Wednesday, December 29, 2010

Making Mornings Manageable

Making sure that your child's morning routine goes smoothly will help set him up for a good day at school.

If mornings are chaotic and disorganized in your house, what can you do to make them less stressful?  

Here are some ideas that to consider:

Make sure that your child is getting enough sleep at night.  Small children need 11 to 12 hours of sleep.  Even 11 year olds need nine to ten hours.  Teenagers, it seems to me, are always short of sleep.  Because they are growing and changing so much, they require much more sleep than we think.  {If your teenager wants to sleep until noon on the weekends, perhaps you should let him.  He probably needs it.}

Chronic sleep deprivation can cause short attention span, hyperactivity, and irritability.  If your children are habitually waking up groggy, cranky, and slow to get moving, or they require an alarm clock instead of waking up naturally, they may be needing more sleep than they are getting.  Set an age appropriate bedtime, and stick to  it.  Smaller children respond to a set ritual: bath, story, song, hug and kiss, lights out.  Try a drop or two of essential oil in the bath water; according to my colleague, Catherine Traiforou Vlasto, CSW, who utilizes aroma therapy in her practice, it's also helpful to place a few drops on the child's pillow or on the soles of the feet.  Good oils for relaxation and sleep include lavender, bergamot, and geranium.

 A handful of epsom salts in the bath water draws out toxins.

If your child has a hard time transitioning to bed:

Strictly limit computer or interactive video games during the school week.  They are highly stimulating to the brain, which makes it difficult to relax and drift off directly after playing with them.  I would suggest that screen time end a minimum of two hours before bedtime.

Remove all electronic games, computers, and televisions from the child's bedroom.

Reduce the amount of clutter and visual distractions in the child's room.

Turn out lights completely.

If your child has respiration problems, snores at night, or is chronically stuffy, this is probably interfering with his ability to sleep deeply enough.  An air purifier, allergy testing, or a consult with an ENT may be in order.  Make sure there is fresh air in the child's room.  Pajamas and bedding should be made from natural fabrics.

Make certain that your child has plenty of exercise and time outside every single day.  Don't you sleep better when you've had a good work out, or have spent the day outside doing chores in the garden?  So will your child.  Unless you live in Alaska or norther Minnesota and the weather is ridiculously cold, so cold that breathing the air will damage his lungs, your child needs to be outside for a good amount of time every single day.   I grew up in the Midwest, where it was plenty cold and snowy.  Starting in kindergarten, unless there was a tornado or an ice storm, I walked half a mile to school and back,  plus home for lunch and back, and went outside for recess twice a day as well.  

If your child's school has a policy of keeping the children indoors at the first sign of cold or drizzle, what can you do to change it?

To alleviate the morning rush and reduce stress, try to organize as much as possible the night before.

 Choose clothing the night before and lay it out.  {Have your child do this, or do it together, so that he can't complain that he doesn't like your choices.}

Make lunches the night before.

Gather together homework and any special items needed for the  next day and put them together the night before.

Have high protein, nutritious, but easy options for available for breakfast, like nut butter on whole grain toast with sliced bananas, string cheese with whole grain crackers, hard boiled eggs, a handful of dried or fresh fruit and a handful of walnuts or almonds, yogurt with almonds or walnuts mixed in,  mochi, or steel cut oats that you have made the night before and can heat up.  {Note that most of the options listed above are also easy to grab and go.}

One little boy I treated, whose parents were at their wits' end because he would honestly forget that he was supposed to be hurrying to get ready in the mornings and would lie in the bathtub and start dreaming, did better when he switched to showers.  He also initiated a schedule for the mornings, and managed to stick to it.

If your older child won't take responsibility for organizing his things or being on time, perhaps it's time to stop enabling him and to allow him to suffer the consequences of being late or for not having his work or his gym attire.  A few humiliating run ins with his teachers or his principal will teach him to be more on top of his game.

Remember that your child will carry whatever happens in the mornings to school along with him.  If he's had a calm morning, he will have a better chance at staying calm at school.  If he's had a hectic, stressful morning, with his parents losing their tempers and yelling, that's what he will be taking with him for the day.

Wednesday, December 22, 2010

Great Day in the Morning

Children with sensory issues can be stubborn, inflexible, rigid, and altogether infuriating.  The temptation to scream at them when they are pushing your buttons can be overwhelming.  Mornings are the worst.  Schedules are tight, everyone has to get out the door, the school bus will be there any minute... and there is your child, still in his pajamas, video game in hand, saying he has no idea where he left his homework and refusing to eat his breakfast.  


  I used to work with a little boy who was a total delight when we were alone in the clinic but had a great deal of difficulty comporting himself in the classroom.  At one point, he was put on a behavioral program by his teacher.  She listed his problem behaviors on a sheet of paper, such as talking out of turn and being disorganized, and then in the next column, she identified the target behaviors she wanted, such as raising his hand to be called on, speaking kindly to his classmates, finishing his work on time, and keeping his desk tidy.  She made copies and sent one home every day, assigning points when he hit his targets.  When he arrived for his therapy sessions, his nanny would let me know his scores for the week, which could range from perfect to almost zero.

For a variety of reasons, I had secretly begun to keep track of what the rest of the child's life was like and how it was reflected in his behavior in the classroom.  My conclusion:  although he did indeed demonstrate issues that were interfering with his academic functioning, much of what was driving his inability to behave at school was not sensory.

Unfortunately, this little boy and his mother had an extremely tense relationship.  She kept him on a short leash, had him scheduled for extracurricular activities and therapies seven days a week, and, although she worked long hours and didn't spend much time with her children, relegating much of their
care to nannies, she expected and demanded a great deal.

 He, in turn, loved to push her buttons, especially in the morning, which was a hectic time of day: four children under the age of seven and two stressed out adults all needing to get bathed, dressed, breakfasted, their belongings together, and out the door, on time for their various buses and trains, before 7:30 am.

 If his clothing was laid out the night before, my little friend would reject every garment out of hand and insist on choosing others, standing in front of his closet endlessly, unable and unwilling to decide what to wear.  If his nanny offered to help him get dressed, he would refuse, claiming his mother would do it instead.  His mother, however, was busy with three other small children and her own complicated morning routine.

My friend's mother was a very beautiful woman with a high profile, high stress career in Manhattan, and had to behave and appear accordingly.  If my friend spilled his milk or accidentally flicked a bit of toothpaste on her clothing, she responded by blowing up at him.   The nanny reported that his mornings  were routinely a disaster, with a great deal of yelling, screaming and blaming on the part of the grownups, and a great deal of crying, acting out, and aggression towards his siblings and the family dog on the part of my little friend.

There didn't seem to be any understanding on the part of  the adults, all of whom were desperate for this child to improve his behavior at school, that there was a direct correlation between the sturm und drang he experienced at home in the mornings, and his lack of ability, especially on the days that started with a screamfest, to pay attention, apply himself, and treat his classmates with patience and respect.

From my perspective, this child was trying to assert some control where he had none, and to get some attention from his ambitious, highly strung, distracted mother.  His clumsy attempts to connect with her continually backfired on him because of her inability to restrain her temper when she was under so much pressure. Consequently, she habitually sent him off to school miserable and out of sorts before his day had even begun.

If you are a therapist or a teacher working with a difficult child, do you know what is happening in the child's life when he is not with you?  If you are a parent of a child who can't behave at school, what is your child's morning like?  If you  send your child off to school after a morning of fighting and yelling, it will certainly show up in his ability to function there.

In my next post, I'll discuss some strategies for making mornings easier.

Wednesday, December 15, 2010

Gift Giving: a Guide for the Perplexed

Toys that promise to make your child smarter are probably going to do just the opposite.  Remember  those Baby Einstein videos?  The promise that they would turn your child into a genius, just by watching?  Um, no.  Sitting passively in front of a video screen does not make a child smart.  Moving his body, coordinating his hands and eyes, solving problems, and using his imagination, on the other hand, will.

In the waiting room of the sensory gym where I practice, there is a little wooden castle, complete with moat and drawbridge.  There are princesses to be rescued, kings and queens whose honor need defending, horses outfitted with chain mail and colorful banners, and knights in shining armor to ride them.    The children become so absorbed in the little world contained therein  that they often have a hard time dragging themselves away from it.

What's a good toy for a child?  Being an old fashioned curmudgeon, I firmly believe that the job of a toy is to help a child develop his skills {coordination, imagination, memory, problem solving, socialization, spatial awareness} in some way.  The more a toy challenges and engages him, the better.  And the simpler and more open ended it is, the more likely it is to do that.

Does your child have the basics?  I recently read  Stones Into Schools, the sequel to the life changing Three Cups of Tea.  {If you haven't read them, I urge you to do so.  They are about the work of Greg Mortenson, who travels the villages of rural Pakistan, building schools for the children in the remotest, most impoverished villages, on the condition that the girls in the villages be educated, and that the education be secular.} His daughter scolded him for not thinking about the children's bodies and their need for fun during recess, and challenged him to supply all of the schools with a jump rope for every child.  He promptly did, and was thrilled to see the children in those poor villages forget their problems for a while, laughing and playing in the schoolyard.

  Does you child have a selection of balls, a jump rope, roller skates, a Hula Hoop, and a bicycle?  {You would be amazed at how few of the children I evaluate in NYC can bounce or catch a ball.}

Games are a wonderful way to teach social skills like turn taking and being a gracious winner or loser.  How about checkers, cribbage, Jenga, Operation, Connect Four, Guess Who, Tier auf Tier, Memory, and Monopoly?  Or for the older child, nothing beats Scrabble.

I would seriously consider putting a few craft activities on the list this year.  People need to make things!  It's in our DNA.  Until quite recently, we needed crafts {weaving, sewing, leather, pottery, woodwork} in order to survive.  No one ever just sat with idle hands.  After the main chores were done, there was handwork to do: repairing saddles and tack,  spinning, weaving baskets, quilting, making candles and clothing.  When those tasks were completed, hands were turned to decorative arts like carving, leather tooling,  embroidery, and needlepoint.

It's always so  gratifying to me in the clinic when I am working on a craft project with a child and he arrives for his session champing at the bit to get at it.  And the pride and pleasure the child takes in his work is always a thrill.  I was moved beyond words once when I visited the home of a child whom I normally saw at my office, and there was a whole shelf dedicated to his projects in the living room, beautifully and artfully arranged by his father, who is a professional artist.

I confess that although I come from a family where the men can {and do} make or repair anything, I never was much of a crafter myself  -- in fact I practically failed my woodworking class in OT school.  Recently, however, I learned to crochet, and have become so obsessed with it that I haven't picked up a book or magazine in weeks.  The possibilities are endless,  the supplies can be as inexpensive or as costly as you like, and the results are beautiful and useful.  The man who cuts my hair begged me to teach him, because he thought it would help him with his free floating anxiety.  I think it most likely would.  Making things is soothing, grounding, calming, and organizing.  If you have an anxious child, supplying him with an activity that is slightly challenging but requires automatic, repetitive movement, like stitching leather, crocheting, or weaving, can be a huge stress buster.  And nothing motivates a child who tends to give up too easily like success!

If you have a Michael's in the vicinity, you're in luck.  They have a huge selection of structured craft activities as well as the raw materials for things like scrapbooking, cake decorating, painting, drawing, and clay.  I like Perler beads, Loom Loopers, {use a metal loom, the plastic ones are too flimsy} wooden models that you glue together and paint, and the Creatology 3D wooden puzzles that you crack out and put together.  Something all the children like to do is sew a felt stuffed animal from kits and stitch together leather pieces to make a coin purse.

Most small children love art supplies.  How about some gorgeous colored pencils, a supply of stickers, some modeling clay, a collection of fun pattern edged scissors, rubber stamps, glitter, origami paper, a little bag of colored feathers, beads, or a box of watercolors?  I hesitate to recommend markers, unless your child has already developed a good tripod grasp.  If he's still struggling, a chalkboard easel and a supply of colored chalk, which you break into small pieces, would be a big help.  I often play games and do silly drawings on the chalkboard with the children, which strengthens up their arms and hands for writing, and they really enjoy it.

I have to say, looking back, that the gifts that made the biggest impression on me were books.  I would like to thank the woman, whose name I no longer remember, who casually pressed a copy of The Enchanted Castle into my hands one evening as we were leaving her house after dinner.  I must have been about ten years old, and it was not my birthday, so she must have just wanted the pleasure of giving it to me.  I don't know if I ever got the chance to tell her how many times I reread it, how I sought out and read all of E. Nesbit's other books, and how now, as an adult, I still hand out copies to every child who crosses my path.

Buy your child your favorite books when you were his age, and read them together.  Make reading a book together before the child goes to sleep a nightly routine.  Books really are the gift that keeps on giving.  Developing a love of reading will open up the world to a child like nothing else can.

Wednesday, December 8, 2010

Things I Wish all Parents Knew

Children NEED and WANT the grownups to be in charge.  It makes them feel safe, which gives them the confidence they require to go and explore the world.  They will feel less safe if they know that they can push you around and bend you to their will.  I highly recommend forgetting about winning popularity contests with children.  It's far better to assume an authoritative role {authority with empathy and respect} and be, ultimately, s/he who must be obeyed.  

Be the alpha dog in your home.  You can be empathic and respectful of your children's feelings while still standing your ground.  If they are trying to wear you down, you can choose not to engage.  Just be mindful about what you do and do not respond to when you are talking to your child. 

 You won't win any popularity contests by being overly permissive or letting yourself be a pushover; you will only confuse your children by handing them over your authority. They won't respect you, and will continue to act out in an attempt to get you to set limits.  If you allow them to believe that obeying adults is optional, they won't listen to you or to anyone, and you will be setting them up for all kinds of behavioral problems at school.  I have treated many children whose parents don't know how to be the grownups, habitually  allowing their children to misbehave without attempting to contain or correct them, and I have to spend an inordinate amount of time establishing my authority when I should be working on their neurological delays.  Children whose parents are clearly in charge accept my authority instantly, are able to develop a good therapeutic relationship with me in a short period of time, and get right down to work.

Never ask a child if he wants to do something when he doesn't actually have a choice.  In order to avoid an argument or power struggle, a child does much better with a command.  "It's time to put on your coat,"  is going to get the job done a lot more efficiently than, "Do you want to put on your coat?"  If he says no,  which you have empowered him to do by inviting him to make a choice about it, you're in for a fight.  Think you don't do this?   I recently heard a father ask his son, "Would you like to come here for therapy?"  Why on earth would a parent ask a developmentally delayed eight year old boy if he wanted therapy?  It's not his decision to make. It's too confusing and unsettling for children when the adults invite them to make important decisions about their welfare.  It sends them the message, "We don't know what's best for you."

Don't use a lot of words with very young children, and don't negotiate with them.  They don't understand you.  Keep your sentences short, and don't try to reason with them.  Remember that the ability for abstract thought doesn't come into play until the age of about six, so carefully constructed arguments are basically wasted on them before then.  Just say no, and then divert them.

Children will try to wind you up for various reasons.  If you frequently lose your temper when your child acts out, you are telling the child that he is in control of your behavior.  This sets him up to believe that he is responsible for the reactions and emotions of others.   If your consistent response to him is irritation, you are sending him the message that he is irritating, and he will become so.  Conversely, if you are consistently patient and respectful, he will automatically extend that courtesy to others.

Choose to take the high road and avoid shaming, hostility or sarcasm when your child is making you crazy. 

Try not to end every sentence with "Okay?".  Every time you say this, you undermine your authority. You should not be asking the child's permission to be the grownup.  Whether you realize it or not, the child is taking this to mean, "Is this OK with you?"  We are supposed to call the shots, and should not be checking in to see if it's all right with them.

Wednesday, December 1, 2010

Feeding the Special Needs Child {Confessions of a Zealot}

 Children with sensory issues often have undetected food sensitivities, especially to preservatives, flavorings, and dyes, and don't let anyone tell you any different.  Artificial sweeteners, especially aspartame, should be strictly avoided.  They are so far removed from anything occurring in nature that the body has absolutely no ability to deal with them.

The Feingold diet is a good place to start if you want more information about how diet affects attention.

  There is a correlation between ADHD and pesticides,  so if your child has attentional issues, the more organic foods you can provision, the better.   Or try to buy the organic versions of the worst offenders. There are many foods that don't contain a high concentration of pesticides, so you can buy the conventionally grown ones if money is an issue.  Speaking of which, can we prioritize a bit here?  What luxuries can you reduce or eliminate so that you can increase your food expenditures and buy more high quality food?  Many people in other countries are accustomed to spending a far higher percentage of their disposable income on food.

Microwave ovens are bad news.  I have never owned one and won't let anyone heat my food in one.   Not only do they change the internal structure of the food, doing heaven knows what to the nutrition,  nuking things in plastic containers leeches toxins into food.  Do you want your children eating that?  I didn't think so. Replace your microwave with a good convection/toaster oven, and get used to waiting an extra minute or two for your food to heat.

 Get rid of your non stick cookware, which flakes toxins into your food as it ages.  Use cast iron instead.  A Lodge preseasoned cast iron skillet costs less than thirty dollars, and it will last forever.  Your great great grandchildren will be able to cook with it.  Cast iron is not very hard to take care of, and is completely non stick if washed and dried correctly.  Cast iron pans do a much, much better job of cooking things that you would normally associate with non stick cookware, like eggs and fish,  which in turn makes you a better cook. Instead of toxins, they add iron to food, which among other things is what allows the body to absorb and retain calcium.  They're reactive, but the only things you really can't cook in them are high acid foods like tomatoes and wine based sauces.

 Industrially raised cows, pigs, and chickens, and farmed fish, are pumped full of antibiotics and hormones, which we ingest when we eat them.   They live horrendous lives, are fed diets that nature did not design them to digest, which makes them ill,  and they die violently.  The {often undocumented} workers who process them, which is a polite way of saying kill and eviscerate, are treated almost as badly.   Don't believe me?  Watch Food, Inc.  or read Johnathan Safran Foer's  Eating Animals.

Restaurant food, especially fast food, tastes good because it has a very high percentage of sodium and fat.  We don't need to be eating it every day.  Take out and eating in restaurants should be reserved for special occasions, and should not be the default option.

  Something I don't consider real food:  Soy.  {I once heard a well known pediatrician say to a group of parents that he wouldn't feed soy to his own children, and that was good enough for me.}  Most soy is genetically modified.  This may or may not be harmful to humans, but genetically modified crops cause harm to insects,  This in turn disrupts the food chain, which eventually will be devastating to all living beings.  We are in danger right now of losing the ability to grow our own food here in the US, because our bees, who pollinate the crops, are dying off.  If we have to import all of our food in order to survive, that leaves us incredibly vulnerable.

Back to soy.  Even Asians, who have been consuming soy for generations, don't depend on it for the bulk of their protein, and neither should we.  They use soy as a condiment, such as a few cubes of tofu in a bowl of miso soup.  Soy milk and soy yogurt are a relatively new phenomenon.  Soy based  hot dogs, sausages and burgers are highly processed and contain tons of sodium and additives.   It's not a good idea to rely on these things, even if you're attempting to eat less meat.   Have some edamame once in a while as a special treat, or have some delicious homemade tofu at a Japanese restaurant, but I don't recommend consuming soy every day.   Which, in fact, if you rely on any processed foods at all, you already do.   Soy shows up in all kinds of places where you wouldn't expect it.  Kashi cereal, many granola and energy bars, breads, crackers,  mayonnaise, even canned tuna fish contain soy, like soy oil or soy protein, in some form.

Many fruits and  vegetables that we could never dream of buying even as a treat are now readily available at supermarkets.  Have you discovered fennel, lacinato kale, chayote, pomegranates, loquats, passion fruit, or ripe plaintains?

Is there a greenmarket near you?  Discover the joys of seasonal produce and watch the the seasons go by in rhythm with the market:  ramps, spring garlic, cherries, berries, apricots, tomatoes, apples, eggplant, peppers, tatsoi, kale, turnips, corn.  Take your children with you and discover these things together.  Or take a trip to your local Chinatown and discover green things and fruits you never knew existed.

Instead of white rice or spaghetti, try farro, quinoa, kamut, and wild rice.  They are delicious, easy to cook, and highly nutritious.

Remember: we are what we eat.  Do you want your children to be eating bad food?