Why Children Act the Way they Do

Why Children Act the way they do

Introduction

  1. Who am I – I’m Heidi, an Occupational Therapist from down in Weyburn. I love teaching so I try to go to conferences or host courses whenever I can. I also have a knack for technology so you can find the handouts for today’s course as well as a webinar of today’s presentation on my website www.e-his.ca
  2. What is occupational therapy – Occupational therapy is a holistic profession where science and heart get mixed. We work to help people of all ages lead more productive, satisfying, and independent lives by facilitating our clients ability to do activities that really give their lives meaning, such as caring for themselves or others, being productive at home, work, or school… or just having fun
  3. Objectives – Today we are going to go over four health conditions that are common in children to help you understand the medical reasons behind their behaviours and what you can do to help them. Depending on if there is time we will go over body mechanics to help you stay safe when working with these kiddos.

ADHD / ADD

What is the average number of years children affected by this condition are delayed?

  1. 3 years
  2. The brain matures in a normal pattern but is delayed on average for three years
    • The delays are most significant in the areas of the brain that control thinking, attention, and planning
  3. The structure between the two halves of the brain has an abnormal growth pattern that may be where the disorder develops from
  4. What are common symptoms of this condition:
    • Inattention, hyperactivity, and impulsivity are the key behaviours in the diagnosis of this condition. Children with this diagnosis have to present these symptoms for six months or more to a more severe level that other children their age.
    • Difficulty staying focused
    • Difficulty paying attention
    • Difficulty controlling behaviour
    • Hyperactivity: constantly in motion, fidget, talk nonstop
    • Be easily distracted
    • Have trouble organizing thoughts and actions
    • Miss details in instructions or their environments
    • Become bored with a task unless they enjoy it and can use that enjoyment for motivation to stay on task
    • Have difficulty learning new things or completing tasks
    • Not seem to listen when spoken to
    • Daydream
    • Easily confused
    • Impulsive: impatient, blurt out inappropriate comments, show emotion without restraint, act without regard for consequences, difficulty waiting turns
  5. List some areas that these children have difficulty with in school:
    • Listening to the teacher for longer than one or two instructions
    • Staying focused on fine motor tasks
    • Following the rules of a game
    • Interacting safely with peers
    • Staying seated
    • Staying quiet
    • Staying in the present rather than tuning out/daydreaming
  6. How to help:
    • Movement!!!! Jumping, swinging, infinity walking, spinning, scooter, heavy work, push ups, weights
    • Remember three years younger
    • Visual timers, singing, clapping, tapping on the table, tapping on body (depends on the child – don’t want to scare them)

Reference: Attention Deficit Hyperactivity Disorder, National Institute of Mental Health (2015) http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml?rf=71264#pub14

Autism

  1. Autism Spectrum Disorder is now known as a group of developmental disorders
  2. We know that Autism has something to do with the way the brain works, as these children’s bodies are usually healthy. One theory to explain ASD: Typically the brain develops according to the areas that are used; this is why a variety of experiences are important for normal child development. With everything learned and applies that connection gets stronger and stronger. In autism the brain develops randomly and the connections stay weak and slow. So if there are too many connections in the visual parts of the brain this child will be sensitive to bright lights because their system will bring in too much. If the area of the brain where touch is interpreted has too many connections they will be sensitive to physical contact and so on.
  3. There are times in our lives where our brains go through huge periods of remodeling. If autism has something to do with a breakdown in the way the brain forms and destroys its connections this is why children are usually diagnosed around 2 – 3 years of age or have severe regressions in function in their teen years
  4. The Spectrum now consists of:
    1. Asperger’s Syndrome
      • The mildest form of ASD
      • Affects boys 3x more than girls
      • Social skills and coordination impaired
      • Usually have a topic of interest that they discuss non-stop
      • Have normal to above average intelligence à High functioning autism
      • At high risk for anxiety and depression
    2. Pervasive developmental disorder (PDD-NOS)
      • Later age of onset
      • Not a severe as autism but not as mild as asperger’s
      • Vary wildly on function
    3. Autistic Disorder
      • The three key symptoms previously discussed
    4. Rett Syndrome
      • Almost exclusively seen in girls
      • Genetic mutation
      • Smaller head growth, stops responding socially, wrings hands, loses language skills
    5. Childhood Disintegrative Disorder
      • Rapid loss of social, communication, and intellectual ability, often a seizure disorder develops
      • Don’t recover lost function
      • Boy are more effective than girls
  5. List common symptoms of this condition:
    • The hallmark symptoms used for diagnosis are: impaired social interaction, communication difficulties, and repetitive behaviours
    • These children may be able to talk, but they talk in quotes.
    • They do not seek out others when they are happy to point out things they find interesting
    • Strange behaviours start to develop - looking at objects in their peripheral vision , like at lines or wheels
    • Obsess/fascination over specific topics or sensory input
    • Specific hand and finger movements start to show up
    • Unusual attachments to routines – day long routines or even in a activity
    • May seem deaf, doesn’t respond to name
    • Sensitive to lights, sounds, or touch
    • May walk on toes
    • Stimming behaviours: flapping hands
    • Does not play make believe
    • Many tantrums: change in routine, when asked to do something new, unknown reasons
  6. Sensory Integration Intervention
    • Theory: Jean Ayres developed this theory (1968) on the basis that: To develop motor and cognitive skills the brain needs to process continual feedback from all of the senses. If information goes missing there are delays in gross motor, fine motor, and cognitive skills

Visual System = sight

Hypersensitive child who is intolerant of visual stimuli (high registration sensory avoider) = oversensitive to light, easily distracted by visual stimuli, want to wear hats or sun glasses, startle easy, avoid eye contact, cover eyes

 Hyposensitive child who shows increase tolerance of visual stimuli (low registration sensory seeker) = drawn to flashing toys, games, miss instructions that are written

List ways you might be able to tell if a child is being visually overwhelmed:

·       Closing or covering their eyes, putting their head down

·       Avoiding bright areas – turning off lights, not wanting to go outside

·       Behaviour significantly worsening even though there has been no change in clothing, sound or temperature

·       Banging their head

·       Tantrum

Auditory System = hearing

Hypersensitive child who is intolerant of sound (high registration, sensory avoider) = become overly emotional when hearing loud noises, cover their ears, make loud noises to compete with the noise, not sure where noise is coming from, not able to follow through with verbal instructions

 Hyposensitive child who doesn’t register sound (low registration, sensory seeker) = enjoy being in loud environments, talks constantly, like to make loud noises/scream, likes to sing and dance

List ways you might be able to tell if a child is becoming overwhelmed by sound:

·       Covering their ears

·       Making a repetitive sound – to drown out other noise

·       Banging their head

·       No longer responding to their name or requests

·       Rocking

·       Tantrum

Somatosensory issues = tactile system

Hypersensitive child with a touch intolerance (High registration, sensory avoider) = overreact to light touch, become aggressive or afraid when have to line up, touched unexpectedly, prefer hugs to kisses, overreact to tiny injuries, avoid certain clothes /fabrics, refuse to wear socks or shoes, dislike baths, brushing hair, clipping finger nails, avoid messy activities

Hypersensitive child who is unaware of their body (Low registration, sensory avoider)= have trouble orienting their arms and legs, not sure where body parts are in space, avoid movement, heavy lifting, jumping, complain when having to do work

Hyposensitive child with a increased tolerance for touch (...) = hurt other people or pets without realizing their pain, bump into things or injure themselves without noticing, not know what part of them is being touched without seeing, be afraid of the dark, not realize then they have dropped something, a lot of difficulty with fine motor tasks

Hyposensitive child with poor awareness of their body (Low registration, sensory seeker) = deliberately bump into things, frequently jump and crash, rub or bite hands, enjoy deep pressure, chew constantly, press hard on writing utensils, handle things with force, break things

List ways you might be able to tell if a child is becoming overwhelmed by touch:

·       Avoiding people

·       Pulling at clothing

·       Holding fingers extended and abducted

·       Rocking

·       Tantrum

Vestibular system = balance system

Hypersensitive child who shows intolerance to movement (low registration,      sensory avoider) = dislike playground activities, caution and slow moving, get sick in cars and elevators, demand physical support from a trusted adult, appears clumsy,

 Hyposensitive child with a increased tolerance for movement(low registration, sensory seeker) = need to keep moving, rock or shake head, crave intense movement experiences, thrill seeker, not get sick when extreme spinning, enjoy spinning , swinging Child with gravitational insecurity = extreme fear of falling, fear of heights, fear of feet leaving the ground, fear of head tilted, tries to be controlling of her environment

7. What are the two common approaches for treating ASD

Applied Behaviour Analysis (ABA) - original

  • Based on the idea that individuals are more likely to repeat a behaviour that they are rewarded for rather than one that is ignored
  • Very time intensive therapy (20-40 hours a week)
  • Based on the idea that to get a response from a autistic brain you need to fill the queue of the mind with one input
  • Instructions are given repetitively until the child complies, they are then rewarded with food or toys or other desired thing. The child it taught to respond to other cues to elicit behaviour. The child is then taught in various settings to help generalize the skill

8. Relationship Development Intervention (RDI) - new

  • Focuses on social relationships
  • Parents are trained how to interact with their child and use teaching moments that present in day to day life.
  • Based on the idea that the autistic brain needs to sort through information in a sequential inefficient manner, and you have to wait till they get to the part where you asked them to do something
  • Instruction or cue is only given once and then body language is used to indicate that a behaviour is expected from the child

9. How to help in the classroom

  • When communicating with the child only request the use of one sense at a time. Get their attention by requesting eye contact first. Then allow them to look away while you give them a simple instruction or a few basic instructions depending on their abilities that day. Or touch them, then let go while giving verbal instruction.
  • Do not touch them while demanding eye contact and speaking at the same time (tactile + visual + audio = overwhelmed)
  • Referencing lists
  • Allow the child to move, use their wiggle seat while they work
  • Visual timers
  • Other visual tools – pictures you/they can point at to see if they have a need that has to be met (bathroom, water, fidget toy, etc...)
  • Aware of sensory needs – in a noisy classroom you might need noise cancelling headphones, or the child may have to work in a different room if that particular room has poor lights (for example computer room)
  • Recess:
    • Children who crave movement --> going to run, jump, fall down, climb too high
      • Encourage as much movement as possible during their break
      • Have clear rules and consequences about how high they are allowed to climb
  • sensory breaks
  1. Children who are afraid to move --> going to cling to you, going to cry when its time to go outside, going to avoid play structures
    1. Encourage them to play games where only one extremity group is challenged at a time, e.g. catching and throwing, or running and kicking
  2. Children who don't want to move --> going to complain about having to go outside, will find a group of friends who chat instead of play
    1. encourage these children to join intramurals
  3. Children who are dangerous to others--> going to play too aggressively and not notice when they hurt Someone
    1. Practice appropriate body space with the child
    2. Practice obstacle courses where the rules are they are not allowed to bump into things
  • Sensory diet

GDD

  1. This is term used to described a child with lower than average intellectual functioning and a delay in two developmental areas
  2. This is usually a diagnosis given before or with another diagnosis – if further testing is required. Common to see this diagnosis with genetic conditions, metabolic conditions, prenatal or perinatal conditions.
  3. List 2 areas a child needs to be delayed in to receive this diagnosis:
    • Delayed acquisitions of motor milestones: sitting, crawling, walking
    • Limited reasoning or conceptual abilities
    • Poor social skills and judgement
    • Aggressive behaviours as a coping strategy
    • Communication difficulties
    • Fine motor / gross motor delays
    • List some areas that these children have difficulty with in school:
      1. Writing and other fine motor tasks
      2. Making friends
    • Keeping up with friends at recess
    • Participating in gym class
    • They fall down often
    • Ability to understand concepts being taught

Cerebral Palsy

  1. Cerebral Palsy is another term used for a group of conditions. These conditions are all the result of damage to parts of the brain that control body movement and muscle coordination. In infancy or early childhood and it is non-progressive
  2. There are types of Cerebral Palsy:
    • Spastic CP = stiffness and movement difficulties
    • Choreo-Athetoid CP: Difficulty coordinating and controlling movement
      • Athetoid CP = Involuntary and uncontrolled movements
      • Ataxic CP = poor balance and depth perception
      • Chorea = jerky movements
      • Dystonia = twisting movements and postures
    • What are two possible causes for cerebral palsy?
      • Genetic abnormalities
      • Fetal stroke
      • Maternal Infections
      • Brain injury from a fall or vehicle accident
      • Not getting enough air when they are being born
      • Infections: bacterial meningitis, viral encephalitis
      • Lead poisoning
  3. Name three symptoms of Cerebral Palsy:
    • Ataxia = lack of muscle control when performing voluntary movements
    • Stiff or tight muscles
    • Exaggerated reflexes (spasticity)
    • Athetosis = slow writing movements
    • Involuntary movements/ Tremors
    • Walking with one foot or leg dragging
    • Walking on toes
    • Crouched gait
    • Scissored gait
    • Muscle tone that is too tight or too floppy
    • Difficulty swallowing / drooling
    • Eye imbalances
    • Intellectual disabilities
    • Blind, deaf, epilepsy
    • Delays in speech development
    • Fine motor delays
    • Contractures: can inhibit bone growth or bend bones, joint deformities
    • Poor bowel / bladder control
  4. List some areas that these children have difficulty with in school:
    • Getting to and from class
    • Controlling fine motor movements
    • Going to the bathroom without assistance/knowing when they need to go
    • Eating lunch and snacks without help
    • Intellectually not able to follow along and participate in academics
    • Gym class
    • Communicating with peers and teachers

National Institute of Neurological Disorders and Stroke (2015) NINDS Cerebral Palsy Information Page (http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm)

Mayo Clinic (2015) Diseases and Conditions: Cerebral Palsy (http://www.mayoclinic.org/diseases-conditions/cerebral-palsy/basics/definition/con-20030502)

Kids Health (2012) Cerebral Palsy (http://kidshealth.org/parent/medical/brain/cerebral_palsy.html#)

Body Mechanics

  1. Cardiovascular health: Overall health will protect you from injury at work better than any other strategy. The Canadian recommended exercise guidelines for adults are – 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise per week.
  2. It doesn’t have to be all at once, but aerobic exercise should be in spans of at least 10 minutes or more.
  3. One back injury makes your four times more likely to have another injury, two injuries makes you 8 times more likely and so on
  4. Lower back injuries are the second most common injury at work (16%).
  5. A number of factors contribute to back pain at work:
    • Force – know your maximum lifting weight, listen to your body
    • Repetition – try to break up your tasks or the position that you complete them in
    • Posture – The back is made up of four natural curves. If any of these curves are out of alignment these cause pain and injury over time.
  6. There are different types of lifts but each lift has the same sequence to follow:
    • Test the weight of the load to determine if you need help to move it – is the child too big to lift?
    • Make sure the load is secure and that items will not fall out or shift – is the child cooperative?
    • Plan the lift, do you have enough room so that you do not have to twist. Make sure that you have a clear path so that you don’t have to climb over anything. Use a cart if you have to move the item a long distance. – don’t lift the child over other children, desks, or other obstacles.
    • Get a good grip on the load, handles are the best – is there a transfer belt around?
    • Is the load easy to reach? Use a step ladder rather than reaching way over your head or standing on your toes. It is ideal to store items above your knees and under your shoulder height. – try to put a child on their feet rather than directly on the ground.
    • Use your legs and arms to lift rather than your back.
    • Use slow and smooth movements.

Deep Squat lift:

If your knees are able to squat all the way to the ground

This is a appropriate way to lift a item if you are standing immediately after squatting down – only appropraite for a cooperative child

Keep the load close to your body at all times

Take a wide stance for more support

Lifting over an edge:

This is a lift that you only use if there is something in the way of your knees and you cannot squat down

It is risky for your lower back and shouldn’t be used for heavy loads

Drag the load as close to your body as possible before lifting

Lift your back leg for a counter weight to protect your back

Kneeling Lift:

This is the best and safest lift when possible.

Kneel on one knee with the other knee up, pull the weight towards your lowered knee then transfer it to the opposite knee. Remember to keep the load close to your body. Then stand up while keeping your back straight and strong.

References:

Physical activity and adults. World health organization (2015) http://www.who.int/dietphysicalactivity/factsheet_adults/en/

Stats Canada: http://www.statcan.gc.ca/pub/82-003-x/2006007/article/injuries-blessures/4149017-eng.htm#a

Lifting Safety: tips to prevent back injuries. FamilyDoctor.org (2010) http://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/first-aid/lifting-safety-tips-to-help-prevent-back-injuries.printerview.all.html

Healthy Lifestyle Adult Health. (2013) Mayo Clinic - http://www.mayoclinic.org/back-pain/ART-20044526?p=1