The School and the Parents...

Recently, a parent called and scheduled a meeting with the school and therapists working with the child. I was really happy- wow! she is really putting her child first this time.
You can imagine my surprise when the meeting turned out to NOT to be a meeting but a written down dictation on what she expects her son to be doing now.

"I want him placed in basic three instead of two."
"No more practical work for him. Move totally to abstract."
"Stop all one-on-one therapy time. He should do full time like his mates."
"No more cutting of his work load. Give him the full load like his mates."

This is a boy who has almost succeeded in coming out of the spectrum but is still having challenges with abstract teachings; he also had a penchant for giving up on a task easily (still working on that) and his mum is too busy to hear any progress report.

I asked her why the sudden meeting and dictates and she replied
“his mates are in basic 4 now” he is taking too long ah!"
I gently reminded her that when we started she had told us that if only he could just communicate his needs and write that she would be okay, now she was dictating the pace. She replied,

 "....eeeehn…I thank God ..but he should do fast and join  his mates."

I told her of the challenges we were facing, the teacher also told her about the IEP we had already drawn up; also that if she would patiently go through it with us, she would see that it suited him well.
She vehemently refused stating that this was what she wanted, that her hubby and a friend discussed it yesterday and they had already come to a decision.

Unfortunately, this is the trend in schools; some parents dictate what is to be taught, styles of teaching  and punitive measures or if possible, no punitive measures whether it conforms to the school style or not and then giving the school an ultimatum..."do it my way or I withdraw my child” and you see schools doing their bidding to avoid losing their students.

All this dancing to the whims of parents and not focusing on enhancing the child's abilities.

The resultant effect?
Lack of disciplinary measures
The schools lose their integrity.



Image courtesy: www.dalmain.lewisham.sch.uk, www.bbc.co.uk, www.inquisitr.com,           www.telegraph.co.uk, blog.losingcontrolfindingserenity.com

What's in a swing?

Aaaahhh......swinging.....an essential part of childhood.

Movement is essential for typical development to occur in all children. Most of us have no problem combining all our senses.
For autistic children and other disorder however, it's a mighty challenging task. Processing stimuli from the senses of sight, smell, sound, touch, taste, balance and body is overwhelming. Those suffering from autism will often withdraw to avoid over stimulation, or try to sort out the input from their senses with self-developed soothing mechanisms and repetitive behaviors.
A significant amount of occupational therapy for special needs focuses on sensory integration through specially designed programs. Some of the greatest tools for sensory integration therapy for autism, cerebral palsy and other type disorders are various types of swings.

Swinging can have powerful impact the brain's ability to process and use sensory information. Whether the child is linear swinging on a strap swing, cuddled up in a net swing for proprioceptive input or spinning in a rotating movement, all of these movements can act as a powerful activator on the body's systems.
People with various autism spectrum disorders such as Autism, PDD, ADHD, Asperger's, proprioceptive dysfunction and tactile defensiveness will benefit from using swings as part of their therapy.
Children, who find the smooth, swaying motion soothing, will relax and unwind while using it. However, children who have a vestibular dysfunction will feel uneasy while in the hammock and might initially protest its use.

For them, hammock therapy is more about regaining equilibrium and learning to tolerate vestibular stimuli. The motion of swinging restores balance to the vestibular system provides proprioceptive input (deep pressure) and generally children feel more "in balance".



The soothing motion of swinging soothes, relaxes and increases concentration. Children who have trouble focusing on tasks such as reading or math, might find it easier to concentrate sitting in a hammock chair, their bodies engaged in a soothing motion.

Therapists, parents and teachers can use swings effectively to reinforce any therapy objectives for children and provide sensory diets for special needs children. In addition, swings can act as a strong motivator. Since all kids like to swing (special needs or not), swinging can be used as a reward for positive behavior.

 




When choosing a swing and swing apparatus it is critical to consider safety at all times.


• Adult supervision is always required at all times.
• Be aware of floor wall and head protection
• Make sure the swings are able to support the user(s).
• Children who are seizure prone may require additional precautions.
• Make sure the child has the ability to stop on their own at a moment's notice.
• The child must want to swing on their own. Never force a child to participate

Happy Swinging!


Image courtesy: makemesomethingspecial.co.uk, how-to-make-tips.com, www.novanatural.com,                                  www.dailymail.co.uk, Geoff Robinson, kidsdreamgym.com

Watch that Splint

I promise this is an interesting topic...

After the Hip Ankle Foot Orthosis (HAFO) was made for Dewunmi who had severe Hemiplegia caused by Cerebral palsy, his mom was so excited but Dewunmi did not like this extra load and inconvenience. He was cranky all through the fittings. 

"Madam I need you to wear him at least 8 hours daily and we have to be consistent because the more he wears it, the better to prevent gradual joint stiffening."

She replied, "Don’t worry, trust me he will wear it even to sleep."

"Ahh!!! No o! Madam this is not a night splint and it could be very uncomfortable, 8 hours is very ok for his age."

After a month, we noticed sores on Dewunmi’s caudal region, I immediately knew that she had ignored my instructions. The HAFO had caused uneven pressure on the caudal bony prominence which had resulted in the development of the sore.

This is why I decided to write a short post on splinting.

Splints and orthosis are temporary devices in neurology used to correct or ensure proper anatomical positioning and sometimes movement and also prevent joint stiffening and subsequent deformity especially for spastic children. It also helps to reduce risk of injury, improve mobility performance and stabilize the joint.

How do Orthosis or splints work?

They work by applying forces to the body. By encompassing parts of the body and preventing movements, muscles and joints can be stretched. Many muscles cross two joints (for example, the calf muscles cross both the ankle and knee). 

To exert stretching effect, either both joints must be held by the device or activities that stretch the joint (passive and active exercises) not in the device should be encouraged. 

Splints and orthosis can also provide stability to help some children stand and walk. 

This is the bio-mechanical explanation of how the device works. 

Materials used include high temperature thermoplast, neoprene and even lycra garments etc.

The following considerations must be properly adhered especially at first fitting and through out the day:

1. Ensure that the splints are well contoured.

2. Always maintain Anti-deformity position (proper body alignment)

3. Snugly position and tighten straps to allow blood flow or veinous return (not too tight, not too      loose).

4. If the splints are too tight or inappropriately placed, circulation is compromised.

5. If a child cannot monitor the status of the affected area, Parents should be instructed to examine the body part for evidence of muscle strain, swelling, redness or sores between straps or muscles around the region.

6. Allow motion out of the splint at periodic interval (parents should learn some passive exercises to perform at these intervals).

7. Avoid or minimize bony prominence.

Foreign Pre-formed Splints

A lot of parents prefer the foreign splints because of the materials and its aesthetic beauty but they have the challenges of “one-size fits no one”  and as such, still have to be custom-fitted by a really experienced Occupational Therapist or Physiotherapist and Orthotist.

Lastly, Orthosis are never an answer in themselves but in many cases they are an extension of the therapist’s arm while away from hands-on active treatment.

The usual trend is this, when a splint, orthosis or an assistive device is made for a child, the parents are usually excited and are consistent within the next few months or weeks, after then, they start faltering, becoming inconsistent with some even totally stopping. 

I understand this because I also see this trend in myself (with abstinence from junk food) but for the device to do what it’s made to do, there has to be consistency and proper adherence to the rules.

Image courtesy:  arthritisbroadcastnetwork.org, www.nopcoclinics.com, www.oandp.org

                            haydentrigg.blogspot.com,  www.wannatowel.com, orthoinfo.aaos.org

                            www.dailymail.co.uk, www.ncmedical.com, www.splints.co.za

Does your child have Attention Deficit/Hyperactive disorder(ADHD)?

What is Attention Deficit Hyperactivity Disorder  (ADHD, ADD)?

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

ADHD has three subtypes:

1. Predominantly Inattentive Type
   The person finds it very difficult to organize or finish a task. They find it hard to pay attention to details and find it difficult to follow instructions or conversations.

2. Predominantly Hyperactive-Impulsive Type
   The person finds it hard to keep still - they fidget and talk a lot. A smaller child may be continually jumping, running or climbing. They are restless and impulsive - interrupting others, grabbing things and speaking at inappropriate times. They have difficulty waiting their turn and find it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others.

3. Combined Type
   A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally.

What are the general signs of ADHD in children?

Children who have symptoms of inattention may:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
• Often interrupt conversations or others' activities.

ADHD Can Be Mistaken for Other Problems

Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.

The above signs may be observed in children frequently and usually do not mean the child has ADHD. It is when these signs become significantly more pronounced in one child, compared to other children of the same age, and when his/her behavior undermines his/her school and social life, that the child may have ADHD.

Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:

Autism,Learning disability,Oppositional defiant behaviour and also co-exist with sleep disorder,bed wetting,eating disorder and meltdowns.

Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.

What causes ADHD?

There is no known cause of ADHD,but possible risk factors include

Genes

Food addictives intake during pregnancies

Mercury exposure during pregnancy.

Interesting link: Possible causes of ADHD (New Zealand's ADHD Online Support Group)

Diagnosing ADHD

This could be done by  Psychologist,Pediatrician,Psychiatrist with input from an Occupational therapist.Also done through observations of the child’s behaviour in his daily routines.

Recent studies by the Food and drug Administation,US,have approved the use of EEG for more accurate diagnosis.

 Interesting links   Diagnostic Criteria for ADHD (ADHD Information Services)

Treatment
Treatment options for ADHD include
Occupational Therapy intervention in which physical,behavioural,social and cognitive goals are drawn up and addressed using therapeutic activities in home and school settings
Psychotherapy
Medications-this should be prescribed by a doctor who is experienced and knowledgeable about ADHD and closely monitored by him.

Autism.

What Is Autism?

Autism is a complex neurobehavioral disorder that includes impairments in social interaction and developmental language and communication skills and rigid, repetitive behaviors. The disorder covers a large spectrum of symptoms, skills, and levels of impairment. It ranges in severity from a handicap that limits an otherwise normal life to a devastating disability that may require institutional care. Some of the different types of autism spectrum disorders include:

• Autistic disorder. This is what most people think of when they hear the word "autism." It refers to problems with social interactions, communication, and imaginative play in children younger than 3 years.
• Asperger's syndrome. These children don't have a problem with language -- in fact, they tend to score in the average or above-average range on intelligence tests. But they have the same social problems and limited scope of interests as children with autistic disorder.
• Pervasive developmental disorder or PDD -- also known as atypical autism. This is a kind of catch-all category for children who have some autistic behaviors but who don't fit into other categories.
• Rett syndrome. Known to occur mainly in girls, children with Rett syndrome start developing normally but begin to lose their communication and social skills. Beginning at the age of 1 to 4 years, repetitive hand movements replace purposeful use of the hands.
• Childhood disintegrative disorder: These children develop normally for at least two years and then lose some or most of their communication and social skills. This is an extremely rare disorder and its existence as a separate condition is a matter of debate among many mental health professionals.

What are some of the symptoms of ASD?

There is no single symptom that would lead to a diagnosis of autism. But someone who shows a number of the following characteristics and behaviours would likely be diagnosed with an ASD:

Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms and severity vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, children with severe autism have marked impairments or a complete inability to communicate or interact with other people.

Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired.

Though each child with autism is likely to have a unique pattern of behavior, these are some common autism symptoms:

Social skills

 Fails to respond to his or her name

 Has poor eye contact

    Appears not to hear you at times

    Resists cuddling and holding

    Appears unaware of others' feelings                        

    Seems to prefer playing alone — retreats into his or her own world

    Doesn't ask for help or request things              

Language

Doesn't speak or has delayed speech

Loses previously acquired ability to say words or sentences

Doesn't make eye contact when making requests

Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech

Can't start a conversation or keep one going

May repeat words or phrases verbatim, but doesn't understand how to use them

Doesn't appear to understand simple questions or directions

Behavior

Performs repetitive movements, such as rocking, spinning or hand-flapping

    Develops specific routines or rituals and becomes disturbed at the slightest change

    Moves constantly or extremely passive

    May be fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the "big picture" of the subject

    May be unusually sensitive to light, sound and touch, and yet oblivious to pain

    Does not engage in imitative or make-believe play

    May have odd food preferences, such as eating only a few foods, or craving items that are not food, such as chalk or dirt

    May perform activities that could cause self-harm, such as headbanging

Young children with autism also have a hard time sharing experiences with others. When read to, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.

As they mature, some children with autism become more engaged with others and show fewer disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral problems.

Most children with autism are slow to gain new knowledge or skills, and some have signs of lower than normal intelligence. Other children with autism have normal to high intelligence. These children learn quickly, yet have trouble communicating, applying what they know in everyday life and adjusting in social situations. A small number of children with autism are savants — they have exceptional skills in a specific area, such as art, math or music

When to see a doctor/Healthcare Practitioner (medical Therapists).

Babies develop at their own pace, and many don't follow exact timelines found in some parenting books. But children with autism usually show some signs of delayed development within the first year. If you suspect that your child may have autism, discuss your concerns with your doctor. The symptoms associated with autism can also be associated with other developmental disorders.The earlier that treatment begins, the more effective it will be.

Your doctor may recommend more developmental tests if your child:

 Doesn't respond with a smile or happy expression by 6 months

    Doesn't mimic sounds or facial expressions by 9 months

    Doesn't babble or coo by 12 months

    Doesn't gesture — such as point or wave — by 12 months

    Doesn't say single words by 16 months

    Doesn't say two-word phrases by 24 months

    Loses previously acquired language or social skills at any age

          How is ASD diagnosed?

There is no single test that will confirm that someone has an ASD. A diagnosis is based on the number and pattern of typical characteristics and on the observation of specific behaviours and disabilities.

Someone with a mild case could go undiagnosed for years, and it might only be detected when the person goes through a crisis that brings contact with professionals who are able to recognize the disorder.

What causes ASD?

Nobody's certain. It's generally accepted that autism is a neurological disorder. Research is focusing on genetics, differences in brain function, environmental factors, viral infections and immune responses and deficiencies and still ongoing.

How is autism treated?

There are different treatment options for Autism.It may include combining one or more treatment approaches.Some of the treatment approaches includes

Dieting:Depends on child.But from experience and parents testimonies,most hyperactive kids really benefit from being placed on Casein and gluten free diet.

Sensory Integration-which tends to treat the root cause of Sensory Processing Disorder,the main foundational effect of Autism of which other symptoms results from. This important treatment approach will later be expantiated on later.

Applied Behavioural Analysis (ABA) and Intensive Behavioural Intervention (IBI), Sonrise programs are designed to actively engage children with communication, socialization, learning and behavioural problems.

I shall be taking treatment approaches one by one on this blog.

I really would love for parents to network on this blog, share ideas and opinions concerning therapies, therapists, diet recipes and other issues concerning kids with special needs.

Your feedback would be really appreciated.

To read more: Autismspeaks.org,  ont-autism.uoguelph.ca, nlm.nih.gov/medlineplus/autism

Images courtesy of  askepupdate.blogspot.com, childswork.com, effectivehealthcare.ahrq.gov,  autism.am,  specialeducationadvisor.com, bbc.co.uk