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A Pediatric Perspective

Early Intervention – What Does it Mean and Who Can it Help?
April 18, 2014 11:29 AM by Wendy Spoor-Hof
I have been working in Early Intervention for the past 10 years but I'm still surprised how many families have never heard that there is assistance for families whose children are experiencing developmental delays before they reach preschool. For those who may not know early Intervention is a part of the Individuals with Disabilities Education Improvement Act (IDEA). Part C of IDEA requires that each state has a comprehensive and multidisciplinary system in place to help families with infants and toddlers who may be experiencing, or at risk for experiencing, developmental delays in one or more of their skill areas (gross motor, fine motor, speech/language, cognitive, self-help/adaptive and social/emotional.) The Wrightslaw website  has a wonderful explanation of what "Early Intervention" is and how Part C of IDEA has been set up to help infants and toddlers who are/may be at risk. 

Numerous studies and research has shown that early intervention is important for several reasons:

  • From birth to three years of age the brain is more "flexible" and the neural pathways/circuits in the brain can strengthened by working on different strategies to help develop the skill areas that are showing delays. In some cases it is believed that the brain can even "rewire" its neural pathways with the help of early intervention.

  • Learning you have a child with developmental delays can be overwhelming at first. Families who may be struggling with not knowing what to do or who to turn to can receive guidance and support from early intervention services.

  • Having a child with special needs often means learning different strategies to help your child meet their developmental milestones. Early intervention services include occupational therapists, physical therapists, speech therapists, teachers, early intervention assistants/associates, Autism specialists, and nutritionists - all who will come to the family in their home environment and help them to better understand their child's needs and teach them the strategies needed for their child to learn to the best of their ability.

So how can you find the Early Intervention provider in your state? The Raising a Sensory Smart Child website has a wonderful list of who to contact in each state.  The National Dissemination Center for Children with Disabilities also has a page that where you can find other state organizations that will help families who have children with delays and/or disabilities.

If you know of a good resource I would love to hear about it. 



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April is Occupational Therapy Month – Celebrate!
April 11, 2014 9:32 AM by Wendy Spoor-Hof
I never set out to be part of the occupational therapy world. I started out in travel but as much as I loved traveling and helping others with their travel needs there was just something missing. The local community college offered a "Healthcare Career Awareness" night and since I knew I wanted to do something in the healthcare field I attended to see what careers were out there. It was on that night that I first learned about "Occupational Therapy" and realized that was where I belonged. It took several more years before I could pursue that dream and I haven't looked back since. As a matter of fact, as some may already know, after being a COTA/L for 10 years I've decided to return to school at the young age of 52 to pursue my OT master's degree. 

I work in birth-to-three and there are still so many people out there who don't understand what "Occupational Therapy" is. I enjoy sharing what I do and what other opportunities there are out there for OTs and COTAs. One of the moms whose son I worked with just graduated with her COTA degree. She went into the field after she became aware of what we do and how big a difference we can make in someone's life. I have another mom who wanted to go back to school now that her kids are in school and is also looking into pursuing a career in the occupational therapy field. 

So, as April is the month to spread the word and celebrate all that occupational therapy can offer I thought it would be fun to share some links on ways to celebrate OT this month:

So from me to you ... THANK YOU!!!! for all that you do as an OT or a COTA and for sharing with those you work with and come in contact with how important and what a difference Occupational Therapy can make in someone's life. 

I would love to hear how OT has made a difference in your life or in the life of someone you have worked with.  What have you or will you be doing to celebrate in April? 

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A Few Feeding Strategies for Picky Eaters
April 3, 2014 9:23 AM by Wendy Spoor-Hof
As I had mentioned a couple posts ago, I am going to share some of the feeding strategies I learned at the Feeding Seminar I attended a couple weekends ago. Although I was a little put off by some of the things that the SLP said, especially when it related to Sensory Processing, I did come away with a few really good tips that I would like to share with you.

Consistency - When I work with babies and toddlers who have trouble moving from pureed to more solid food I usually suggest to the families to try and crumble up pieces of saltines or other types of easily dissolvable crackers.  I've always liked the way the crackers can be crumbled into little bits and mixed with the baby food or pureed food. The SLP suggested that, as long as there are no allergies, a better solution to getting the puree a little thicker would be to use Wheat Germ. She suggested that although the crackers would work they don't always allow the consistency to be uniform and there are sometimes bigger pieces that might be more of a challenge when going from puree to solids. Wheat germ can be used to gradually increase the consistency of purees but without the possible unexpected lumps that crackers can cause. It is also packed with vitamins, minerals, and protein.You can also add more wheat germ to the puree until it is quite thick and roll it into small balls that the toddlers can try to pick up and eat. The small balls would still dissolve very easily once they are placed in the mouth making for a successful finger fed piece of food.

"Utensils" - When encouraging a child who has been solely tube fed learn how to begin to be an oral feeder its ok to use other things besides a spoon and fork. I have always been a fond user of the medicine cup and eye dropper to begin to get tastes into a child's mouth safely Sometimes seeing a spoon full of food heading to your mouth can be a scary thing for a child who is not use to eating. It's a little different if a small amount of food has been placed in a small medicine cup or in an eye dropper and gently "poured" into their mouth in small amounts. It's also much easier when using either one of these items to accurately keep a record of exactly how much food they are taking. 

Distraction - Distraction can work wonders!  I do not feel it is wrong to start off using distraction when encouraging children to eat. Watching a favorite T.V. program or playing with a favorite toy in the beginning is okay. We want the child to become more comfortable at mealtime and not to be stressed. It's not that a child will forever be watching the T.V. in order to eat - it's a way to help them begin to enjoy eating. For older children who may not be active eaters I've found it helps to have fun at the mealtime so it's not so much a chore. We've used a small shovel from a sand box toy to use instead of a spoon. The child thought it was so much fun to use something different that they didn't realize just how much they were eating. For older children we've used colorful toothpicks to pick up food.  My own son wouldn't eat Salisbury steak unless we used toothpicks in cut up pieces and then he would eat two helpings. 

Spit Cup/Napkin - I am a huge fan of the child being able to spit something out they may not want to eat.  I know I have shared this before but it bears repeating.  Think of the one food that no matter what you do with it you just cannot bear to eat it - to swallow it.  When you have a child who doesn't want to eat it could be for a number of causes. Many children have experienced pain due to acid reflux and don't want to go through that pain again.  Even if they are now on medication they still remember eating being painful. the best way to get them to gain trust in eating again is to allow them to taste the food without the fear of having to swallow it.  This can be done with allowing them to spit into a cup or to spit into a napkin. 

At dinner time you would use the same cup each time or use the same colored napkin. This is a cue to the child that when they sit down to eat they can feel comfortable knowing they won't have to swallow.  It won't mean that they will always spit out all their food. What it means is that they will be so much more willing to lick the food or take a bite of the food because they won't have the fear that they will have to swallow it and feel pain.  At first they may just take a bite and spit it out right away. After a couple times they will take a bite and hold it in their mouths a little longer before spitting it out. Eventually they will take a bite and chew it a couple times and then spit it out.  Before you know it they will be taking a bite, chewing, and swallowing it. 

It takes a little patience but I have allowed a spit cup to be used since my kids were young. We moved to a spit napkin when they got older so it was more accepting when they were out. To this day, my kids are now 14 years-old and 20-years-old, I can present them with any type of food and they will take a bite. I can't even begin to share how many different foods they've tried and come to like thanks to this method. Just the other night my 14-year-old tried the green beans at dinner that I cooked a new way and actually asked for seconds!  If there is no fear of having to swallow children are more likely to try new foods...or to even sit and try eating at meal time.

These are just a few strategies that may be worth trying when it comes to working with picky eaters. The first thing should always be ruling out any underlying medical issue that may be causing the child discomfort or pain when eating. The last thing we want to do is set up a feeding plan that is sure to fail if the underlying cause of the "pickiness" is due to a medical issue. 

Have you found one strategy that works well with the picky eaters you work with?  Is there something you have used that helps to encourage your picky eaters to enjoy mealtime more?  I would love to hear about them and share them here.

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Life Update
March 28, 2014 9:00 AM by Wendy Spoor-Hof
I know last week I had mentioned that I would be sharing with you some tips I learned at the feeding seminar I attended a couple weekends ago but I'm afraid I will have to share those at the beginning of next week with you.

One of the hazards of working in pediatrics - especially when you go from house to house - is that you often will catch a cold or, in my case last week, the flu. Even though we ask our families to cancel their visits if the child we are seeing or anyone in the house is sick, it doesn't always happen. I can't complain too much as the last time I was this sick was probably 5-6 years ago. This past week though I missed work and was in bed with fever and aches and even after they had subsided about mid-week- I was so totally knocked out and left dealing with nausea.  I finally started feeling better mid-week and have been back to work but playing catch up with all the paperwork and reports due and my weekly blog here.

I will have for you at the beginning of next week some interesting tid-bits I picked up from the feeding seminar.  Also a few reminders of strategies and techniques because it doesn't hurt to have a reminder here and there just in case it's one we may have forgotten or don't use any more.

The other little thing I wanted to share is that I have made up my mind, and made the commitment, to return to school and get my OT Masters degree. I will start at the end of July with an English class on report writing (hello MLA my old friend). And then start full time on the weekends come October. I am very excited and a little nervous but after I weighed the options with my family we all decided it would be best for me to return to school.   It will open more doors down the road (as one thing I would like to do is teach eventually.) I know it will have its challenges but I'm sure there will be many rewarding things happening during the next two and half years as well.  I will share how things are going along the way. Wish me luck!

In the meantime, please accept my apologies for not having the feeding information I had promised this week.  I hope everyone is staying healthy and has a wonderful weekend.

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Feeding Intervention Strategies
March 21, 2014 10:36 AM by Wendy Spoor-Hof
I attended a workshop this past weekend on feeding intervention strategies for infants with special needs.  It was offered by our local state education resource center. The person who was giving the talk was a SLP who has been working with children and doing feeding interventions for many, many years.  It was overall a good workshop but there were a few things that, as a COTA, I didn't agree with. I will preface this by saying that she did admit she wasn't completely knowledgeable when it came to sensory processing information.

The first thing that struck me as not quite correct was when she was talking about children who were tube fed from an early age and had very little, if any, oral motor food intake. The SLP stated that these children start off with a sensory aversion and need to be slowly introduced to oral sensory stimulation before they can begin to be introduced to food.  I do agree that sensory input without food should be done first but I do not agree that this is a "sensory aversion" that the children are stating off with.  In my opinion, and from what I have learned, this is a "food aversion".  The children have never had the chance to taste any type of food at all so how could it be considered sensory?  At this point we don't know if they are going to have trouble with textures or tastes so how can we classify it as "sensory", right?  It is food that they are averse to - all food - regardless of its shape, taste, color, texture.

The second point she made which I wasn't on board with was that she felt nuk brushes and the rubber teethers shouldn't be used when working on oral motor input and increasing jaw movement.  She felt that a child needed to completely close their mouth in order for them to get the most input and that the rubber teethers did not allow them to do that.  She felt that using a toothbrush worked best. I have worked with children for over 10 years and have found both of these items to be extremely helpful.  I would also think that when working with a child who is just getting use to oral motor input one would not necessarily want to use a toothbrush as the bristles could be a bit off-putting for most kids.  I've found the nuk brush and the rubber teethers to be gentle but firm and offer good input when it comes to closing down on them.  I particularly like the nuk brush because when you get to the point where the child is beginning to be accepting of taste you can dip it into juice or baby food and offer it as oral motor input with taste.  I've found most children are very accepting of this and it's a great prelude to getting them to begin to take baby food.

Lastly she shared that one of the methods she uses when a child is learning to eat and starting to find the balance between intake, swallow, and breath is "shoveling" the food in.  She will do it in steady quick movements so the child will get use to having the spoon rhythmically going in and out and thus learning to get into a rhythm of closing their mouths on the food, swallowing, and breathing.  I can honestly say that I would be a bit nervous about this method only because I have found that if I increase the texture or the taste (depending on where the child's level of food acceptance is) I can help them to be aware of the food in their mouth and also get into a rhythm of "oh, there is food in my mouth" swallow, and then breath.  I would be nervous that if I shoveled the food in, even in a steady rhythmic pattern, the child might become overwhelmed and become uncoordinated with their swallow/breath rhythm and aspirate. 

I know we all have our own tried and true methods that we are comfortable with working on.  I enjoy going to workshops to learn of other methods that have been found to work.  As therapists it is our responsibility to be open minded when it comes to "new" ways of trying to get our kiddos to eat but it is also our responsibility to pick and choose what we feel comfortable doing and to question those techniques we aren't sure about.  Just because it might work for someone else may not mean that it will work for us - especially if we may not feel comfortable doing it.

As I mentioned this workshop overall was a good workshop and next week I will share some the new strategies I will be trying with my families.  In the meantime, what are your thoughts on food aversion vs sensory aversion, shoveling vs increasing taste/texture, and nuk brushes/teethers vs toothbrushes?  What techniques have you tried that have worked, not worked when it comes to helping a child who has been tube feed begin to accept and enjoy eating?

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Sensory Processing Evaluations
March 14, 2014 10:11 AM by Wendy Spoor-Hof

Recently I was asked by a team member to do a Sensory Profile evaluation on a young boy who was "bouncing off the walls" and stuffing handfuls of food in his mouth before he would start to chew and swallow it. It sounded like a little guy who was doing some sensory seeking as far as his vestibular or tactile systems might be concerned.  It also sounded like he was experiencing some oral under-awareness when it came to his eating skills. The funny thing is that when I did the Sensory Profile with his mother he came out just at the end of the "normal" range for vestibular/tactile and right in the middle of "typical" for oral motor.

I can't say as I wasn't surprised with the oral motor section because nowhere in the questions did it ask if he was "stuffing" his food or anything even close to that. The one question asked was if the child was aware of food that was left on his lips (he wasn't.) The other questions he scored well in because he wasn't licking or chewing on everything just on a few things. He wasn't mouthing any objects more or less than a typical toddler his age.  He drinks from a cup and he will eat a variety of food. He will stuff most of that food in his mouth all at once, but he will try anything and eat most textures and flavors.

It was really frustrating because he is getting ready to transition to the school as he is turning three soon and our Birth-to-three services will stop. I wanted to have an accurate picture of his sensory needs as support by and the schools will often ask for a Sensory Profile. I told the mom that I would be happy to write up the results of the Evaluation but I thought that would not be fair to them. We discussed how it would show there were no sensory concerns but that we both knew that wasn't true. In the end we decided that I would write up a summary of his sensory needs based on my clinical judgement so I could make note of his food stuffing.

So my question to my fellow therapists out there - Have you found anything besides the Sensory Profile that can access how a child is doing with regards to sensory integration?  Is there a tool you use besides clinical judgement and the Sensory Profile to assess sensory processing challenges in the children you work with?  I would love to hear your thoughts on what works and what doesn't work for you.


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Oh, Look, a Squirrel!
March 10, 2014 1:28 PM by Wendy Spoor-Hof
My youngest son was diagnosed with ADD (Attention Deficient Disorder).  For those who aren't familiar with ADD a conversation can go something like this:

Me:  "Hey bud, how was school?  Do you have any homework?"

N:  "Good. I don't think so. I'll check. Can I have a snack? I'm starving. Jay said something funny today in school. Did you watch American Idol?  Who was your favorite? I really like this car picture. Wow did you see that bird at the bird feeder? I need my shirt washed."

Me: "Can you check your agenda to see if you have homework please."

N: "OK." (heads towards where he left his backpack) "Can you put an extra drink in my lunch tomorrow? Is tomorrow a gym day? Did you watch American Idol?  Did you see where I put my phone? I have to climb this weekend for that fundraiser. Alex is going to help me. Can I stay longer this weekend at the gym? I really need new climbing shoes."

And this can continue for quite some time unless I can reign him in and get him to focus on just his homework.  It's not that he is trying to avoid it. He honestly gets distracted by what he might see (bird at bird feeder, lunch bag near his backpack) or hear (TV commercial for American Idol), or remember (climbing for fundraiser this weekend) and whether he has homework or not is completely forgotten.

I won't even share how many times we've headed for school only to turn around because he forgot to put his lunch, or homework, or gym shorts, or phone ...   in his backpack. It didn't matter that I may have reminded or asked him just seconds before we headed out the door to make sure he had any of those items. Something came along and distracted him before he made it to check and he ended up leaving without it.

Thankfully there are strategies out there that can be used to help keep children like my son on task. Some of the strategies we use are:

  • A check list at the door before we walk out listing what we need (lunch, homework, gym clothes, etc.). The list can be a paper one or written on a white board. The important thing is to make sure the items can be checked off or crossed off once they are done. This also helps to know what needs to be done next.
  • A homework area that is clutter free to eliminate as many distractions as possible.
  • One thing we added to N's desk is a timer. This helps him to stay on track with how long he is spending on each assignment. He also likes challenges so we try to offer him enough time to be successful but that will also give him a chance to finish his homework before the timer goes off. If he doesn't finish in time he will put that assignment down and go to the next one, coming back to it later with more time on the timer. This does not work for a child who may also have anxiety issues as they will spend more time being anxious about finishing than they will doing the homework.
  • Along with the homework chart a behavior reward system works well as children love to be praised and rewarded for their good deeds. There are numerous charts that can be used but it's best to check to see which one is more appealing to the child who will be using it. A couple examples of charts can be found here, and here, and there is even an iReward chart app here (for those tech savvy kids.) They can also be found at most office stores. When we started this my son was offered a reward of extra allowance or a fun activity or meal out. More often than not he chooses to do a fun activity or have a meal out. This is lovely for us because it means more one/one time with him. J So we all get rewarded.
  • We have also taught our son to make a list during the day on his iPad or in his notebook of things he needs to do before he forgets them. Most children have an agenda once they get into middle school and high school and they can keep notes of what they need to remember for the next day in their along with their homework assignments. If you are working with a younger child you can make a photo check list of most forgotten things (school picture day, signature needed on permission slips, after school activity, sports sign up) and they can circle the things they want to remember to talk to you about when they get home.

One final strategy that I find most helpful is allowing myself time to walk away or to count before I react. This can be hard when I am watching the clock in the morning and knowing that he has only so many minutes to get out the door or he will be late for school while getting frustrated that he has yet again, for the 3rd or 4th time, gone upstairs to get this watch or his school ID and has come down with everything but the item he went up there for. I know my words of upset can ruin his day and I try hard to keep that in mind as I circle the dining room table one more time.  As a last resort I will go up there with him and challenge him to find it before I do (which usually results in me standing at the bedroom door asking him to look in the direction where it is "hiding".)

These are a few of the strategies we use. Have you found any that work well for your children or children you work with?  I am always looking for ways to help my son and the kids I work with stay organized and on task.  I would love to hear what works for you. 

(On a side note - I can understand how my son and children with ADD feel at times because I am so that person who walks into a room and can't remember why they went in there and stand there trying to remember until something catches my mind and reminds me or distracts me.  I'm also the person who will start cleaning in one room, take something from that room to where it belongs in another room and then realize I need to clean or pick up something in that room.  I then bring something from that room to another room and begin the cycle again.  By the end of the day I end up with the rooms in my home only half cleaned.  So yeah, I've been there too, how about you?  J )



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Finding Their Nitch
February 28, 2014 8:44 AM by Wendy Spoor-Hof

I think one of the hardest things about being a parent of a child with special needs is watching them as they struggle to find their footing in the "real world."  Many of our kids have challenges that prevent them from being able to participate in the same activities that their peers participate in. When they are younger this may not seem to make too much of a difference but as they get older the differences between what they can and can't do tends to stand out more. They watch as their peers are doing things they can't do and they work on trying to find their own niche in the world - someone that they will be accepted and feel like they belong.

My son has several learning disabilities that cause school work to be a challenge to him but, if that was all he was challenged by, it may not have made too much of a difference with regards to being able to keep up with his peers. Unfortunately my son also has a rare health condition where his body is not able to regulate its temperature when he exerts himself during activities. This basically means that he is not able to fully participate in any sports activities. He can do most of what is required of him in gym class but when it comes to an organized sport such as baseball or soccer it, he is not able to participate. This may not seem like a big deal but at a certain age the friendships are less made over video games and matchbox car collections and more over what sports you play. In middle school you begin to hang out with the kids on your sports team. When you can't play sports, and you LOVE sports, this can be very difficult.

There are still after school activities that many non-sporting children will turn to and gain friendships from but when you have learning disabilities on top of the health challenge the last thing you want to do is be on the yearbook staff or any other after school activity that requires you to have to plan or organize or write. For my son he wanted something that required him to do something physically and allowed him to a part of a competitive team.

I've worried about my son as I've watched the friendships from elementary school fall away as these friends became more involved in their sporting teams.  I've worried as I've watched my son try to find where he "belongs" and where he can be accepted for what he can do, instead of what he can't do.  And then something surprising happened. Something I never would have expected my son to stick with, let alone find it to be his niche.

Last year an in-door rock climbing gym opened in a neighboring town and it wasn't long before Central Rock Gym became a valued part of our life.  My son finally found not just a sport that he can do without getting overheated but also sport where he was not just accepted but welcomed into with open arms.  He joined their team and will be participating in rock climbing events this year.  He has made friends with climbers not just his own age but also a few years older than him.  He loves going there and we joke that he would live there if he had the option.  He has become so familiar a part of the gym that he is now even helping out with some of their climbing events. 

This may not seem huge to some parents out there but when your son typically will not say "boo" to the person next to him if he hasn't known him for years - hearing that he wants to help out at an event that will require him to talk to people he doesn't know is huge!  What's more is that my son, who rarely cracks a smile out in public can more often than not be seen smiling and laughing with his fellow climbers.  He will even go in early before team practice to hang out with some of the other climbers or practice a particular skill.  What means even more to me is that he will ask other climbers to help him or help other climbers without hesitation.  Again - huge!  This was a kid who never felt comfortable going to or talking to someone other than his immediate family. 

I know how hard it is for us parents, whether your child has special needs or not, to watch as they find their way and find a place to call their "own." I never would have thought it would be rock climbing for my son and I can only suggest that to all the parents that are out there and are in the same boat I've been in - look beyond the typical groups and activities that all the other kids do and see what else might be out there to join. A few things that come to mind, that are accepting and accommodating of our children with special needs, are Boy Scouts/Girl Scouts, bowling (there are teams and competitions, just check with your local alley to see what they offer and they offer special needs accommodations too), rock climbing, local drama clubs (not just for acting but there is a so much that needs to be done backstage such as painting and building, following lines, wardrobe, etc.), and gymnastics (great to develop motor skills but can also often accommodate special needs.)

 I know this is a small list but I will gladly add to it. Do you have a place where your child has been able to find their niche?  Is there a group that has made a difference in your family's life?  I would love to hear about them and be able to share them so other families would also know about the options that are out there. Here's to helping all our children find their niche in the "real world". 



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The Many Benefits of Music Therapy
February 21, 2014 9:39 AM by Wendy Spoor-Hof
 Music speaks what cannot be expressed, soothes the mind and gives it rest, heals the heart and makes it whole, flows from heaven to the soul.  ~Angela Monet

When I say "Music Therapy " what immediately comes to your mind?  Do you picture children sitting in circle time singing songs and doing the hand motions that go along with it? Or do you picture a person playing a guitar and singing to children who are seated at their feet listening and rocking back and forth to the music?  I'm sure there are many who aren't in the therapy field who see just that but music therapy is so much more and it's a shame that it is not recognized as such by the majority of our insurances.

Working in Birth-to-three we see many children who respond to songs.  Children who may not want to work on range of motion or fine motor skills with toys will move their hands and arms to Itsy Bitsy Spider and Wheels on the Bus. When you think about those songs and the movements you realize that they work on both range of motion and fine motor skills.  But to the child it isn't "work" because it's music! 

Fine motor isn't the only area that can be worked on through music.  Gross motor skills are improved with each pull to stand to swing to the music.  Balance is improved with the rocking to the rhythm of the song.  Songs like Ring Around the Rosie and Head, Shoulders, Knees and Toes all work gross motor skill areas. YouTube has a list of songs that can help with gross motor skills.

Many children even learn to "sing" before they learn to talk.  We sing to children right from the moment we hold them.  I know my first song to my sons was "You Are My Sunshine" when they were being rocked to sleep.  As they were growing up I'd sing all the nursery rhymes with the hand motions to go along.  We learn to sing the songs and then to start leaving out a word here or there to see if they would fill in the blanks.  Because they had heard the song so many times they would often fill it in.  Old McDonald had a Farm is often an introduction into animal sounds, which can lead to spontaneous words when you later ask "what sound does a cow make?"  Rice University School of Music has an excellent page outlining all the reasons why music and singing is important to children.  

For some very involved children music is what brings the smile to their faces.  When they hear a song either being played in the room or sung to them you can feel a connection being made.  Children who can't speak or who can't move much can still "feel" the rhythm of the music.  One little girl I work with who is very involved will brighten up with smiles and try to rock her body when we start singing.  We have been trying to work with her insurance company to understand how important Music Therapy would be to her but at this time they are not seeing the importance of music to her therapy needs.  It's a shame but it's something we hear very often when talking with other Birth-to-three families and pediatric companies.

I am happy to say that there are many hospitals that are now reaching out and accepting more options to help their patients.  Here in Connecticut, Connecticut's Children's hospital (CCMC) in Hartford has a program called "ArtReach" which offers music, dance, and art therapies to help with the physical and emotional well-being of their pediatric patients. Yale Children's hospital has Child Life services which offers art and music therapy.  They also offer massage, yoga, and Pilate's services to help with their patient's mind and body well-being. 

It is important for all of us to promote other types of therapy options to our families and to try and show the insurance companies the important impact it can make to the children we work with.  One day perhaps it won't be such a big fight to get these "alternative" therapy options paid for by insurance so more children will be able to reap their benefits.



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Sensory Fun With Snow and Ice
February 14, 2014 10:28 AM by Wendy Spoor-Hof
 As COTA who works in Birth-to-Three a lot of my time is spent on driving to/from my visits. I love driving because I get to see so many cool things.  The other day when I was driving home I passed a church that had a sign in the front of their yard that read: "Whomever is praying for snow please stop!"  I actually laughed out loud.  I've lived in New England most of my life and am quite use to the snow but I can understand how, for families with young children, it can be exhausting.  I'm sure by now the kids are climbing the walls wanting to get out and play but where I live that hasn't been possible because of how cold it has been.  This doesn't mean though that you can't still have fun with the snow.  Join me as I share some fun sensory play you can do with snow and ice.

Just because you can't get the kids out in it doesn't mean they still can't enjoy it in the house.  Two things I have done both with my own kids and with kids in daycares I've visited and worked in are:

  • Snow day indoors - bring the snow inside and place it in a sensory table or large Tupperware container and allow the kids to use their summer beach shovels and pails to play in the snow. You can even color the snow with washable markers (just stick them in and the color will diffuse right into the snow) or use a Kool-aide mixture and spray bottle to paint the snow (this can also be done outside if it's a nice day)

  • Make edible snow ice cream - this is best to do when it is the first snow fall that day and there is no chance of anything getting into the snow (salt, sand from plowing, animals running around in it, etc.).

  • Snow Glass - If you know there is going to be snow heading out, a couple days before fill balloons with colored water and freeze them. Before going outside for the day "pop" the balloons and take out the frozen circles of colored ice. Place then in a container and go outside with them. You can hide them in the snow (but leave enough for the kids to see a little of the color) and have a scavenger hunt. You can do it by asking "who can find the green snow glass?" or you can just give each child a pail and have them go on a "colored egg" hunt. You can use food dye or Kool aid packages.

  • Frozen Bubbles - This is one activity that will have to be done by an adult outside while the kids are inside if it's a daycare activity as most have restrictions on what temperature it can be before children are allowed to go out and play. You will need a very, very cold day and a bottle of "bubbles". Go outside and blow bubbles and watch as they freeze and fall to the ground. If you blow them over snow they will fall and remain intact. You can blow several, gently collect the snow around the bubbles and the bubbles and bring them back inside for the children to explore.

  • Frozen Ice Captures - This is another fun balloon activity but if you don't have balloons you can use plastic cups. Fill the cups with water and add anything that kids can play with safely. Some fun things are glitter, sparkles, food coloring/Kool-Aid coloring, small plastic animals, small blocks, colored string, etc... The list is only as limited as your imagination. Add different things to several balloons or cups and freeze them. The next day take them out and pop the balloons or overturn the cups to get the ice out. The kids will then have fun holding, playing with, manipulating what has been captured and frozen in the ice. Best to do this in a sensory table or large Tupperware type container.

  • If you or the family you are working with is adventurous they can place snow in the bathtub and allow the kids to either lean over the tub and play or get into the tub after putting on snow gear and play. The cleanup is easy - drain the tub after the snow melts.

These are fun sensory ideas to help make a snow day pass along quicker.  The children have fun touching and holding cold snow and ice without having to be out in the cold. It can also help to get them more willing to go outside without being sensory defensive with the cold and/or snow.

Have you done any other types of snowy/icy play with your kids?  What have you done and did they like or dislike the activity? 


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What Do You See?
February 7, 2014 11:02 AM by Wendy Spoor-Hof
The picture is one that is being shared on Facebook with the caption: "Some see Down Syndrome; some see Pit bull... we see the best tea party ever!"  I honestly saw neither - what I saw was two best friends playing together and my heart melted.  It wasn't until I read the caption that I looked closer and saw the facial characteristics of Down Syndrome and noticed the puppy was a Pit Bull. 

And then I got to thinking. . .How sad it is that people so often do just that. They look at a child with disabilities and see just the disability and not the true child.  I can't even begin to tell you how many times I have worked with a child and heard from their parents that they've been told their child will never walk, or talk, or any number of other things. And my heart breaks for them. How can anyone really know what any child is capable of doing?  Yes, there are some disabilities that doctors can predict the outcomes for quite accurately but there are others, especially the rare ones that there is just not enough information on, that they can't possibly know what the child might or might not be able to do. And there are some that have a range of abilities. Until any child starts growing and developing I don't think we can predict what they are or aren't capable of achieving.

And that is what I share with the parents.I tell them I don't want to give them false hope but that they should follow their hearts and watch and follow the cues of their child. I share how I've worked with many children who were not supposed to walk, or say "mama", or do any number of things and who have had their own agenda and have surprised the doctors with their determination and development. I advise them to stay off the internet because all too often all that is shared on the internet is the worst case scenario. I've often felt we need to set up a bragging website for each of the disabilities that is out there - if for nothing else but to give a little hope because a little hope can go a very long way.

I think one of the saddest things we can do is put limitations on our children and that goes for whether they have disabilities or not. One of the favorite stories that I share is how my youngest son wanted to do everything his big brother (who is 6 years older) did. So when his big brother played baseball and hit balls pitched to him, my youngest son wanted to do the same. It didn't matter that at his age he should be hitting off a Tee - he wanted the balls pitched to him.  So we did what he asked and Nick learned how to hit a ball pitched to him. When he was old enough he joined T-ball and one day they were practicing with the Tee and he kept missing. We asked the coach to please pitch the ball to him. The coach looked at Nick, looked at us, and said "He is too young to be able to hit a ball pitched to him.  e doesn't have the eye/hand coordination yet to be able to do that."  We finally convinced him to just try it.  Sure enough, the second ball that was pitched Nick hit and he hit it hard.  It went right over the rest of the players' heads. The coach watched the ball sail away and then looked at us and shook his head. I shrugged my shoulders, smiled and said "Sorry Coach, guess we forgot to tell Nick he couldn't hit a ball that was pitched to him." The coach just laughed. And Nick continued to hit those balls.

As a pediatric therapist, I try to look at the children I am working with and know what their restrictions, what their limitations, might be but I don't stop there. I try to push a little every now and again to see if they have the determination and the heart to move a little further than what is expected of them. If we only see what a child can't do and only work within those "limitations" how will we ever get to see what they might be able to do?  What they are capable of doing?

With that said, please know that I try not to give false hope but I believe there should always be some hope.  Maybe they won't walk but can they maybe scoot on their bottom?  Or maybe roll all over the room to get to what they want?  Maybe they can't say "momma" but can they sign it? Can they look into their mom's eyes?  As a pediatric therapist, I think my job is not just to know what a child might not be able to do because of their disability but to see beyond that. To see more than just the disability.

So tell me, honestly what did you see?  A child with a disability playing with one of the meanest dog breeds out there?  Or did you see a child and a puppy enjoying tea together?

Dyslexia is Not a Gift
January 31, 2014 10:55 AM by Wendy Spoor-Hof

I've always said that if I was going to write a book about my son's struggles with Dyslexia it would be titled "Dyslexia is not a gift." I know that the belief behind dyslexia being a "gift" is that it allows those individuals who have it to look at the world in a different way and be able to use skills they may not have otherwise used if it weren't for the Dyslexia. Now that is a very good way to look at it - when you're an adult - but not a good way when you're a child struggling to fit in and praying every school day, in every class that you won't get called on to read.

When my son was in preschool, I began to notice that he was writing several of his letters backwards and mislabeling those letters (b was d, q was g, E was 3). I was concerned about the possibility of him having Dyslexia. I would bring this up to his teacher's attention and was told it was "typical at that age" and to "give it time. I brought it up again in Kindergarten and was told the same thing, "give it time."  I volunteered in his Kindergarten class on a weekly basis and would notice him listening eagerly during circle time until it came to the letter recognition and simple math they would do at that age. I watched as his peeked interest would go from bright eyed and excited to turning and looking out the window. I mentioned this to his kindergarten teacher (who was new) and was told that he was just being "lazy." She felt that when the work got too hard he just couldn't be bothered to do it. I never believed this for one moment but felt maybe he did just need a little more time.

And so he was given more time and I brought it up to his 1st grade teacher, his 2nd grade teacher, and each time I would hear those words over and over until he was in 3rd grade and falling behind in anything that had to do with reading and/or math. I asked for him to be tested for Dyslexia, as I was sure he was showing all the signs of having it, but was told by the school that they do not test for that.  They would offer him reading help but when I asked if it was "research based" I was told it wasn't but that the program they used was shown to be effective with their students who fell behind in reading.

So I watched as my youngest son who loved going to school, and would go eagerly each morning, came home every afternoon looking like he had just battled all the WWF wrestlers he loved to watch. We worked on his homework and he struggled. Words he had known at the beginning of the assignment he would forget by the end of it. Our nights turned into nightmares as he felt stupid and couldn't understand why everyone else "got it" but he didn't. I lost my patience more times then I care to admit.  Gift?  No, not by any stretch of the imagination was what my son had to go through a gift. 

To make a long story short we paid to have the testing done. Took money out of our retirement fund and paid a Neuro-Psychologist to test him over a couple days' times. We were not surprised when his test results showed he had a fairly moderate case of Dyslexia that resulted in impaired reading and math skills. With report in hand we went back to the school. It took a year and the threat of bringing in our lawyer before he was offered the reading help he needed. 

He started the Orton Gillingham reading program in the 4th grade and continued it throughout elementary and middle school.  He made really good progress and is age level with his math skills but he still struggles with reading and I can't help but wonder how much stronger his skills would have been if he had received the intervention earlier on rather than later. 

The sad thing is that our story is not an exception - our story is being played out in schools all over the states.  It is believed that 1 in 6 children have some form of dyslexia. Very few of those children are getting the research based reading program help they need to become good readers. Many children give up and feel "stupid." They are the ones who start acting out and causing trouble because they would much rather be thought of as the class clown or class trouble maker than they would the kid in class who can't read. And if they don't have the parent support at home and the school isn't required to test for Dyslexia and offer the appropriate intervention then they often become the kid that drops out.

I'm sharing this with you because recently Rep. Bill Cassidy (R-La) has introduced a House Resolution (H.Res 456, 113th Congress) that is "calling on schools and State and local educational agencies to recognize that dyslexia has significant educational implications that must be addressed."  H.Res 456 is asking that Dyslexia be recognized and the right research based interventions be put into place to help those that have been properly diagnosed.  The Resolution points out how significant this issue is (1 in 6 children) and that it is proven early intervention can help these students to be better equipped to handle the struggles associated with Dyslexia when the proper strategies are put in place. 

This Resolution is so important that the Yale Center for Dyslexia and Creativity is asking the community to reach out to their Congressional Representatives and ask them to please sign this Resolution.  Their website is providing the contact information for each State's Representative and even a sample letter to help you know what to say when you contact your Representative.

Dyslexia is not a gift. Not to a child struggling with it, not to the parents trying to get their children the help they need. Not to the Therapist and Special Education teachers trying to work with the students without having the right interventions available to them.

So if you have a few moments, please take a moment and write to your local Representative and ask them to vote for H. Res 456.  My son and I would greatly appreciate it - as would 1 in 6 students who struggle with it every day. Thank you.



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COTA/L to OT/R – Decisions, Decisions
January 24, 2014 9:39 AM by Wendy Spoor-Hof
On a personal note, I have been working at a COTA/L since 2003 when I graduated from Bay Path College's weekend COTA program.  It was a wonderful program that allowed me to work full time and attend college on the weekends.  It was hard work but with the support of my family I was able to do it.  Did I mention that I was doing it at the age of 41 after already having worked in the travel field for the past 20 years?  It took me a couple years to get up the courage to go back to school and I have never regretted that choice and love working as a pediatric COTA but I am coming to another fork in the road and have to decide which direction I want to go in.

As much as I love being a pediatric COTA in the birth-to-three field I can't help but feel that I might be even more valuable to the company I work for and to the therapists I work with if I was to become a OT/R. As it stands right now my case load and the territory I cover is quite large as I'm the only one who services the occupational therapy needs in our office. I'm able to do this because COTAs are not allowed to do evaluations so I have the room in my schedule to see more children. However, this leaves the lion's load of the evaluations that are referred to us with motor concerns to the PT in our office to cover.  If I was to get my Master's degree I would be able to take some of that load from her.

So I am at that fork in the road...  trying to decide what would be best for me, my family, and my job.  I have been accepted into the COTA to OT Master's degree program at New England Institute of Technology.  It's a weekend program just like my COTA program of study was at Bay Path.  What's nice about this program is that it is every other weekend at the college and then on-line study in-between.  Quite doable for a full time working mom like myself.

But I am now 51 and I have to figure in the cost of the 2.5 years of study and weigh it with what the pay increase may be.  As I am not independently wealthy or have a wealthy family member who may want to sponsor me I will need to take out loans for what financial aid won't cover.  Do I want to have to go back to paying back a student loan again?  On the plus side there would be more opportunities for me to work as a pediatric OT/R than there are as a pediatric COTA/L.  On the negative side it would mean going back to studying and research papers and classwork assignments and all the fun things that come from being a student.  On the plus side, once both my kids graduate from high school we could look into working overseas where there is more opportunities for a OT/R than there is for a COTA/L.

Decisions, Decisions. . .

Has anyone else made the move from COTA/L to OT/R?  If you have, are you happy you did it?  If you haven't, do you wish you could do it? 

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Revised MCHAT Screening Tool for Autism
January 16, 2014 11:29 AM by Wendy Spoor-Hof
The American Academy of Pediatrics recommends that all children receive autism screening when they are 18 months and again when they are 24 months old. Healthcare professionals have been using the MCHAT to do this screening and although it was a good screening tool there was concern that it too often flagged children as being at risk for Autism. No screening tool is perfect but this one helped to identifiy children who might qualify for more intensive early intervention services due to being at risk for Autism. 

This past December the MCHAT was revised to improve it's accuracy. The tool is now called MCHAT-R (Modified Checklist for Autism in Toddlers - Revised.)  his tool will now show whether a child is at "low", "medium", or "high" risk for Autism.  There is also a "follow-up" part to this new screenining tool.

Autism Speaks also has an elecronical version you can access on their site here and they are offering the the Follow-Up Interview part as well.

The Official MCHAT website has a free downloadable version that can be accessed in numerous languages.

Has anyone started to use this revised edition yet? What are your thoughts on it? My thoughts are that if it is going to be better at screening the risk factors I'm all for it. Even if a child may show a "low" or "medium" risk it will alert the parents to the fact that there may be something else going on with their child even if they are not at a "high" risk for Autism.  This may help get more early intervention help for the child and the delays they may be showing can be addressed.

What are your thoughts?

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Helpful Apps for Vocalization Practice
January 10, 2014 9:52 AM by Wendy Spoor-Hof
As I mentioned in last week's blog a new pilot study has that found children with autism had increased vocalization with the help of augmentative apps used on iPads.  It is believed that because the augmentative apps are saying the words the children are hearing the same way each and every time the children hearing those words are better able to repeat them.  What is nice is that more and more families are able to afford tablets over augmentative devices as they are less expensive and easily available.

As I mentioned last week I would like to share some of the more popular augmentative apps this week.  A few that I have heard children enjoy using and have been found to be useful by therapists are:

  • Articulation Station - good for early sounds
  • Pocket Artic - over 300 cards (1000 at each level)
  • Webber Photo Artic Castle - practice articulation skills at the word, phrase, and sentence level
  • ArtikPix - flashcard and matching activities for children with speech sound delays
  • See.Touch.Learn - Designed by professionals specifically for those with autism and other special needs.
  • Tiga Talk Speech Therapy Games - "is a fun way for children to develop speech sounds through playful voice-controlled games that can improve speech clarity, articulation, and instill confidence."

These are a few of the apps that are available and have been found to be useful by therapists for helping children who are delayed in learning how to vocalize.  As I'm sure everyone is aware there are more apps out there but these are the ones that come up the most frequently on everyone's favorite lists.

Have you had any success with a specific app when it comes to working with children with speech delays or with children on the Autism spectrum?  I would love to hear which ones you have found useful and which ones have not helped at all.



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