Innovative Therapy Services

I must admit, with the summer coming and my children out of school, the pressure of what to do with them is up!! I am a working mother of three very active children. Like most parents, I want to raise my children with certain values. I typically do not want to enroll my children in every summer activity or camp, as they are on vacation from school. Recently though, I find I am snapping at my children more, or ignoring them, because unlike the last two summers, when my schedule was more flexible, I cannot spend all my time catering to all their needs. I am sure most parents can relate, especially given today’s economy.

I have signed my children up for summer activities, but I am not signing them up for more than three activities a week. I am tempted to put them in every summer camp and activity offered in my community. After all, they will have fun. They will all come home exhausted and we can all have a relaxing evening, either reading a book or playing a game.  Then, I can tuck them in bed with a little kiss on the cheek, and “I love you.” But why do I find myself feeling guilty?

In today’s society,  kids are over-structured and over-scheduled in our attempts to give our children a successful happy childhood. While it is true that summer adventures teach children self discipline and problem solving skills, among other skills; too much structure and activity can increase stress for both the parent and the child/children. It also limits family communication and sibling relationships. This week I discovered something, my children are the happiest when I communicate with them about simple things. I took my children hiking. My son ran in front of me and collected flowers and said, “Here mommy, it is a treasure”. My seven year old daughter listened to my ipod, and asked if I could hear the music. My ten year old daughter talked about “animal rights,” and I nodded. I felt at peace! Kids wanted to be heard not silenced with activities.

Simply put, as a working parent I find I am less stressed when my children are not over-stimulated or over-scheduled, or whining for my undivided attention. I keep a journal entitled, “Family: What Works.” This journal not only helps during occasional melt downs, but it has helped me recognize what is important to my family and reduced the pressure to conform to the norms. Here is an example from my journal last month.

I have been keeping this journal for the last 3 months and now I can see what works to calm me down and keep my family peaceful. I am also using it to plan our summer adventures. For the summer, on the days I am feeling very stressed and I do not feel like I can handle sibling bickering, we will ride our bikes downtown or hike. Even my older 2 are  keeping a journal of what they consider FUN! Here are tips for your own journal:

Family: What Works Journal

• Should be simple entries. It does not have to be daily entries
• It is a reflection,  not a time consuming report.
• It should help for future planning.
• It should be about time spent together.
• Reflect both successes and failures.

You are certain your child is intelligent, and her teacher is also certain she is intelligent. However, your child continues to struggle academically. You wonder if your child is just not trying hard enough, but she follows all your instructions, and does not get into trouble at school. As a matter of fact, she is very conscientious about her work. She stays up longer than most of her peers trying very hard to complete her assignments. It is likely your child may have language-based learning difference (LLD). LLD affects the way the brain processes information and can impact how a child learns to read, write, hear and speaks.  All students have different learning styles, but some students experience a greater disconnection between their academic aptitude and their ability to learn. LLD is not a reflection of low intelligence but it can negatively impact your child’s self-esteem and confidence. 

Students with LLD may have problems understanding what they read (grade level materials). They may also have problems with spelling, sequencing information and difficulty organizing information they present. LLD students often ask clarification immediately after receiving instructions or lectures. Below is a checklist for you and your child’s teacher to complete if you suspect your child may have LLD.

1.  Does the student have difficulty using complex vocabulary to describe, with details, a wide range of topics. For example using indirect speech such as irony or predicts what might happen in a complex story?  Yes     NO

2.  When reading a book, the student can deduct the meaning of unfamiliar words based context clues or prior knowledge.   Yes     NO

3.   Can the student describe the differences between the two meanings of sound in sentences like? For example, “The creaking sound makes me wonder if the bridge is sound.”    Yes     NO

4.  Can the student write a paragraph with descriptive sentences about topic with details about characters, plot, events, etc.,?  Yes     NO 

5.  Does the student read stories and accurately retell what she has read?   Yes     NO

6.  Can the student read and understand instructions for a game, a recipe to bake cookies, instructions about how to build a model and she is able to explain the process to someone else?          Yes     NO

7.  The student can compare one story character to another,  and can compare information from two or more newspaper articles.         Yes     NO 

8. The student can read a chapter of a book set in the past or the future and talks about how things are different compared to the present.   Yes     NO

Having LLD does not mean your child is less intelligent than her classmates. It just means she may need language strategies to support her learning style. We use language strategies to enhance the students learning style.

Dealing with oral motor issues at home is quite complex and can be very frustrating, particularly if everyone around is convinced that your child is just faking the problem or seeking attention. Childhood oral sensory disorders and feeding related issues that may accompany this disorder can go undetected for several reasons, especially if the child does not exhibit other delays. It is often thought that the child will out grow the problem. Now let be clear there are certain times children will just refuse to eat certain foods, especially around ages 3-5, when they are learning to exert their new found “will” power. Kids exerting their will power and also going through the “I am not hungry stage,” may take few bites and if parents add their favorite snack along with it a little ketchup etc., the child may willingly eat the food with no other symptoms. Some children at times may need a little more bribery during this phase. This is also considered normal childhood behavior. However, children with oral sensory disorders will continue to exhibit very difficult behaviors around meal times and things having to do with input to the facial mask areas (cheeks, face, lips mouth tongue, palate etc). Typically the behaviors may include:

1. Prefer only one type (e.g., dry, crunchy) of textured foods
2. Exhibit excessive oral habits (e.g., bite sleeves and buttons from shirt and other toys)
3. Abnormal tongue posture ( often sucking their tongue)
4. Mouth breathing
5. Teeth brushing is a nightmare
6. Face washing is a disaster
7. Easily gags on food

Looking at the above list you can see why some children with oral sensory related issues may go unidentified, given that some of the listed behaviors can apply to any child at any given time in their life. That is very true! While some of the above behaviors can be seen during the infant years, and even at early toddler years, it is expected as the child’s motor system matures, so should the oral sensory system.

While I believe that all children have their own internal developmental time line, based on current research and findings it is important to take a second look at a child’s oral motor skills at each developmental stage, just like we check their weight, height and other developmental milestones. Looking at a child’s oral motor developmental history can help parents address feeding related issues early on and prevent oral motor behaviors that may result from unresolved oral sensory issues. A good oral motor examination will also explore the following:

1. Birth history
   Breastfeeding/bottle feeding history
   Motor developmental history
   History of reflux
   Prolonged illness
   Frequent upper respiratory infections
   Frequent allergies
   Adverse reactions to different textures to the body and face
   History of choking (as infant)
   Difficulty transitioning to different textured foods (stage 1, stage 2 etc.)
   Tongue thrust

If you truly suspect your child’s refusal to eat his vegetables/food, brush teeth and mouthing things goes beyond just normal typical child behavior it is OK to seek professional support. Oral motor sensory difficulty can be hard to diagnosis in normal children who do not exhibit neurodevelopmental delay. Oral motor sensory issues can occur with children who have had prolonged hospitalization, Tube feeding, neurodevelopmental delays and it can occur without the existence of other developmental disabilities.

The following books are recommended to parents:
 Childhood Motor speech Disability, by Russell J. Love
 Just Take a Bite, by Lori Ernsperger (Author), Tania Stegen-Hanson (Author)
 How to Get Your Kid to Eat: But Not Too Much (Paperback) by, by Ellyn Satter

If you are interested in more information on oral motor feeding or oral sensory issues please contact me by e-mail.

By Uduak Osom,
Owner/Director,
Innovative Therapy Services

Welcome to the ITS blog!  The therapists would like to use this blog as a venue for comments and sharing information on speech and language intervention.