability to manage time with greater independence. Check out our previous post, Assistive Technology for Time Management, for ideas!
Picture Adapted Cookbooks: Preparing a simple meal or snack is one of the greatest acts of independence for pre teens and teens. This simple right of passage can be missed for teens who struggle with reading or have difficulty with multi step tasks. Picture supported cookbooks can help users with limited reading abilities prepare simple meals and snacks. The Stepwise Cookbook series takes this concept a step further and truly simplifies the process. Each cookbook has a set of picture supported recipes that are presented in a simplified, easy to follow format.
SchKIDulesElastic Shoe LacesStepwise Cookbooks
Small modifications and the use of mid to low tech assistive technology can be a powerful tool for independence. Be sure to visit to assistive technology section of Therapro’s website to see all of the available tools!
The ability to manage time is an essential life skill that is critical to independence. When the ability to manage time is impeded by factors like decreased executive functioning abilities or cognitive limitations, independence can also be impacted. In this post we are covering a few mid to low tech assistive technology solutions that can support time management abilities.
Schedule Reminders
Remembering to do a task at a scheduled time is one time management skill area. While smart devices are often loaded with ‘reminder’ features, there are times when a non screen option is preferred. The Time Cue and Voice Cue are great options! Simply record any message and set the time for the message to be played.
TheTime Cue allows for a single message, up to 10 seconds long to be recorded and played back at a set time. For example, record “go to gym class” and set it to play 1:25 (or whenever gym class is happening!). There is even a space to include a picture of the activity for additional support!
The Voice Cue can record up to five messages, with 60 seconds of total recording time. This is a great tool for tasks like remembering to take morning and evening medications.
Sequencing Helpers
Multi step tasks are another area of time management that present their own set of challenges including remembering the order of the sequence, remembering to do all of the steps in the sequence, and doing the steps for the correct amount of time. There are a variety of assistive technology options available that can help.
The Two Minute Turtle Toothbrush Timer helps cue the user through the steps of toothbrushing, ensuring all quadrants of the mouth are brushed for the recommended amount of time. It works by pushing a button on the top of the turtle which causes one of the turtle’s fins to light up. Each of the turtle’s four fins represents a quadrant of the mouth. Each fin will stay lit for the recommended 30 seconds of brushing time. When time is up, the light in one fin will turn off and the next fin will light up indicating it is time to move to the next area of the mouth! Pro tip, this is also a great tool for handwashing!
Visual schedules, whether written out or picture supported, can be a game changer for individuals who have impaired executive function skills and who need support managing multi step tasks. Schedules can be created for specific routines (like a morning self care routine), for parts of the day (like a morning classroom schedule), or the whole day. SchKIDules offers a quick and easy solution for creating picture supported schedules. The Home Bundle includes 72, 2”x2” magnets that depict common routines, chores, outings and extracurricular activities. The Education Bundle includes 66, 2”x2”, magnets that depict common school and special education activities.
Time Visualization Helpers
Conceptualizing the passage of time is a third area of time management and this can be tricky! Offering a visual repression of time and time passage can not only help with this concept but it can also decrease stress and anxiety. Visual timers are the perfect solution for this challenge area.
Time Timers offer a simple solution for time management. With the patented red disk, Time Timer makes elapsing time concrete by reaffirming the analog clock in its clockwise movement and provides the ability to judge how much time is left without having to know how to tell time. Simply move the colored disk to the desired amount of time, as time elapses, the colored disk disappears.
Resetea is a time management tool that offers the ability to sequence up to 12 related tasks. It is different from a typical schedule because of the unique light cue that marks the passage of time. To set it up, first use the included template builder to create a sequence of tasks (for example homework and then free time or math class, English class, lunch) and then place the visual in front of the light screen. Next set the desired time for each activity (up to 60 minutes) and press start. The activity schedule is back lit with progress colors; no light indicates future task(s), white light indicates the task in progress, and red light indicates task(s) completed.
There are a variety of tools available to support users ability to manage time. Helping users access and utilize these tools will support overall independence!
The phrase “executive function” as described in the Harvard Journal, Developing Child, refers to a set of skills. These skills underlie the capacity to plan ahead and meet goals, display self-control, follow multiple-step directions even when interrupted and stay focused despite distractions, among others.
No one is born with executive function skills but nearly everyone can learn them. Adults set up the framework for children to learn and practice these skills over time by establishing routines, breaking big tasks into smaller chunks, and encouraging activities involving rules, directions and planning skills.
As our child becomes more competent and these areas of the brain develop, it enables them to plan for themselves. It also allows them to focus and stay engaged with information to complete tasks. Research has shown by 12 months of age, a child’s experiences are helping to lay the foundation for the ongoing development of executive function skills.
Get Ready, Do, Done
Sara Ward and Kristen Jacobsen’s framework, “get ready, do, done”, to support skill development provides a process to develop the executive functioning abilities. This system is easily incorporated into all activities.
Implementation
The first step is to help your child or student visualize what the project will look like when it is done i.e., what does the end look like. Children need the opportunity to visualize the end before they plan their steps. This is especially true for a child who lacks the motor control to move their body or communication skills to verbalize their intent. A child may have the ability to plan a task but lack the opportunity when others bring materials to them, place them on their surface and physically help with each step.
Next, you want the child to visualize the steps they need to take. It may involve cutting a circle, drawing a picture, gluing, etc. You want your child to think through the process. Let the child tell you what steps they want to take before beginning.
Last, to “get ready” the child should tell you what materials they need. Is it markers, paper, ruler, glue stick, etc.?
Accessibility For The Child With Special Needs.
When a child can visualize what their completed project looks like, they can talk through the process and collect needed materials as independent as possible. What if a child is unable to communicate verbally or walk over to get what they need? Here are strategies that provide inclusive opportunities to use this framework. It allows the child with neuromotor difficulties to participate in opportunities that lay the foundation for executive functioning. The goal is to support their abilities and not allow their impairments to limit their learning.
Get Ready, Do, Done provides a visual or template to clearly demonstrate the thinking process.
Strategies To Support Inclusive Learning
Positioning Needs of the Child: When completing activities that require attention, concentration and upper extremity control, optimal positioning is important. A child seated upright so they can view what their project looks like when completed. Positioning the child at 90:90:90 for the hips:knees:ankles with feet supported is usually preferred.
Tray Surface: Supporting the upper arm on a table surface provides a base of support for upper extremity control. By increasing the contact surface of the forearm and hand, it provides stability and increased sensory awareness of movement in space. We have found a tray surface that supports the elbows, by curving around the body, makes a significant difference. The work surface should be large enough to fit materials and support the upper body. Common errors are elbows falling off the table or not enough room for materials.
Organization of Work Surface: For the individual with motor coordination, it can be helpful to have a container where materials are placed avoiding knocking them off the tray. This can be a small bowl or box that serves as a “waiting area” for items such as scissors and glue.
Vision Considerations: The size, colors and position of the project are important. Placing the project that is “done” and showing what the end looks like should be of a size, position and contrast that supports vision needs. Placing it on an easel, on the wall or at an angle that allows for easy viewing is helpful and allows the child to visually reference the project that they are completing. Adjusting the size by enlarging pictures or having a black contrasting background may help the individual with vision impairments.
Activity Selection/Material Considerations: Using templates and/or pre-made cut outs may help the individual with motor impairments. If the end is a picture of a farm, using a template that supports coloring inside can be helpful. Using stickers that allow the individual to place or glue them reduces the motor demands. Forming Wikki Stix into shapes that allow the child to color inside simple shapes is another option.
Tool Use: Using adaptive crayons or adapted markers, glue sticks and other materials may allow the child to do the task without hand over hand assistance. You want to reduce the motor demands when you increase the cognitive requirements. There are many options to help children hold their own tools. The Functionalhand allows children to hold objects in either the horizontal or vertical orientation. Any size crayon, marker, glue stick, dry erase markers or school tools can fit into the flexible cord system. For children who are unable to sustain a grasp on the Functionalhand independently, the Eazyhold strap is the ideal complimentary product.
Finished project displayed on a slant board as a visual reference for “Done”
Alistair references done while he uses the Functionalhand to paint his cow.
Do
Keeping the activity initially simple and building on the concept once the child is familiar is important. Initial activities may be to color pictures and glue them in position. Having two sets of icons, one showing the action and the other showing the tool helps them to understand the difference.
Use a picture of the action for “Do”
Use a picture of the item for “Get Ready”
You may start by showing the pictures and asking, “do we cut first or color first”. Using “first” and “then” concepts allows your child to know there is a progression to activities and reflect on the order. The child can point, answer or place the icons in order.
Get Ready
Several strategies will assist the individual to be actively engaged in the “ Do” and “Get Ready” process.
Use picture icons that allow the child to point to or grasp to put in the “Get Ready” column. Using Velcro to keep the pictures in position may be helpful.
Use an augmentative communication device with a page that lists options and allowing the child to point to or use a stylus to access their selections individually. The child can then grasp the item to put into their “waiting area” bowl or box or you place them upon making their selection.
Summary
How does a child with neuromotor impairment that may lack the postural control to move, reach and communicate get the same opportunities to develop executive functioning skills as other children? Structuring the learning opportunity and providing activities in a manner that supports their thought processes to plan and participate in the execution of tasks is important. Incorporating alternative strategies to minimize hand over hand assistance is the start. The key is to let the child do as much for themselves as possible both in terms of thought process and motor participation. Learn more about Executive Functioning by listening to Therapro’s Lecture series on this and other topics.
References
Ward, S., & Jacobsen, K. (2014). A clinical model for developing executive function skills. Perspectives on Language Learning and Education, 21(2), 72-84.
What Is Executive Function? And How Does It Relate to Child Development? (N.D.) Center for the Developing Child Harvard University. https://developingchild.harvard.edu/resources/what-is-executive-function-and-how-does-it-relate-to-child-development/
