Author: admin

Why can’t my child sit still?

Does your child struggle to sit still at school or even at home? There could be several reasons for this and not just because they don’t want to do the task.

Retained primitive reflexes
Seeking vestibular, proprioceptive and/or tactile input
Poor core strength
Poor upper body strength
Low muscle tone
Attention deficits
Avoiding or are sensitive to external sensory stimuli

Today, children are expected to sit for longer periods of time. In fact, in some kindergartens some children are being asked to sit for thirty minute blocks during circle time at some schools.

The problem: children are constantly in an upright position these days. It is rare to find children rolling down hills, climbing trees, and spinning in circles just for fun. Merry-go-rounds and teeter-totters are a thing of the past. Recess times have shortened due to increasing educational demands, and children rarely play outdoors due to parental fears, liability issues, and the hectic schedules of modern-day society. Lets face it: Children are not nearly moving enough, and it is really starting to become a problem.

From my observations in many classrooms in different schools over the past 5 years more children are walking around with an underdeveloped vestibular (balance) system today–due to restricted movement. Balance and poor postural control are noticed also. In order to develop a strong balance system, children need to move their body in all directions, for hours at a time. Just like with exercising, they need to do this more than just once-a-week in order to reap the benefits. In fact, children need this form of movement on at least a daily basis. Therefore, having sports practice once or twice a week is likely not enough movement for the child to develop a strong sensory system.

Children are going to class with bodies that are less prepared to learn than ever before. With sensory systems not quite working right, they are asked to sit and pay attention. Children naturally start fidgeting in order to get the movement their body desperately needs and is not getting enough of to “turn their brain on.” This is the body and brains way of feeding it’s systems with the movement and sensory input it needs to support self-regulation. What happens when the children start fidgeting? We ask them to sit still and pay attention; therefore, their brain goes back to “sleep.” If behaving poorly, some kids get sent to the corner or mat which is the worst thing we can do. A child does not typically do things innately to be naughty. Instead see it as a sign they are giving you asking for help. Instead, send them on a run around the oval or on an errand.

Fidgeting is a problem and a sign your child is sending us.. It is a strong indicator that children are not getting enough movement throughout the day. We need to fix the underlying issue. Recess times need to be extended and kids should be playing outside as soon as they get home from school. Twenty minutes of movement a day is not enough! They need regular movement breaks 3-4 times a day, 15-20 minutes of play outdoors in order to establish a healthy sensory system and to support higher-level attention and learning in the classroom.

In order for children to learn, they need to be able to pay attention. In order to pay attention, they need to move more.

Handwriting Essentials

To be able to handwrite we need to be able to engage in the numerous essential skills. That’s right…. handwriting is not just as simple as sitting down and writing. For your child there may be some other things going on that makes handwriting that little bit trickier. For functional handwriting we need to consider:

Head Control – To be able to effectively handwrite we need to have enough strength to be able to hold our head up and move our head. We need to be able to move our head to shift our gaze from what we are writing to what we need to copy on the whiteboard (in the classroom) or a laptop or iPad screen. Without the control to hold our head up we aren’t able to see what we are writing, which means we may miss form letters or write on a diagonal, making reading our work tricky.

Postural Control – To be able to handwrite we need to be able to have enough postural control to be able to sit and maintain an upright position in our chair. If we are unable to appropriately sit in a chair we aren’t able to write neatly as we cant form our letters appropriately.

Visual Perceptual Skills – this is important when in a classroom setting as your child needs appropriate visual perception to be able to judge what has been written on the board to be able to copy it or follow the instructions. Without this your child may struggle to engage in writing tasks within the classroom environment.

Reflex Integration – if children have retained reflexes they will struggle with the motor control component making handwriting difficult. This can also be the reason for limited postural control, upper body strength and/or bilateral coordination. Working to integrate your child’s reflexes is particularly important for their handwriting abilities.

Visual Motor Skills – these are the skills that guide any movements (small or big) based on any visual information they are receiving. Therefore, this plays a large role in letter and number formation and without appropriate visual motor skills they are unable to interpret the letters and numbers they see to then be recreated.

Upper Body Strength – if we have limited upper body strength then we might struggle to hold the pencil or have enough grip strength to be able to write half a page to a whole page of writing which is expected for school aged children.

Bilateral Coordination – this is important to be able to use both sides of the paper. If your child does not have appropriate bilateral coordination and integration they will struggle to write from the left to the right side of the page and will only write on one side.

Fine Motor skills and hand strength

Motor Planning – is the ability to coordinate muscle action towards a purposeful goal. Children with motor planning difficulties have an inability to conceive, plan and carry out a skilled, non-habitual motor act in the correct sequence from beginning to end. Incoming sensory stimuli must be correctly integrated in order to form the basis for appropriate, coordinated motor responses. When the incoming sensory information is not being processed or integrated properly in the brain, the child’s motor output is affected. This can result in poor postural control and low muscle tone, problems with bilateral coordination, gross and fine-motor skills and/or poor motor planning (dyspraxia). These issues can have an effect on many aspects of the child’s daily living, development and learning performance and can commonly be an issue when handwriting.

If you think your child might be struggling with one or all of these areas, it may be worth contacting an occupational therapist for an assessment. The occupational therapist will be able to walk you through the areas that are particularly difficult and why they are so difficult, as well as, giving strategies to develop the underlying skills that are affecting your child’s ability to handwrite.

Gross Motor Skills

Gross motor skills is defined as the movements of larger muscle groups such as arms, torso, or legs. However gross motor skills play a large role in our fine motor skills. As we develop our larger muscles first, if we don’t have appropriate gross motor skills we will usually have poor fine motor skills too. This is why it is so important to work on gross motor skills first before moving to fine motor skills.

There are several underlying factors that are important for gross motor skills and without these skills gross motor skills cannot be developed. These include:

Muscle strength
Muscle endurance
Motor planning
Motor learning
Postural control
Sensory processing
Body awareness
Balance
Coordination
Crossing midline
Proprioception
Muscle tone

The strategies that can support # with his motor development and motor planning difficulties, but are not limited to, include:

Activities to work on your child crossing their midline would be beneficial in addressing motor planning activities.
Work on graded activities ie if completing an obstacle course, ask them to complete one part. Then get them to repeat that one part 3 times, before asking them to do the first task and then do a second task. Allow your child to repeat this 3 times and then add a third component. The instructions over time can be a little more complex.
Break down motor sequences into manageable units. Use imitation, verbal guidance, visual cues and physical help as needed, but try to keep these to a minimum.
Play imitation games such as “Simon Says”, sing songs (“the Hokey Pokey”) and use stories that involve imitation.
Obstacle courses including bilateral movements, crawling, climbing, hopping, skipping, jumping, bear or crab walks etc.
“snow angels” on the floor or in sand
Activities that encourage both fine motor and gross motor skills would be beneficial, whilst incorporating core strengthening.
Utilising fitness apps to incorporate fun gross motor activities. Some examples can include Wii Sports, SWORKIT for KIDS, Go Noodle, Just dance, Pink Oatmeal and more. Ask your OT for a more extensive list.

Your child’s development and performance can be supported in the school and home environments if they are provided the appropriate opportunities to have regular, purposeful movement breaks throughout the day. This may include physical activities, providing them with “heavy work” activities throughout the day, modifying the environment and embedding school tasks with sensory and gross motor activities that will support attention.

Fine Motor Skills

When we think of fine motor skills in children we often think of difficulties with handwriting but fine motor skills is much more than that. Fine motor skills is anything that we do that uses the coordination of the smaller muscles in our hands and fingers. The efficiency of doing these tasks also plays a role in our execution of these skills; this means that the harder we have to work the less likely we will do the task well. This is often where occupational therapists come in to help develop these skills to make the tasks a little more easier for your child, so when we (or you as the parent or teacher) ask them to do a fine motor task it is not met with an emotional outburst. Disguising fine motor skills in fun activities helps to encourage and motivate such learning and development

Play that have a fine motor component:

Construction play ie lego and blocks
Playing with dolls or imaginative characters
Games and puzzles
Arts and craft

Self-care skills that have a fine motor component:

Dressing ie buttons, shoe laces, zips etc
Eating
Grooming tasks

Academic skills that have a fine motor component:

Pencil/crayon/texta skills
Scissor skills
Manipulatives used in academic skills such as Literacy, Numeracy and Art

Fine motor skills are an essential part of everyday life not just for school aged children, but for children of all ages. Without age appropriate fine motor skills young people struggle to develop their independence to become their own person and develop life skills to be able to dress, and feed themselves, which becomes increasingly important as they turn five and start school.

But how can I tell if my child has poor or delayed fine motor skills you may be asking yourself?

The list below shows at a quick glance how your child might be indicating they are having difficulties in this area (please note this is not an extensive list).

Preferring outdoor or gross motor tasks such as playground, kicking a ball to avoid engaging table top tasks.
Avoidance or refusal to engage in table top tasks such as playdoh, slime, drawing, colouring etc.
No interest in picking up scissors or pencils, crayons.
Interested in passive technology activities e.g. watching a show instead of playing a game or using a stylus that requires fine motor skills.
Might be referred to as bossy when playing, as will ask their peers to draw or make something for them so they don’t have to engage.
May have an emotional outburst when something is too hard or ask their parent to complete the task before trying to fix the problem themselves.
Using hands to eat their food instead of attempting to use cutlery.
Waiting for parents or carers to dress them, do buttons and zips, tie shoes or brush teeth for them.

If you think your child may fit into one of these categories, the first step may be arranging a consultation with an occupational therapist to assess if they have fine motor difficulties and how they can be supported to develop these skills.

What is Paediatric Occupational Therapy?

Occupational Therapy? But my child doesn’t have a job! That’s right an occupational therapist can help your child because within the world of occupational therapy an occupation is defined as every day activities that people do that bring meaning and purpose to their life. This means that every activity a child engages in, can be referred to as an occupation. You may be thinking but why is this an important aspect for my child and why are they so important? Occupations or everyday living tasks are essential to development as they impact health, wellbeing, provide a sense of justice (what’s fair and what is not fair), foster meaning and purpose and assist in shaping your child’s identity.

The goal of Paediatric occupational therapy is to encourage a child to engage in meaningful occupations such as playing with others, engaging in school work, engaging in self-care skills, engaging in fine or gross motor skills, engaging in age appropriate chores. These are all imperative for development, functional capacity and to create independence, which is what we all want for our children.

Occupational therapists are usually the first port of call when a child is diagnosed with developmental delays or delays with social skills, motor skills (fine/gross/visual), executive functioning (problem solving, memory, attention), gross motor skills or self-care routines. Some of the reasons a child is referred can also include; delays in developing visual motor skills, sensory integration concerns, delays in play and social interaction skills (particularly at school or kindergarten). The best thing about occupational therapy is that your child might perceive it as play or fun activities and games. This is what makes them engage so well while developing their underlying skills that are needed. It’s a good thing we love to play!

If you have any concerns take our quick quiz on our website today and contact an Occupational Therapist to discuss further, should you answer yes to any of the questions.

Case Study 3: Is your child or student like Jacob?

Jacob is an 8 year old boy. When he came to Learn Sense Grow he had a ‘fixed’ mindset about handwriting and had trouble completing morning, school and afternoon routines. His parents reported that he was not confident at school or with sports, and lacked self-esteem. This was having an impact on his resilience in the classroom, when making new friends and when learning new skills (such as new sports).

The process:

An Occupational Therapy standardised assessment revealed that Jacob had ‘below average’ fine, visual and gross motor skills. The Occupational Therapist explained to Jacob’s parents that this could be influencing Jacob’s self-esteem and confidence, thus impacting on his resilience. The assessment also showed that Jacob had trouble with motor planning and sequencing, impacting on his ability to write and follow routines. Jacob was recommended to complete three terms of OT to help work on these skills.

The Occupational Therapy assessment highlighted that Jacob was under responsive, meaning that he needed lots of movement to ‘wake up’ his body throughout the day. The OT explained Sensory Integration theory, and that Jacob would also need a ‘Sensory Diet’ to help speed his engine up to complete these daily routines.

The Occupational Therapist first observed to see which activities helped to speed up his engine, and which activities slowed his engine down. Based on this, they created a ‘Sensory Diet’ for Jacob and his family to follow in the mornings before school, during school and after school.

Next, Occupational Therapy sessions were tailored to helping Jacob develop his fine, visual and gross motor skills. Jacob completed fun games and activities and his skills developed over time. Whilst doing so, the Occupational Therapist ensured that they continued to discuss self-esteem, confidence and a ‘growth mindset’ to help develop resilience skills.

The Occupational Therapist collaborated with Jacob’s teacher and parents regularly to ensure that routines were being followed through with at home and school. A visual schedule of morning and after school routines was developed for home, and a checklist was developed at school, to help plan and sequence the activities.

The benefits:

The ‘Sensory Diet’ enabled Jacob to wake up his body in the morning, during the day and after school, which made him more alert to follow instructions.
Focus on visual, fine and gross motor skill development improved Jacob’s strength and coordination in all areas. This had a flow on effect to his confidence and self-esteem.
Jacob learnt about self-esteem and confidence, which enabled him to focus on his strengths and understand that everybody has challenges.
Jacob developed a ‘growth mindset’ through working on the above goals, and working directly on the impacts of using a ‘fixed’ mindset.
His handwriting legibility, sizing and formation improved over the course of OT.

The result:

Jacob is now a confident young boy in the classroom and at home. He understands his body systems better to attend to instructions, and knows when and how to ‘wake up’ his body. His self-esteem, confidence and resilience building have enabled Jacob to try out new sports, and he is now a big soccer fan! Writing is still not one of Jacob’s favourite subjects, but he uses his growth mindset and confidence within the lesson to persevere. Jacob is a much happier and more engaged boy at home and in the classroom.

Case Study 2: Is your child or student like Mark?

Mark is a 7 year old boy who is diagnosed with Autism Spectrum Disorder (ASD). He is an only child and enjoys playing with Lego and video games at home. Mark is very strong willed and his parents report that he becomes angry very quickly, sometimes with an unknown trigger or cause. Mark is beginning to throw things at his parents, slam doors and break objects around the house when he is angry. Mark’s teacher reported that he becomes angry at school and tends to clench his fists and disengage with activities, but does not show this kind of aggression at school. His parents came to Learn Sense Grow to help Mark understand his emotions better and control his anger towards his parents.

The Process:

Mark underwent two terms of Occupational Therapy at his home, as this is where most of the challenges lie. Mark was assessed on his ability to identify his emotions and others, which revealed that Mark can identify basic emotions in himself and others (angry, happy, sad) but had trouble identifying more complex emotions (confused, frustrated, annoyed, surprised, disappointed). The focus of therapy was first on educating him on how to identify these feelings in ourselves and others.

Next, using the Social Thinking® 10 core competencies outlined in an earlier Blog Post, Mark was taught about the ‘size of the problem’. He was taught about small, medium and big problems, and the reaction size that we are ‘expected’ to react to the problem in the same way (small, medium and big reaction sizes). Several real life and example scenarios were worked through in sessions so that Mark understood this well.

After this, Mark learnt about his body and warning signs of anger, frustration, annoyed and disappointed feelings. Using ‘The Zones of Regulation’ framework and methodology, Mark was taught how to identify when he was in each zone and how to help regulate his body when it went into the ‘yellow’ zone to avoid him reaching the ‘red’ zone and having a big reaction. He learnt strategies to regulate through each of these emotions and zones. Both his parents and teachers practised the strategies with Mark when he was calm to ensure that he knew what to do when he began to experience those feelings.

The Occupational Therapist also helped to set up calm or quiet areas in the classroom and home environments, with sensory tools to help Mark calm down. Visual schedules were created around using the quiet spaces to help Mark remember when and how to use the areas.

The benefits:

Mark can now identify complex emotions in himself and others.
He has developed his self-help strategies to take a break, ask for help, go to his quiet/calm down areas and use his regulation strategies.
Mark is starting to identify the size of the problem, and understands that his reaction size is expected to match the problem size.
He is able to identify with ‘The Zones of Regulation’ and bring his body back down into the ‘green’ zone so that he can continue participating in activities and other people have ‘good thoughts and feelings’ about him.

The result:

Mark is now using his calming strategies and emotional problem solving at school and home. He is not needing to use his quiet/calm down corner at school anymore, and continues to use it at home to try and avoid aggressive outbursts. Mark is happier that he feels more in control of his emotions, and this has helped him to use his words and strategies in a number of other situations, which has helped him build and maintain good relationships with his peers.

Case Study: Is your child or student like Elizabeth?

Elizabeth is 7 years old and has been diagnosed with ADHD. When we met Elizabeth she would chew her uniform, bark and toys. She also seeked out to touch most things in her path. Her parents described her as “busy and impulsive”, that she would “constantly bump into things” and “couldn’t concentrate on instructions”. Through an Occupational Therapy assessment, Elizabeth was diagnosed with a Sensory Processing Disorder, with preferences to seek sensations and difficulties with spatial awareness to know where her body is in space. The assessment also revealed that Elizabeth had poor coordination and gross motor skills which were contributing to her profile.

The Process:

Through Occupational Therapy, Elizabeth and her family learnt about our sensory systems, and the Sensory Integration theory. Elizabeth’s Occupational Therapist trialled different types of sensations and movements at the clinic, home and school environment, to help develop a suitable Sensory Diet for Elizabeth to meet her sensory needs. A Sensory Diet involves scheduling certain movements and opportunities to receive sensory information within her day, to help achieve a more ‘calm-alert’ state during the day.

Through this, the Occupational Therapist and Elizabeth found out that vestibular input (bouncing, jumping, crashing and rebounding) followed by deep pressure (pressure to the muscles or joints) was a good formula for Elizabeth. Each morning, at 12:00 at school and in the afternoon Elizabeth completed similar routines involving jumping on a fitball, crashing onto crash mats, hopping and skipping, followed by rolling on the fitball and using a weighted pillow/blanket.

Elizabeth was also taught the Engine Program, where she learnt about her body engines in terms of three main speeds; ‘too slow’, ‘just right’ and ‘too fast’. Elizabeth learnt the warning signs that her body was moving ‘too fast’ and what to do when this happens. She was taught deep breathing strategies, asking for a break and noticing when she was not concentrating to help her come back to the instructions/task at school and home. There was a focus on the impact that a ‘fast’ engine can have in the classroom and when playing with friends, where Elizabeth learnt through the Social Thinking ® methodology taught, the ‘expected’ and ‘unexpected’ behaviours.

The Occupational Therapist also taught Elizabeth some activities to complete that helped to integrate her reflexes. Across three terms, Elizabeth slowly integrated her reflexes into her bodily systems.

The benefits:

A Sensory Diet helped Elizabeth to keep her ‘body and brain’ focused whilst at school, and in preparation for after school routines and bed routines.
Elizabeth is now aware of when her engine is running ‘too fast’, and can use her strategies to do deep breathing, take a break and complete her Sensory Diet or use her weighted products to reach a ‘just right’ engine.
Integrating reflexes into bodily systems to make room for new coordination and spatial awareness development.
Elizabeth is aware of how her ‘fast engine’ can impact others, and how they perceive her.
She has a greater awareness of her social environment and that others have thoughts and feelings about her, therefore able to respond more appropriately at school and in the classroom.

The result:

After weekly Occupational Therapy across three terms, Elizabeth gained awareness and the skills to manage her co-existing Sensory Processing Disorder and ADHD. Elizabeth can now attend in the classroom and at home to multiple-step instructions, and has learnt valuable skills in slowing her engine down. This in turn has supported her social development and help her sense of self.

Anxiety and Panic Attacks in Young Children

This is an issue that we believe is becoming more and more common for our young children and people in today’s society. While everyone experiences anxiety at some point in their lives, some of our young people experience anxiety more than the average person. At Learn Sense Grow we often see anxiety being projected through other emotions and actions, and having a functional impact on our young people, and their families lives.

What is anxiety?

Anxiety is a survival instinct and response to our brain perceiving that we are in a threatening situation. It is a safety mechanism that helps us to get out of dangerous situations; so it serves a helpful purpose in our body when we are in these situations. As children come across new experiences and situations, anxiety or worry is ‘normal’ to some degree. A typical response is when children learn to cope with their fears and worries. However, in some of our young people, their brain perceives that they are in danger, even when they are not in fearful or new situations, and they find it difficult to overcome these fears or remain calm. This is anxiety.

Anxiety and technology:

As technology is becoming more common and unavoidable in our society, we are seeing many young people impacted by anxiety as a result of social interactions. The rise of technology has largely meant that we focus less on interpersonal, face to face situations, creating a stress response around real time social reactions. For many of our young people who also experience social awareness challenges, this creates a heightened sense of anxiety around environments where in person communication is necessary.

How can anxiety impact young people?

When our body perceives that we are in danger, our autonomic nervous system kicks into gear and generally reacts in three main ways;

Fight; becoming verbally or physically aggressive
Flight; running or walking away from a situation, or refusing to go to a situation
Freeze; mind goes blank, physically freezing when required to perform/speak.

When children have this response to typical or ‘normal’ situations, this has a number of physiological and functional impacts. It can stop them from participating in school, home or community activities, can isolate them from their peers or family and can discourage them from completing age appropriate tasks. This can lead to avoiding these fearful or anxiety provoking situations, so the child may feel that they are more fearful and unable to manage it next time.

Outside of the triggering situation, anxiety can also have physical and cognitive impacts. In some situations, we see children who experience physical symptoms such as panic attacks, stomach aches, headaches and sleeplessness outside of the fearful event. Cognitive symptoms are equally as debilitating, as young people can experience irritability, difficulty concentrating, overthinking and ruminating over situations.

What is a panic attack?

In some circumstances, if a child experiences regular anxiety, they may also experience ‘panic attacks’. ‘Panic attacks’ can develop quickly without any warning or triggering situation present, as a result of anxious feelings. They can last from minutes to hours, and generally have a number of the following symptoms:

Heart races or pounds
Dizziness or light-headedness
Trembling or shaking
Feeling smothered or being short of breath
Intense fearfulness
Loss of reality

(https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Panic-Disorder-In-Children-And-Adolescents-050.aspx)

Panic attacks can have significantly debilitating impacts on the child and their family.

What can I do if my child experiences anxiety or panic attacks?

Learn Sense Grow strongly encourages you to seek advice from your doctor, a Psychologist and/or Occupational Therapist if your child is experiencing any of the above symptoms. Therapy and intervention will differ depending on the severity and regularity of symptoms. It is important to seek assistance when your child first experiences these symptoms, as early intervention is key. If left untreated, it can have an impact on a young person’s mental, emotional and functional ability, further impacting life at school, home and in the community.

Through a collaborative approach, working with the child’s family and school, and better understanding the young person’s triggers, panic attacks can often be stopped and anxious symptoms can be lessened so that the young person can reach their fullest potential.

With Global changes in the world as a result of COVID, we are more aware than ever of mental health. Medicare has increased rebates to support people experiencing such difficulties. At Learn Sense Grow we have Occupational Therapist’s with Mental Health Care provider numbers so that you can access these supports and better support your child. A GP referral under this scheme is required.

Please contact us for any further information or recommendations today.