Thursday, June 26, 2014

Care for your special child in Nigeria

Raising a child with special needs can be very challenging and one needs all the help one can get. Enter the therapy sessions. The good thing is that in Nigeria, one can get this help and more more. It is also good that parents are enlightened about what is going on and  understand the kind of help they are getting. 

In the U.S, U.K, and Canada, one approach is usually the norm in Therapy sessions. 
In Nigeria, the therapy sessions are a bit different, some adjustments have to be made hence the tasks are lifted out of a combination of 2 or more approaches in developing and implementing a individualized plan(IEP) for a child.

The belief is that the combination of Therapist led approaches (structured learning) and child led approaches through play, gives optimal learning effect.

For example, Dayo who is a shy 7 year old boy diagnosed with Cerebral palsy and dyslexia, has challenges in self care like belting his trousers, buttoning his shirt, identifying the back and the front of his shirt and academic skills which include memory,weak grip in handwriting and conversation skill development.

In drawing up program and implementation for Dayo, we combined drills and tasks from 
SONRISE (child led)
and NDT and massage therapy.

I know, I know, what nonsense is this? please speak english....
Now I would like to give a short overview of these common learning approaches used in Nigeria.

Sensory Integration Therapy: Sensory Integration is the neurological organization of sensations for use. These sensations include 
Auditory [hearing]
Gustatory [tasting]
Visual [seeing]
Olfactory [tasting]
Tactile (touch)
Vestibular (balance,gravity)
Proprioception(provides information about where body parts are and what they are doing).

Sensory integration Therapy is the assessment and use of purposely selected individualized multi-sensory experiences to treat a variety of developmental and learning difficulties including
Cerebral Palsy
Attention Deficit/or Hyperactive disorder and other developmental coordination and behavioural disorders.

Sensory integration postulates believe that deficits in sensory input result in concept (reasoning academic, and motor learning (posture,milestone developments).

Neurodevelopmental Therapy (NDT):  This intervention focuses on increasing function and the individual’s strengths through proper positioning and strengthening exercises.
The goals of this treatment include the acquisition of as much normal muscle as possible, facilitation of normal movement patterns, it could be of the head,arms,trunk,legs,or tongue.
It is a hands on, problem solving approach where the therapist uses his or her hands to provide guidance and optimize function.

Appropriate Behavioural Analysis(ABA): This type of therapy focuses on behavior. 
In teaching self-care play, language and conversation skills, It uses discrete trial training (breaking down complex skills into simpler graded components) and the use of reward systems, i.e increasing useful behaviours by positive rewards and reducing maladaptive behaviours such as aggression that may cause harm or interfere with learning.

It involves mostly one-on-one interaction. ABA is Therapist led (This means that the Therapist dictates the pace and skill to be learnt and other activities in therapy session. 
ABA is usually the Gold standard for all bevioural Therapy approaches because of its precise behavioural  data collation approach to monitoring progress and research oriented. Parents complain of it making the child too robotic and too structured.

TEACCH: An Acronym for the Treatment and Education of Autistic and communication handicapped children.
TEACCH draws up an IEP based on the uniqueness and the peculiarities of the individual with special needs.It was formerly developed for individuals with Autism but has been found useful in treatment of other developmental conditions in teaching functional skills.

TEACCH  makes the most of an individual’s strength within a structured familiar environment(structured teaching).

SONRISE is a child-led, one on one therapy for kids with Autism. It teaches how to bond well with the child, build trust and making the child know you accept the child the way he is by joining in the child’s unique stimming behavior then gradually encouraging the child to build more complex functional skills in a non forceful way.

Stimming: Self-stimulatory behavior and self-stimulation, is the repetition of physical movements, sounds, or repetitive movement of objects common in individuals with developmental disabilities, but most prevalent in people with autistic spectrum disorders] 

This style of therapy mostly follows the child’s interests. It's usually a very slow learning method of teaching but it has recently been backed by researches.

Relationship Development Intervention(RDI)
This method focuses on a child”s difficulties with flexibility of thought,emotional regulation and prospective taking.It uses everyday activities such as working,cooking,cleaning,football to build up simple conversational skills and complex skills.It uses lots of incidental learning opportunities to teach.its also a family oriented therapy approach.

Montessori Therapy approach
This is the best approach is  for kids with learning disability in a school based setting.

Where they develop cognitively at their own pace to learn age appropriate self care,school skills,group and social skills and also give kids opportunities to balance their sensory needs through sensory based activities and different age levels of kids in group setting encourages peer imitation i.e. the younger ones benefitting from watching the older ones and the older ones benefit by helping the younger children.

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Friday, June 20, 2014

Are they compatible?

In marriage, it is said that the more compatible a couple is, the higher the chances of a successful marriage. The same goes for the therapist and the child, also the therapist and the parent.

For any therapy program to be successful, the child should like the therapist and the therapist should like the child. Once the therapist and child have had time to bond, the child should be able to trust and respect the therapist. This not only makes the therapy sessions easier, it helps the child improve.

There is also the parent-therapist compatibility; this means that there is great rapport and free flow of communication between both parties, in other words, they are on the same page. The consequences of this compatibility are well planned therapy sessions and easy, consistent follow-up of the child.

According to Tumbi, a shadow therapist at Serendipity Heights, Akoka, Lagos, taking time to see what happens with one's child during his or her therapy sessions at least once a week, would really go a long way in motivating both the child and the therapist. It would help the parents to better understand what is going on and how to follow up their child after the therapy session is over for the day.

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Wednesday, June 18, 2014

A saint of a mother: By Frances Hardy

I was surfing the net and i came across this story and all i could say was...WOW! This is truly a strong and special woman....Simply just have to read this...

Her husband committed suicide leaving debts of £1m, yet she raised seven children - six autistic, two with cerebral palsy. And she's still smiling.
Vikie Shanks has raised her seven children alone in rural Warwickshire
Six of her children have autism, two cerebral palsy and another dyslexia
Her husband Paul committed suicide in 2007 leaving substantial debts
But against all odds, the whole family are leading happy, healthy lives
'I've got a lot of grit. I'm not the sort of person to be beaten,' she says

For Vikie Shanks it was just a typical family teatime. In the garden, her daughter Lorie was crying hysterically. She’d been trying for an hour to score 20 consecutive netball goals.
Her quest was obsessive, her focus intense. She’d managed 15, but she hadn’t yet achieved her target.
And now Vikie was telling her to come in and eat. But Lorie wouldn’t — actually she couldn’t — abandon her mission, because it wasn’t just a game: it was a compulsion.
Meanwhile, inside the house, Nikita — who was then nine years old — seemed possessed of a manic energy. She was twirling around, her arms flailing like a windmill.

Vikie Shanks with (from left) Mirie, 19, Nikita, 17, Kacie, 20, Pippa, 13, Osborn, 15, and Lorie, 19. She has raised all seven of her children alone since the death of her husband Paul in 2007

Vikie tried to calm her, but Nikita was implacable. She lashed out, hitting and kicking her mother.
On the sofa, Jamie, Vikie’s eldest child, tried to adjudicate in a dispute with two of the younger ones about what they should watch on TV. The squabble had reached a dizzying crescendo.
Vikie took a deep breath, gathered herself and returned to the kitchen. That’s when the drama over the pasta sauce kicked off. ‘I was stirring the tomato sauce when my son Osborn came in,’ says Vikie, 56, a widow.
‘He was absolutely stricken and crying uncontrollably. “You’ve got the wrong sauce, Mum,” he screamed, and I realised I hadn’t bought the usual brand — the one I’d used for years — but a different one that had been on special offer.
‘And Osborn — who is factual, rigid and likes life to be ordered and predictable — was distraught. He couldn’t cope with the change in routine.

‘I remember feeling exhausted, completely wrung-out. I felt like running into the middle of the field behind our  house, throwing my arms in the air and screaming.
‘But there was only me, so I just had to soldier on. When there’s no one else to field a ball to, there isn’t an alternative.
‘Everyone says “You must be strong”, and I think I probably am quite tough mentally. I’ve got a lot of grit. I’m not the sort of person to be beaten.
‘I try to deal with life by focusing on solutions rather than problems. And, of course, a bit of laughter helps as well.’
Indeed, Vikie has often had to summon up every vestige of her strength, humour and resolve to deal with the many curve balls life has thrown at her.

Six of Vikie's children have autism and two cerebral palsy. Kacie, third from left, is severely dyslexic. However, the former model has instilled in her children that life's problems are there to be surmounted

In 2007, her husband, Paul, committed suicide, and since then she has been lone parent to her seven adored, but demanding children: six daughters — Jamie, now 23, Kacie, 20,  19-year-old twins Lorie and Mirie, Nikita, 17, Pippa, 13 — and only son Osborn, 15, all of whom live with their mother in a ramshackle house set in 13 acres of rural Warwickshire.
Motherhood on such an epic scale is challenge enough, but Vikie’s parenting task is gargantuan, for six of her seven offspring have autism.
Two also have cerebral palsy, while Kacie — the only one not affected by autism — is severely dyslexic.
'Everyone says “You must be strong”, and I think I probably am quite tough mentally.'

You might imagine that Vikie, a former model, would be crushed by the weight of her responsibilities, but, in fact, she is resourceful and cheerful and presides over her chaotic household with remarkable serenity.
Her children, too, have been instilled with her maxim that life’s problems are there to be surmounted.
Each one of them has learned to circumvent, or deal with, the difficulties their autism has presented them with. All are leading happy, productive lives.

Nikita, Lorie, Osborn and Pippa were diagnosed as autistic when they were four. Osborn and Pippa also have cerebral palsy, which has affected their balance, ability to walk and manual skills.
Jamie and Mirie have milder symptoms of autism, but psychologists have confirmed that they are on the spectrum.

Nikita had the most intractable behavioural problems, with violent meltdowns — but the 17-year-old has graduated from special school to a mainstream college, where she is studying drama.
Vikie is delighted by her transformation. ‘There were times when Nikita’s  behaviour was quite horrific,’ she says.
‘She’d trash the house, and thump and slap me. I was covered in bruises. She was so full of anger; like a little wild animal.

The siblings pictured in 2004. The mother says each of her children has learned to circumvent, or deal with, the difficulties their autism has presented them with - and are all leading happy, productive lives

‘She found it hard to verbalise why she was so frustrated and angry, but it was because I couldn’t read her mind. It was heartbreaking.’ The violent outbursts diminished as Nikita’s self-awareness grew with age and  she learned how to develop strategies for coping.
Three of Vikie’s children — Jamie, who has had a role in an independent feature film, Lorie, working for a season as a Red Coat at Butlin’s in Somerset, and Mirie, who has qualified as a drama teacher — have fledgling careers in performing arts. Now Nikita is hoping to follow their lead.
Vikie believes autistic children have a natural capacity to act.

‘They’re perpetually acting out different roles in order to fit in,’ she says. ‘While the rest of us know intuitively how to behave in polite society, autistic people have to learn that skill.’
Indeed, Vikie remembers having to explain the nuances of etiquette in painstaking detail to Lorie about a decade ago.

‘We were at a fete and she’d won a big inflatable hammer. She was larking around, hitting her sisters on the head with it, and they were laughing. Then she hit me and I laughed, too. But when she went over and hit the elderly gentleman running the swing boats, he was less obliging.
‘He said sharply to me: “I suggest you teach your child to observe boundaries.” So I had to explain to Lorie very carefully which people in her life it would be all right to hit in a playful way.
‘Her teacher? No. My best friend? Yes. She could not grasp that what  would be fun in some contexts, would be considered rudeness in others.’

Vikie's husband Paul, pictured, took his own life in 2007 aged 51. He was severely depressed, the mother says, and had various mental health issues

All the children have obviously taken on board their mother’s lessons; when I visit their home near Kenilworth, they are sweet, charming and courteous.
‘I don’t mean it in a rude way, of course, but who are you and why are you here?’ says a bemused Pippa, when she comes in from school to find me helping Vikie unpack her vast grocery shop.
‘And would you like to come and see our chickens?’

Outside we chase three escaped hens back into their pen. After major surgery in 2011 to correct her inward-pointing feet, Pippa is able to walk more easily. She and her siblings love the security, peace and freedom of the family home in which they have lived their entire lives. Little wonder they were distraught when they learned the route of HS2 — the proposed high-speed railway line — is scheduled to run 100 yards from their home.

Vikie’s life is already mind- bogglingly busy. Aside from parenthood, she has written a book about her life; she runs an autism support group, Autism One On One, and speaks about the condition. Now she has added campaigning against HS2 to her commitments.

The family home falls just outside the compensation zone. She would not get a penny if she wished to move, which she doesn’t. But then, of course, her rural idyll will become a building site; the value of her home will plummet.
 ‘While the rest of us know intuitively how to behave in polite society, autistic people have to learn that skill.’
‘We’ll have to live with years of construction work, then the noise, vibration, disruption of the train itself,’ she says. ‘For any family it would be sheer hell. For young people with autism, that level of disruption is disastrous.’

You may consider, of course, that the family has suffered enough. Vikie’s husband, Paul, took his own life in 2007, aged 51. Vikie and their children had to deal not only with their grief and loss, but also with the awful nature of his death.
‘Paul was severely depressed and had suffered for years from various mental health issues,’ says Vikie. ‘He cut his wrists and throat and bled to death. The police found him in the woods behind our house.
‘I just felt abject terror. I didn’t have time for grief. I didn’t know how I would look after so many children on my own.

‘And Paul left debts of around £1  million. I hadn’t realised he’d remortgaged the house to the hilt, and though many of his debts were written off, I still had to struggle with the financial chaos he’d left.
‘At the time, we were running our own company supplying games to conferences, exhibitions, business meetings, and all I could do was plough on, like a steam train.

The family in 2007 - around the time of Paul's death. The family were distraught when they learned the route of HS2 - the proposed high-speed railway line - is scheduled to run 100 yards from their home

‘One week I had to take the children to 18 appointments — GPs, hospitals, physios, speech therapists, psychologists — and I was trying to run the business, too.

‘I had to organise life like a military campaign. Some nights I didn’t even go to bed. Then, in May 2008, I collapsed. My doctor wanted me to stay in hospital, but I wouldn’t.

‘I knew it would traumatise the children. I had to go to bed for four weeks and a nurse came to me every day. We got by. We weren’t beaten.’ Vikie is the youngest of three children, and her brother Tony, 59, is autistic and lives in sheltered accommodation.

Though science has yet to prove autism is genetic, Vikie aligns herself with the growing body of experts who believe it is. Her younger children’s cerebral palsy, however, is not linked to their autism, and is merely an unfortunate coincidence.

‘Osborn was born with the cord around his neck; Pippa with severe jaundice. Both are connected with cerebral palsy,’ she says. It seems extraordinary that an afternoon spent with a family beset by so many problems should prove to be uplifting. But it is.

Vikie herself is the youngest of three children and her brother Tony, 59, is autistic and lives in sheltered accommodation. The mother believes autism is genetic and was passed down from her sibling

Kacie, a budding fashion designer, alone in a world not governed by the quirks of autism, grew up with an unusual perspective on life.
‘I think I became a bit confused about what was socially acceptable,’ she says. ‘I thought it was usual to be dealing with meltdowns  and I assumed people inadvertently upset each other all the time.’

Each child has an astute level of self-awareness. Pippa tells me: ‘New situations make me anxious. And I’m not too good at expressing my feelings. When I’m sad I usually laugh, which means I laugh when I get told off. And sometimes I nudge people a bit too hard if I’m excited. But I don’t mean to hurt them.’
Osborn’s autism manifests itself differently. ‘He’s factual, pedantic, adorable and funny,’ says Vikie. ‘If I say it’s 8.30am, he’ll say: “Actually, Mum, it’s 8.28am.” And he doesn’t understand metaphor.
‘He’ll dissect every conversation down to the minutest detail. He’s scientific. He doesn’t do chit-chat.’
'I just felt abject terror. I didn’t have time for grief. I didn’t know how I would look after so many children on my own.'
So, how does he cope living with seven women? ‘Usually very well, though it can be tricky,’ he smiles.
I ask him to tell me about himself. ‘I don’t really like to describe myself, because if I’m positive it could sound boastful,’ he begins, tentatively. ‘But I think I’m fair, moral and ethical and I can be honest, even if it hurts. I think being autistic can make you less afraid to be blunt.
‘And there are situations that freak me out. For instance, if I meet a group of teenagers in the street I feel intimidated. I was bullied in the past. There aren’t so many people around like me.’
Against extreme odds, Vikie has produced a kind, confident and sweet-natured brood of children.

She worries about their futures — of course she does — and their capacity to live autonomously, but she remains confident and hopeful they will. Neither does she view their autism, which has undoubtedly been a challenge, as an encumbrance. On the contrary, she feels there is much to celebrate.
‘They are all learning to understand the world and how it works,’ she says. ‘It’s a huge, constant pressure, but they are dealing with it.
‘And there are many positives about autism. The children have the ability to focus intensely, to immerse themselves in a task and dedicate themselves absolutely to it.

Reflecting on the past few years, Vikie says: 'Though it's been very tough, I've watched my children's development and I wouldn't change a thing. Because it's been quite magical'

‘They have the capacity to cut to the crux of things because they see everything in black and white; they’re not clouded by emotion.
‘It makes me so upset when I see parents bursting into tears when their child has just been diagnosed as autistic. I want to tell them there is much to be hopeful about.
‘Though it’s been very tough, I’ve watched my children’s development and I wouldn’t change a thing. Because it’s been quite magical.’

UNRAVELLED: The Inspirational Story Of A Journey Out Of Darkness by Vikie Shanks and Lynne Barrett-Lee (Thistle, £3.99, from Amazon).

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Culled from

The parents and the therapist: The A-team

After the diagnosis, the next step is usually therapy. Unfortunately, most Nigerian parents interpret “Therapy” as total almost instant recovery of the child and when this does not happen [and it usually doesn’t], they end up going from therapist to therapist, looking for that therapy miracle.  How does this happen?

 First thing some parents do, is to earmark a certain amount of money, get a therapist, then give the therapist a time limit for the child’s recovery to take place. The therapist and the child are left to their devices. If no recovery is seen in a month or two, it’s time to get a new therapist; this adversely affects the child’s progress.

Well, researches have shown that team approach to therapy is the most effective. This team includes the Occupational Therapist, Special Ed. Therapist, parents and siblings.

The rehab team does not necessarily need to have all the professionals shown above; just the ones important for the child's therapy program.

The “Total recovery” mindset should be replaced with “Total independence” mindset which could in some cases, become full recovery.

This Total independence mindset should be translated into goals and goals broken down to daily tasks and drills  which are fully supervised by an experienced professional from the rehabilitation team. The family should monitor and participate in these activities and follow up too.

Taking care of a special child is not easy and it is understandable that one would want the child to recover and have a good life [as quickly as possible too] but the truth of the matter is that the road to total independence is a long one, it takes time, work and patience.

While we give these fantastic parents kudos for their great work, the therapists should be appreciated too and if they [parents and therapists] can work together, we have an A-team.

Okay, I just had to put up this movie poster.

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Tuesday, June 17, 2014

The Special Kids Series Episode 1: Attention Deficit Hyperactivity Disorder [ADHD]

Well, Ollie wants me to write, so I will write. Please I will write anonymously for now. I hope my writing skills are alright. My son is 6 years old. At 2, he could not sit still for a second; he slept at 1am and woke up at 4am and when he does wake up, the entire household knows. He is our first child so with no prior experience, I thought that most boys were this boisterous and active. I had to get him a personal maid to follow him around so he does not hurt himself.
When he started school, his teachers kept complaining so I had to change his school, thinking the teachers were incompetent to handle him.

At his new school, after 3 weeks, they called me for a meeting and suggested I take my son for prayers. “You know, Madam, there is nothing God cannot do.”
I asked what they were insinuating….
”.....Nothing oooo, Madam…just a suggestion.”
I left there with tears in my eyes, confused, angry and worst of all, clueless. A good friend directed me to a Montessori school around Lekki and after evaluation by a renowned psychologist and an Occupational therapist, I finally got a diagnosis for my son, Attention Deficit Hyperactivity Disorder-ADHD. From evaluation, they said he was “high functioning”. I was like,
 “Einstein material, right?”
“We don’t know yet, Madam”

We started therapy immediately with Morning school facilitation [meaning a therapist would follow him to school every day to see how he did] and afternoon sessions at home.

He also did a lot of Sensory exercises [using his hands on materials for example, toys]  especially with a sensory brush. Later on, monitoring of behavior, organizational and academic activities followed.

We were advised to remove all sugary food from his diet, reduce junk food and fizzy drinks, which we did. Initially, we [The pediatrician, the therapy team and myself] argued about medication but his dad and myself decided to stick to therapy and see how it goes first.

My son is 6 years old now and you won’t know that he was ever hyperactive. He is so high functioning that it scares me. He reads books that are meant for 12-15 year olds. His maths is also the same. We have even limited T.V. time because he can memorize a movie. He still has challenges with socializing and we are trying to get him to initiate friendly social conversations.

All in all, things are good now and we are grateful for all the help and information we got concerning our son. Having a child with ADHD is not the end of the world. Yes, it is challenging but God has been good.

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