When The Teacher Says Your Child Might Have Attention Problems

When The Teacher Says Your Child Might Have Attention Problems

by | Oct 9, 2020 | Executive Functioning Skills

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

Has your child’s teacher sent home a note to let you know your child may have an attention problem?

First of all, you’re not alone. The A.D.D. Resource Center estimates over 6.4 million children in the United States ages four through 17 have been diagnosed with attention-deficit/hyperactivity disorder (ADHD), which is characterized by an ongoing pattern of inattention, hyperactivity, impulsivity -or all three behaviors combined- that can interfere with a person’s executive functioning or development. Teachers are often the first to spot an attention deficit or hyperactivity disorder in their students.

However, the reasons these behaviors may be related to ADHD are the same reasons these behaviors may be related to a general developmental delay, also called a sensory processing delay.

4 Major Areas of ADHD Behavior

  • Inability to sit still, fidgeting, continuously moving around while trying to listen
    • This may occur because the child is not able to look and listen at the same time. Why do people pace when talking on the phone? Visual information is removed and in order to enhance the auditory information, they access vestibular (movement) information by pacing or moving around. Our movement system and auditory system are connected to the same cranial nerve, so they affect one another.
    • Another reason for fidgeting may be that the child’s postural control system is not in balance and they are not able to stay put in a stationary position at a desk.
    • A child may not have the ability to sit still because some reflexes from early development haven’t yet been integrated.
    • Being distracted by things that are happening in the environment
      • Human beings normally process information from all of our sensory systems at any given moment with the same split-second timing. However, not all kids are transporting every avenue of sensory information at the same rate and speed. Being in a classroom environment can be quite overwhelming for them, despite their cognitive intelligence being able to understand the material.
      • The visual pathway and the auditory pathway in the brain both need to process information at the same time and speed for adequate working memory, which is how kids learn. If this doesn’t happen, the information reaches the prefrontal cortex at different times, like a badly-dubbed movie. The child becomes overwhelmed with new information and starts omitting one sense in favor of another.
      • Both of these above scenarios cause great fatigue in the attention system and makes a child more vulnerable to being distracted.
    • Impulsivity
      • Such as a child who raises their hand whenever they want, simply because they have something to say right then.
    • Capability of having great ideas, yet not able to put them to paper in a thoughtful, organized structure.
      • Executive functions have not developed adequately to support organization, working memory and attention.

The Nature of Attention

  • We’re not born to pay attention. We must develop our attention.
  • Attention isn’t only a chemical process. It’s also a developmental process.
  • Attention is a high-order structure in the brain that a child attains based on their early development.
  • The developmental delay is about the sensory systems not developing at an adequate rate and speed.
  • Attention disorder often goes hand-in-hand with behavior-like impulsivity, when a person simply cannot delay their gratification, but this is also part of a timing disorder.

What can you do about it? Call us to learn more about our unique new program that delivers another unique opportunity for understanding your child.

A Total Approach Attention Deficit and Executive Functioning Program

As occupational therapists we consider the impact of central nervous system development early in life as it relates to occupational function. Our new attention deficit and executive functioning program can help clinically decrease symptoms of attention difficulties, impulsivity, hyperactivity, and inattention while improving executive functioning skills of your child or anyone struggling through these behaviors.

By decreasing symptoms, wellbeing and productivity can be revitalized – which will help to improve academic outcomes, social skills and self-esteem, whether you’re age 5 or age 99.

Unique Comprehensive Program

  • Assessment includes developmental hierarchy, attention measurement, executive functions, including working memory and social function
  • Assessment is tailored to each individual profile
  • Program is designed for individual needs and could include Occupational Therapy (OT), Speech Language Pathology (SLP), DIR®/Floortime™, Sandplay Therapy, and Executive Functioning Coaching
  • Appropriate for people ages 5 to 99
  • Executive Functioning Coaching
    • Certified Executive Functioning Coaching (EFC) available
    • Different options of assessment available to determine best program delivery
    • Offers practical ideas and strategies for home, school, college, and the workplace

There are center-based and virtual options available, so do not delay. Give us a call today at 1-484-840-1529 to discuss your situation.

Your Child’s Irritability Has A Reason

Your Child’s Irritability Has A Reason

by | Jul 9, 2020 | Executive Functioning Skills

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

Learn the three origins of irritability in children, three reasons your child won’t tell you why they feel irritable and three ways to help them cope with their irritability. 

The Summer of 2020 is unlike any summer we’ve seen in a long time. Many summertime activities that kids and parents look forward to are curtailed due to ongoing precautions against COVID-19. Those lazy, hazy, crazy days of summer life as we know it will be different. 

Families are indeed struggling through stressful times right now, and these stressors are affecting everyone in the family. As a parent, you not only may be experiencing frayed nerves and anxiety, but you may have to calm your child’s irritability as well. 

Irritability in children is closely related to anger and aggressive behavior and can be defined as increased proneness to anger. According to the National Center for Biotechnology Information (NCBI), irritability includes both behavioral and mood components and manifests as inappropriate temper outbursts and sullen, grouchy moods. Developmentally, irritability peaks during a child’s preschool years and is associated with developmental delays later in adolescence. 

Make no mistake: Your child’s irritability has a reason, and it won’t simply go away without a little investigation and a lot of love.

Three Origins of Irritability in Children

Children are often irritable when they’re hungry, tired or not feeling well—they have an upset stomach or they’re coming down with a cold or a fever. 

Once you’ve determined that the irritability is not a sign of illness, however, you’ll need to consider other origins, such as the following: 

1. Your child may be struggling with emotional self-regulation, their ability to effectively respond to environmental stressors in the moment and how efficiently they recover from the effort. 

Sometimes children are irritable because something is bothering them inside. They’re reacting emotionally to something that’s happened in their lives, such as a huge change in their routine, a parent being away from home or a death in the family. They may be worried about being lonely this summer without their friends or if they’ll be able to go back to school in the fall. This may emotionality manifest as irritability.

The challenge for you as a parent in helping your child learn how to regulate their emotions is understanding why certain levels of stress stop them from responding effectively. Learn more in my article, “Emotional Regulation and the Importance of Early Developmental Experiences.”

2. Your child may be struggling with unexpressed anxiety. Typically kids don’t run to their parents and say, “I’m feeling anxious right now.” Mostly they try and suppress their anxiety, masking it with a smile—to appease and satisfy you. They recognize something is wrong, and they don’t know what that is. Because they think their anxiety is “wrong”, they don’t want others to witness it due to a sense of shame. As they try to hide their anxiety, it increases their irritability and tendency to exhibit outward frustrated behavior. As they grow older,this may lead to performance anxiety or lack of executive function—mental skills like working memory, flexible thinking and self-control that we need to learn, work and manage daily life. They may find it hard to focus, follow directions or regulate their emotions due to this hidden anxiety, which shows up as irritable behavior. 

If your child is irritable, look at whether they may be harboring some anxiety and the reasons for it. It’s actually good that you’re getting this sign earlier rather than later. 

3. Your child may be struggling with a central nervous system sensory issue. Sensory processing disorder (SPD) occurs when the brain does not organize and respond to the sensory signals received from a child’s body. If their autonomic nervous system (ANS) does not develop to the best capacity, they may struggle with developmental delays such as dyspraxia or lack of sensory modulation, the ability to regulate the activity between the sympathetic (arousal) and parasympathetic (inhibition) systems. Learn more in my article, “How Sensory Modulation Contributes to Behavior in Children.”

Three Reasons Your Child Won’t Tell You Why

1. Your child does not know why they’re feeling irritable, so they can not tell you why they’re feeling this way. They will become increasingly more irritable if you insist on discussing it with them.

2. Your child may not want to admit to doing “wrong”. Often children think what they’re feeling is something that’s wrong or undesirable. Therefore, it’s a taboo subject even to talk about.

3. Your child is living their own “fantasy”, which is their reality and they are not prone to share it. Their internal working model could be that they think they should be perfect in everything they do, which is not possible, of course. When they disappoint themselves with an imperfection like irritable behavior, they don’t want to further the feeling by telling their parent and risk disappointing you as well.

Three Things You Can Do About It

1. Don’t over-talk your child’s irritability with them, which can increase the frustration they are feeling inside. Simply validate your child’s emotion and allow them to recognize that the emotion they’re feeling is OK with you. If you don’t show them it’s OK, then your child may continue to think it is wrong to feel this way.

2. Try not to solve the problem for your child. In typical development, children learn to figure out their own solutions to problems, so you want your child to do the same. As a parent, one of the ways you can help shape this behavior in your child is by modeling. 

Your children are always watching what you do. They see how you handle stress. They watch how you treat other people and observe how you deal with your feelings, even when you think they aren’t paying attention, and they emulate it. 

People learning by watching others is called social learning theory. Kids repeat what they hear, and they imitate what they see, especially from their parents. When you use good modeling behavior, such as showing your kids healthy ways to calm down, pointing out good sharing behavior among a group or telling them how you feel, you’re modeling the kind of behavior that you want to see in them and that it’s OK with you. 

As a result, your child is gaining self-acceptance, self-awareness and self-identity from the way they view how you are viewing them.

3. Contact us! If you’d like to learn more about how to help an irritable child, schedule a free phone consultation with one of our therapists, who can give specific insight into our approach.

The Reading Process and Timing

The Reading Process and Timing

by | Jun 19, 2018 | Executive Functioning Skills

We discussed the impact of the visual and auditory system in the process of reading in the last 2 blogs. Not only do these processes have to be in good order on their own, but also, according to Keith Rayner’s research, they have to at least operate within 5 to 20 milliseconds from each other. This intricate timing involves several stages of development.

After a baby is born, the baby has to find him / herself in this world of space and time. Hopefully the sleep / wake cycle is an easier one for parents, but this, and developing a feeding cycle, starts setting up the first sensorial experience of time lapsing between events. At the same time, the cooing between mommy and baby starts a back and forth cycle that occurs within a rhythm of back and forth and sets up that lovely co-reciprocity. Quite soon, the developing baby starts experiencing another rhythm of day and night. In the second year of life some understanding starts to dawn that there is time and space between morning, noon, and night.

If the pressure of reading is too early for the child, it may contribute to distortions or building inadequate pathways of compensations that grow into habits we do not want.

At about 2 years (of course more or less for some), the child starts to understand that there is a yesterday, today, and tomorrow, including these time concepts into play with rapidly developing language and vocabulary. All of this timing though, does not rely on our cognitive ability, but rather on the wiring of our sensory systems. This is important, as without this “time travel”, it is very difficult to integrate older learning into new. We are essentially living only in this moment and in the “here and now”. During ages 2 to 4, we are refining the incorporation of timing within our body coordination. Now that our reflexes are integrated, our voluntary movement flows with a certain coordination between different body parts and we are learning to grade our movement while incorporating timing.

The child is now ready to want to “read” the book by him / herself, as the world is also transitioning between being a picture thinker, to using words to visualize your own picture. We are able to coordinate our “looking” and “listening” in order to pay attention with both systems simultaneously, while also being able to use the timing between these sensory systems to develop an adequate working memory span for the comprehension of reading.

By the way, the process still undergoes refinement until the ages 5 to 7. If the pressure of reading is too early for the child, it may contribute to distortions or building inadequate pathways of compensations that grow into habits we do not want. Exposure to words, stories, and narration is important from very early on, but the reading process itself is a sensory experience and the automaticity of decoding relies on this intricate development. It is important to understand that we cannot “teach” timing, we can only understand it within our senses in our cerebellum as a developing feature. Yes, the child with body timing issues can learn the cognitive concept of time and use a watch or clock to guide this structure externally, but this cannot be applied to the important development of an inner timing between the senses in order to truly read with fluidity, rhythm, and automaticity.

Pay Attention!!! (Third in series on Executive Function Skills)

Pay Attention!!! (Third in series on Executive Function Skills)

by | May 12, 2017 | Executive Functioning Skills

Shane is sitting in his classroom, and the teacher is explaining a new math problem and the steps to solving it. He loves math and is really trying to listen. He looks away out of the window to other kids playing outside while he keeps listening to the teacher. His teacher notices this and requests of him to look at her as she is explaining this more complicated issue. Shane knows he has to look at his teacher, though finds it really difficult to do and after a while, he starts to fidget and move around in his chair and gains another comment from his teacher to stop fidgeting. As far as the teacher is concerned, Shane must have ADHD. He always appears distracted and constantly has to fidget in his seat. For Shane it is a whole other story.

There are so many different reasons why this scenario could be playing out before we need to consider such strong diagnosis such as ADHD or ADD. I will cover these differential diagnostics according to the hierarchy of development. First, it could simply be that Shane has not integrated attentive primitive reflexes such as the ATNR (Asymmetrical Tonic neck Reflex) or STNR (Symmetrical Tonic Neck reflex) or others, and the seated position causes discomfort because of this.

Secondly, it could be that Shane does not have sufficient balance between his postural extension and flexion in order to maintain this seated position for prolonged periods of time. A third option could be that there may be a processing speed delay in either his visual or auditory system, causing him to prefer the stronger of both in order to capture some of the instruction. Or it could be that he is not able to time the visual and auditory instruction together in his brain, causing him to need to look away so at least he can use one channel of information.

Because sensory processing, reflexes, postural control does not carry an official medical diagnosis in the DSM, doctors feel obligated to place him in some category and ADHD appears to be a good fit.

His teacher feels rightly so that a further step needs to be taken in getting Shane in a better position to learn from the teaching environment. So she suggests that his parent and herself complete a Connor’s rating scale and sure enough, Shane is considered at risk for ADHD and the notion of stimulant medication is discussed. Everyone has his best interests at heart, but what if this is not the right route and that chemical intervention might not be what he needs at all? Truth is that if I answer the questions on a Connor’s rating scale and compare with the answers I get from completing a Sensory Profile, we will also find a sensory explanation to the very same questions. Because sensory processing, reflexes, postural control does not carry an official medical diagnosis in the DSM, doctors feel obligated to place him in some category and ADHD appears to be a good fit.

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But what if the teacher referred him to occupational and / physical therapy? And we discover that the underlying building blocks are not in place for him and that rather than seeing him as a “behavior issue”, we discover he is really trying hard with what he has? Shane has no other body to compare himself to. He has no sense of comparison what it may feel like for his peers. All he knows is what he sees. They appear to cope fine; therefore he has to find a way. He compensates, he copes through cognition and long term memory, he tries it all, but as the grades and performance demands increases, his coping strategies become less effective and soon other behaviors start, impulsivity and daydreaming increases. It is not willful, but rather an outflow of a boy who is not in charge of his system, but does not know why.

As professionals we have to support families in “chasing the why” before simply accepting the most obvious route. Human behavior has never been obvious, the subtleties are multiple and we have to address issues at their root cause in order to be the most effective clinicians for every child coming through our door.

One last thought is that anxiety could be another factor that can look exactly like an attention profile. I am doing a webinar on this on May 22, 2017. E-mail me at maude@atotalapproach.com if you are interested.

Noooo!!! It is going to be Forever!!! I am Never going to be able to do what I want to do!!! Part 2

Noooo!!! It is going to be Forever!!! I am Never going to be able to do what I want to do!!! Part 2

by | Mar 1, 2017 | Executive Functioning Skills

Time is an elusive skill for Kayla as she struggles with developing her executive functioning skills. As a baby she had to learn to understand different cycles of sleep and wake as well as night and day. She struggles with impulsivity and finds it difficult to wait for someone to finish their thought before she jumps in with her own contribution. She frequently struggles with the ability to bring in the past experience into the present, as she remains in the moment, instead of fully employing past, present, and future, another building block in the understanding of time.

Our own internal sense of timing lies within these concepts, as well as our own body’s ability to anticipate timing. After we develop body timing, the intricate process of integrative timing starts to build. Our ability to look at the teacher, while listening to him at the same time, the ability to listen to kids in the background play, yet still to continue focusing on a task at the same time, relies on the integration of our different senses and their ability to work together. Yet another layer to consider would be reading decoding. Dr. Keith Raynor’s research stated that a good reader would scan lexicon on paper for about 11 to 18 character letters at a time in one saccadic eye movement before fixation takes place. During this visual fixation, phonics kicks in within 5 to 20 milliseconds, and this enables us to decode unfamiliar words in a fairly even way. The timing between the visual and auditory system is important for decoding to become rapid and automatic. Frequently programs focus on one or the other skill, but it is timing them together that makes the difference to reading fluency.

When Kayla has to write an essay, she has to think a thought, plan the sequence of events as well as her sentence construction with language pragmatic skill, while she also has to negotiate her penmanship and grammatical rules in constructing her thought. All the while she has to keep her main idea in mind, while she also pays attention to the detail of her writing. Written expression is likely the most intricate of all in timing different systems to work together in an efficient manner. Therapy that targets integration as a goal, is not complete until this process of timing have also been included and addressed.

Our own internal sense of timing lies within these concepts, as well as our own body’s ability to anticipate timing. After we develop body timing, the intricate process of integrative timing starts to build.

Timing and Rhythm goes together in assisting Kayla to keep pace with her peers. It is that innate sense that transpires into a timely production of task in the time allotted for it. She develops her own sense of pace by the understanding her own body has reached in terms of working with a certain rhythm, while keeping track of time. It simply does not help to ask her to work at a faster pace, because even though she understands your words, she does not have the ability in her body to create an adaptive response to the command. It leaves her feeling frustrated that her mind is willing, but her nervous system cannot comply.

Kayla will frequently be found to ask the same questions over and over. The question with “when” is especially frequent, because the common words we use such as “in a moment” or “in 5 minutes” or “after dinner” does not make sense to her. For her, all of those answers in the space of time could be “now” and the insecurity of this loss of sense of time leaves her feeling vulnerable and exposed as she cannot affect closure and anxiety reigns. For her it is as if she has been left in mid-air. Difficult for us to understand as we rely on this system so much, we take it for granted in ourselves.

One more aspect to cover with regards to time is how difficult it would be for Kayla to be interrupted. Her parents and teachers frequently struggle with transitioning her from one activity to another, especially if the first activity was the preferred activity. If her parent tells her that it will be quick and she will be right back to her video game, two major areas are going to come into play. Number one would be that since she has a limited concept of time, taking her from her preferred activity would be “forever!” and the word “quick” was not attuned to. The number 2 aspect of this is that Kayla may be in the middle of a plot that she is focusing on and knows that when she is interrupted, for however small amount of time, she would have to renegotiate much of what she had already gone through to pick up the thread where she has left off. Even though timing is not the only aspect involved in this (more to come), it certainly is part of the equation. Kayla has to develop the ability to be busy with a task that she have allotted a certain amount of time for, being interrupted by the teacher or another student, and being able to make a quick calculation in her mind with regards to how and when she will be able to make up the time lost.

Understanding time is complex, but this skill can be addressed through targeted therapy that considers the building blocks first and then focuses on timing it all together. Without this skill Kayla would always carry the burden of being late for everything, frequently being last to finish, needing extended time for tests, and frequent power struggles between herself and authority figures that require her to respond at a certain pace within a certain amount of time.

In my next blog we will discuss the important skill of paying and sustaining attention.

Stay tuned!

Maude

To Be Able to Execute Planful Behavior: Part 1

To Be Able to Execute Planful Behavior: Part 1

by | Feb 3, 2017 | Executive Functioning Skills

How to understand what it means to become organized

This writing is the first in a series of writings that is going to focus on executive behavior. This is the kind of behavior we would all like to see in our children; and ourselves, to have a goal, to plan towards it, to complete it in a timely manner without undue frustration or emotional upheaval. The ability to plan activity in a step sequence requires both motor and cognitive functions. While the mind sweeps forward to set a step-by-step action in place, the body keeps up with the know-how of what a step sequence would feel like.

We assume she sees what we see, but for her the next step in planning is a big black hole where all the ideas are floating away, not gaining solid ground to enter into the functional process.

Let’s start with considering the ability to initiate a task. We frequently observe Sally being slow to “get going” on projects and we have to either repeat an instruction or encourage and sometimes think that she may have an attention difficulty causing her to be distracted from starting a task. But Task Initiation requires the ability to begin a task without undue procrastination, in a timely fashion, which implies that she would have an innate sense of timing in place to respond adequately. Each new task will bring the challenge of the “new and novel”, which would be difficult for her as she struggles with motor planning deficits and would have to reorganize all her systems to accommodate this new learning. As she struggles with developmental delay, she has also learned to anticipate when tasks will be too hard, just by looking at the proposed activity and will want to avoid based on memory alone.

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The act of planning itself involves the ability to manage current or future tasks by setting goals and developing appropriate steps ahead of time. Again, being able to understand a step sequence and time lapsing are crucial skills for delivering this skill. It provides Sally with the ability to create a road-map to reach a goal or to complete a task. We assume she sees what we see, but for her the next step in planning is a big black hole where all the ideas are floating away, not gaining solid ground to enter into the functional process. Planning also involves being able to make decisions about what is important to focus on and what is not important. This requires of the brain to really need inter-hemispheric organization, because she cannot become so immersed in the detail that she forgets the “whole” of the idea she was planning towards.

The process of organizing the materials needed for a task can influence the planning potential. This requires the ability to establish and maintain a system for arranging or keeping track of important items. Systems are tough for Sally. Once she is in the moment putting a structure together, she can perhaps follow her own strategy, but a week later the same system appears to be non-existent as it never related to the level of integration required to make it permanent. Structure is important for her, but she frequently requires consistent supervision in order to maintain the structure. Once routine is established and have been repeated several times, she can learn to rely and cope with the structure in place, but the skill is not generalized over into new and novel other areas she encounters in every day life, unless someone imposes another structure to organize by. When Sally is left to her own devices, she is not able to keep track of information or materials.
Next time we will cover the concept of time and having goal persistent behavior. Stay with me as I uncover more ground as to what executive behavior really asks of anyone and in the final writings of this topic, we will cover what can be done about it. Sufficient to say at this time that you can accommodate for Sally’s difficulties, but you can also remediate, so she does not have to look back again. Executive difficulties causes great performance anxiety in children and school becomes a mass of information that cannot be structured or contained even while students like Sally have sufficient intelligence. It is not about being smarter, but having the necessary building blocks that would support Sally in automaticity and self-sufficiency.

Stay Tuned!

Maude