Sunday, March 29, 2009

Enforcing Rule #4

Please read the earlier post for details on Rule #4

No shoes. No shirt. No service.

That pretty much sums up life. It is not an option to go barefoot for your entire life. And we have already concluded that preschoolers grow while shoe sizes remain constant. Therefore setting up the demand for new shoes. Once shoes become "acceptable" to Crash he has very few problems keeping them on (I can save these issues for another post at another time).

So, how have we gone about helping Crash to accept his new shoes...

1. Way in advance (especially when there is a good sale) we take Crash shopping for new shoes. We expect him to get his foot measured, but tell him straight up he can choose if he wants to try on the shoes at the store.

We ask his input on color and markings and usually let him choose between 2 different pairs. Most of the time he refuses to make a choice and may end up kicking or pushing the shoes away (which is also unacceptable and lands him quickly into time out). We are trying to give him some control over the situation and offering opportunities for him to push beyond his comfort zone.

2. We leave the shoes in a visible spot and make no reference to their impending doom. Crash knows they belong to him and he most certainly knows what shoes are for. I do not make a big deal out of this.

3. We start talking about how old his shoes are getting. We try a couple times to glue or repair broke areas (of course we don't "repair" them to the best of our abilities insuring another much needed repair will have to occur shortly. When Crash can understand logically a need for something to occur (even if that something is viewed by him as uncomfortable) he is more likely to accept the change or discomfort (of course he still puts up a good fight).

4. His old shoes disappear. We tell Crash that his shoes got too old and worn out and they are gone. End of discussion.

5. His new shoes are placed by the door and a "fun" outing is planned (trip to the library, park, grocery store...preschoolers think just about anything is "fun".

6. Crash is given a choice. Put on the new shoes, or stay home.
Crash wants desperately to go. He can even tell you why he has to have new shoes. After many tears and numerous rounds of the "mom puts one shoe on, Crash kicks ones shoe off" game, the shoes are on, and the tears are flowing. By the time he is buckled, the shoes are off.

But, he wore them to the car. I celebrate the minor victory and prepare for the next battle. Each battle is shorter and my victories are longer. By the next day he says "Mommy, my shoes aren't scary any more." Battle Over!
...or so I thought We still have minor issues for the next week or two. More verbal protests than anything else. Now all we have left to do is find a good sale on the next size up to start this all over again.

Rule # 4



Rule # 4: New shoes are inevitable

I have yet to hear of a pair of shoes lasting a lifetime. Although this is not saying that I would not be interested in an expand as you grow indestructible shoe. I just have not found it yet.
Unfortunately a preschooler is constantly growing which means every few months it's time for a trip to the local shoe store. Sounds pretty painless and even fun to pick out a brand new pair of shoes. The Police Officer will compare designs and try on all kinds of shoes to find the "fastest" ones. Wouldn't it be awful to have slow sneakers? Crash will happily accompany everyone on this trip. As long that is as the shoes are NOT for him. If I were to ask Crash to try on new shoes we would have a complete screaming crying meltdown in the middle of the store. I am quite certain even the speediest and most experienced sales clerk would not be fast enough to get new sneakers on flailing feet.
He will however consent to having his feet measured. Good enough for me. I will buy a size bigger than what he measures. A little room to grow and plenty of time to let him get used to the idea of new shoes.

Crash's rules about shoes:
#1 Shoes should be a constant never changing predictable entity.
#2 New shoes are scary.
#3 New shoes are squishy.
#4 New shoes are not the same.

What's going on:
Crash enjoys predictability and control. Shoes that are perceived as comfortable help him remain regulated and in control. Changing this routine is very challenging and forces him to give up some of this control. He doesn't realize that the new shoes may also be comfortable and is so busy fighting the change he is unable to process this new information. Add to this some of his tactile defensiveness and new shoes become quite a trying experience. Everyone knows you have to break in new shoes before the become comfortable. This break-in period for Crash can be all most unbearable because to him his shoes really do seem too squishy and scary. Add to this he is a preschooler and his thought process isn't quite mature enough to understand.

Monday, March 16, 2009

Book Review-Sensory Tools for Tots

This is a fantastic resource for parents, preschool teachers, early childhood educators, therapists, or anyone interested in learning more about sensory processing. This book was written by Diana A. Henry, MS, OTR/L, Maureen Kane-Wineland, PhD, OT/L and Susan Swindeman, OTR/L, BCP and it offers everyday solutions to help young children and their families learn to deal appropriately with every day challenges of living with a sensory processing disorder. This book touches on routine activities of every day life such as eatting, bathing, brushing teething, going to bed and provides strategies to help children engage in and complete these activities. This is a short book with an easy to follow format offering checklists and lists that make it easy to share with everyone invoved in the child's life.

Click here for Sample pages

Henry Occupational Services

Monday, March 9, 2009

What is a visual schedule?

A visual schedule can be used for any activity or sequence of events to tell the individual what activities will occur and in what sequence.

Because the schedule is in picture format most everyone will be able to understand the events on the schedule. We use this with Crash to lessen the anxiety he feels during the dressing routine to decrease his screaming tantrums that typically occur when getting dressed. This provides predictability and clearly lays out the expectations. At the end we placed a treasure chest to indicate a "surprise" that would happen if he completed his schedule. This surprise might be to watch a little of a favorite movie, or a bite of a apple , or a piece of cheese. We never defined the surprise so we could make it fit into any situation.

We also have a morning routine schedule and a schedule for getting ready to go outside.

Additional information about visual schedules

How to make a visual schedule:

We chose to incorporate some of Crash's favorite characters to increase his motivation to complete the visual schedule, but this is optional. We also made his schedule portable so it can go to grandma's house or the YMCA or where ever we may need it to go. Finally, we placed a strip of velcro on the back of the schedule for Crash to put the pictures after he completed each step.

1. Define your schedule: Is it for a specific procedure (getting dressed) or a routine of events that will happen in sequential order .

2. List the specific steps

3. Using Google images search for a specific image to represent each step. Images should be concrete and self explanatory.

4. Cut each picture into a small square.

5. Use clear contact paper (found most retail stores with the shelf liners) or a laminator to seal the pictures to prevent them from getting ripped or torn.

6. Use sticky back velcro and place one side of the velcro on the picture and th other on the schedule board.

Saturday, March 7, 2009

Enforcing Rule #3

Please read the earlier post for details on Rule #3

Causing harm or placing others in harms way is not acceptable even if it is the result of faulty neurology. We had to find a way for Crash to get this type of input in a safe and controlled manner. We also have to teach him to recognize symptoms that mean his body requires this type of input and how to APPROPRIATELY seek it out.

But Crash is 3. This would be like taming the "Tasmanian Devil"?

It is POSSIBLE. Here is what we did...

1. We give Crash opportunities for appropriate jumping and crashing throughout his day. We have a huge bean bag chair in our living room that is very comfortable to sit in, but purchased for the specific purpose of running into and crashing.

2. We have a jumping pit in the basement. Crash can go down there at any time and jump until his heart is content.

3. We have been increasing Crash's awareness of his body and teaching him to request "deep pressure". This actually happened naturally and we later turned it into a technique for Crash. When we saw him out of control as a toddler we would go over to him and give him a huge long hug. His body would relax during the hug and he would be more in control afterward. Crash now comes to us throughout the day and asks for hugs. It is important to note that these hugs last 30-60 second and I hug his entire body with one arm squeezing his legs and another arm providing pressure around his shoulders and back. Little hugs do not work.

4. We have tried several ideas from an Occupational therapist as well including
--weighted vest
This is a simple vest with 1-2 lbs of weights sewn into it. It provides a calming effect for the short period of time that it is worn. Crash enjoyed this vest last year. These can be very expensive to purchase. If you know anyone that can sew, they are pretty simple to make.
--neoprene vest
This is made out of wetsuit material and provides a constant squeeze. It works wonders with Crash, but can be very challenging to get on because of some of his tactile concerns.
--weighted blanket
This is similar to the weighted vest. Crash will sleep with it or keep it on his legs while watching a movie.

Rule #3

Rule #3: Bowl with your buddies

Sounds like a very common practice in the bowling alley, but what about in your house with Crash playing the role of the human bowling ball?
This isn't necessarily a huge problem in our house since the Police Officer is bigger than Crash and it is quite hard to get a "strike" (however, it is possible). While visiting relatives, this is another story (especially when visiting the littlest ones).

Crash quite frequently bowls "strikes" when visiting his little cousin. He truly loves this little guy and enjoys playing with him, but has been told countless times that little cousins can "break" and we have to be very careful with our body (hands, arms, legs, etc...) so little cousins don't fall over.

From an outsider prospective, Crash appears to blatantly disregard this rule. He is frequently be talked to or timed out for violations. And to make matters worse he is laughing while he is committing the offense. Does he really not care that he is hurting others?

Without a doubt, he does not want to hurt anyone. He is NOT laughing because he is causing pain or in glee for disregarding rules.

So what's going on...

Everyone is familiar with the 5 senses (see, hear, smell, taste, touch), but there are a few more. One is the PROPRIOCEPTIVE sense which involves "sensory input and feedback that tells us about movement and body position. It's "receptors" are located within our muscles, joints, ligaments, tendons, and connective tissues. It is one of the "deep senses" and could be considered the "position sense" (www.sensory-processing-disorder.com)

Therefore the sensory receptors inside Crash's muscles, joints, and tendons receive "faulty" messages about how he is moving and where his body is in space. Crash is in constant movement to help his body know where it is. Crashing into people or other objects helps provide this awareness and it helps him feel secure in his environment.

Check out this interesting article about sensory processing:

Sensory Processing: Through the Eyes of Dysfunction

Sunday, March 1, 2009

Enforcing Rule #2

Please read the earlier post for details on Rule 2
We live in the mid-west and hibernation is NOT an option. So what did we do?

First, we took a closer look at the situation to see if we could define "scary" and "squishy." When working with a three-year-old, this can be a challenging task. But we found out that typical "ski jackets" are very noisy. As you put your arm into the sleeve there is a swishing sound. Every time you move there is a swishing sound. When you sit down the coat rubs the "swishy" fabric on your neck. Could these things be the culprit? After much trial and error we found a cloth jacket with no neck. This coat was much more acceptable to Crash, but it certainly did not solve all the problems. In order to get the coat on we went back to the visual schedule we used for dressing and made more picture symbols for outside clothing items and added another surprise at the end.

Next, we found some very light weight cloth mittens (without tags). We also found a hat that tightly squeezed his head. Crash is a fan of deep pressure and finds it calming. My thought was maybe the hat could provide a little of this deep pressure to help him organize his body to tolerate these winter experiences. Well, it was a good thought, but winter experiences are still challenging.

So how does Crash make it through each day? Sensory Mommy picks and chooses her battles. Does he really need to wear his boots if there isn't a foot of snow on the ground? Will his fingers fall off by the time he gets from the house to the car? Is it really cold enough for snow pants? When the answer to any of these questions is yes, we use our visual schedule and a very motivating surprise, and the phrase, "You can take them off as soon as _____." We let Crash decide what items to put on in what order and then follow our schedule. We encourage him to talk about his dislike for items of clothing and we acknowledge how he feels while reinforcing the importance of wearing the specific items. Does it work all the time? No. Is it ever his choice? Not really. But it allows him to feel as though he has a tiny bit of control over something that is so obviously painful for him.

Rule # 2

Rule # 2: Only bears can hibernate during the winter.

As nice and idealistic as it sounds to only go outside when the weather is above freezing, it just isn't practical living in the mid-west. Winter happens and there is nothing anybody can do about it except hope for an early spring. Very few people look forward to bundling up, but life goes on or they move south.

Our family enjoys sledding outings, building snowmen, and usually spend hours shoveling each winter. The Police Officer thinks it is his sole responsibility to move all the snow that has been shoveled off the side walk back onto the sidewalk. He asks to go outside all the time and hurries to get all the layers of clothing on to be the first one to make footprints in the fresh snowfall.

Crash has never asked to go outside in the winter. In fact he has only played in the snow twice this year and that was under protest. He would be happy if rule # 2 was: Humans hibernate during the winter. Because this is not the case, here are Crash's rules about winter clothing:
Rule #1: Coats are scary
Rule #2: Coats are squishy
Rule #3: Snowpants are too squishy and too noisy
Rule #4: Mittens are too noisy (the waterproof material makes a swishing sound when you rub your hands together)
Rule #5: Boots are to squishy
Rule #6: Snow is too wet

I suppose I could go on, but I bet you get the idea. When asked if he wants to go outside to play he simply says no. When asked why he says it is too scary. He will watch from the window or happily read a book relieved that he isn't being made to endure the torture of these winter items.