Sensory Processing Disorder

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She fidgets constantly. She is almost always making noise. She loves spicy food. She plays so roughly, crashing toys into one another. She doesn't seem to know where her body ends and the rest of the world starts. She trips over her own feet. She is so intense.

He lays on the floor a lot. He is afraid of playgrounds. He hates the tags on his shirt, to the point where I need to cut them off because they drive him crazy. Everything seems to be too loud for him. I don't know if he understands the world around him, because he seems to be scared of becoming involved. 

And they scream - about things that we don't understand. The meltdowns are sudden and severe. 

__________

Even though it seems like these kids are completely opposite, both are descriptions of children with Sensory Processing Disorder (SPD - sometimes known as Sensory Integration Disorder, or SID). Parenting a child with SPD can be extremely difficult, because unless you have similar struggles, you will never truly understand what it feels like to live in a body that doesn't process sensory information properly. People with SPD have a hard time appropriately acting on information received through the senses, and that can make certain social situations difficult to navigate. 

So, what causes Sensory Processing Disorder? 

The exact cause has not yet been identified, according to Lucy Jane Miller - author of Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. The most important thing for parents to know, is that their parenting style hasn't caused their child to have SPD. Studies have shown that it is likely a neurodevelopmental disorder, and if so, the cause has been coded into your child's genetic material. 

Is Sensory Processing Disorder the same as Autism? 

A significant number of kids with an Autism Spectrum Disorder have problems with sensory integration - yet studies have shown that most children with SPD are not on the spectrum. The Autism Spectrum has certainly got a sensory component, but there are other signs that are primary social. 

Sensory Processing Disorder looks a lot like ADHD - is it the same? 

SPD is a fairly new diagnosis, and through the years many children have been misdiagnosed with Attention Deficit Hyperactivity Disorder. It's no secret that the two disorders present in a similar way, but the treatment can be extremely different. ADHD is often treated with medication, and SPD is treated by addressing sensory needs.

What do I do if my child displays signs of Sensory Processing Disorder? 

Find a good Occupational Therapist (OT). Ask around for a referral, some children at your child's school may be seeing an OT outside of school hours, and their parents are your best resource. Some Occupational Therapists will treat SPD with a therapeutic listening program, which are a series of uncompressed music files that affect brain activity. And OT will also help provide your child with a myriad of sensory experiences, and a "sensory diet" to assist self regulation. 

What is the role of a Behavior Specialist when it comes to a child with SPD? 

Many of the signs of SPD are behavioral, though they come from sensory needs. Behavior Specialists can help you with parenting a special needs child - making realistic goals, helping you ride the waves of a meltdown, and making plans to manage your child's behavioral effect on the family unit. We can help you function together as a stronger family, despite the difficulties presented with SPD. 

How do I know which behaviors are in my child's control, and which are directly caused by SPD?

This is the age old question, asked by every parent of a child with special needs. It may make you feel better to understand that there is no definitive answer, and your question is likely to be looming for years to come. We highly recommend researching SPD to gain a better understanding of your child's disorder - and therefore become closer to knowing why they do what they do.

What are some resources that will help me? 

The Out of Sync Child - by Carol Stock Kranowitz

The Out of Sync Child has Fun - by Carol Stock Kranowitz

SPD Foundation - www.spdfoundation.net 

Vital Sounds - www.vitalsounds.com

If you are living in the San Francisco Bay Area and would like to talk to a Behavior Specialist about your child's SPD, contact us at info@kahlonfamilyservices.com

Autism and Recess

The best part of most children's day is recess.

It's the time where there's no structure, everything is child-led and they can happily use their outside voices. 

But, for children with social differences, recess can be a total disaster. 

Why do kids with Autism generally struggle with recess? 

Autism affects social skills, often isolating the person from their peers through various means. Children with Autism rely heavily on schedules and predictability in order to feel safe and in control of the world around them. In addition, children with Autism have a really hard time knowing the difference between reality and fantasy. During recess, children find themselves in games that are led by peers - meaning that they don't carry the same level of compassion, grace and structure as their adult-led counterparts. Games that are invented by children often do not have a coherent framework of rules, and these loose rules may vary from day to day or from person to person. As you can imagine (or remember) - games that are invented by children are generally not "fair" or logical, and they can be a bit of a popularity contest. With all of these facets combined, you can see how children with Autism would struggle. 

As parents, how can we set our children up for social success? 

(1) Open dialogue with your child's teachers

Understanding that teachers have a lot to do (and that your child isn't their top/only priority) you can still create a way to communicate regarding his social skill development. Your child's teacher should be more than happy to send an email here and there about how things are going. If there are recess issues, you can ask to be made aware of them if it isn't already part of the school's procedure. In our opinion, the best way to process recess issues is to be able to talk about them at home and at school. With everybody on the same page, we can achieve a lot more in a shorter span of time. Be careful not to overstep your boundaries with the teacher, while still asserting your willingness to be involved and give support to your child's social development. 

(2) Facilitate play dates

Does your child have consistent friendships? If so, develop these by having regular play dates. If not, it's time for you to start getting proactive! Ask your child's teacher who is seems to gravitate towards at school. If he's more likely to play alone, ask the teacher to think of a few good "potential matches" for friendships. If you can get the email addresses/phone numbers of a couple of their parents, start trying to arrange a play date. Keep play dates short, task-focused and if your child needs it - stay around to help facilitate social success. If your child has problems with aggression or dangerous behavior, stay close by and do your best to avoid his frustrations from escalating. Do what you need to do in order to make the initial play date successful - even if that means that it is only 30 min long! You don't have a second chance to make a first impression. 

(3) Being honest 

It will not benefit your child if you keep her from knowing which of her behaviors are socially unacceptable. If she is doing something which is antisocial or unexpected, you are her consistent and loving guide. When you tell her what is going on, be "matter of fact" without being judgmental. The best way to support her, is to provide her with a concrete way to approach the situation differently. Role play it at home and try to practice these social skills in everyday life. 

(4) Role models

Let your child see you being sociable. When preparing for guests to come over to your house, involve your child in setting the table, getting dressed up and preparing a meal that others will enjoy. Engage your child in the empathic reasoning behind how and why we entertain guests. When you are going to someone else's house, show your child the etiquette of taking along some wine or flowers. When going out for a meal with family or friends, show your child how to engage in conversations that are interesting to the other person. Talk about it with your child afterwards - process through social skills together. It sounds tacky, but for children with delays in social development, this kind of instruction is vital. 

(5) Social Skills Groups

Another great way to prepare children for the social world around them is to enroll them in a social skills group. At Kahlon Family Services, we run social groups for children and teens of all ages, focusing on the skills we need to make quality connections with others. Since life is about community, these groups are really important for helping kids make leaps and bounds in their social development. 

If you have any questions about our social groups, or would like to enroll your child, please contact us at info@kahlonfamilyservices.com or visit our website on www.kahlonfamilyservices.com 

Speak for Yourself

One of the biggest problems that special needs kids have, is that everybody wants to speak for them.

As a parent, it is very tempting to want to fight every one of your child's battles with your voice - because after all, you have the voice which is most likely to be heard. When you see other children staring at your child, laughing at the way he acts or excluding him because he doesn't understand the game, it is nearly impossible for you to sit back and do nothing. Whatever hurts your child hurts you.

There comes an age where instead of speaking for your child, you need to give him his own voice. (Obviously if your child can't physically talk, or suffers from impaired speech, this advice won't apply. Go on being your child's voice!) You are building up a capable human being, who may be different to those around him, but nonetheless able to stand up for himself.

How do we make the transition?

(1) Equip your child with words
Some people decide not to have their child diagnosed, for many reasons, and that is an individual choice that needs to be respected. For those of you who are more forthright with the diagnosis, you may choose to tell your child that he or she has Autism (or whichever difference affects him) and allow him to fully understand what that means. This can be incredibly empowering for children who behave in ways that seem unexpected to others - they have a word for what makes them behave like this, and it can be easily expressed to adults and children alike. We have seen a child with Dyslexia sit in front of her class and explain what it feels like for her to have problems with words, and tell everyone why she has trouble reading. She then gave the teacher a picture book about Dyslexia and the whole class learned together. Nobody makes fun of her - they now understand that her brain works differently, while she feels safe and accepted.

(2) Allow processing time 
Before you jump in to answer questions for your child, consider counting to five - slowly! Your brain might work at lightning speed, but your child may need a moment to gather his thoughts. His delay may appear like he is ignoring you, and he might be. When parents and caregivers jump in too quickly, they mean well, but take away the child's voice. The child will soon get used to others speaking for him, and he won't see the value in stopping what he is doing in order to answer a question he probably doesn't want to answer. Try counting to five, asking the child to make eye contact with the person asking the question, and have the question asked a second time if he didn' hear it at first. If he's still coming up blank, try starting his sentences and see if he can finish. If not, give clues. Provide the scaffolding!

(3) Give him ownership of his differences
It is OK to be different - did you know? Some of the game-changers in our world have been people with significant differences! Einstein probably wasn't a great conversationalist and Isaac Newton was listed in a Wikipedia article for having a Retrospective Diagnosis of Autism. Your child is who she is, and she can make the best of it with confidence. Empower her to live life being proud of who she is, and knowing that she can live a life of great purpose.

(4) Define him by his abilities 
On occasion, you will need to tell people that your child has a special need. You may leave it at that, or you may give the name of his or her diagnosis. Whatever you do, lift up your eyes and see that he is much more than the label which has been given to him.

One wise Mom once said to me,

"Each day I learn to let go of him a little more. I don't own him, and that's the only way he will grow".

We hope you'll learn to do the same. 

Social Skills for Pre-Teens

Need social skills? This book's got plenty!

Growing up is hard. Growing up with Autism is even harder.

When you think back to your 'tween and teen years, no doubt you have memories of some of the most awkward years of your life. It's almost like the body grows too fast for the brain to catch up. Getting older requires a greater reliance on social cues, as the pressure to fit in becomes of paramount importance. People with Autism (and various other differences) have significant trouble with matching their behavior to the behavior of those around them. As a pre-teen, you can see how this could pose a problem. There is no magic wand for a social impairment - but as your child's advocate, you can help him learn what others may pick up naturally. 

We have come up with a few practical tips on how to help your growing child onto social success: 

(1) Be Honest

It may feel as though you are constantly 'at' your son or daughter about manners or social cues. If you feel as though you are starting to criticize your child, look at the way you are going about your "help". It is not helpful to tell him that he's rude, or that he stinks or that he'll "never learn". You may not want to run the risk of hurting his feelings, so you might try to ignore his behavior. In the long run, this is counterproductive, because he won't learn that what he is doing is inappropriate - until someone tells him in a not-so-gentle way. It is, however, helpful to point out behaviors that are socially unacceptable, explain why and model a more appropriate choice. 

(2) Talk About Hygiene

As bodies grow, they require more maintenance. Perhaps you have a child who doesn't like to take showers - now is the time to start teaching her why our bodies need to be clean in order to stay healthy. Take your child to the store and let her choose a deodorant that she likes, and teach her to use it as part of her morning routine. Pre-teen girls will need some coaching when it comes to looking after their bodies as they start shaving their legs and armpits, and start tackling "that time of the month". Teenage boys will need some help knowing when to use deodorant... and when they're using too much deodorant. All adolescents need help with these things, but teens with Autism will need some extra help - and some extra concrete ways of having these hygiene routines explained. Be honest, and be specific. 

(3) Use Books
Some things can be very awkward to discuss with your children. While we don't recommend throwing a book at them and walking away, we recognize that printed truths can sometimes be easier to handle than those which are spoken. Providing your child with quality (and modern) resources that help explain what's going on with their bodies may be one of the best ways to get the message across.

(4) Dating Education 
Some families have strict rules about whether or not pre-teens and young teens are allowed to "date". It might be useful to talk with your parenting partner about your child and the dating arena, and pre-decide on the stance you will take when the day comes. Some teenagers will decide independently that they are not going to date, and others may not have access to a romantic interest. It is important to teach your socially different teen about how to go about attracting a partner. Some may be too timid or have such limited interests that they are difficult to approach. Others become fixated on a person, and become "too much" for that person to handle. It is also important that your child understands not only the "mechanics" of sexual activity, but the socioemotional implications of such intimacy. It may be difficult for young people with Autism to understand the emotions of their partner, and how some things they do might be considered hurtful.

(5) Encourage Expression 
Your child may be really quirky, and this has probably caused him to be socially excluded at some point. As his parent, encourage him to harness the positive sides of everything that makes him who he is. There is no doubt, the most interesting character looming inside your child - and with a little encouragement, you can help him to shine. She may enjoy playing games that seem nerdy to you, or engaging in hobbies that you simply don't understand. Usher her towards a group of like-minded individuals, where she can be confident and understood. Try to limit her involvement in social media, and maximize her face-to-face social interactions. You may find summer camps, support groups, interest groups, community groups or after school programs that offer extension in the way your child likes to express himself the most. 

(6) Find a Mentor
There is infinite value in finding someone who understands your child, and someone who your child can trust. Teenagers won't want to tell their parents everything - don't be offended - you probably kept a lot of things from your parents, too. Think about your circle of friends, and if there is a standout person who fits the bill for being a mentor. Most adults would be flattered if they were asked to mentor a teen, and you might find that opening up your child's inner social circle will bring new light to some of the social skills which were previously confusing. 

School Shadowing

Kahlon Family Services provides ‘shadows’ to people of all ages requiring extra help towards independence. ‘Shadowing’ is a relationship-based behavioral intervention. For children, a shadow refers to a Behavior Specialist assisting a child at school by first observing, taking data and consulting with the child’s family and teacher, wherein the specialist highlights areas of concern and develops a plan for behavior modification. 

The shadow helps the child on a daily basis, first by building rapport with the child and his/her family. The shadow then begins by meeting the child where he/she is 'at'. The next step is challenging the child to develop further self-sufficiency, through open communication and incentive tools. The goal of a shadow is to assist the child without hovering or embarrassing them, while making discrete modifications to their behavior and classroom environment in order to set the child up for success. Oftentimes, the shadow will act as though they are an extra teacher in the classroom so that nobody knows which child is requiring extra help, to protect the child’s privacy. The ultimate goal of shadowing is that the child will reach full independence at school, with a greater awareness of how to self regulate.

Kahlon Family Services also offers shadows to very young children in Early Childhood settings, as well adults with disabilities in the work environment, with similar (but developmentally-appropriate) goals.

How do you know if your child would benefit from a ‘shadow’?
- Has your child’s teacher mentioned that your son/daughter ‘checks out’ regularly in class, and therefore, has great difficulty completing tasks?
- Does your child struggle with sensory integration or an attention deficit?
- Does your child have difficulty with executive function, fine motor skills, impulsivity, following instructions or being part of a group?
- Is your child ‘acting out’ and being sent away from group/educational activities because of behavioral issues? Is he/she ‘in trouble’ most of the time, and missing out on vital learning?
- Has your child’s school mentioned that without extra assistance, your child may be excluded because of behavioral issues or special needs that they can not reasonably accommodate?

If it has been suggested that your child receive extra help, or if you feel as though his/her educational future is jeopardized by any of the above issues, we can help you. Please contact us for a consultation, on kahlonfamilyservices@gmail.com 

Executive Functions

Are you raising a child who has trouble following directions?
Does it take your child a really long time to finish a task?
Are you often frustrated by how distracted your child becomes while he is supposed to be doing something "quickly"?
Does it seem like everything you say is going in one ear and out the other?
Maybe it is.

Executive Function is an umbrella term for the cognitive processes that manage, regulate and control other cognitive processes. In other words, Executive Function is the "office manager" of the brain. It is the brain's ability to manage learning and behavior. Many children on the Autism Spectrum have problems with Executive Function, though children who are not diagnosed with Autism can also be affected. When a child has impaired executive function, she won't be able to hold onto multi-step instructions. One of our 7 year old clients with this problem once described it (in his own words) like this:

"It's like there's a strainer in my head. You keep talking and telling me things, and it's all just falling through the strainer. I am trying to listen, but it's like I can't hear you."

Exactly how do Executive Functions (EF) work?  

And how can we alter what we do with kids who have impaired cognitive control? 

(1) Planning

Outworking a "plan" is a very common and natural process that most people develop in childhood. For children who have issues with EF, the process of creating a plan and working it out will be two very different things. It will often look like they are being impulsive or inconsiderate, but the fact is, they haven't developed the ability to think empathically. 

How can you help? Work with the child to overtly teach planning skills. For example, socially; If two children are playing a ball game together, running up and stealing the ball (in order to join in) would cause the other children to become upset. Looking at the game, seeing how it's being played and asking, "Can I play?" would be more likely to cause social success. 

(2) Working Memory

"Working Memory" is the system that actively holds multiple pieces of information in the mind, and figures out how to use (or discard) the pieces according to the situation. In other words, this contributes to the sentiment of the little boy's "strainer" quote. 

How can you help? Take a deep breath. Your child isn't being lazy or silly when he forgets what you've said. This can be very frustrating to an adult! You probably can't understand why it is so hard for your child to take in information, but just slow down everything you are saying. Present instructions in a FIRST/THEN/NEXT structure. 

(e.g. First eat dinner, then take your plate to the kitchen, next take a shower.) 

(3) Attention

Adults often overestimate a child's attention span. Enough said. 

How can you help? You can watch your child in various contexts and time how long she appears to be paying attention. If on average, she seems to be able to spend only 4 minutes listening to somebody speaking to a group of children, that is her current attention span. You can help by recognizing that is all she can do, but slowly trying to increase the span by providing environmental changes. At school, a child may be more attentive if they sit closer to the front. They may also benefit from sitting at the back and being allowed to move around while content is being taught. A "fidget" is a blanket term for a number of small items that can be held, manipulated and squeezed during direct teaching times, by children who may otherwise play with clothing, shoelaces or look out the window. 

(4) Problem Solving

Think about adult life - problem solving is undoubtedly one of the most important skills that you can develop. Childhood creativity is often birthed out of problem solving skills. If a child is conditioned to have problems to be "fixed" on their own, they will become less anxious when problems arise in life.

How can you help? Obviously a big part of problem solving is about planning. As planning is an issue with EF impairment, as a parent or teacher, we recommend that you regularly expose your child to safe versions of problems that require solutions. Build up your child's tolerance to unexpected situations, and make sure that he is the one developing and outworking the solution. At first, he may need some scaffolding, and you can provide a bridge for him through suggestion. It is so important to celebrate his efforts to make things right, by himself. 

(5) Verbal Reasoning

Your child may not understand what you are saying, the way you are saying it. Sounds complicated? 

How can you help? If your child seems to be taking everything you are saying at face value, totally literally or getting caught up in the semantics - take a moment to boil down what you are saying to its truest and most basic form. She may also be looking for loopholes in behavioral boundaries you are presenting. This can become very frustrating to adults, and sometimes this will be her version of cleverly disguised humor, but it is more likely that she is just hearing your words literally. By understanding that her processing is impaired, you will be able to alter your communication. 

(6) Inhibition

Kids with EF impairments may be extremely hilarious, because they lack inhibition. As a parent, caretaker or trusted adult, your job is to help your child understand when a certain behavior is inappropriate for the situation - because they will not realize it on their own. 

How can you help? When the child is acting in an unexpected way, try to help him by taking him aside to point out how the other children are behaving. Instead of making him feel bad about himself, help him with the empathic skills he hasn't yet developed. For a time, you may be like an external version of his self control, though it is a goal to transfer those skills to independence. 

(7) Mental Flexibility

If you change up a schedule, or throw an unexpected curveball at a child with EF impairments, you will notice that she will have a hard time accepting the change. You don't have to shield the child from changes, because real life involves curveballs. But you can help make them more palatable. 

How can you help? Firstly, understand that mental flexibility is a challenge for your child. The meltdown is not an attack at your inability to control the world, it is more of a coping mechanism from a child who is struggling to control anything in his world. Providing your child with daily schedules is a great tool, but also, creating some times where a "?" appears on the schedule is helpful in building up tolerance as far as mental flexibility goes. You can teach spontaneity through a schedule! And if you are brave enough, you can even start adding in some schedule changes in everyday life, to build your child's tolerance. Maybe once a day you can switch two items around, and  coach your child through the situation. 

(8) Task-Switching

Most people can go from one task to the next fairly seamlessly - think of it as "tabbed browsing" on a computer. Mental tabbed browsing is way too confusing for a child with EF impairments. 

How can you help? When one task finishes and another starts, be very specific about how the transition will play out. This will be very noticeable at school, when one subject ends and another begins. Saying "Get ready for Math" is very arbitrary, and may require a post-it note on the child's desk with the exact items he will need to have ready for Math. 

If you have more questions about Executive Function, or have sneaking suspicions that your child's EF development is delayed, contact an Occupational Therapist. If you are in the San Francisco Bay Area and are interested in behavioral services for your child, contact us on info@kahlonfamilyservices.com 

The Value of "Time In"

This is going to seem like crazy logic... But what if you traded "time out" for "time in"?
Hear us out - OK?

If you're honest, you'll admit that when your children act out you'd probably prefer to send them to their room instead of sitting in a quiet place with them while they calm down. It is against your human nature to want to draw closer to a human being that is driving you crazy. You might also be thinking, "Wait - isn't that rewarding unacceptable behavior?" Truthfully, it depends how you do time-in.

"Time IN" is the opposite of time out. Instead of sending your child to be alone after he misbehaves, you accompany him to a quiet area to help him calm down. This is not meant to be fun, but instead, a very tangible way of showing him that you will be there through anything.

(1) Spend 10 minutes of uninterrupted, child-led playtime with your son or daughter every day. 
It doesn't matter if he punched someone in the face at school, or if she just told you that she hates you. They are separate issues to deal with, and obviously are not things to treat lightly. Quality time, especially in the face of behaviorally challenging seasons, is a giant investment into your child's future. More than money can buy, time will establish an opinion within your child that she is worth loving - every single day. This will actually greatly reduce your child's longing for attention, and therefore meet a need that causes the most behavioral problems.

(2) Time in is togetherness. 
If you make a habit of carving out unconditional quality time for your child every day, providing "time in" instead of time out as a behavior management strategy will not be the kind of attention your child is craving. She would much prefer playing with toys and reading books.

So, time IN is in many ways like time OUT, but it involves both parent and child. Set a timer, only engage in conversation when your child is calm, hold her if she is physically unable to calm herself, and finish the session with forgiveness. Talking about what has happened is only important in the debrief - do your best to let go of the offense after the time-in.

Go ahead... give it a try. And let us know how it goes! Email us at info@kahlonfamilyservices.com