“Cookie Cutter Therapy”- Why it’s OK with me….

The other day I did an autumn arts and crafts project with all of the students on my caseload.

Every. Single. One.

Kindergartners as well as fourth graders.

Very often we hear about the problem of a “cookie cutter therapist”.

Meaning – a therapist that does one thing with every single student regardless of their goals or deficit areas.

A lot of people have a problem with this and so do I – sometimes.

I might sound like I’m contradicting myself because I said I’m OK with doing the same activity with every single student but here’s the thing:

One of an occupational therapist’s best and greatest qualities is creativity and flexibility. Teachers have this gift, too!

Every single child has different goals – so tweak that activity to work for them!

Change it Up!

Here are some ways to tweak this simple fall craft.

  • For really weak fine motor skills, take one piece of tissue paper in each hand. Hold the student’s hands up in the air like a “Y”. Crunch the tissues into little balls without using his other hand or his chin or even his belly to help with the crunching.
  • To work on mid crossing midline; place the paper to the other side of the student’s body.  Put the helping hand on vacation (meaning behind his back). His dominant hand has to crossover in order to glue on the leaves of the tree.
  • My student with weak grip strength had to use a clothespin to pick up each tissue ball and place it on the tree.
  • My student with really poor scissor skills had to cut the tissue before he crunched. He also cut a piece of green construction paper to make grass for the bottom of his picture.

So – if you were a random person standing at the door of my occupational therapy room, you’d see every student come out with a picture of a tree with different colored fall leaves on it.

It might look like I’m doing cookie cutter therapy but I’m not.

It’s ok to re-use an Idea

My point is – give yourself a break! It’s OK to do the same or similar activity with different students.

Just use your creative mind to tweak it to work for that student and the needs of that student.

For teachers, this may mean creating groups of students who will complete the task in a different way. For example, the red table will use clothespins to pick up the leaves and the blue table has to crunch with two hands in the air in the shape of a Y.

Once you give yourself permission to do one activity with all the kids; you’ll see how easy it is to change it up.

Need an AMAZING Activity to do with your kids this week?

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For the Hardworking Therapists Who Work With Children with Special Needs

therapist guilt, fine motor skills, primitive reflexes

I’m sure you’ve heard of Mom guilt, Daughter Guilt, and Irish Guilt, but have you ever heard of Therapist Guilt?

I may have invented it…

You’ve probably read letters and blog posts written toward the parents of children with special needs; talking about how strong they are and how hard they work to help their children.

It’s true.  But many of those selfless parents still have “The Guilts”.

WHAT ARE “THE GUILTS”?

When you have “the guilts”,  there is always something you feel guilty about.   It could be about not having a spic-n-span house, not being able to go to loud family events, or losing your patience with a child with special needs.  The guilt is always there.

It’s often there for therapists, too.

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Toileting and Sensory Processing

Potty-training can be a challenge for parents, but it’s also an important part childhood development. The normal struggle can be even more difficult when there are sensory processing issues. Recognizing that they need to go, wearing big girl or big boy underwear, and being able to use different toilets can all be impacted by sensory processing.

Why does Sensory processing matter?

Toileting requires a significant amount of body awareness.  Children have to understand how their body is feeling, learn how to release their bowel and bladder muscles in order to go, and feel that they have “finished” and their bowel or bladder is now empty.  

Sensory processing is a natural part of the toileting process. 

A bathroom environment can be overstimulating to start with.   We receive sensory information from our eyes, ears, skin, muscles, and joints and our brain’s job is to organize the information, select the important parts, and disregard the rest. When a child’s sensory systems are functioning appropriately,  they are able to participate in activities of daily living such as potty-training.  However, if the sensory systems are not integrated properly, toileting can become problematic.  

Everything parents Need to know

  1. WHAT IS SENSORY PROCESSING?
  2. HOW SENSORY SYSTEMS RELATE TO TOILETING
  3. BODY AWARENESS NEEDED FOR TOILET TRAINING
  4. PROBLEMS
    1. POOR INTEROCEPTION
    2. SENSORY DEFENSIVENESS
    3. POOR REGISTRATION OF SENSORY INPUT
    4. SENSORY SEEKING
    5. SENSORY AVOIDING
  5. HOW TO HELP: 15 AMAZING STRATEGIES FOR TOILETING
  6. CHILDREN WITH SPECIAL NEEDS

what is Sensory Processing?

Sensory Processing refers to how the nervous system detects, regulates, interprets and responds to sensory information.  Sensory Processing is an important factor in considering a child’s attention, memory, behavior, and function (Ahn, Miller, Milberger, & McIntosh, 2004; Gardner &Johnson, 2013).   A child’s brain needs to be able to register sensory information from the environment and react appropriately to it.  If a child has difficulty regulating and processing sensory information, they may have Sensory Processing Disorder.

Sensory Processing Disorder is a neurological disorder in which the sensory information that a child perceives results in abnormal responses.   Children who have difficulty processing sensory information often have inconsistent responses because they have a hard time discriminating between which sensory information is important and which can be ignored.  

It is important to note that many children (and adults for that matter) have difficulty with processing certain types of sensory input.  Typical things such as disliking certain smells or textures, feeling seasick on rides, or preferring certain foods do not necessarily mean that a child has sensory processing disorder. They may simply still be learning to process certain sensory stimuli.

There are eight  sensory systems in our bodies:

  1. Tactile System (touch)
  2. Vestibular System (balance)
  3. Proprioceptive System (position in space)
  4. Olfactory System (smell)
  5. Visual System (sight)
  6. Auditory System (hearing)
  7. Gustatory System (taste)
  8. Interoceptive System (internal body awareness)

Interoception is our ability to sense what is going on inside our bodies internally.  It includes sensations such as thirst, hunger, fatigue, pain, breath, itchiness, nausea, temperature, etc.  It also includes our sense of if we have a full bladder or bowel, and if we have “released” it. (Garland, 2014).

An Explanation of the Sensory Systems related to Toileting

The proprioceptive, vestibular, and touch senses are primary influences on the integration of our senses.  The interoceptive sense also plays a crucial role in developing the foundational body awareness needed to function as a child.

When a child is unable to integrate and react to sensory information appropriately, the child will not interact with his environment in a functional manner.  He may have exaggerated responses to typical noises or sensations or withdraw from certain stimuli. The child cannot consistently process sensory information, so their responses will be inconsistent, too.

If the child has decreased body awareness, they may demonstrate an inefficient grading of force or movement.  For a boy, this may mean they have difficulty using the right amount of force when holding or aiming the penis.  This might result in a child pressing so hard that it’s difficult to pee,  holding too tightly, or having difficulty holding steady.

Our vestibular system helps us to maintain our balance. The fluid in our inner ear moves as our head moves, sending messages to our brain about where our body is in space (Abraham, 2002).   Some children with vestibular dysfunction present with “gravitational insecurity“, which makes them seek a secure position during activities. They may dislike swings, being picked up, or participating in activities in which they are not in control of their body in space.  These children might be fearful when attempting to sit on a “grown-up” toilet where their bottom is unsupported because they feel like they may fall.

Children with vestibular, tactile, and proprioception difficulties may have difficulty with eye-hand coordination and depth perception. It may be difficult for them to aim appropriately or estimate where to stand.

Many children with sensory processing difficulties have auditory sensitivities that interfere with toilet training.  Think of the loud echoes, flushing toilet, the hand dryers, etc.  Noises that are simply loud to an adult can be piercing to a child with auditory sensitivities.

Tactile sensitivities can interfere with toileting, too! Children may dislike the sensation of pooping, wiping, or even sitting on a hard seat.   If they are under-responsive to touch, they may not realize that they aren’t covering their hand properly with the toilet paper, they aren’t wiping well enough to clean themselves, or that they’ve soiled their clothing.

potty training, #functinalskillsforkids

Sensory Processing and Body Awareness needed for Toilet Training

When our body is able to receive and interpret the signals from our skin, muscles, and joints, we are able to feel and know what our body is doing without looking at it.  When a child has poor body awareness, it can lead to difficulty coordinating their body to do all of the components that are involved in toileting.   It is not automatic to feel the urge to go and just go to the bathroom.  Each step of the task must be thought out and carefully performed, so it is important to be patient.  It’s hard to know what to do if you can’t feel what you are supposed to feel!

Typically, toddlers and preschoolers spend a lot of time learning the “ins and outs” of toileting.   Children are expected to be toileting independently before entering Kindergarten.  Children with difficulties modulating sensory input find potty training to be a much bigger challenge than a typical child.  The bathroom can be an overstimulating environment, so asking a child with sensory integration difficulties to focus on the task at hand (ie; peeing or pooping) is a challenge if they are overwhelmed with fear or anxiety about other sensory signals they are receiving.  Problems with toileting and sensory processing might include (but not be limited to) the following:

Toileting and Sensory Processing Problems

1. Toileting and Sensory Processing Related to Poor Interoception

  • May be unaware that his bowel or bladder is full.
  • Feels that they need to go, but not be able to discriminate whether they need to urinate OR have a bowel movement.
  • Unable to “push” in order to go; don’t understand how to make those muscles work
  • Cannot feel that they have had an accident or that their clothes are soiled.
  • Unable to bend and reach behind them to properly wipe

2. Toileting and Sensory Processing Related to Sensory Defensiveness

  • Dislikes the feeling of “peeing” or “pooping” and withholds.
  • Fearful of falling into a regular sized toilet
  • Dislikes the feeling of wiping or being wiped.
  • Prefers the parent to wipe them
  • Does not like to wash their hands
  • Takes off all their clothes to use a toilet
  • Avoids flushing the toilet

3. Toileting and Sensory Processing Issues Related to Poor Registration of Sensory Input with a Hyperactive or Over-reactive Response

  • The child is fearful of the sensations involved when they pee or poop.
  • Reports that the act of “peeing” or “pooing” hurts terribly, crying, etc.
  • Extreme reaction to the sound of the flush or the air dryer
  • Gags, or chokes at the smell of the poop
  • Visually distracted by details in the bathroom, including lines in the tile, dust on the floor, etc.

4. Toileting and Sensory Processing Related to Sensory Seeking

  • Repetitively flushing the toilet
  • Fecal smearing
  • Repetitively having accidents in pants, enjoys the sensation
  • Playing in the water
  • Playing in the sink
  • Asks to use the toilet in public constantly

5. Toileting and Sensory Processing Issues related to Sensory Avoiding

  • Avoids wearing big girl or big boy underwear, prefers a diaper
  • Will tell you when the diaper needs to be changed, doesn’t want a wet diaper
  • Difficulty tolerating new bathrooms, public bathrooms, etc.
  • Covers ears when flushing, air hand dryer goes on, etc.
  • Holds nose for bowel movements
  • Avoids using certain toilets with “hard” seats
  • Avoids going into the bathroom, “sneaks off” to poop in diaper behind a couch, etc.

potty training, sensory processing

How to Help: 15 Amazing Strategies for Toileting

1. Try a  4 in 1 Stages Potty Seat which is closer to the ground and fits a smaller bottom. It also helps transition to use a grown-up toilet

2.  Try fun potty seats like this Race Car Potty and Character Underwear that are motivating!

3.  Try using flushable wipes and a Wipes Warmer to make the experience of wiping more enjoyable

* one consideration for this is that your child may begin to rely on it…. if you are out in public and don’t have warm wipes, will it be a problem?  Take that into consideration before making it part of your routine.  But if you are desperate, it’s worth a shot!

4.  Sing Songs to make toilet training more fun:

  • “Let it go! Let it go!”
  • “Push it out, Push it out, WAY OUT!”
  • “Pee Pee in the Potty, Pee Pee in the Potty!”
  • “I just want to Potty all the time, Potty all the time, Potty all the time!”

5.  Use painter’s tape to make a line for boys to know where to stand

6.  Offer Toilet Targets  or use goldfish crackers or fruit loops (get the pee in the hole!)

7.  For children who aren’t sure if they have to pee OR poop, let them sit.  It’s hard to tell which muscles are which.

8.  Provide an inviting environment depending on your child’s sensory needs:

  • For a sensory seeker, bright lights, fun music, and toys alerting aromatherapy (peppermint and eucalyptus).

  • For a  sensory avoider, soft lighting (night lights) and music, calming aromatherapy (lavender and chamomile).  *Click for more info about Aromatherapy

9.  Let your child leave the room before flushing if they are defensive, OR let your child choose if they flush or you do.

10.  Use earplugs to block the sounds, (especially in a public bathroom), OR keep post-its in your bag to put over the automatic sensor.

11.  Use a soft toilet seat.

12.  Keep a  Potty Training Chart   or offer Potty Reward Stickers for Boys or Girls

13.  Try a toileting schedule. Have your child sit on the toilet every 15 minutes for a few minutes. If they go, Wahoo! big Praise. If not, that’s ok, we’ll try again in 15 minutes.

14.  Provide a Kitchen Timer for set “potty” sitting times.  Let your child set the timer so they are a part of the process.

15.  If your child is fearful of the sensation of pooping in the toilet, have them help you dump the poop from the diaper into the toilet and then flush it.

Toileting and sensory issues

Toileting and Sensory Processing in Children with Special Needs

Very often problems with potty-training, such as accidents, difficulty recognizing if they have to go, struggles with hygiene, fear of flushing, and refusal to use the toilet are the result of an inefficient sensory processing system.  It is important to note that children with developmental delays and other diagnoses may need more time to be trained.   As parents and educators, it is essential to treat the process with patience.  Your child has a lot of information and sensory signals to make sense of and every child has to go at their own pace.  Do not feel the “peer pressure” from other parents that your child “should be” ready.

Sensory Processing Resources

Affiliated resources:

sensory processing

Click on the image for more info. It will take you over to my pals at Your Kids Table so you can see what all the fuss is about!

Additional Potty Training Resources

Establishing Toileting Routines for Children Tips – a Printable from the American Occupational Therapy Association

6 Tips for Successful Potty Training from the American Occupational Therapy Association

References

Abraham, M. C. (2002). In Pressnal D. O., Wheeler K. (Eds.), Addressing learning differences: Sensory integration; practical strategies and sensory motor activities for use in the classroom. Frank Schaffer Publications.

Ahn, R., Miller, L., Milberger, S., & McIntosh, D. (2004). Prevalence of parents’ perceptions of sensory processing disorders among kindergarten children.  American Journal of Occupational Therapy, 58, 287-293.

Crozier, S. C., Goodson, J. Z., Mackay, M. L., Synnes, A. R., Grunau, R. E., Miller, S. P., et al. (2015). Sensory processing patterns in children born very preterm. American Journal of Occupational Therapy, 70.

Daunhauer, L., Fidler, D., & Will, E. (March 2014). School function in students with down syndrome. American Journal of Occupational Therapy, 68(2):167-176. 

Garland, T. (2014). Self-regulation interventions and strategies. Eau Claire, WI: PESI Publishing & Media. Shelly J. Lane, PhD, OTR/L, FOATA, Isabelle Beaudry-Bellefeuille, MScOT; Examining the Sensory Characteristics of Preschool Children With Retentive Fecal Incontinence. Am J Occup Ther 2015;69(Suppl. 1):6911500194p1. doi: 10.5014/ajot.2015.69S1-PO6099.

Functional Skills for Kids

#functionforkids

This post is part of the Functional Skills for Kids series.  See all of the bloggers who are participating and more about the series here. For more information on the components and considerations related to Toileting, stop by and see what the other Occupational Therapists and Physical Therapists on the Functional Skills for Kids team have to say:

Potty Training, Toileting and Fine Motor Considerations  | The Inspired Treehouse

Gross Motor Skills and Toilet Training | Your Therapy Source

Toileting and Sensory Processing   | Miss Jaime OT

Potty Training with Attention and Behavior Problems | Sugar Aunts

Modifications For Potty Training  | Therapy Fun Zone

Preparing Your Child & Environment for Potty Training | Growing Hands-On Kids

Potty Training Instruction Tips  |Kids Play Space

Teaching Concepts for Potty Training Through Play |Your Kids OT

#functionalskillsforkids, toileting, potty training

Do you have an amazing toileting trick or tip? What potty training strategy helped your child?


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Happy Mat and “Making Mealtime EZPZ” Giveaway!

May’s Theme on Miss Jaime, O.T. is Sensory Processing!

I’m so excited to announce my next giveaway!

THIS GIVEAWAY HAS ENDED!

We have a Happy Mat from EZPZ AND a copy of the book “Making Mealtime EZPZ”

EZPZ

*This post contains affiliate links

ENTER HERE TO WIN

a Rafflecopter giveaway

EZPZ has offered to raffle off a Happy Mat and a AND a copy of the book “Making Mealtime EZPZ”   *See the raffle details below 

Want to know more?

ABOUT EZPZ and Happy Mats

ezpz products are different than anything else on the market.

Each product is an all-in-one placemat + plate/bowl made from high-quality silicone. What else? The mat SUCTIONS directly to the table, making it difficult for tiny hands to tip over.

Other special features:

  • Placemat + plate captures most of the mess
  • 3-4 Happy Mats can be stacked and carried with food
  • Promotes self-feeding and develops fine motor skills
  • Easy to clean with warm soapy water (silicone doesn’t support the growth of fungus, mold or bacteria)
  • Dishwasher, microwave and oven safe
  • Made from 100% silicone that is BPA, BPS, PVC and phthalate free
  • Easy to store (place in utensil drawer or cabinet)
  • Built to last (silicone is bendable and flexible and doesn’t fade, corrode or deteriorate)

WANT TO LEARN MORE?

Check out the EZPZ website online or on Facebook!

To see the amazing variety of products, fabrics, and designs that are available.  Here are just a few:

EZPZ EZPZ EZPZ
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The EZPZ GiveAway Details:

    • Raffle starts May 10, 2018  and runs until May 17th at 4 pm EST.
    • The winner of the Happy Mat and book will be picked randomly and announced Thursday night, May 17th, on Miss Jaime, O.T.’s Facebook Live video.
    • The winner will also be notified via email.
    • The winner will get a Happy Mat and a copy of the book “Making Mealtime EZPZ”

Don’t want to wait?   You don’t have to!

EZPZ is offering 10% off the entire store!

Click this link– NO PROMO CODE NEEDED

Offer ends May 31st, 2018

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Weighted Lap Pad Giveaway!

May’s Theme on Miss Jaime, O.T. is Sensory Processing!

To kick off the month with a bang, I’m so excited to announce a giveaway!

We have a handmade custom weighted lap pad, valued at $40, up for grabs!

ENTER HERE TO WIN

a Rafflecopter giveaway

KP Designs Shop has offered to raffle off a custom-made lap pad- You get to pick the fabric!    *See the raffle details below in regards to choosing your fabric. 

Does your child love princesses?  Fish?  Trains?  No problem!  KP Designs Shop provides fabrics according to your personal preferences, offering emotional and physical comfort to kids and adults who hadn’t found it.  When you order from KP Designs Shop, you can choose from hundreds of different fabrics and patterns.

Want to know more?

Weighted Lap Pad Giveaway

Click the Image to Enter!

ABOUT WEIGHTED LAP PADS AND BLANKETS

Weighted blankets and lap pads are often recommended for individuals with sensory integration disorder, Autism, anxiety, ADHD, Rett Syndrome, PTSD, Restless Leg Syndrome, and many other conditions.  They provide the body with proprioceptive input which can cause the brain to release neurotransmitters like serotonin and dopamine.  These neurotransmitters released by the brain have natural calming effects.   This can help people to calm down, sleep, and relax when they normally wouldn’t be able to.

ABOUT KP DESIGNS Shop Custom Made Weighted Products 

KP Designs Shop is run by a pediatric Occupational Therapist.  Each order is custom-made, which makes every order special.  Customers get to choose their fabric and pick their product.  Then KP Designs Shop customizes your purchase according to your weight and fabric preference.

WANT TO LEARN MORE?

Check out Kp Designs Shop ‘s website  online or on Facebook!

To see the amazing variety of products, fabrics, and designs that are available.  Here are just a few:

The Weighted Lap pad GiveAway Details:

    • Raffle starts April 30th, 2018  6 pm and runs until May 7th at 12 am EST.
    • The winner of the weighted lap pad will be picked randomly and announced Monday night, May 7th, on Miss Jaime, O.T.’s Facebook Live video.
    • The winner will also be notified via email.
    • The winner can choose from a variety of fabrics available specifically for this giveaway.

a Rafflecopter giveaway

Don’t want to wait?   You don’t have to!

Kp Designs Shop is offering 15% off weighted lap pads and blankets with the promo code “MISSJAIMEOT”  till the end of the month!

Offer ends May 31st, 2018

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Sensory Theraplay Box

Do you know a child who just LOVES Sensory toys?  I mean gooey, flashy, squishy, squeezable and spinnable toys that stimulate their senses of sight, taste, touch, smell, and hearing.

As a pediatric Occupational Therapist, I have to admit that I have a LOT of students who love sensory stimulation.  And I have a bunch of sensory toys that I use routinely in my therapy sessions.

But it’s very easy to get stuck in a rut. 

My kids get bored with the same toys over and over.  But I don’t have time to go scouring for new sensory toys all the time.  And the families that I work with aren’t sure what to get or where to get the perfect sensory toys for their children.

But there’s a solution!

Sensory toys, SPD, sensory processing,

I recently discovered Sensory Theraplay Box, a subscription sensory play box that’s delivered to your doorstep!  This is such a cool idea – a box full of new sensory toys specially hand picked by a pediatric Occupational Therapist delivered to your house during the first week of the month.

Each box is different! It’s filled with toys to help develop important sensory-motor skills & stimulate the senses.  These are perfect for getting your child to engage in sensory play!

Here are the details:

  • A variety of toys to engage your child in fun, silly sensory play!
  • Boxes ship out the first week of each month
  • Items are therapeutic & can be calming or help manage anxiety
  • Curated for children with autism/ sensory needs in mind, but suitable for children of all abilities
  • Each month’s box is carefully assembled by a licensed occupational therapist and includes a description card inside

You know when you are looking for the perfect gift and you just don’t know what to get?

It’s the worst.

This is the perfect gift for a child with Sensory Processing difficulties.  Or a child who thrives on engaging sensory play.  Actually, it’s the perfect gift for any child!

The Sensory Theraplay is a wonderful gift idea for birthdays, holidays, or other special occasions.   It’s an amazing way to get a child actively playing with sensory toys, using their imagination,  and learning how to self-regulate.

THE PERFECT GIFT FOR A CHILD WITH Sensory Needs, AUTISM OR ADHD

The Sensory Theraplay Box is filled with engaging, appropriate toys that encouraged children to functionally play and use their hands.   The boxes are designed for children who have sensory needs, but they are fun for any child!

I have to say, I am impressed with the quality and range of toys that were included in my box.   I brought them to school and my kids were psyched!

“Where did you get this?”

“Can I keep this?”   

The variety of toys included in my box appealed to all of my students.  Those who needed alerting activities were excited with the stimulating toys, and those who played with the calming activities showed improved self-regulation.

CHECK OUt Some Sensory Theraplay Boxes:

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A Valentine’s Day Motor Monday: Super Simple Hand Strengthening

I have a confession: I love the Dollar Store.  I just do.

The problem is that it’s impossible to leave without a few extra things.

BUT – that’s how I ended up with my latest and greatest Valentine’s Motor Centers.  

I swear I just went in there for a couple of birthday cards, but when I saw the “seasonal section” filled with Valentine’s Goodies, I couldn’t resist.

These adorable pink and red Valentine’s Day “table scatter” hearts were the perfect size for little hands to work on grasping.  I just started adding to my basket.  

Sigh.

Why resist?  It’s for the children!

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