OT what is it??

OT what is it??
Kids learning through doing!!

Thursday, December 22, 2016

SELF-Regulation and the Autistic Child

Hypothetical Situation* (names not actual names)

“Joey”* participates in a self-contained classroom in his public school.  He has done very well.  Over the past 12 months his verbal skills have dramatically.  He now speaks in full sentences and expresses his needs, thoughts and feelings.  His echolalic speech has dramatically decreased.  He is no longer speaking in cartoon conversations, etc.

Joey no longer needs to be in constant movement. He is following directions and can sit a table to complete a 3 step fine motor task for up to 30 minutes.

Concerns still remain when with spontaneous (non-task related) actions. Recently he was rehearsing a church program that was being led by older teenage boys and he was jumping around and could not “stay still” even though he was reminded by the leaders to do so and also by his mother.

There are other situations similar to this that are a concern to his mother and to some degree cause a level of embarrassment when these incidents occur.

The Immediate questions for the family is how to control him and how to limit these unusual behaviors. Questions also arise as to if these behaviors should be tolerated as “sensory based” or are they just “mis-behavior”?

What is sensory what is not

Almost everything we do as human beings is sensory: we feel, we speak, we smell, we touch and when we do we react to those experiences.

What makes the Autistic child different is that they do not have a filter through which to decide how to plan what to do when.

These children do not have the intuitive ability to follow a motor emotional cue to redirect their actions.

These reactions are sensory.  Occupational Therapy teaches self-regulation as well as standard motor emotional response patterns that help meliorate and qualitatively enhance the child’s repertoire of socially acceptable behaviors.
However, in novel situations such as having to follow specific directions in a typical group of peers, these learned behaviors cannot easily be recruited because the situation is so different from those within the child’s familiar expectations.

For the Autistic child following verbal directions is difficult because they cannot visualize what is being asked of them.  In larger unfamiliar groups, being given verbal directions, particularly “reprimands” is almost intolerable for the Autistic child. They do not have the emotional resources as to how to alter their behaviors to “do it right” and they do not completely comprehend what it is they are doing wrong.

These sensory inputs: everyone around the child (personal space), the sound of singing (noxious to a child with auditory sensitivities), visual spatial processing (where to stand), proprioception /body awareness (how to be still) become muddled for this impacted child.  And the more he is told to stop, the more sensory agitated he becomes so he gets to the point where is cannot stop.

To the uneducated he looks like BUT IS NOT a misbehaving child. This is why it is important to explain to the “leaders” in these situations that Joey may need a little more “TLC” than the other children.

Things to do that may help
1.     Instead of the (usual) putting the out of sync child in the back, place Joey in the front so that the stimuli of others around him is reduced.
2.     Have him wear a weighted jacket so that he can feel him body more securely
3.     Put on sound reducing head phones so he can “hear” but muted so that he is not over reacting to the extraneous noises
4.     Rehearse the songs (or play or __) at home before he gets to the rehearsal and/or the program
5.     Gently remove him from the situation and (in private) give him deep pressure massages to the neck and back for about 2 minutes.
6.     Let him do jumping jacks if he is expressing the need to move.

Things to understand
1.     Joey is doing his best
2.     This is not about parenting
3.     The “annoyance” of others is their problem not yours
4.     Take self judgment out of the picture—you know your child and you are doing your best.
5.     This is not intentional on the child’s part it is reactionary and in part sensory and learned behaviors: (the child learned in situation “A” to do “B” but in novel situations he is at a loss.  It is the treatment of Occupational Therapy to diversify his reaction repertoire.

Wednesday, December 21, 2016

NEW Sensory Summer Camps --WEEKEND program too

Summer 2017 camps

Early Bird Registrations by March 1st for special discounts!!
A Counseling and Occupational Therapy sensory group camp
June 9, 2017 – June 11, 2017

3 Days  Friday Saturday and Sunday

The program involves 10 (3+ daily) fun filled hours of outdoor sensory learning with the dual supervision of a registered and licensed occupational therapist and Armann Fenger, LAPC, NCC Director of Learning on the Log. He is a licensed professional counselor and an expert in the fields of counseling, physical education, etc. with the learning challenged child.
Your child will be exposed to techniques for learning how to:
• Transition from one task to another
• Tolerate more than one sensory stimuli
• Motor plan
• Organize self
• Divide tasks into “doable” parts
• Prioritize
• Decrease frustration in challenging situations
• Tolerate unfamiliar situations
• Co-operate with peers in task demand situations
• Increase endurance
• Increase problem solving abilities

The program will be offered for children entering Kg through 6th. Program will have a minimum of 10 students and a maximum of 15.
Costs include all park, recreation, materials fees, summary report, etc.
10 Hour Program (inclusive of end of session report) offered at $37.50/hour 
Non refundable 30% deposit required
Contact Children's Special Services, LLC for registration forms and more information
View Map on website www.childrens-services.com
Children's Special Services, LLC in conjunction with Learning on the Log
7501 Auden Trail
Susan Orloff, OTR/L FAOTA 770-394-9791
Pick up and drop off location to be announced



WIN™ Write Incredibly Now™ LABORED TO legible in just 12 hours ~sensory handwriting utilizing games, crafts and sensory experiences in a fun fast way to legible handwriting -preschool through grade 6--addressing pre-and early writing through grade appropriate penmanship . FUN Craft oriented doing/feeling and creating!
Pace Academy
June 19-20-21-22


July 10-11-12-13
9 AM-12  PM

12 hour program at $46/hour


Sensory Social Skills/POP™ Personal Options and Preferences
Learning exploration, curiosity, creativity, sharing, organization, sharing space and materials.
Registered Music Therapist , Occupational  Therapy and Pediatric Yoga  integrated into the programs.
Children ages 2-8
Sensory regulation techniques, sharing, delayed gratification/, motor skills both through crafts, music therapy and pediatric yoga, listening skills, social responses, and MORE!!

Pace Academy 

June 26-27-28-29

9 AM-Noon
Sensory Social Circles/POP™ $37/hour

Susan  Orloff, OTR/L, FAOTA
CEO/EXEC Director
Children's Special Services, LLC
Twitter OTRLovesKids
Clinical Assoc. Professor
GA Sate University OT Dept.

This e-mail and any attachments may contain confidential and privileged information. If you are not the intended recipient, please notify the sender immediately by return e-mail, delete this e-mail and destroy any copies. Any dissemination or use of this information by a person other than the intended recipient is unauthorized and may be illegal. Unless otherwise stated, opinions expressed in this e-mail are those of the author and are not endorsed by the author's employer.

Sunday, January 3, 2016

How to pick a really GREAT pediatric OT

I did not write this but I thought this was a great piece of information to share!!  

Also want to let everyone know that registrations for our summer camps are open NOW and there are Early Bird Discounts for sign ups before March 10, 2016
Get more information on Facebook, Twitter and on our website http://www.childrens-services.com/

By Sabina Anna Rebis, M.D.

Pediatric OTs should:

Lay the groundwork from the beginning.
At the first visit, expect more questions than answers. "A parent will fill out a sensory questionnaire and provide a developmental history for the therapist," says Meghan Corridan, an occupational therapist in New York City who treats children with a variety of disabilities and delays. A child will then undergo a session where he may be observed while cutting, grasping, or playing at a table. "While working at the table, the child is also assessed for attention span, frustration tolerance, and language skills," Corridan says. Motor skills may be assessed in a therapeutic gym using swings, therapy balls, and other equipment.
Make visits consistent and address expectations.
The number and length of therapy sessions per week vary, depending on the developmental delay. "For children with isolated handwriting or fine-motor difficulties, we can work together for up to six months to a year," Corridan says. Children with more extensive developmental delays or disabilities may be treated until they outgrow a therapeutic gym, usually around age 8 or 9. Corridan sees children with mild delays once or twice a week; those with disabilities usually have three sessions per week.
Have an eagle eye for improvement.
Occupational therapists hone in on even the subtlest signs of improvement and advance activities appropriately, teaching parents what to look for and how do the same at home. "Parents notice that the kids are able to do certain activities for longer amounts of time and are having an easier time keeping up with their siblings or peers. Schools may notice that a child's attention is improving or that they have a better grasp on writing instruments," Corridan says.
    Minimize frustration.
    "Frustration is a very important thing to keep under control; if a child gets frustrated during therapy -- which is inevitable -- he will begin to avoid activities," Corridan explains. She's always watching for signs of frustration and jumps in to provide suggestions before the child has a chance to throw in the towel. "I can tell that a child is making progress with his frustration tolerance when he begins to ask for help without my prompting it."
    Make work feel like play.
    Adding one extra challenge to an activity is the fundamental idea behind keeping kids motivated. "In the therapeutic gym, I am sometimes able to 'hide' the work by adding it into an obstacle course," Corridan says. She also uses technology to her advantage: "The introduction of the iPad to my therapy sessions has been a huge motivation to my kids. There are so many great apps that work on fine motor skills, handwriting, and visual perceptual skills. I find that the kids who sometimes avoid all those activities are far more likely to do them when on the iPad."
    Get parents involved without overwhelming them.
    "I keep parents in the loop and provide them with activities to do at home," Corridan says. "These might be strengthening activities like drawing on an easel, or doing wheelbarrow walking with their child at home." But she doesn't rely too heavily on parents, believing that it's important not to turn a parent into an occupational therapist at home: "Parents should still be the parents and not the therapist."

      Thursday, April 30, 2015

      Transitioning from homeschool to high school

      Case Study: *(names changed)
      Jack is a 14 year-old teen who is transitioning from homeschool to public high school. He has been homeschooled since mid-fourth grade when school got “difficult” and kids got “mean”.  He has a diagnosis of Tourette’s Syndrome that is manifested by intermittent body movements and a speech processing delay.

      Although he has not been diagnosed, his behavior suggests high functioning autism.  He is very ritualistic, displays rigid thinking, poor eye contact, cannot make inferences and has difficulty understanding simple “jokes”.  With his fixed sense of “right and wrong” and “fairness”, he has little tolerance for “gray areas” and /or “maybes”.

      Initially seen in OT for fine motor issues, Jack is now able to write legibly in cursive and paraphrase articles from the newspaper etc.

      He prefers to memorize rather than reason out tasks and has difficulty with organization and sequencing.  When “stumped” he sits and waits for the OT to help him as he does at home with his mother/teacher.

      He has returned to OT to learn basic high school survival skills inclusive of but not limited to note takings, task organization and social awareness of self and others.

      Current concerns
      The differences between homeschool and high school are huge.  At home he does not need “ask” for help because his needs are anticipated in school he will need to raise his hand and ask for help.

      At home he gets immediate feedback as to whether he is right or wrong and gets redirected. At school he may have to wait days to get a test and or homework back.

      He likes to try things first to see if he can do and then he will ask for help. Often in school there are no instant “replays”.

      It is difficult for him to reason out what he needs to ask and/or how to ask it. He is used to immediate intervention. In school with often 27+ children in a room learning to wait and move on while you are waiting is a necessary skill.

      At home mom “waits” for him to write his responses, in school the pace is much faster.

      At home mom can offer “cues” as needed, at school this is not usually an option.

      Many of the kids he will meet will have been together since elementary school. And although there is novelty to being the “new kid” social adaptation and learning how to go with the flow are essential school/social survival skills.

      Occupational Therapy Interventions (partial list of ideas)

              Create motivation: easier said than done but help to delineate the difference between fun and happiness.  With fun being equated with a movie or an amusement park experience (all you have to do is “show up”) and happiness being equal to learning and achieving something.   Get the teen to name something he has done that is “fun” and something that he has conquered as “happiness”.

        Teach how to ask the question: Provide novel experiences that he has not done before (pedaling a foot bike, etc.) and get the teen to think through the process of learning what he/she already knew and what they had to learn.

        Make a process booklet for reference: outline in booklet form what are the elements of getting a task done (i.e., establishing what comes first, how to know when you are done, how to proof-read, create priorities, etc.)  Let the teen talk and the OT write and then review it (with them with them using their own words) for understanding.

                Role play classroom situations:  inclusive of note taking and the elements of how to get down the main ideas; capturing key words, working in a group or with (an assigned) peer. What do you do if you do not like the person?

       Practice task problem solving: use visuals—what happens when the teacher want “X” and you are sure it is “Y”.  Taking correction is a very big part of this.  Reasoning and keeping things in perspective, not making a “fix this” into an “indictment” of yourself and/or self-worth.  Learning the art of compromise.

        Mind shakers:  things to do that can help you “get back” when you go “blank”; repeat in your mind the words you are hearing, write the last word you recall, blink hard and fast 2-3 times, etc.

       Facilitate study habits:  when appropriate have the teen learn something as if they had to teach it to someone else.  The best way to learn something is to teach it.  Practice cross referencing notes with textbooks or online information and write write write write it down!! Research has shown that our immediate memory lasts just under 10 seconds for full recall.

        Experience using inferential thinking:  Use scripts from plays or movies (there are plenty of them online from old radio shows, etc.) and have the teen say in their own words what they think might happen next and why.

         Teach debate techniques:  substantiating what you say with actual facts instead of feelings to support your argument/reasoning.  This will help with thought organization and sequential thinking.

      Transitioning from the slower individualized pace of homeschool to the often “hard knocks” of high school can put that teen on a sharp learning curve, but with careful preparation and “behavioral tricks” in his “back pocket” it can be done—and furthermore it can even be fun.