Many of my clients’ therapy goals include working on multistep sequential directions.

“First, find the game, then find the book.”
“Before you get the game, get the book.”
“After you get the book, get the game, then get the bubbles.”

Frequently, these sequential directions also include early concepts such as spatial, size, temporal and quantitative concepts. Sequential directions are frequently used in the classroom, so they are extremely important to master! While there are many functional ways to practice multistep sequential directions at home, one of my favorite ways is to incorporate kids into cooking! Note: “cooking” can be a term used very loosely for young children, i.e. have them “make” chocolate pudding by mixing milk with an instant pudding pouch or “make” an ice cream sundae in a specific order for a fun, summer treat!

Here is a favorite family recipe that will get your kids cooking and practicing sequential directions. Note: this recipe is made with whole-wheat flour and eggs but could easily be made vegan or gluten-free.

INGREDIENTS
• 1/3 c melted coconut oil (or oil of choice)
• ½ c maple syrup or honey
• 2 eggs
• 2-3 ripe, mashed bananas
• ¼ c milk of choice OR water
• 1 t baking soda
• 1 t vanilla extract
• ½ t salt
• ½ t cinnamon
• 1 ¾ c whole wheat flour

INSTRUCTIONS
1. Preheat oven to 325F and grease a 9×5 inch baking pan (**this direction for parents only – the rest can be kids or parents!)
2. First, pour the oil and honey into a large bowl, then whisk together.
3. Add the eggs to the bowl and mix well, then mix in bananas and milk.
4. Before you whisk again, add the baking soda, cinnamon, vanilla, and salt.
5. Pour the batter into the loaf pan, then sprinkle with a pinch of additional cinnamon.
6. Bake 55 to 60 minutes or until a toothpick or knife inserted into the center comes out clean.
7. After you let the bread cool for 10 minutes in the pan, transfer to a wire rack to cool for 20 minutes.
8. Slice. Eat. Enjoy!

Caitlin Brady, M.A., CCC-SLP

Recipe credit:

Healthy Banana Bread!

Parents often ask the therapists whether they should sit in with their child during therapy sessions or if they should stand back and let the therapist work alone. If the parent(s) are available to be present during the child’s session, the therapists highly encourage them to participate in the activities and ask questions. For example, if the child is learning how to practice using sign language to communicate his/her wants and needs, it would be beneficial for the parent to be present at the sessions. This way the therapist can encourage the parent to take part in learning and modeling the signs in order to help the child work on this goal outside of the session. Knowing that each therapy usually occurs once a week for an hour, it is important for the parent(s) to practice the strategies while the therapist is there so that they can then carry the strategies over into the week, increasing their child’s chances of learning the new skill.

We realize that not all parents can be present during their child’s sessions. In those cases, it’s important for the therapists to talk with the child’s caretakers at the time (teacher, nanny, extended family, etc.) and give them tips on how to help the child work on specific goals in their daily environments. Knowing that it is not always feasible for a parent/caretaker to accompany a child to each session, it is important that the information is communicated to the parent/caretaker at the end of the session – including demonstrations of the skills – so they can expose the child to the skills throughout the week.

Therapists should encourage the parents and caretakers to ask questions during or after a session so they fully understand what they are asked to do and why it will benefit the child. Overall, therapy sessions that include parental and caregiver participation not only teaches the adults how to learn and incorporate the developmental strategies into their child’s routines, but works on continually building a relationship between the parent/caregiver and child.

Brittany Hill, MS, MSW, LSW, DT

What is Early Intervention?
o Early Intervention (EI) is a state-funded program that provides services to help babies children birth to three years of age and toddlers with developmental delays or disabilities. Each state has their own EI program system that offers both assessments and ongoing therapeutic services. for children between the ages of zero and three and their families.

What steps do I need to take to enroll my child in EI services?
o You will begin by contacting your local EI office to set up an initial evaluation (please reference additional information below to find your local EI office). Anyone can refer a child to Early Intervention without a doctor referral. As a parent, you can refer your child for services without a doctor referral. You will be assigned a service coordinator who will work with you to schedule an evaluation with a team of EI professionals in order to determine your child’s eligibility. If your child is determined eligible, the EI team will create an ongoing service plan to best meet your child’s needs.

How do I know if my child qualifies for EI services?
o To determine EI eligibility, your child will need to complete an evaluation with a team of therapeutic professionals. The initial evaluation typically consists of assessments by a developmental therapist as well as a speech and language pathologist, an occupational therapist, and and/or a a developmentalphysical therapist. Upon completion of the evaluation, the therapists will inform you of the results including any measurable developmental delays. If your child is found to be at least 30% delayed in one or more areas of development, the EI team in the assessment domains and will provide recommendations for ongoing therapy (frequency and intensity of services, i.e. one1 time per /week for 60 minutes) if applicable. At this time, the service coordinator will work with you and your team to create an Individualized Family Service Plan (IFSP) detailing your child’s current needs and family-centered goals for therapy.
o Your service coordinator will find therapists in your area that have availability for ongoing services. The therapists will then contact you to schedule therapy sessions for your child. If you are interested in working with a therapist from PlayWorks Therapy, you may request one of our providers during the creation of the Individualized Family Service Plan (or at any time during the process). .

What services are provided?
o Early Intervention provides services to support all aspects of your child’s development. These services may include one or more of the following:
-Speech and language therapy
-Occupational therapy
-Developmental therapy
-Physical therapy
-Audiology or hearing services
-Assistive technology
-Counseling and training for a family
-Medical/nursing services
-Nutrition services
-Psychological services

Where are services provided?
o Every effort is made to provide services in your child’s natural environment. This means that therapy typically takes place in your home or at your child’s daycare/education center.

Who pays for these services?
o Under Part C of the Individuals with Disabilities Act, the following services must be provided at no cost to families:
-Initial evaluation to determine eligibility
-Development and review of the IFSP
-Service coordination
o Ongoing service fees are determined by the policies of your state. In Illinois, if you have public insurance (e.g. All Kids), all fees are waived. If you have private insurance, In Illinois, your family-fee is calculated based on the size of your family and your income. Additionally, you You will may be asked to provide your medical insurance information to determine if your public or private insurance will cover the cost of EI services. If insurance covers the cost of therapy, you will not be assessed a family fee. If services go towards your deductible or are not covered, you will be assessed your family fee. .
o You are not required to provide this information, however, and EI cannot use your insurance without your written consent. If you do not give consent, the program may not limit or deny services to you or your child.

What happens after my child turns three?
o If you and your team believe that your child would continue to benefit from therapeutic services, you can attend an evaluation through the public school system to determine eligibility for the Early Childhood program (3 to -5 years of age). Your EI service coordinator should contact you about three to six months before your child’s birthday to schedule this evaluation and to answer any questions you have about transitioning from Early Intervention to Early Childhood.
o If you do not wish to continue services with your public school system, you can contact a private therapy company, including PlayWorks Therapy, to schedule an evaluation and to discuss ongoing services.
If you are currently seen by a PlayWorks Therapy, please contact our office at (773) 332-9439 and speak with our case coordinator to facilitate a seamless transition.

I am interested in therapy; however, I am not interested in utilizing the Early Intervention program. What are the next steps?
o To schedule a private evaluation through PlayWorks Therapy, please call us at: (773) 332-9439, or email scheduling@playworkschicago.com.

For more information on the Illinois Early Intervention program, please visit the DHS website.

To determine your local EI office in Illinois, please visit the Provider Connections website.

Autumn Smith MS, CCC-SLP

As a developmental therapist, parents are always asking me for toy recommendations. Here is are five developmentally-appropriate toys for toddlers that I love to use in therapy sessions:

1. Mr. Potatohead
The classic Mr. Potatohead is a fantastic, battery-free toy that people have enjoyed for decades! With Mr. Potatohead, children learn about body parts and can explore their placement on the potato. Children also work on their fine motor development while placing features on Mr. Potatohead. Parents and caregivers of older children can expand their play with this toy to learn functions of body parts and explore different facial expressions.

2. Playdough
Playdough is a great for symbolic or imaginative play, language development, and sensory exploration! Playdough can be molded into food or animals to encourage symbolic play. For their language development, children can work on color identification or following directions while manipulating the dough. Playdough can be used for imitation of gestures (e.g. rolling, poking, patting, etc.). You can also hide small toys inside playdough for texture or sensory exploration (while supervised, of course!).

And if you’re looking for an easy kitchen activity with your child, you can make the dough yourself!

Homemade Playdough
1.5 cups flour
½ cup salt
2 teaspoons of cream of tarter
2 tablespoons of oil
1 cup of boiling water
Food coloring

Mix all ingredients in a large bowl and then knead until smooth. Store in an airtight container to keep soft.

3. Melissa and Doug Nesting Blocks
These blocks are great, as they can be used for so many different areas of development! Parents and children can work on joint attention (when two parties are engaged in the same activity, sharing attention with a particular toy or activity) by taking turns stacking the blocks. Fine motor skills are developed through the motion of stacking. Children can work on their animal, color, or letter identification, as well as animal sounds, with the colorful pictures on the blocks. And while cleaning up the blocks, children can work on their understanding of size concepts while nesting the blocks.

4. Farm Set
I really like the “Little People” farm set but really any will do! This is a great toy for symbolic play and language development. Children can engage in symbolic play by feeding or putting animals to bed. It is another great toy that can be used for imitation of different play gestures. Children can also work on their receptive language by following directions provided by their caregiver or matching the sounds to each animal (use this toy while singing “Old McDonald”!) For older children, you can discuss the kinds of animals that live on a farm and those who do not.

5. Melissa and Doug Cutting Food
Whether it is the fruit, food, or grill set, children love the Melissa and Doug play food! This toy provides children the opportunity to imitate adult behavior (which we know they love to do!). Not only can you discuss the different types of food, it provides children fine motor practice and is a great symbolic play activity.

Kimberly Shlaes, MAT, DT

One question parents often ask me is, “How do I teach my child to care about others?” The answer may be simple: show care for the people around you. Your son or daughter is watching you! Children watch your interactions closely and they tend to imitate what they see. When you demonstrate positive interactions with your child and others, they are likely to follow your example.

Here are some ways you can encourage your child to develop the caring characteristics of empathy and kindness.

Model Empathy.

Empathy is the ability to consider the perspective of another person. It’s valuing someone, and trying to understand his or her thoughts and feelings.

First, model empathy towards your children. Be considerate of their perspective by listening and seeking to understand how they feel. For example, if you help your child to name an emotion they are feeling, it can show that you value and understand them: “I see you are mad because it’s time to clean up your toys. I know how much you love playing with your trains, but now it’s time to have dinner.” By validating your child’s feelings, and voicing understanding, you are teaching them to consider someone else’s perspective. (Please see my previous blog post on Teaching Your Child to Manage Emotions)

Next, demonstrate the same thoughtful behavior towards other people. Talking to your child about your concern for others, and sharing some of your own feelings will help them to develop compassion for others:

“I think Sarah is feeling sad because you got to the swing first. Sometimes I feel sad when someone else is first.”

“Did you see the smile on Sarah’s face when you gave her a turn on the swing? I think she felt happy.”

You can also use pretend play to teach your child, by making up stories:

“Oh no! The cow isn’t sharing the ball!  The horse is feeling left out.”

As your child grows, discussions about empathy should become more natural and you may be pleased to discover that they remind you to consider the other’s feelings!

Please check back for Part Two: Practicing Kindness.

If you have questions related to supporting your child’s social emotional development, please contact one of our pediatric social workers.

Laura Mauriello, MS, LCSW, DT

Warmer weather is finally here (or so we’re told). Along with spring weather comes new opportunities to learn language while getting outside and having fun.

Go for a walk
A simple walk around the block can include many opportunities to help your child expand his/her vocabulary.  As we all know, spring in Chicago means construction. Children love watching the construction vehicles and talking about what they see. Name the vehicles and their actions as your child watches in awe.  You can also talk about airplanes, bicycles, and animals as they pass. Try skipping, jumping, or clapping as you walk, and see if your child will imitate your actions. Building gross motor imitation skills is very helpful for language learning.

Go to the park
The playground is a great place for children to learn to interact with their peers. When it is nice outside it is almost a guarantee that you will run into other young children who can act as language models for your child. This may also provide a great opportunity for your child to work on early social skills like turn-taking.

Take a trip to the zoo
Did you know that admission to the Lincoln Park Zoo is completely free? A trip to the zoo will provide a great opportunity to talk to your child about animals, and animal sounds. The Lincoln Park Zoo also has a great sing-a-long for young children every Wednesday and Friday morning at 9:15 and 10:00 a.m. at the Main Barn in the zoo’s Farm-in-the-Zoo.

Meryl Schnapp M.A., CCC-SLP

It’s true that lots of children can be described as “picky eaters.” Many children refuse to eat their vegetables at dinner and would prefer to eat chocolate for breakfast. For other children, being in the same room as a food that they don’t like can trigger a meltdown. These same children may avoid complete food groups or certain food textures.

For some children, this “picky” phase will be one that they outgrow. Other children may require therapeutic intervention to broaden the number of foods that they tolerate and will willingly accept.

“Picky eaters” and “problem feeders” may present similar characteristics. So, how do you decide if your child would benefit from feeding therapy? Below is a list of general differences between “picky eaters” and “problem feeders.”

Ultimately, if you have any feeding concerns, always consult with your pediatrician. If your doctor agree that your child is not just a “picky eater”, he or she can refer you to a certified speech-language pathologist. It can be helpful to keep a food log detailing foods that your child accepts and rejects to bring with you to your doctor visit and feeding evaluation. A speech-language pathologist can help your “problem feeder” discover new foods, and can help to create happy and healthy mealtimes!

Julie Euyoque, M.A., CCC – SLP

Source: http://www.sosapproach-conferences.com/articles/picky-eaters-vs-problem-feeders

What is Sensory Processing Disorder?

Sensory processing disorder refers to the way the nervous system receives messages from the senses and turns them into appropriate behavioral or motor responses. It is a condition in which the brain has trouble receiving and responding to information that comes in through the senses. Sensory Processing Disorder exists when sensory signals don’t get organized into appropriate responses. Someone with Sensory Processing Disorder may find it difficult to process and act upon information that they receive from the senses, which can make it difficult to complete various every-day tasks.

What does Sensory Processing Disorder look like?

A child with SPD may exhibit clumsiness, behavioral problems, anxiety, or have trouble in school. SPD can look very different from one person to another. One child may over-respond to sensation and find physical contact, clothing, light, food, or other sensory input to be unbearable. On the other hand, one child might be under-responsive to sensory input and show little reaction to stimulation. Some “red flags” in preschoolers include:

• Over-sensitive to touch, noises, smells, and other people.

• Difficulty making friends.

• Difficulty dressing, eating, sleeping, and/or toilet training.

• Clumsy; poor motor skills; weak.

• In constant motion; in everyone else’s face and personal space.

• Frequent or long temper-tantrums.

If you suspect your child may have difficulty with sensory processing, contact a pediatric occupational therapist at PlayWorks Therapy to complete an evaluation.

Caitlin Cassidy, OTR/L

There’s no denying the conveniences that technology allows us, but are modern conveniences affecting child development? Televisions, smart phones, and tablet screens seem to be everywhere you turn, and shielding your young toddler from screens may feel impossible. The American Academy of Pediatrics (AAP) has updated their recommendations for screen time to reflect the inevitable change our world is experiencing. Previously, they called for a “Screen-Free Environment” for children under 2 years. Now, with many apps and programs targeting young children, recommendations allow for limited amounts of screen time for children under 2.

How should we manage expectations with technology?

There are many key points to be mindful of when exposing your toddler to technology, but it is important to remember that setting limits and rules is up to you! Perhaps time on the iPad can be limited to 15 minutes, or the phone app can only be played after all the toys are picked up. Maybe you want to declare your child’s bedroom or the dinner table “screen-free zones”. The AAP outlines some screen time rules to guide parents through the difficult decisions. For example, interacting with technology alongside your child is a more beneficial way to introduce them to this modern world. The AAP states that “passive video presentations,” where kids sit and watch the screen alone, do not encourage language development. Try your best to watch videos alongside your toddler, or play along with the app! To this point, the AAP reiterates that content matters! Spend some time researching the best apps or video programs (see the list below!) to make better use of limited screen time.

But handing over the phone or iPad is the only way I can get time for work and chores!

Screen time can help us make it through the day, but it can’t replace the valuable growth that happens in good old-fashioned play time with caregivers! Cognitive and language development are optimized during unstructured play time, and when toddlers play with others. If you need 15 minutes to yourself, try encouraging your toddler to interact with toys and other real objects as opposed to the screen. If your household has determined that your toddler’s screen time will coincide with doing the dishes, try to find the most highly recommended apps and videos for them to use during this time.

What apps should I be using?

Try these apps to optimize your toddler’s screen time:

Busy Shapes
Moo, Baa, La La La
Peekaboo Barn or Peekaboo Wild
Eli Explorer
My Very Hungry Caterpillar
Tozzle – Toddler’s Favorite Puzzle
Baby’s Musical Hands

Sites like CommonSenseMedia.com, Parents.com, and TomsGuide.com are other great resources for technology recommendations.

Leanne Sherred, MS, SLP-CF

What you’ll need:

• 1 balloon
• 1 straw
• Yarn (between six and ten feet)
• Tape

Directions:

1. Tie one end of the string on the back of a chair or similar item.
2. Thread straw onto the string, and attach the loose end of the string to another chair.
3. Inflate the balloon, but don’t tie it!
4. Tape untied balloon to straw and get ready to for action!

This activity is great for practicing phrases like “ready, set, go!”, “go balloon”, or “more air!”. It is also great for naming objects in your home like “tie the string to the chair”, or “tape the string to the table”. For added fun you can set up two rockets and have them race!

When you are done, kicking around tied balloons or hitting them into the air can provide hours of entertainment. This creates the perfect opportunity to practice action words and get all the winter wiggles out!

Caution: always supervise play with balloons, as they can be a choking hazard for children three and under.

Jessie Delos Reyes, MA, CF-SLP

Image and idea source:http://discoverexplorelearn.com/balloon-rockets/