Cris Rowan, an amazing pediatric occupational therapist from British Columbia, is back from last week to share some of her expertise on the impact that technology has on a child’s physical, mental, social, and academic health. Please listen to last week’s episode to learn more about Cris, or check out last week’s blog!

She shared some astounding facts with us, including:

• The American Academy of Pediatrics states that children 0-2 years of age should have zero TV time, but they get 2.5 hours on average per day.
• France banned baby TV due to negative effects.
• Baby Einstein videos are linked to children having delayed speech.
• Children should have 1-2 hours per day of total technology use (TV, video games, computer time, etc.). She doesn’t advocate for completely unplugging a child from technology because our future is so dependent on it.

The Impact on a Child Physically:

• 15% of Canadian children are obese. This rate doubles if a TV is in a child’s bedroom.
• 15% of Canadian children are diagnosed with Developmental Delay, which hugely impacts their ability to print and read.
• Stress – a chronic & high adrenalin state is detrimental to our immune, endocrine and cardiovascular systems. 20 hours of technology use per day has resulted in blood pooling, blood clots, strokes and heart attacks. Our bodies respond to technology (i.e.- video games) as being real, causing the body to feel the stress of this type of stimulation.
• Sleep disorders are on the rise and children are having difficulty getting to sleep and staying asleep.

The Mental Effects of Technology Use:

• 14.3% of Canadian children have a diagnosed mental illness, such as anxiety or depression.
• Anxiety is the fasting growing disorder in Canada and the US.
• 9% of Canadian children are diagnosed with ADHD. Every one hour per day of technology use prior to the age of seven, increases that child’s risk of attention problems by 10% upon school entry.
• Behavioral problems are being diagnosed at high rates and medication is becoming more of a common treatment. Cris started an initiative called “Unplug-Don’t Drug” in Canada to work on reversing this trend.

The Social Effects of Technology Use:

• Social isolation, suicide, rage and violence are becoming more pronounced with the increase in overall technology use. Brandon Crisp from Ontario and Daniel Petric from Ohio were talked about as examples.
• Media violence is classified as a public health risk in the US now due to resulting child aggression.

The Effects of Technology on Academic Success:

• 15% of Canadian children are classified as having learning disabilities (LD).
• Illiteracy is on the rise as well as children with developmental delays who often have printing and reading deficits.
• The increase in technology use correlates with lower grades, higher drop out rates in high school, and lower university pursuits.

Cris really emphasized the need for parents to have “sacred time” in the home where they are completely unplugged from technology and fully engaged in spending time with their children. She recommends these sacred times to be at least: during dinner time, during car rides and 1-hour before bedtime. Next week she has agreed to come back for a third and final time (for now at least) to help us find ways to balance our children’s use of technology with activities they need in order to grow and succeed in today’s world.

Thank you so much Cris for sharing this information with us today. For the listeners, if you haven’t listened to the previous episode or looked at the blog, I encourage you to do so. If you would like to contact Cris or sign up for her monthly newsletter, you can find her at:
www.zonein.ca

info@zonein.ca

1-888-8zonein (888-896-6346)
604-885-2666

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It’s back to school time, and there isn’t a parent out there who doesn’t want their child to make friends and do well. Preparing children for school isn’t just about getting new clothes and re-establishing sleep routines, it’s also about making sure children’s minds are able to pay attention and learn.

Today we have Cris Rowan with us- an amazing pediatric occupational therapist and child development expert from British Columbia. She has been in practice for 20 years now and has spent the past 15 years working in schools; she is SIPT certified, and she is the owner of “Zone’in Programs, Inc.”- which offers products, workshops, and trainings to improve children’s health and enhance their academic performance. She provides training throughout North America on topics such as Sensory Integration, attention and learning, fine motor development, and the impact of technology on child development. She is also an expert reviewer for the Canadian Family Physician Journal, and she authors a very informative monthly Zone’in Developmental Series Newsletter which is how I found her!

As kids today are changing, and more-and-more kids are having problems with attention, learning and behaviors, Cris talked to us about the most important factors we need to consider when looking at balancing our kids’ daily activities for healthy child development. She stated “studies have found that children who use more that 1-2 hours per day of combined technology (TV, video games, internet, texting), are likely to encounter a variety of difficulties, both at home and at school” and that “wise parents might consider helping their children “unplug” their way back to school, but “pulling the plug” is too extreme”.

Balanced Technology Management (BTM) is a concept Cris Rowan developed, that states children need to learn how to manage balance between activities they need to grow and succeed, with technology use. There are 3 critical factors outlined below that need to be addressed in order to balance good child development based on this concept.

1. Movement – the vestibular system is the sensory system found inside the inner ear which is responsible for helping children to learn their center of gravity, set their core muscle tone, successfully coordination their right and left sides of their body as well as the upper half with the lower half of their body. It also helps the eyes learn to talk to each other for coordinated activities such as reading, copying, etc…

• Young children require 3-4 hours per day of active rough and tumble play to achieve adequate sensory stimulation to their vestibular and proprioceptive sensory systems for normal development.
• Vestibular and proprioceptive input ensures normal development of posture, bilateral coordination, optimal arousal states and self regulation necessary for achieving foundation skills for eventual school entry.
• Infants with low tone, toddlers failing to reach motor milestones, and children who are unable to pay attention or achieve basic foundation skills for literacy, are examples of inadequate vestibular and proprioceptive input.
• The use of safety restraint devices such as infant bucket seats, toddler carrying packs and strollers have further limited movement in children, as have TV and videogame overuse.
• Many of today’s parents perceive outdoor play as ‘unsafe’, which additionally limits essential developmental components that are usually attained in outdoor rough and tumble play.

Cris’s favorite activity recommendations for movement inside the home include: using a platform swing suspended from your ceiling; wrestling; and building forts and knocking them down.

2. Touch – the tactile system is the sensory system throughout our entire body that sends information to our brain about what we touch and feel.

• The skin is the largest organ of the body, with 70,000 receptors per square inch.
• Tactile sensory input is a biological need, and without touch humans would die.
• Tactile stimulation is integral to child health and well being.
• When infants are deprived of human touch, they develop into children who exhibit excessive agitation and anxiety, and may become depressed by early childhood (Dr. Ashley Montagu).
• Technology is grossly limiting access to necessary tactile stimulation, and many children are touch deprived.

Cris’s favorite activity recommendations include: hugs; reading books together; playing “hands-on”; rolling the child tight in a blanket to play “burrito” games; or tucking the child in tight to bed, or into the corners of the couch with a blanket (which is great for anxious or agitated kids).

3. Human Connection – this is defined as the primary attachment bond between infant and parent.

• The critical period for attachment development is the first year of life
• Connection to technology is causing a disconnection from self, others, nature and spirit. This is more and more often seen in a parent who spends time using technology outside of working hours and therefore less time connecting with the family. Cris asks the parents about their technology use first, before looking at their child’s technology use.
• Disconnection is most apparent in children with Autism, ADHD, anxiety, depression and bipolar disorders, all of which are increasing in number and severity.
• Attachment disorders are causally related to child and adult addictions.
• It’s highly valuable to have one parent at home with a child through his or her first year of development (when possible), in order to strengthen this human connection and parent bond.

Thank you so much Cris for your time and expertise on this new and very important topic of balancing our technology use for the benefit of our children!

Next week, Cris Rowan has agreed to come back to talk more specifically about how too much technology use can affect a child’s physical, mental, social and academic health. I highly encourage those who are reading this blog to listen to this episode to get more great information, national statistics and details from Cris on this topic.  I also encourage you to check out Cris’s website, games and products, and to sign up for her free monthly newsletter, which has been amazingly informative to me! You can connect with her in the following ways:

www.zonein.ca
info@zonein.ca

1-888-8zonein (888-896-6346)
604-885-2666

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Every therapist is going to have their own way of assessing a child when first seen and tested for sensory processing difficulties and/or any other related concerns. Today’s podcast will hopefully help you to understand some of the common tests, the reasons why they are done and what they mean in order to get treatment started for your child. I should start by making sure everyone knows that Sensory Integration Disorder or Sensory Processing Disorder (the newest and most accurate term) is based on “theory” and is not totally proven scientifically. As of now, occupational therapists and other health professionals study the nervous system and how it works in terms of brain stem processing and then apply techniques that are expected to be helpful based on what is known from science and current brain research. It’s well known that these techniques are helpful and the right combination can certainly make a world of difference for a child with these difficulties.  The questions at hand are: “how” it exactly works and “why” there are so many factors that make each child’s treatment so different from the next child.  Because there is such variability, it’s very hard to pull a large group of children together, all with the same symptoms, in order to study their response to treatment with the most elite type of research which is a double blind study.

The following categories are often, but not always assessed in order to get a good overall picture of a child’s developmental and sensory processing status. Remember, every child is different!:

1.  Sensory Processing -
Tests for sensory processing are highly variable as there is no set and definitive way to assess sensory processing and monitor progress over time.  The most comprehensive evaluation tool available for testing sensory processing skills is the SIPT test, which is the “Sensory Integration and Praxis Test”.  Therapists can take courses in order to become certified in the administration and interpretation of this test, but there are many ways to get the necessary information in order to help a child get better, so this is only one way to test a child.  Commonly therapists use comprehensive checklists, the Winnie Dunn Sensory Profile, parent feedback and the evaluator’s observation of the child during all testing to make judgments on a child’s sensory processing skills and difficulties.  A comprehensive assessment will give information on each of the child’s seven senses, to determine if the child “over” or “under” processes information coming into the brain from each sense.

2.  Sensory Modulation/Self-Regulation Skills -
These are terms that are similar in their definitions, although “sensory modulation” is the term used to assess the brain stem’s “automatic” ability to maintain homeostasis or calmness throughout the day in order for children to learn, pay attention, have good behaviors and appear to be well-adjusted and well-coordinated.  Children who fluctuate between being overly and under-sensitive to certain types of sensory stimulation (i.e.- touch, or any other sensation, like sound, or movement) within a matter of seconds, minutes or hours, often times have a “modulation” disorder, as the sensory systems cannot balance out on their own.  The term “self-regulation” is used when a child can remain calm and appear to be well-adjusted in an ideal environment, but can’t maintain a good level of calmness when a high level of stimulation or stress is present around him or her.  Kids with self-regulation difficulties can be perceived as being “fine” until they go to a party, eat too much sugar, or get provoked by their peers in some way.  They are often easily excitable, frustrated or quick to anger in “specific” situations, whereas a child with a modulation disorder is experiencing these feelings and emotions more often throughout the day.

3.  Motor Planning/Praxis Skills -
From a sensory perspective, motor planning, also known as praxis, is the ability to quickly and efficiently take in sensory information, process it and respond with a motor action.  Motor planning difficulties impact a child’s ability to transition between tasks, accept changes in plans and routines and be more flexible in nature when plans or activities do not go as expected.  Motor planning difficulties in the broader sense of the word are related to a lack of motor coordination.  This is what you will most likely find if you do a search on the internet for this term, so try not to get confused, as this information may not apply to your child properly, if he or she mainly has sensory-related motor planning difficulties.

4.  Attention -
Attention is the end result of having good sensory processing, self-regulation, postural endurance, eye muscle coordination/endurance and big muscle coordination skills.  It’s also based on a child’s frustration and learning potential as he or she can become avoidant and therefore appear inattentive when tasks are overwhelming or hard.  It’s very important to determine the cause of attention problems, because there are more than a handful of ways to make attention skills better, and the therapist needs to determine how your child is going to make life-long gains in this area.  Food and chemical sensitivities, lack of sleep and high intelligence are other reasons why children may be inattentive!

5.  Muscle Endurance/Tone -
Muscle endurance is based on how long the muscles can hold in a particular body position before they get tired, and muscle tone is based on the amount of messages the brain sends to the muscles in order to keep them activated over a period of time.  Difficulty with the prone extension (superman) and supine flexion (cannonball) positions is strongly associated with difficulty achieving higher level postural control, balance and movement.  These are positions where the child has to hold his back, neck, stomach and hip muscles up against gravity for the assessment.  A lack of endurance or tone is often the reason why children have a hard time sitting still, paying attention over a period of time, or standing in one place without fidgeting or tiring.  Respiratory weakness also effects a child’s ability to sustain good upright posture, attend quietly to tasks when seated at a table, and maintain self-regulation when excited or physically active.  Children are also commonly known to “W” sit to assume a more stable position when they have deficits in their postural stability.  This is not good for the ligments on the inner sides of their knees over time.

6.  Reflexes -
Some therapists believe it’s important to test reflexes which are primitive motor movements that infants and young children have innately built into their bodies for survival and for very basic skills (i.e.- survival skills).  It’s known that these reflexes need to disappear over time in order for children to acquire higher level coordination skills between the right and left sides of the body, as well as between the upper and lower halves of the body.  Sensory therapists often look at the lack of reflex integration to mean “nervous system immaturity”.  This is good general feedback for a therapist to consider when looking at the overall strengths and weaknesses of a child.  The post rotary nystagmus (PRN) test assesses the vestibular-ocular reflex. that gives us information on how well the brain interprets movement at a reflexive level.  The vestibular system is the sensory system that detects movement, which is responsible for activating greater balance, posture, attention, ocular skills, coordination and motor planning skills in the developing child.  This test is used often by therapists who are more experienced in identifying and treating sensory processing disorders, who have a keen eye for knowing how to interpret the results of this assessment.

7.  Bilateral Coordination -
This is an important area to assess as children with sensory processing difficulties quite often have a hard time integrating or coordinating the right and left sides of their body together.  When a child is born, he or she has two brains (the right hemisphere or brain, and the left hemisphere or brain).  Children learn to reach across their body for objects, and cross their legs and even eyes over to the other side of their body as they learn through play exploration.  Each time this is done, a pathway is made in the corpus collosum which is the connector piece between the two sides of the brain.  As these connections are made, skill is being established.  This is why children don’t know how to crawl when they are first born, hold their own bottle with two hands right away, hold their own pacifier, or ride a bike.  Children have to learn to integrate the right and left sides of their body in order to complete all coordination activities that require both sides of the body to do something at the same time.  The body’s extremities can even be doing different tasks at the same time, such as: one hand holds the paper while the other hand cuts, draws or writes.

8.  Gross Motor Coordination/Balance -
Gross motor skills are coordination skills that involve large muscle groups of the body for many activities such as balancing, skipping, hopping, being coordinated for P.E. classes, bike riding, engaging in after-school sports and completing many outdoor recreational activities.  At a more basic level, gross motor coordination skills are required for a child to maintain his or her balance, crawl, and walk.

9.  Eye-hand Coordination Skills -
This term is pretty self-explanatory as it relates to overall coordination skills that involve the eyes having to be lined up with the body to complete a task such as: throwing or catching a ball, batting a ball, and playing many sports or games that involve larger body movements (compared to an activity such as handwriting which is more often considered a visual motor activity).

10.  Ocular Motor Skills -
Eye tracking difficulties can cause frustration or resistance toward any activities involving the eyes, including reading, writing, copying skills and/or sustained attention with the eyes over a period of time.  Convergence difficulties (moving into a cross-eyed position) can affect depth perception skills for activities such as walking up and down stairs or escalators, riding a bike or focusing on table top tasks.

11.  Fine Motor Coordination -
This is the child’s ability to use his or her fingers in a coordination manner for activities such as writing, drawing, coloring, stacking blocks, cutting, tying shoes, buttoning, snapping and zipping clothes (just to name a few!).

12.  Visual Perceptual Skills -
Visual perceptual skills are based on the brain’s ability to make sense of what is seen with the eyes in order to complete puzzles, identify the difference between similar objects, pictures or designs, and to understand how to form letters using diagonal lines, curves and straight lines.  This does not include how well a child coordinates his or her fingers to complete such tasks.  It only considers what the eyes see and therefore what the child understands.

13.  Pencil Grasp/Hand Strength & Dexterity -
A pencil grasp is often affected by a child’s hand strength and ability to maneuver the pencil in his or her hand efficiently (which is dexterity). A child should have a 3-finger tripod grasp for an efficient grasp and his or her hand and arm should not be moving, as the fingers should be doing the work on their own.  This is expected of children when they are in their preschool/kindergarten years now.  There are many fun activities on the internet that can help make hand-strengthening fun for children such as play-dough activities when done with all the play-dough tools, the use of hole punchers, cutting thick paper, using mini-staplers, tearing construction paper or multiple pieces of paper at the same time, coloring or scribbling on paper with tiny broken pieces of crayon (so only 3 fingers can fit, versus 4 or 5), etc….

I hope this is a helpful guide for you and I encourage you to ask your therapist questions anytime you don’t understand why he or she did a certain test, what it means, and how that information will help your child to perform better.  The more you ask questions and become involved, the faster progress your child will make!

Best wishes for fast progress and much success!

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Often times OT screenings are being done in private schools, by private practice therapists, to help identify those children who may be in need of Occupational Therapy services. This is very different from meetings and tests that may be administered in the public school system, so this episode is dedicated to explaining what a screening often entails and what parents should do when they receive the results. So many problems are overlooked by top professionals, including quality teachers and doctors because they are not trained to look at certain symptoms in the way that a sensory therapist has been specifically trained. So if your school is offering OT screenings you just might want to jump on the bandwagon and get an opinion straight from the professional!

Screenings are informal assessments that typically take approximately 15 minutes to complete by a licensed occupational therapist. The purpose of the screening is to get a quick overview of the child in order to see if any “red flags” present themselves, which would indicate the need for a full OT evaluation. An evaluation is a comprehensive assessment that includes standardized tests, which often takes an hour, and sometimes longer. This is a compilation of specific assessments that define the child’s skills to be “average”, “above average”, “superior”, “below average” or “poor” in all areas that were tested. The evaluation then ends with recommendations for treatment. Occupational therapy on average may be two times per week, 30-60 minutes per session over a period of 6 months, before another formal assessment is completed to measure gains made. This may be different based on your insurance policy or the severity of your child’s difficulties, so this information is just a guide.

It is extremely valuable to have an occupational therapy professional complete a screening on a child when the parents or teachers are not sure of what is going on for that child. A quick and inexpensive screening is an opportunity for the professional to review any concerns reported, to see whether OT services or even another type of service would be appropriate to pursue. Early detection of difficulties is “key”, as children can make great progress in a short amount of time with assistance. So why wait until your child is really unsuccessful in school, lacking behavioral control, unsuccessful with social interactions, behind in his or her developmental or coordination skills, and/or lacking self esteem?

Examples of categories that may be assessed in a screening include, but are not limited to:

1. muscle tone/strength- muscle tone relates to the amount of messages the brain sends to the muscles to activate over a period of time; low muscle tone is most common in children who have difficulty sitting still, holding a pencil, focusing with their eyes, and/or who are lethargic or get tired easily.
2. balance – i.e.- to stand on one foot, walk on a balance beam or curb, or walk on their tippy toes.
3. sensory processing – often relating to sitting still, paying attention, keeping their hands to themselves, not invading others’ space, demonstrating self-control verbally & physically, and responding appropriately to touch, sounds, movement, smells and the ability to remember and follow directions.
4. fine motor and visual motor skills – related to forming letters, writing words/sentences, staying within the boundaries of lines and having good sizing of letters, as well as age-appropriate drawing, or coloring, and ability to manipulate buttons, snaps, shoe laces, or food containers, etc…
5. ocular motor skills – related to moving their eyes smoothly to watch a moving target in all directions, which is needed for good writing, reading, attention skills and copying from a book or the board in a classroom.
6. visual perceptual skills – this is related to how the brain interprets what it sees versus how the child can control his or her hand/finger movements for eye-hand coordination activities (which would be considered visual motor skills, not visual perceptual skills) some visual perceptual activities involve drawing pictures or people, completing puzzles, and stacking blocks to match a model or an example.

Examples of common concerns that arise with children in the following age ranges include:

1. infants – colicky baby symptoms, always fussy, hard to calm down
2. toddlers – constantly on the go, very irritable, may not like being touched, more rough or withdrawn than other toddlers, fearful with a “deer in headlights” look when prompted to try something new, hyper, or very high-maintenance and may be generally very difficult to manage
3. pre-k – difficulty following directions, sitting still, touching peers without excessive force, may show resistance to following class routines or distress when changes occur in plans or routines (more so than his or her peers), may have a harder time than others with physical activities and/or fine motor activities
4. kindergarten – difficulty sitting at a desk without constant fidgeting or standing, holding a pencil correctly and keeping up with classmates with reading and writing lessons, over-reactive to touch, movement, sounds, easily upset with changes in plans or routines, may dislike school or feel self-conscious about doing certain activities if they are not as good at something than his or her peers
5. grade school – difficulty with sitting posture, sustained attention, academic skills are slow, unmotivated or resistant to going to school, having physical/verbal outbursts, uncoordinated, or being socially awkward
6. middle/high-school – lack of organizational skills, attention problems, uncoordinated for sports or physical activity, craves movement or sports, may like extreme sport activities, withdrawn, or socially awkward, can’t handle “change”, may not have any friends or may not have many friends, needs to be protected more than his or her peers

This is certainly not all-inclusive, it’s just a quick “cheat sheet” to give you an idea of what symptoms or challenges may present themselves for children in a school environment. These symptoms can happen and stand out in children of all ages, so don’t let the above categories fool you; they are just there to give you an idea.

I hope this information helps you to figure out what is needed for your child. You should be able to contact the therapist who screened your child if you have any further questions or concerns.

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Dr. Charlene Messenger has been so gracious to give us her time and share her expertise with us again. Today she agreed to come back on the show to explain how Psychoeducational testing is broken down in order to do different types of testing for various children, provide us with helpful tips on how to help work on memory; share strategies on how to reward children when working with them to prevent frustration, share a success story with us, provide tips for parents that are struggling to find answers and talk about some of the self-help tools she has created can be used as resources to help parents. She talked about how Psychoeducational testing is broken down into these 4 components:

1. Intelligence (IQ testing) which can cautiously be assessed as early as 2 years of age.
2. Achievement/Academic Testing- i.e. reading skills.
3. Process Testing- which looks at functions such as memory, and can assess auditory, visual, and perceptual-based difficulties.
4. Behavioral/Emotional Testing- which includes screenings for anxiety, depression, mood disorders, ADD/ADHD, etc…

She also talked about how “memory” problems are so easily misidentified and misconstrued these days. She stated that back in the 70’s they didn’t have treatment options for memory problems, but now there are many ways you can practice and strengthen memory skills, like you would strengthen a weak muscle. She encourages parents to check out library books that give 100’s of activities or find memory games on-line, such as subtraction games for your child to do in his or her head, or having them find 3-4 random objects in the house and bring them back to you using only their memory.

She also teaches us that when we challenge children, we need to make sure we are allowing them to have 2 successes for every 1 failure. This is a good balance to achieve so your child is not overly frustrated with tasks that are too easy or hard. Dr. Messenger used the great example of: Shaquille O’Neal practices what is “hard”, not what is “easy”. This is how we acquire difficult skills.

Dr. Messenger feels we can all make a huge difference in the world of a child when we use multiple approaches, and this can be the best way to address children who have sensory processing difficulties. She shared an example of when a parent brought her child into her office feeling like there was a mental disturbance and that medication would be beneficial. It turned out this child needed dietary changes, behavior modification techniques (a simple behavior chart), training in self-control with some play therapy used, exercises for home, and a supportive teacher.

As far as helpful tips for stressed parents…Dr. Messenger encourages parents to take care of themselves, and be patient (as hard as this may be) as nagging and scolding children are not highly effective parenting tools. She also encourages us to be aware of each child’s developmental stages and mental ages, so we are setting our expectations at an appropriate level for them to understand and feel successful. Dr. Messenger also has some great resources on her website including some self-help materials she has developed herself, including her long time book: Secrets of the Third Little Pig which you can find in an Orlando Public Library or on-line, and a game she’s creating for kids that comes with a higher level manual for parents- teaching self-help skills.

Thank you again Dr. Messenger, you are such a pleasure and we are so grateful for your time and expertise over the past 3 episodes.

If you would like to schedule an appointment with Dr. Messenger, find out more about her services, or benefit from the extensive knowledge and resources posted on her website, you can visit her web page at:www.brighterpathways.com or contact her office at 407-895-0540

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