Tag Archives: pediatric therapy

Parent Question: How does developmental therapy support speech and communication skills?

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“The initial evaluation team recommended developmental therapy for my child but my concerns are with her speech. How can developmental therapy help support her speech? I thought that it focused on preschool readiness skills?” — Concerned Parent

Developmental therapy (DT) focuses on the whole child and often addresses different areas of development, including speech and communication. DT can often be used to complement and support speech therapy by helping your child learn pre-communication skills. These skills include sharing joint attention, attention span, imitation of gestures and play ideas, and general play skills and are essential in learning how to speak! This blog will explain these skills and how you as a parent can help your child with their pre-communication skills.

Pre-communication skills
Joint attention: Joint attention is when two people share attention with an object or activity. This can be demonstrated by sharing eye contact, using gestures, and/or other non-verbal and verbal communication. While children can learn some skills from toys and objects independently, they absolutely need to be able to share joint attention with another person to learn language and how to communicate with others.

Attention span: In order to learn any new skill, one must have the attention span to attend to an activity. On average, a child is expected to attend to a single activity for – at minimum – one to one-and-a-half minutes per year of age. And as they age, a child should be able to attend to several activities in a row.

Imitation of gestures: Imitation of gestures always comes before imitation of words. It is important for your child to learn that they can imitate what other people are doing! Once your child is consistently imitating familiar gestures (such as waving or clapping), novel or play gestures (feeding the baby a bottle, for example), and “invisible” gestures (this is a gesture that you can do but not see yourself do, such as sticking out your tongue or tugging your ear), we know that your child is on track to using sounds and words to communicate.

Play skills: A child’s “work” is play! It is important for your child to engage in functional play with toys to learn the concept the toys are targeting. Engaging in functional play provides your child opportunities to use language to communicate. Play is also a great measure of a child’s cognition!

How can parents support pre-communication skills?
Joint attention: Engage in a preferred activity that your child has mastered – we want to make sure they can focus on learning the skill of joint attention and not forcing too many cognitive demands at once. For example, if your child does not yet match, you would not use a puzzle for this activity. Activities with lower cognitive demands – such as popping bubbles – is much more appropriate for a joint attention activity (but if your child has mastered matching, feel free to use a puzzle!) After blowing bubbles a few times for your child, pause the activity. Give him or her the opportunity to come to you and show you that they want “more” by using eye contact or gesturing to you what they want. If they only look at or touch the bubbles, bring the bubbles near your face to encourage eye contact. Once they look to you, provide praise and blow more bubbles! Continue this routine as long as your child will tolerate.

Attention span: Toddlers are notorious for having a decreased attention span! Everything is so new and interesting to them, no wonder they want to bop around the room and get into everything! Make sure you create a learning and play space that is conducive to attending to activities. Having a large number of toys available at all times or always having the television can create many distractions for your child.

When starting to work on increasing your child’s attention span, your goal should be to complete one activity – that’s it! An activity with a clear beginning and end, such as a puzzle or book, are great activities to start with. Engaging in symbolic play with a baby doll, for example, would be considered an open-ended activity that can be finished after one minute or ten. And again, you want to choose something that they have mastered so they are not expected to complete an activity that is new or particularly challenging.

Imitation: To work on a child’s imitation skills, you can start by imitating them! If they bang a toy on their highchair, you do the same. Encourage your child to do the gesture again before imitating it again. Once you go back and forth a few times, change the gesture – rub an object on the highchair instead for example. If your child does not imitate this gesture, do it again. If they continue to not imitate this gesture, provide hand over hand assistance to show them exactly how to imitate this gesture.

Play skills: Sometimes, children need to be taught how to play functionally with objects! Just like any other skill, play needs to supported and taught and it is up to the child’s first teacher – their parents – to show them just that. Parents should be modeling appropriate play with toys and encouraging the child to do the same (this is also where those imitation skills come in handy!) Help your child master functional play by setting aside a few minutes every day to provide your child your undivided attention and PLAY!

Questions or concerns?
If you have questions or concerns about your child’s pre-communication skills, please contact us at info@playworkschicago.com or 773-332-9439.

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Reference:

Teach Me to Talk. (July 30, 2018). Sorting Out the 11 Prelinguistic Skills… Retrieved April 25, 2019 from http://teachmetotalk.com/2018/07/30/sorting-out-the-11-prelinguistic-skills/

Photo Credit: PublicDomainPictures from Pixabay

Feeding our Senses: What is a Sensory Diet?

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Does your child love to run, swing, and jump? Engage in messy play with finger paint and shaving cream or seek out hugs and cuddles? Or perhaps they prefer to watch other children navigate the rock wall at the playground or quickly wipe their hands clean when dirty? Our sensory systems are responsible for how we take in sensory stimuli from our environment, process and interpret the information internally, and produce appropriate responses. We rely on proper functioning of eight senses (yes, eight!) to maintain a regulated state, in which we are better able to understand, interact with, and grow within our environments.

What are the eight sensory systems?

  1. Sight: helps us process what we see
  2. Hearing: helps us detect and process sounds, beats, and frequencies
  3. Smell: helps us detect and process scents and odors
  4. Taste: helps us process and distinguish between different tastes
  5. Touch: helps us process and understand how things feel on our skin, such as soft or hard, hot or cold
  6. Vestibular: provides us with a sense of balance, movement, and an awareness of orientation in space
  7. Proprioception: provides information about position and movements of our muscles and joints, including pushing, pulling, and deep pressure sensations
  8. Interoception: provides an internal sense of how our organs feel, such as hungry or thirsty, our sense of temperature, our feelings of pain, and when we need to use the bathroom

What happens if our sensory systems do not process stimuli correctly or efficiently?

When our brains are unable to make sense of the information our bodies receive, we often respond to the environment in inappropriate or unexpected ways. While the reactions formed in this disorganized state, often referred to as deregulation, present differently for every child and depend on both the type and number of sensory systems affected, responses often aim to find more of (seek) or stay away from (avoid) input. Examples include but are not limited to:

  • Sight: excessively looking at moving, spinning, or shiny objects; appearing bothered by bright lights
  • Hearing: appearing to ignore people when spoken to; becoming distracted in noisy settings; covering ears in response to loud noises
  • Smell: showing heightened sensitivity or aversion to scents and odors; may impact feeding routines
  • Taste/oral: preferring a limited variety of foods; difficulty trying new foods; excessive drooling
  • Touch: difficulty tolerating having nails trimmed or wearing certain clothing textures; refusing to touch or play with various textures, such as grass, sand, finger paint, or Play-Doh; wiping hands clean immediately after getting dirty
  • Vestibular: appearing to excessively enjoy or look for movement opportunities (running, jumping, rocking, etc.); seeming clumsy; appearing fearful of ordinary movement, such as when both feet are off the ground (e.g. swinging)
  • Proprioception: biting or chewing on non-food items; excessive bumping into, pushing, or hitting peers or objects in the environment
  • Interoception: not feeling full after eating; missing the urge to use the bathroom at the appropriate time

These sensory responses may lead to overarching difficulties with a child’s ability to attend to academic activities in the classroom, maintain balance and coordination, plan and sequence novel tasks, build social relationships, perform self-care activities, such as dressing and feeding tasks, and participate in family routines and schedules.

Sensory diet: what is it and how can it help?

A sensory diet is a carefully designed series of sensory-based activities in which a child is encouraged to participate to increase regulation and attention throughout the day. Much like we eat healthy foods to give our bodies the nutrients they need, sensory diets are made to meet the specific sensory needs of each child. While sensory diets typically incorporate touch, movement, and proprioceptive input, strategies targeting any sensory system can be included to promote optimal regulation. Sensory diets are often organized into schedules based on a child’s daily routines, activities, and family plans to maximize participation and success and can be easily modified as the child’s needs change over time. See below for an example of a sensory diet:

If implemented correctly, sensory diets provide consistent access to specific amounts of sensory input needed throughout the day and result in more appropriate responses to environmental stimuli over time. When successful, children are better able to participate in meaningful activities and daily routines, develop important foundational skills, and more effectively understand and engage in the world around them.

Questions or concerns?

If you have questions or concerns about whether your child may benefit from a sensory diet, please contact us at info@playworkschicago.com or 773-332-9439.

Caitlin Chociej, MS, OTR/L
Occupational Therapist

References:

Bodison, S., Watling, R., Kuhaneck, H.M., & Henry, D. (2008). Frequently Asked Questions About Ayres Sensory Integration. American Occupational Therapy Association. Retrieved April 14, 2019 from http://www.aota.org/Consumers/WhatisOT/FactSheets.aspx.

Smith Roley, S., Mailloux, Z., Miller-Kuhaneck, H. & Glennon, T. (2007). Understanding Ayres’ Sensory Integration. OT Practice 12(7).

STAR Institute for Sensory Processing Disorder. (2018). Your 8 Senses. Retrieved April 14, 2019, from https://www.spdstar.org/basic/your-8-senses.

Photo Credit: Sharon McCutcheon via Pexels

Ouch! My Child is Biting!

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It is never a fun moment when your child’s teacher calls, informing you that your child bit a classmate. Or what about when your child bites you or their siblings? Biting is a stressful experience for everyone involved. Let’s discuss why it may happen and what can be done to prevent it.

Is biting normal?

While not every child will bite, it is a very common behavior in toddlers. Biting usually stops by three or three-and-a-half. However, just because it is a normal stage of development does not mean it is an acceptable behavior. In order to try to prevent age-appropriate biting, we first need to try to understand what may trigger it.

Why is my child biting?

Toddlers are experiencing so many new feelings, both physically and emotionally, during this time in their development. These changes could lead to feeling the need to bite. Understanding why your child may be biting may help you support them from biting.

  • Teething – This can be a painful process, especially getting those two-year-old molars, and sometimes clenching their teeth on something (or someone) helps relieve the tension they are feeling in their mouths.
  • Sensory needs – Our bodies seek out what it needs in many different ways. Some children’s mouths need more stimulation to feel “awake” or regulated. Their bodies may also need more large muscle activities, such as running, climbing, and jumping to release that tension and energy they are releasing with their jaws.
  • Big emotions – Have you ever been so excited or angry that your clench your jaw or fists? Luckily you have the inhibition skills to avoid biting those around you in those moments. Toddlers are learning about a lot of new feelings and how they make their body feel. Sharing, tiredness, fear, and overstimulation are really tough to navigate when you’re just learning and can be overwhelming. Toddlers are also learning to be more independent from their caregivers and recognizing that things they want may not be what the people around them want for them. That causes frustration that may lead to biting too.
  • Few words – Toddlers are also learning language skills. Often times their communication skills are not developing as fast as the large emotions mentioned earlier. Biting can be an effective way to get a point across when they do not have the words to do so. You may see more biting in children who have a language delay.

What can I do?

  • Do some detective work – Are there any patterns to your child’s behavior? Do they tend to bite before lunch/nap time? Is it when other children encroach on their personal space? Have there been recent changes to their regular routine or family dynamics? By noting when biting happens most often, it may prompt you to give extra support during those times, such as offering a snack, making naptime a little earlier in the day, or having two of the same item to assist with sharing.
  • Offer an alternative – If your child is biting due to teething or sensory input, redirect them to a chewy tube or teething ring. Sometimes a wet washcloth kept in the refrigerator or freezer offers a soothing sensation to chew on for sensitive gums.
  • Model appropriate language – As mentioned before, sometimes biting gets a message across faster than words can come out. Help teach your child the power of words by modeling language they can use. For example, “I need space!” “Move, please” “My turn!” Encourage them to ask for help from an adult if their words are not enough with their peers.
  • Read books – There are many children’s book about biting, such as Teeth are not for Bitingby Elizabeth Verdick. Reading together can provide the opportunity to talk through situations without the intense emotions of the moment.
  • Reinforce expectations – Remind your child that, no, biting is not allowed. Be firm, but try to not to express anger. You want your child to know that you do not approve of the behavior, but that you still love them. Remember to replace the unwanted behavior with the preferred behavior. Example: “Ouch! It is not okay to bite. Biting hurts. You can bite this teether instead, but you may not bite your friends.”
  • Wash, rinse, repeat – Children learn through repetition. They may not remember to stop biting after the first time you redirect them. Or the fifth. Like learning any new skill, it takes time, practice, and patience. Remember that children’s inhibition skills are still developing until age four, even if they know what they are doing is wrong. And to be honest, some of us adults are still mastering avoiding the things we know are not good for us!

Questions or concerns?

If you have questions or concerns about your child’s biting, please contact us at info@playworkschicago.com or 773-332-9439.

Becky Clark, MS, DT
Developmental Therapist

Reference:Zero to Three. (2016, February 22). Toddlers and biting: finding the right response. Retrieved April 8, 2019, from https://www.zerotothree.org/resources/232-toddlers-and-biting-finding-the-right-response.

Lieberman, A. F. (1995). The emotional life of the toddler. New York: Free Press.

Photo Credit: PublicDomainPictures from Pixabay

Increasing Participation in Daily Routines

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Establishing routines in your child’s life are crucial in that they help to create expectations and predictability. However, certain routines can often be difficult to follow when considering a parent’s work schedule and child’s behavior at particular times of the day. Children often feel as though they experience a loss of control when being asked to constantly “do this and that.” Parents-don’t panic! Try implementing these small tricks at home and school, which have been shown to increase your child’s participation and motivation to engage in routines!

How can routines help my child?

Routines are created to help your child understand what he/she should be expected to do throughout the day. Routines are important in a variety of settings, including the home and school. It is the parents’ and teachers’ duties to enforce these routines on a daily basis, which can include specific activities as well as consistent responses that reinforce participation. For example, if a child is expected to sit for circle time and he/she is having difficulties, it is crucial that the teacher responds in a consistent way in order for the child to understand that circle time is the next step and the child is expected to participate.

What if my child has difficulties following routines?

If your child is having difficulties following specific routines at home or school, creating a visual schedule of the specific steps in that routine can help to increase your child’s motivation and control of the situation. For example, if your child demonstrates resistance towards the morning routine, follow these simple steps to create a visual schedule:

  1. Take pictures of your child engaging in each step of the routine (e.g. waking up, getting dressed, eating breakfast, etc.)
  2. Place the pictures vertically on paper, numbering each step to help the child understand what needs to be done first/last.
  3. Allow the child to mark each step once completed. Ask your child how he/she wants to mark the steps (e.g. putting a sticker next to the completed step). Laminating the schedule is a fun way in which your child can “X” off the steps and then erase for the next day.
  4. Use this schedule every day for at least two weeks, which will allow for sufficient time to understand whether it is making an impact or not. It is important that all caregivers use the chart with your child in order to build consistency. 

How do these visual schedules actually help?

Visual schedules serve many purposes for children and caregivers. First, the pictures on the schedules allow children to see themselves in action, which adds an extra fun factor. Secondly, the schedule allows children to have increased control, in that they are able to mark off each completed step. Lastly, the schedule serves as reminders to the caregivers as to what the child has done and what he/she needs to further complete. It is also helpful for caregivers to add in an incentive if the child is able to complete all steps included in a routine (e.g. giving your child extra play time before leaving for school).

Questions or concerns?

If you have questions or concerns about your child’s routines, please contact us at info@playworkschicago.com or 773-332-9439.

Brittany Hill, MS, MSW, LCSW, DT
Assistant Director of Social Work Services
Licensed Clinical Social Worker

Photo Credit: Openclipart-Vectors via Pixabay

Reducing Screen Time in the Home

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Tablets, smartphones, computers, televisions, and more…our world today often seems to be dominated by screens. Yet, one of the most common warnings heard by parents everywhere is:

“Don’t let your child have too much screen time!”

This warning may instantly lead many parents to wonder, “How much is too much?” And once that is determined, “What can I do to set limits on screen time in my home?” Let’s take a look at these common thoughts and questions!

Why is too much screen time a bad thing?

Recent research has produced a variety of results on the potential negative outcomes for children who spend too much time each day watching or using screens. Dr. Cara Booker and colleagues discovered that children who use screens heavily tend to be less happy and suffer from more social/emotional problems than their peers. The content of what is behind many screens can often encourage feelings of discouragement and low self-esteem.  Children who spend a large amount of time “tuned-in” to a screen also tend to miss out on learning and practicing important social skills, such as maintaining conversation and managing social conflict. Additional studies report that children who spend more time watching and using screens also spend less time sleeping at night. Screens can cause physical stimulation within your child’s brain, causing excitement that makes it more difficult to calm down and get ready fro sleep. Too much screen time is also linked to a higher risk for obesity, one reason being that screen time while eating can distract a child’s body from understanding when it is full, which may lead to over-eating. Overall, children who are exposed to increased screen time tend to present with increased cognitive, language, and social/emotional delays.

How much is too much?

With significant potential harms noted, it is important to ask, how much screen time is too much? To answer this question, The American Academy of Pediatrics created age-based guidelines on screen time for children. The exact numbers, as well as additional useful tips on appropriate media usage for children, can be found on their website:The American Academy of Pediatrics Age-Based Guidelines.

Helpful Tip: The American Academy of Pediatrics also offers online tools for families to create a unique “Family Media Plan” or to use a “Media Time Calculator.” Find both tools here.

Remember, these guidelines are just that – a GUIDE – and every family will run into days where screen time exceeds the recommended amount. That is okay!You may find that during a particularly stressful day at home, or over a long weekend spent mostly in the car, your child’s screen time total adds up to much more than the number stated in these guidelines. As long as these “excess” days are limited, and not the norm, they will not have the same negative effects on your child.

Steps to Reducing Screen Time

Once you begin to notice that excessive screen time is the norm in your home, it is time to consider taking action! Here are seven steps to get you started:

  1. Eat all meals without a screen
  • Allow meals to be a time to interact with one another. Share a favorite story from the day, or something you hope to see happen that day!
  1. Set up “technology-free” zones
  • Choose one area of your home. This is a great opportunity to get your child’s input. If they contribute to creating the technology-free zone, they will be more likely to actually utilize the technology-free zone! *NOTE: Be sure all beds are zoned to be “TECH-FREE”
  1. Set a timer when using screens
  • Sand timers, kitchen timers, and digital alarm clocks all work well! Before screen time begins, have your child set the timer with you (to the pre-determined time allowed) and review what happens when the timer goes off.
  1. Schedule specific times each day to “un-plug”
  • As a family, decide on a period of time during the day when you will collectively “un-plug.” This means parents too! Together you will put all phones, tablets and computers away. Turn off the TV and tune into your environment instead. *NOTE: Timers can be used to track your un-plugged time too!
  1. Use parental controls
  • Most devices offer an option for parental controls. Using this setting will allow you to set time limits and make sure that your child is only exposed to parent-approved content.
  1. Model limited screen use
  • Your children learn from watching you! Practice limiting your own screen time so that your child will see it can be done (and hopefully see the benefits as well).
  1. Replace screen-time with a different engaging activity
  • Have a plan ready for what your child can do with the time he/she used to spend with a screen. Below are just a few of many options available for activities that can replace screen-time, and better promote your child’s health and development!

Examples of Alternative Activities

Questions or concerns?

If you have questions or concerns about your child’s development or the effects of screen time in your home, please contact us at info@playworkschicago.com or at (773) 332-9439.

Stephanie Wroblewski, LCSW
Licensed Clinical Social Worker

References:

Grant, Sheena. “Do Children Have Too Much Screen Time and Does It Matter How Much Time They Spend on IPads, Smartphones and Laptops?” East Anglian Daily Times, 17 Oct. 2015, www.eadt.co.uk/ea-life/do-children-have-too-much-screen-time-and-does-it-matter-how-much-time-they-spend-on-ipads-smartphones-and-laptops

The American Academy of Pediatrics Website, (Itasca, IL, USA). American Academy of Pediatrics Announces New Recommendations for Children’s Media Use. Retrieved from: https://www.aap.org

The American Academy of Pediatrics Website, (Itasca, IL, USA). Family Media Plan. Retrieved from: https://www.healthychildren.org

Photo credit: Photo by Hal Gatewood on Unsplash

More Than Words: Building Social Communication Skills

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Does your child have difficulty playing with other children? Do they prefer to play alone or demonstrate challenges in making friends? This blog will discuss what pragmatic (social) communication is, review the signs of a pragmatic language delay or disorder, and provide strategies for encouraging pragmatic language development in your child.

What is pragmatic language and why is it important?

Pragmatic language or social communication refers to the appropriate use of language in social situations. It is not only what we say, but also how we say it. This includes being able to understand and use nonverbal cues such as body language and facial expressions. Pragmatic language is comprised of various important skills for successful communication, including eye contact, turn-taking, initiating and maintaining conversation, and understanding and using humor, among others. Children may have difficulty with one or more of these skills. It is important to support the development of your child’s pragmatic language skills so that they can learn to express themselves, understand others, and build relationships with family and peers.

Signs of a pragmatic language delay or disorder:

  • Preferring to play alone for an extended period of time
  • Limited eye contact while talking and/or playing
  • Difficulty taking turns
  • Limited initiation of conversation or play
  • Difficulty maintaining a topic of conversation
  • Difficulty participating in pretend play activities
  • Difficulty understanding or expressing emotions
  • Difficulty understanding another’s point of view
  • Difficulty interpreting tone of voice or body language
  • Difficulty making inferences
  • Difficulty using appropriate greetings
  • Difficulty adapting language to different listeners (i.e. talking to a friend the same way as to an adult)
  • Difficulty adapting language based on environment (i.e. talking the same way on the playground as in the classroom)
  • Not providing background information when appropriate

Strategies for building pragmatic language skills:

  • Pretend play:Engage in pretend play activities with your child, such as playing house, pretending to bake cookies, or pretending to be a veterinarian. Pretend play facilitates growth in cooperative back and forth play, ability to act out social situations, and ability to understand another’s perspective.
  • Turn-taking games:Turn-taking is a fundamental skill of communication as it teaches the basic back-and-forth exchange of a conversation. Through turn-taking games children learn to wait when it is someone else’s turn and they learn how to identify when it is their turn. Turn-taking games could be as simple as rolling a ball back and forth or taking turns blowing bubbles. You could also play simple turn-taking board games with your child to support development of this skill.
  • Story time:When reading a book with your child, try to make it interactive. Based on their age and language skills you could ask them to describe the pictures and what they see. For older children you can ask questions such as, “How do you think he feels?” or “What do you think she will do?” Prompting your child to answer these types of questions will help your child to make inferences, learn to understand another person’s perspective, and have a better understanding of emotions.
  • Be a good role model: You are your child’s best teacher. Model appropriate social communication skills such as making appropriate eye contact, using appropriate greetings, asking on-topic follow up questions, etc. Help your child to use these social communication skills when talking to family, teachers, and peers.
  • Facilitating peer interactions:Children need practice in order to learn to share, take turns, and play cooperatively with others. Setting up play-dates that you can be present for is a great way to facilitate peer interactions and relationships. You can encourage your child to communicate with their peer by prompting them to initiate conversation and play ideas. In addition you can encourage them to maintain play and communication with their peer by prompting them to ask on topic questions and make on topic comments.

Questions or concerns?

If you have questions or concerns about your child’s pragmatic language skills, please contact us at info@playworkschicago.com or 773-332-9439.

Claire Kakenmaster, MS, CCC-SLP
Speech Language Pathologist

Photo Credit: Image by HaiRobe on Pixabay

Teaching Play Skills to Children with ASD

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Pretend play can often be very difficult for children with autism spectrum disorder (ASD) because it directly impacts their ability to develop and understand social skills along with communication skills. Play skills are necessary for children to establish and create meaningful relationships with peers and understand the world around them. This blog will help provide some information to help engage your child with ASD while learning new foundational and essential play skills.

Where do I start?

Just like every child is different, every child with autism is different. It is important to understand your child’s strengths and weaknesses. Before introducing new unfamiliar activities with your child, make sure your child is at a ready-to-learn and regulated state. This means your child is demonstrating a calm body and is ready to play. It is important to reinforce eye contact and joint attention while playing with your child to help increase their engagement skills. Your child’s skill level, attention span, and interests will determine and help guide you in the right direction to begin introducing new unfamiliar play. Begin where your child is at and remember to slowly build on their current level of understanding and skill. If your child resists the new play, begin new play schemes with some of your child’s favorite games or toys. Remember, all children learn by repetition and benefit from having a model or demonstration with how to the use objects appropriately.

Sensory Play

Sensory activities include activities that stimulate our senses, whether in a positive way or a negative way using all our senses: taste, sound, visual, tactile, and smell. These different textures, colors, smells, taste, and experiences impact the way you experience the world around you. Sensory-based activities help children become engaged and focus on the activity presented. These activities can improve attention span, increase flexibility and exposure to new items, and help self-regulation. Please use caution when implementing new sensory items with your child and notice for any aversive or negative reactions.

  • Music is a great way to engage any child! Fingerplays (e.g. “Wheels on the bus”) and dancing improve your child’s attention span, imitation skills, and gross-motor coordination.
  • Water, whether it’s outside when weather appropriate or in the bathtub all year round.
  • Play-Doh (roll, squish, animal shapes)
  • Waterbeads (fill and dump, have animals swim)
  • Sand

Functional Play

Functional play is the child’s ability to use objects as they are intended and expected (e.g. block to build). Use cups to fill up and dump the water/waterbeads in the bathtub or a car to drive across the sand. Use the blocks to build a tower and crash them. Provide hands-on assistance and a demonstration if your child does not use the object functionally.

Pretend Play

Pretend play or symbolic play is when a child uses a realistic item or non-realistic item as something else (i.e. using play food or a spoon as a toothbrush). Use animals in the bathtub to walk across the tub and use the sounds associated with each animal. Once your child has mastered the play imitation skills, expand upon this play and encourage your child to have the animals go down the slide in the bathtub. Use their favorite stuffed animal during meal times and encourage your child to “feed” their animal. Continue the child’s bedtime routine with their favorite animal, while you demonstrate and explain what you are doing with your child and their animal.

Questions or concerns?

If you have questions or concerns about your child’s play skills, please contact us at info@playworkschicago.com or 773-332-9439.

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Reference: The Australian Parenting Website (2017). Play and children with autism spectrum disorder.

Retrieved from: raisingchildren.net.au/autism/school-play-work/play-learning/play-asd.

Photo Credit: rawpixel via Unsplash.com

Gender Differences in Autism Spectrum Disorder (ASD)

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Are girls with autism being missed?

A growing body of evidence supports the hypotheses that autism spectrum disorder (ASD) is being underdiagnosed or misdiagnosed in girls. Why might that be? And how could that affect your child? We will delve into a few of these issues in this blog post.

First, an overview of autism spectrum disorder.

What is ASD?

ASD is a biologically based, neurodevelopmental disorder. Meaning, autism is a disorder present at birth that affects how the brain develops. Individuals with ASD often display behaviors that are repetitive in nature and have difficulties participating in social situations. Autism is characterized as a “spectrum disorder” because it presents differently in each individual, causing the symptoms to vary in type and intensity. The current prevalence of autism is 1 in 68 children. Autism is more prevalent in boys, presenting with a ratio of four boys to every one girl with autism spectrum disorder.

Red Flags:

Potential signs of ASD that you might notice in your child are outlined below.

  • Your child does not use gestures to communicate, such as pointing, clapping, or nodding their head
  • Your child does not use a combination of eye contact, gestures, sounds, and words to communicate
  • Your child has a delay in speech and language skills
  • Your child does not imitate actions, sounds, or words that they overhear
  • Your child does not respond when you say their name
  • Your child has sensory differences, including over- or under-sensitivity to certain sounds, textures, smells, etc.
  • Your child has unusual ways of moving their hands or bodies
  • Your child has significant difficulty with transitions
  • Your child does not play with, or similarly to, other children their own age

The red flags outlined above may indicate a difference in your child’s development. If your child exhibits one or more of the red flags mentioned above, it does not necessarily mean that they have autism spectrum disorder. For example, not responding to their name could be due to a potential hearing loss. It is recommended that you discuss any concerns regarding red flags with your child’s medical team, including their pediatrician and therapists.

So, Girls:

Why are they being missed?

As mentioned above, professionals in the field have begun to discuss this issue of underdiagnosis or misdiagnosis of ASD in girls. One potential area of difficulty is that assessments commonly used to diagnose ASD are based on data collected from the general population of children with autism, which consists of more boys than girls. That means the tests are less sensitive to detecting girls with ASD. Girls with well-known or easily understood symptoms will likely not be missed, but those that present with less obvious red flags may be. As ASD is less common in girls it might not be the first diagnosis that comes to mind, especially if symptoms are less severe. Although girls may and do exhibit some of the red flags outlined above, it can present differently or less obviously in girls. It is also common that girls are intrinsically more socially motivated, so symptoms of social communication difficulties may be less obvious.

What does it look like?

A few more specific signs of ASD that you might notice in girls are outlined below.

  • Your child has interests that are age-appropriate but very intense
  • Your child plays with toys in a “pretend” but repetitive manner
  • Your child displays sensory differences, but might begin to hide these as they get older
  • Your child has extreme reactions to change or transitions
  • Your child is exhausted after social interactions
  • Your child has difficulty making or keeping friends
  • Your child has difficulty with conversational skills, such as topic maintenance and turn taking
  • Your child may internalize their emotions, resulting in anxiety

How does this affect your child?

The slight variation in type or intensity of red flags in girls may cause them to be diagnosed with something other than autism spectrum disorder, such as an anxiety disorder or a language disorder. The misdiagnosis results in recommendations that may be less appropriate or encompassing of symptoms and may result in your child missing out on early intervention strategies to support their development.

What can I do? 

If your child is demonstrating the behaviors above, or any general red flags for autism spectrum disorder, consider following up with your child’s therapist or pediatrician. Although individual speech-language therapists cannot provide a diagnosis of autism spectrum disorder, they can make appropriate referrals for testing and possible diagnosis.

Questions or concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall Burgoon, M.S., CCC – SLP 
Speech-Language Pathologist

References:

Bartley, Janine. “Autism Spectrum Disorder.” Grand Valley State University, 4 Dec. 2018, Grand Rapids. Lecture.

Rudy, L. (2018, December 4). Symptoms of Autism in Girls . In VeryWell Health .

Volkers, N. (2018, April). Invisible Girls. The ASHA Leader, 23(4), 48-55.

Photo Credit: Photo by Jens Johnsson on Unsplash

Home Bodies: Gross Motor Activities You Can Do at Home

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What are gross motor skills?

Your child’s gross motor skills allow them take their first steps, play their favorite sports, and sit upright in their chair at school. Gross motor skills involve stabilization of our large muscle groups and active movement of our whole body to carry out these meaningful activities. In order to develop age-appropriate gross motor skills your child will utilize the following body mechanisms: muscle strength, muscle tone, activity tolerance, motor planning, postural control, body awareness, balance, coordination, and proprioception (our sense our body position and body movement).  If your child is having difficulty with their gross motor skills, they may appear to be clumsy, have difficulty completing activities of daily living such as dressing, or avoid physical activity.

Laying the Foundation

In order to develop more refined skills, such as fine motor skills, your child will need to build a foundation of age-appropriate gross motor skills. For example, in order to complete fine motor tasks at school, your child must first demonstrate appropriate trunk strength and postural control in order to sit upright in their chair. Once your child develops appropriate trunk strength and postural control, he/she will need to develop gross motor shoulder stability in order to prevent his/her shoulder from moving when engaged in writing activities. It is when these gross motor abilities of trunk strength, postural control, and shoulder stability are present when your child is able to develop more refined skills. Our gross motor skills lay the foundation for the more sophisticated and intricate small muscle movements.

Home Work

In a literature review of fundamental movement skills conducted, researchers found a positive relationship between children’s development of gross motor skills and health benefits such as increased physical activity and decreased sedentary behavior*.

At-home gross motor activities are just a jump, skip, and a hop away:

  • Obstacle Course: indoor obstacle courses are a wonderful way to get your child crawling through tunnels, jumping over “lava,” and running to the finish line. This also provides additional opportunities for supplemental sensory input for increasing overall regulation!
  • Yoga: yoga is excellent for incorporating whole body movements, core strengthening, and increasing our sense of proprioception. In order to further develop our body awareness, have your child imitate yoga poses in front of a mirror in order to increase his/her understanding of how his/her body is positioned in space. Yogarilla cards are a great resource for various yoga poses in a fun format for your child.
  • Dance Party: join in on the fun with your child and throw a dance party! Choose action-based songs, such as “I’m Going on a Bear Hunt.” Incorporate action-based songs that involve activities requiring the use of both the upper and lower extremities to utilize your child’s motor planning and coordination skills.
  • Play Catch: a simple back and forth game of catch with either a ball, balloon, or bean bag can facilitate development of motor planning, body awareness, and bilateral coordination. Additionally, with the balloon allowing more time to move throughout space, encourage your child to keep it off the floor utilizing different body parts, such as their feet or even their elbows.
  • Simon Says: have your child participate in a gross motor version of Simon Says. For example, you can state, “Simon says jump up and down. Simon says touch your toes. Simon says stand on one leg.”
  • Animal Walks: completing animal walks such as bear walks, frog jumps, crab walks, etc. Your child might even want to create their own kind of animal walk!
  • Bubbles: blow bubbles and have your child pop them with a body part that you designate. Try to blow the bubbles on each side of his/her body in order to promote crossing their body.
  • Tummy Time: If your child is not yet walking, encouraging him/her to spend time on his/her stomach will allow him/her to bear weight onto their arms. For example, you can place your infant’s desired toys around them in a circle so he/she has to bear weight onto his/her arms to reach out for them. If your child is walking, increasing the amount of time your child is bearing weight on his/her arms such as in a crawling position or lying on his/her stomach strengthens his/her shoulders, arms, and hands for the development of more precise fine motor skills. This can be done by playing games or completing puzzles in an all-fours position or army crawling during transitions.
  • Clapping Games: using both hands in coordination to complete clapping games such as patty cake are a material-free way to practice gross motor skills such as bilateral coordination and motor planning.
  • Stand Up: create a vertical surface for your child’s arts and crafts activities. When standing and using a work station in front of him/her (such as a piece of paper taped on the wall) instead of below them, your child is actively engaging and strengthening the muscles in his/her shoulders, arms, and wrists to promote gross motor development.

Questions or concerns?

If you have questions or concerns about your child’s gross motor abilities, please contact us at info@playworkschicago.com or 773-332-9439.

Reagan Lockwood, MS, OTR/L
Occupational Therapist

*Reference: Lubans, D.R., Morgan, P.J., Cliff, D.P. et al. Sports Med (2010) 40: 1019. https://doi.org/10.2165/11536850-000000000-00000

Photo Credit: Photo by Julia Raasch on Unsplash

Aspiration: What Is It and What to Look Out For

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Have you ever had the feeling that something went down the “wrong pipe?” This is a common sensation that people feel when food or liquid accidently enters their airway instead of traveling to their stomach. Most of us are able to protect our airways by coughing up any material that goes down the wrong way. However, some children are unable to cough up material that enters their airway, putting them at greater risk for material entering their lungs, otherwise known as aspiration. Feeding your child can already be a stressful experience, especially when it comes to their safety. Therefore, it is important to understand the signs, symptoms, and risk factors that are associated with aspiration to identify when it is appropriate to seek medical attention.

What is aspiration?

Aspiration is when food, liquid, saliva, or any other foreign item enters the airway or lungs. Aspiration can occur in infants, children, and adults, and can vary from mild to severe. If persistent and untreated, aspiration can lead to serious health issues, such as pneumonia.

What are the risk factors for aspiration in infants and children?

Aspiration is most commonly caused by a swallowing disorder, otherwise known as dysphagia. Other risk factors for aspiration include, but are not limited to:

  • Abnormal anatomy, such as cleft palate, paralyzed vocal folds, or esophageal atresia
  • Premature birth and related complications
  • Reflux disorders
  • Neurological disorders
  • Other medical diagnoses, such as Down Syndrome

What are the signs and symptoms of aspiration in infants and children?

Aspiration can result in overt signs/symptoms, such as:

  • Coughing or choking during feeds
  • Wheezing and/or breathing problems (stop breathing or fast breathing)
  • Voice sounds wet or gurgly after feeding
  • Signs of distress, including facial grimacing, tearing of the eyes, arching back, or redness in the face
  • Repeated lung or airway infections
  • Slight fever after meals

Aspiration can also occur withoutovert signs of swallowing difficulty, meaning that the child does not cough or show symptoms when material goes into their lungs. This is known as silent aspirationand is best detected by a formal video-swallow study, as it cannot be observed by the naked eye.

What can I do?

If your child is demonstrating ANY signs or symptoms of aspiration, notify your speech-language pathologist or contact your medical provider to discuss the need for a formal swallow evaluation. After a swallowing evaluation, your medical team will be able to determine which consistencies are safest for your child to eat and drink, as well as create a plan of care to improve your child’s swallow function.

Questions or concerns?

If you have questions or concerns about the safety of your child’s swallow, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

Reference: Aspiration in Babies and Children. (2018). Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/aspiration-in-babies-and-children.html

Photo Credit: Jens Johnsson via unsplash.com