Dyspraxia an overview

This slide comes from a facebook page, they also include dyslexia, dysgraphia. I found this quite helpful to understand dyspraxia. 

it's all about motor skills

Now I know it's been some time since I have posted it seems having two children with things going on for them has made me one very busy Mum. Anyway so this year when I took my 4 year old to the pediatrician it was a shock and to be honest I never thought it was as bad as they said it was. He come up quite badly apparently my son who was 52 months old was coming up at around 36 months in four areas which is a far cry from where he should have been. Even now 5 months later it still brings tears to my eyes. 

What brings me to this post is my recent investigation into what dyspraxia and motor planning mean, surprisingly looking back I even see it written in my eldest child's OT reports. When we took my 4 year old to a second paediatrician yep I wanted a second opinion. We did feel that the report was rather short and there wasn't enough information. The paediatrician discussed his concern about his motor planning skills. It was evident because he struggled to work out how to get onto the bed, and even drawing a person was hard work for him and he looked at me and said "I can't do it Mum" as reassuring as I could be I told him that "just try, do you best" this made me fall apart on the inside. 

Hearing that the paediatrician believes that he's going to find things hard, school will be hard,  all the things that you do at school cutting, drawing is going to be tough for him, not every day just some of them. Honestly you want your children to do their best, but seeing my boy look at me and say I can't do it and knowing that in that moment he couldn't. I thought back to all the mornings and even this morning where he struggled to get dressed, even tonight it was a major drama. It's hard work but I realised that it is harder for him, sometimes he can't do it and I know that sometimes we tell him off even though we didn't know at the time he couldn't. Hindsight can be painful. 

Once we got home and I started thinking about what he the paediatrician, I was then worrying about everything does he mean dyspraxia how bad is it, what does it really mean? So researching I found some information first in Raising a Sensory Smart Child on page 202 it says that "motor planning, also called praxis, is the ability to conceptualise, plan and to perform an unfamilar action... if a child is dyspraxic, he has trouble figuring out how to do non-habitual actions. The problem may occur at any point in the process: a child may have trouble coming up with an idea of what to do, how to plan and organise what his body needs to do, and/or how to sequence and execute these movements." The phrase "I don't know and I can't" are reverberating in my head when I read this. I know my boy is not severe in his motor planning issues but I can admit that I know it is an issue for him and adequate support is essential for him

Another book I referred to is the Out of Sync Child possibly also known as the bible for Sensory Processing Issues, it has a checklist for how a child with dyspraxia presents:

• Have trouble conceiving of, organising and performing activities that involve a sequence of movements, such as cutting, pasting, colouring, assembling collage pieces or recipe ingredients, applying nail polish, and so forth. Novel experiences as well as familar activities may be difficult.
• Have poor gross-motor control for running, climbing and jumping.
• Have poor eye-hand coordination.
• Require visual cues to perform certain motor tasks that other children can do without looking, such as zipping, snapping, buttoning, and unbuttoning clothes.
• Put on gloves or socks in unusual ways
• Have poor fine motor control of his fingers for precise manual tasks, eg., holding and using eating utensils and classroom tools, such as crayons, scizzors, staplers and hold punches.
• Struggle with hand-writing, drawing, completing work-sheets, and similar tasks.
• Have poor fine-motor control of his toes for walking barefoot or in flip-flops.
• Have poor fine-motor control of his mouth muscles for sucking, swallowing, chewing and speaking.
• Be a messy eater.
• Have poor self-help skills and not be a self starter, requiring another persons help to get going."Pg 108-109

After waiting some time we finally got the report with some information further about this, and apparently at this time he hasn't been diagnosed as dyspraxic however it doesn't mean that he won't either. So for now, I have worked out something humbling sometimes they aren't not doing what they are told to be naughty, sometimes just sometimes they actually can't do it. Once again I realise how much I don't know!

An exciting addition to my toolbox

Today I stumbled upon a post of a limited time only reduction of the price of this app, EASE pro. I moved fast and I was rewarded unfortunately the app price reduction wasn't for long. However I thought for those who missed out it might be helpful to see what is available should you decided to purchase this in the future. 

On the left is the main screen you see when you open the app. Just as in the theme of a sound engineer's interface what else would you expect from app designers who specialise in sound engineering apps. First up you see a preset number which you can change which changes the effects of the modulation of the sounds. Below the presets the headphones represents user settings, on the right you can change individual side settings turning down the volume or cancelling the sound. 

Below this row the dial looking button allows you to open the settings. On the right of that is the play and skip buttons. Before playing you need to select the module you will be using. When you press play the time lapsed is showing in the larger screen.

Once you click on the clock dial button it takes you to the control panel screen, from here you can select your modules, find out more information this includes the user guide. In the advanced settings you can set passwords for admin and users. Also you can access user presets which is individual settings for different users which would be really helpful for occupational therapists with more than one client. 

You can also add more modules from this screen, below that you will see the results of the modules that were adding during installation.

Below you will see the screen showing the modules available on the select module screen, the Native module comes with the purchase of the app. Following this you can purchase within the app from my quick research it is a little more expensive from within the app, however as you can see if you go to the Ease listening website and purchase the app modules from there, they are much cheaper. 

Now I have you a quick tour of the app and it's features, I feel I also need to give an introduction of what Ease listening is. So I first was introduced to this therapy type when my son Josiah was exhibited some symptoms because of a clearing of fluid in his ears and we noticed a dramatic difference in how he was reacting to noise and other issues. 

Here is a link for a post "a new exciting sensory processing tool on your idevice" some information when this app was first released with a few links to their websites. When we first started listening therapy or therapeutic listening here is some of the journey that I recorded in this blog firstly "sensory therapy" and further on "progress of sensory therapy" some interesting effects in "it's the little things we miss" and then a month later "it's only the beginning". At this point we really noticed the difference and my son at 5 learnt how to put his socks on, pretty major stuff. For us it really made a difference from a child who was scattered, couldn't put his socks on and various other issues to someone who was much more organised able to do things like make a bed, or follow a routine. 

preventative breaks

It never ceases my to see how small insignificant activities can make such a difference to a child's sensory experience. While thinking about a discussion on how a child can communicate their sensory needs. At the same time I have been reading an article by Sue Larkey on a similar concept called a preventative break, all combining with information I learnt yesterday about the value of sensory input to ease transition to a new activity.

The holy grail for us as parents is the idea that our child can have a form of self regulation this is "is the ability to maintain a level of alertness appropriate to a given activity. Adequate self-regulation is essential to the development of attention, regulation of sleep/wake cycles, and the control of emotions, as well as the daily transitions that make up a child's routine."  Honestly I notice this issue in regards to being able to understand their bodies, what their senses are trying to communicate with them and thereby being able to handle the challenges of the senses and problem solving skills. This skill is something that has to be taught to any child who has sensory processing issues. 

Sue Larkey introduces the idea of preventative breaks, using activities and skills to enable a child to ask for help and defuse the sensory overload that is building. In her explanation of teaching these skills she introduces the concept of a break card, which a child can ask for an activity that would assist them in their self regulation such as a movement break, wall push ups and breathing. 

Social Stories

Carol Gray originally introduced the concept of a social story. If you are considering using social stories often I do recommend you buy her book which gives you hints on how to write a great social story.

In teaching these skills Sue mentions the importance of social stories in this process. My thoughts on the subject are also in this process teaching a child how their sensory system works. An example could include:

When I hear sometimes the noise can be:

• too loud
• too soft
• too much

If my ears are having trouble sometimes I might:

• cover my ears
• make more noise
• find it hard to think

When my ears tell me something's wrong I can

• find a quiet place
• ask for the noise to be turned up (TV) or ask Mum for headphones
• ask for the noise to be turned off

Augmentative communication

This type of communication can be a powerful tool in helping our children learn self regulation. We can use a simple break card as Sue Larkey describes which would look like this:

I can

• ask for a movement break
• do wall pushups
• have a drink

Ipads can give us some useful tools to easily create social stories and and others to help our children communicate needs to us.

In the case of choices and feeling we can use:

My choice board

I forgot this app existed, it is a choice board app that has different boards that are easy to create show a child what they can and can't have. This can be easily utilised and divided into senses to show children how they can help themselves feel better.

Choice works

This app has a great section called a feeling board. It has simple instruction and visual cues to show When I feel (insert emotion) I can .... and ..... to feel better. 

Also included in this app is a visual schedule I think this is a great app for our younger kids as visually it is simple and I have been able to use it for the feelings board and learnt a lot about my second boy's feelings.

It would be great to in the process of teaching these skills add a sense each week and learn all about it, what could work is to have a visual cue on the fridge with pictures of each sense and then use that in communication about their self regulation skills. 

Social story apps

Keeping in mind, I haven't needed to use social stories often but we do use a calming book sometimes. There are quite a few apps that are spoken of, but it is really hard to recommend the social stories apps as they are so varied, these apps include, icommunicate, speech journal (another fantastic mobile education store app) and I think you can even use imovie to make a social story video if you like as well. 

Using preventative breaks to aid transition

Particularly in the school environment, sensory tasks can really help a child to transition and provide a valuable opportunity to build the sensory diet into the daily routine. For example when finishing an activity you can punctuate the routine with activities such as bouncing on a small tramp, doing a lap on the bicycle, wall pushups, respiration activities. This can help I think also when getting ready for school and transitioning from play to getting ready for school. I also find using routines and even better an ipad with a routine will really help a child be empowered to follow a schedule and complete tasks with minimal involvement. I have mentioned it before I have bought large cooking timers to help at home and this can help (there are apps such as time the timer that can work too) finishing a task or helping a child do a task, I generally use the time to remind myself to shut up and give the child the time including processing time, to complete the task. 

This has all been processing lately and I have some new ideas of how to tackle the sensory needs of my son. At one point I think I believe that my son's issues with sensory processing were not so bad. Since watching "traffic jam in my brain" and attending the "autism-the whole person conference" raised some valid issues. Interestingly enough I can see how easy it would be for someone to dismiss a child like mine's concerns in the classroom setting. Please share your ideas of how you teach self regulation and what apps you use. I would be happy to share more on what social story apps are available if you need me to!

the why of what they do

Every parent that deals with sensory issues knows what a meltdown is. Now this is something that most parents may think they have experienced, often it is only a milder version a tantrum. Let's not misunderstand normal behavioural issues as a meltdown as believe me some kids have insane behavioural issues but a meltdown has some different components things to look out for:

Pre meltdown

• small fractious moments usually occur before a meltdown, a child may seem unreasonable about small things. Something that doesn't normally set them off will become a major issue.
• look at their body language take notice of (physical movements, [are they clumsy, falling over, jerky] emotional temperature [responses to situations and interactions are disproportionate to the expected norm for them], vocal temperature [their voice may change they may get louder often more whiny and bossy, or may start making noises] 

During the meltdown

From my experience I have noticed the following:

• physical reactions (hitting, kicking, running, pushing, throwing)
• emotional component (usually appearing angry, extreme versions of emotions, lack of ability to be able to engage in a discussion about their behaviour)
• vocal component (usually crying, yelling, demanding, screaming)
• normal coping techniques have no effect (breathing, counting, space, talking to them)
• discipline will have no effect
• if you leave the situation often it may not change their behaviour

Post meltdown

This is often a fragile time

• it is good to offer a cool/hot drink and some food, meltdowns can be exhausting
• some quiet space or activity to allow them to regroup
• this is the time once they have recovered to discuss what happened

Another concept which is as fluid as anything is the idea of a neurological threshold:

"Neurological thresholds refer to the amount of stimuli required for a neuron or neuron system to respond. When the nervous system responds really quickly to a sensory stimulus, we say there is a low threshold and when the nervous system responds more slowly than expected, we say there is a high threshold for responding. All of us need a balance between low and high thresholds so that we notice just enough things to keep aware and attentive, but not so many things that we become overloaded with information and feel distracted.

At the extreme ends of the neurological threshold are habituation (related to high thresholds) and sensitization (related to low thresholds). Habituation refers to the process of recognizing familiar stimuli that do not require additional attention (Dunn, 2000). For young children, habituation is essential so they might focus their attention on the activity at hand. Without this process, children would be constantly distracted by the variety of stimuli that are present in the environment.

Sensitization is the process that enhances the awareness of important stimuli. It is significant to development because it allows the child to remain attentive to the environment while engaged in play or other learning. The ability to modulate (organize/ balance information from all sources) responses of the nervous system (i.e., balance between habituation and sensitization) permits the young child to generate appropriate responses to stimuli in the environment.

References: (Baranek & Berkson, 1994; Dunn, 1997a) (Dunn, 1994, 2000; McIntosh, Miller, Shyu, & Hagerman, 1999; Wilbarger, 1995)

In the context of a child's life and emotional regulation, at times the amount of stimuli required for optimal arousal (the place where we are ready to learn and engage) can change from day to day. Meaning that a behaviour or stimuli one day will not cause a meltdown can cause a meltdown tomorrow. Simply because their threshold is much lower or higher as the case may be. So for example after a trying day at school a child may have a low threshold or high threshold and will be primed for a meltdown.

The goal for any child would be to allow a child to be able to receive and interpret their world is such a way that they can stay in the state of optimal arousal. This means that us as parents needs to pay particular attention to allowing our child to experience many things and use tools to facilitate this process, particularly important for each child to be able to learn in the school environment or to feel comfortable at home.

Often (honestly) we can not quite figure it out why they have a meltdown, partly because sometime the lead up was at school. However prevention is an amazing tool. Providing extra sensory tools during trying times can help such as after school and getting ready for school some suggestions that I heard recently in a conference include the following (and some from my own experience)

• An electric toothbrush can be calming
• Routines and schedules (doesn't matter what form)
• providing sensory diet activities that are needed
• removing any sensory things that overload your child such as noise, smell and sight
• keeping them well fed, plenty of water and enough sleep works wonders

Getting down to the latest revelations:

The primary goal for sensory processing is to enable your child to achieve an optimal level of how they are feeling not too much, not too little. It is an insane process and one that unfortunately is worked out through trial and error, this information I have found helpful. There are two types of nervous systems discussed: 

Parasympathetic nervous system: This is where our nervous remains most of the time and when we are at “ready state” for learning, social interaction, and alert and awake.  

Sympathetic nervous system: The state of “fight or flight”.  This part of our nervous system is intended for safety and the ability to react to a perceived dangerous situation.

The issues with these two states is that in children especially (without any sensory processing issues) are prone to fluctations in moods and behaviour. Part of their development is learning to regulate their emotions. Often they feel out of control of their world, then add in any other stresses we can see why they don't cope so well. 

What can occur is the child feeling particularly out of control, not understanding their environment or their body. This is a scary experience for anyone. Let alone if you add in any communication issues and other mental health issues. Secondly once they are in the place that their senses are overwhelmed they will feel on the edge and it takes not much at all to send them into a full scale melt down.

So how do we know what type of state our children are in? Another blog article suggests these are signs of the fight or flight state.

"There are many different manifestations of “fight or flight” but some common responses may be:

• Hitting, kicking, biting, spitting, pushing (especially while standing in line or in new challenging/overwhelming situations or activities)
• Trying to run or escape from the situation
• Trying to hide under something like a desk, table, or chair 
• Burying themselves in a teacher’s arms, avoiding all eye contact, or trying to curl up in a ball on the floor or at their desk
• Covering ears or eyes
• Crying or screaming
• Hiding in the closet, under couch cushions, or under covers in bed
• Shutting down completely and not speaking or responding
• Even falling asleep unexpectedly"

Consider these as signs that your child is trying to avoid stimulas and struggling to cope with their environment. Taking cues from their behaviour, it is important to remove stimulas in an attempt to avert a full scale meltdowns. If you consider the list above, if they are covering their eyes or ears it could be an auditory or visual issue, if they are psychically reacting it could be a tactile issue.  As I was told yesterday "there is always a reason for their behaviour".  

Sometimes and this is not that uncommon we are clueless as to why and what our child is experiencing. Aside from sensory activities and a sensory diet, yesterday I discovered this tool called a Motivation Assessment Scale that can help in the classroom or at home to assess why things are happening. It is worth investigating to see if you can identify the cause and redirect the behaviour or eliminate it all together (wouldn't that be nice). Another topic that has raised my interest is the idea of preventative breaks which has been discussed in an article by Sue Larkey. I also plan to include some of the resources I got from the latest conference I attended.

coming soon

Upcoming reviews 

Please forgive the presentation of the graphics, couldn't get them to align properly!

Raising a Sensory Smart Child: 

The definitive handbook for helping 

your child with Sensory Processing Issues

        

Traffic Jam in my Brain:
Sensory Processing Approach
to Challenges Associated with Autism, ADHD,
Learning and Behavioural Differences
by Gen Jereb

the finer details: sitting in a w position

In the past I have seen it noticed that my son sits in a w position, even therapy assistants bug my son to sit in a different position. At the time I thought it was just plain annoying, I honestly thought would you leave the kid alone! So whilst reading one of my new books Raising a Sensory Smart Child by Lindsey Biel, I come across this topic and this time I thought I should actually take an interest. 

In case you are wondering what on earth I am going on about, this is what W sitting looks like. Lindsey discusses this in her book "When sitting, a child with low tone may always sit on the floor in a position that resembles a W, bearing weight equally through his bottom, legs, knees, ankles, and feet. This widens his base of support and frees up his arms for play. In this position, this trunk is inactive and he often slumps. While this is a very stable, secure position, it does not encourage the development of postural control." pg 200

The question is what to do about it. The issue with W sitting it can reveal other issues that can be at play such as low muscle tone, stiffness in the hips, instability in sitting which can all be linked to childhood disorders such as sensory processing disorder, also associated with children with autism, and in our case the issue of hyper-mobility of their joints.

From here I think it is important not be become a sitting sheriff and pester our children to sit properly or correctly. More importantly it is to teach them what to do and strengthen them to be able to do it. One issue that can arise is the fact that your child might not be ready developmentally (such as a baby or toddler) or your child's individual delays might slow, this is something that you as a parent and your OT if you have one should be deciding.

If you are thinking of doing something then this is where to start. I found a great article that gives some practical tips from Learning Links. What will assist your child to sit better are firstly building up their core strength through activities such as using a scooter board, swimming, standing on a balance board or sitting on a fit ball and as a parent modeling other ways to sit is helpful, encouraging different ways to sit in a non threatening manner will also help. What will be the challenge for some time is it is easier for your child to sit in the w position, so they will naturally resort  to sitting this way. I would even bet that they don't even know why they sit this way. But as they get older it is even more important that they learn to sit in a different way. So here's to change.