Child Mind Institute’s Speak Up for Kids!

National Children’s Mental Health Awareness Week (May 6-12, 2012)

Fifteen million children in the United States have psychiatric and learning disorders, but very few of them will be identified and get the help they need. Stigma, lack of awareness, and misinformation about diagnosis and treatment mean kids miss out on early intervention we know can transform lives. The Child Mind Institute’s Speak Up for Kids is about standing with these kids and families so our message is heard: childhood mental health matters and treatment works.

During National Children’s Mental Health Week (May 6-12, 2012), Speak Up for Kids helps to break down the barriers of that prevent millions of children from getting the early intervention they deserve. Without treatment, children with psychiatric disorders are more at risk for school failure, bullying, substance abuse, incarceration, and suicide.

Join us! Help us to ensure that every child receives the early intervention that we know is crucial to transforming lives. Speaking up is the first step.

Visit childmind.org/speakup to add your voice to this important cause. Our goal is to turn the globe green—the color of children’s mental health.

As part of Speak Up for Kids, mental health professionals will give free talks in their communities to share helpful information about childhood mental health disorders and other topics relating to raising healthy, happy kids. Topics include: ADHD, anxiety, behavioral challenges, bullying,depression, trauma, and social media.

Find a talk near you: childmind.org/map

If you cannot attend a talk, participate in our Live Web Events. On Monday, May 7th, Dr. Steven Kurtz will present “Is it ADHD or Just Inattention?” LIVE on Facebook. We’re also hosting a live Facebook talk on Friday, May 11th with Dr. Melanie Fernandez, who will present “The Difficult Child: Managing Behavior.” The Child Mind Institute will also host a live tweetchat on Tuesday, May 8th on “Parenting 2.0: Parenting in the Digital Age.”

That is why it is very important to choose the therapy which will produce the best results for the child.  Personality, genetic traits, family dynamics and more all influence development.  What works great for one child may fail the next child.

When evaluating a patient, therapists look at motor skills (actions performed by the brain telling the muscles how to move), behavior and sensory integration ability (how the brain interprets all sensory input).

Behavior and sensory issues often go hand-in-hand, as is the case with Autism Spectrum disorder and ADHD and related disorders. Motor skills are divided into gross motor (movements of the large muscles) and fine motor (movements of the upper extremities and especially the hands). There are also visual motor skills, but I will leave those to a later discussion.

In order to simplify the explanation, let’s say that all responses are based on messages coming in to the brain or going out from the brain. We take in messages based on sensory signals from the environment. For example, when you want to pick up a glass of water, your eyes see the glass and your brain automatically calculates how far you need to reach, how firmly you need to grip, how strongly you need to hold, how far you need to lift and how to move your muscles to drink and swallow. Thankfully this all happens in a split second and we don’t even realize it’s happening. For children and adults with motor or sensory problems, the information is either interpreted incorrectly or isn’t sent correctly. And that is it in a nutshell. In order to know exactly where the problem lies, both physicians and therapists conduct an evaluation. Once they diagnose the problem, the treatment protocol is decided based on symptoms, deficits and other factors.

Normal motor skills are defined by the ability to modulate strength according to the need of the situation, and to coordinate movement sufficient for the activity.

There can be too much tone, too little tone or mixed tone. Children with Cerebral Palsy generally have too much tone during movement, and too little tone at rest. Children with Down Syndrome almost always have too little muscle tone. When treating, the goal is to try to get a balance of strength and tone so that movement can be performed accurately and according to the demand of the situation.

Sensory problems are generally the result of an internal regulation problem.

Children with autism either don’t interpret information from the environment correctly or don’t respond appropriately – or both. Children with ADHD seem to have difficulty filtering information. They take in too much information and then have a hard time focusing on a task because they can’t block out irrelevant information.

Some diagnoses have both sensory and motor issues that need to be treated.

I am going to list some common problems, and list possible treatment protocols for the problem:

High tone, mixed tone and spasticity:

• Ball therapy – This helps with improving trunk control and strengthening underlying weak muscles so that they can work better when opposing muscles have too much tone

• CIT (constraint induced therapy) –This is fairly new but gets amazing results. The treatment requires constraining the good side and forcing the affected side to learn to do the work. This is excellent for hemiplegia. This program is done in a clinical setting and generally supervised by a doctor.

• Motor Learning Theory – This can be used alone or in conjunction with CIT. The therapy requires the child to repeat a motor skill over and over in a specific pattern until the brain forms an engram of the movement. This therapy also gets amazing results.

• Massage and stretch and shake (yes, shake) – These techniques relax a tight muscle.

• Kinesiotaping – This is the practice of applying special tape in a specific pattern to provide input to the muscle and help re-educate the muscle to respond better.

• Body wear such as Theratogs brand – These are specially designed shapes that are worn by the child and are designed to influence tone and movement.

• NDT (neuro developmental treatment) –This therapy should only be administered by someone trained and /or certified. Treatment is aimed at improving trunk stability and mobility with the ability to maintain a balance between flexion and extension.

• PNF (proprioceptive neuromuscular facilitation) –This is a manual resistance technique that works by simulating fundamental patterns of movement. Everything we do is in movement patterns. This seeks to inhibit the “bad” tone and promote the “good” tone.

Low tone problems

• Ball therapy – The goal is to improve strength by forcing the core to stabilize and align properly. It’s basically the same as we would do at the gym

• NDT – The goal is to promote balanced flexion and extension

• Weight lifting – The same goal as for adults. Currently there are pediatric weights and equipment available

• Exercise – This should be a variety of resistance and anti-gravity activities. There a couple of books in my store that give activities to address both gross motor and fine motor problems.

Sensory Integration Problems (autism, out-of-sync child, ADHD, sensory processing disorder)

• Heavy work activities, weighted vests, weighted blankets – These help the child gain awareness of their body in space and provide comforting input. One therapist I know used to load up a kids shopping cart and made the child push it around until she was tired just before bedtime.

• Vibration therapy – Vibration is soothing and provides tactile input. It is also great for oral motor defensiveness. Products like the vibrating snake and z-vibe are awesome.

• Deep pressure – Sensory kids crave deep pressure input like sandwiching.

• Wilbarger brushing – This is something that should be done by a trained therapist, but it can be taught to a caregiver who will be committed to the program. It requires using a special soft bristle brush (like surgeons use) to brush the body in a specific pattern at prescribed times throughout the day. It has proven to be effective in calming the sensory child.

• Sensory toys and rooms – If you have the space to develop a sensory room, great. If not, you can get a few toys. The Sensory University (click on coupon on home page) offers a tremendous variety

Behavior issues (can be combined with sensory)

• ABA (applied behavioral analysis) –  Technically speaking, ABA is the attempt to sole behavior problems by providing antecedents and/or consequences which change behavior.  It is concerned with using environmental events to change behavior in desirable ways.  Most people regard ABA as strictly the domain of autism spectrum disorder.  However, it can be used for any beahvior problem

• Behavior modification – ABA is one type of behavior modification technique. Programs like 123 Magic are excellent for children with ADHD and ODD (oppositional defiant disorder). Behavior programs are also good for Down Syndrome kids. In general, all behavior programs use reinforcement and consequences to achieve a specific behavior.

This is by no means a complete list, but the most common problems brought to a therapist’s attention would be treated by one or more of the above treatment techniques and activities. If anyone has a specific question, I am happy to answer by email. Much of what I wrote I have already discussed in other blogs, and specific instructions can be found on some of those posts.

photo credit

Copyright (c) 123RF Stock Photos baby

 Touching therapeutically is physcially and emotionally helpful. Who doesn’t feel better after a relaxing massage? Well, infant massage fosters good parent-child interaction, helps with eye contact, improves sensory responses and can actually help with muscle tone and development.

When my son was a baby, he developed eczema very early. Eczema is always problematic, but was especially so with my son because he had it around his rectum. The skin would be irritated, cracked and often oozing. As a result, he started to hold back his bowel movements because they were painful when they touched his wounded skin. Elimination problems led to constipation and other gastro-intestinal problems. To help calm my son’s distress I would perform tummy massage and he would calm. Interestingly enough, my son constantly asks to have his tummy rubbed or his back massaged. He is now 6.

Although I am primarily my son’s mom, I am also his  therapist. He is ADHD combined type. He is hyperactive and inattentive and spends his days constantly chewing items he shouldn’t be chewing. When his kindergarten nap blanket was sent home at the end of the year, it was misshaped and ragged from chewing. He managed to chew the entire blanket! He seeks the input he senses his body needs. I understand his cravings. Massage is one of my favorite techniques for addressing these needs and helping him to get calm and organized. My son loves getting massaged and the interaction strengthens our relationship. Touch used therapeutically helps my son cope. I credit this to starting massage for him when he was a baby.

I located a blog post which describes why infant massage can make a difference in baby development as well as the mother/child relationship.

Massage can help improve infant weight gain and help preemies to thrive. To read this informative article, click here.

Facing some hard truths about your child who has a developmental problem isn’t easy.  The following is intended to shed some light on different therapies and what they actually can help with.  

This article was originally published a year ago.  It is offered as part of Best of the Best, so I wanted to make it available to those who may not have already read it.

I consider my son to be “special needs” . He was recently diagnosed with ADHD combined type. He has trouble adhering to a structured protocol, and needs re-direction and supervision to ensure that he is paying proper attention. My son has a never ending urge to chew on a variety of things: clothes, blankets, Legos and more. 

I am the first to acknowledge that despite my efforts, it is likely that my son’s issues cannot be cured. Whatever combination of genes produced my wonderful child also wired his brain to work in a certain way. Once coded, the gene pattern is permanent. I can help my son learn to “harness” some of these behaviors in ways that will promote better attention and ultimately better learning. But I cannot fix or cure him of his ADHD. I can help decrease dysfunctional symptoms, and promote improvement in function, but I can’t undo what nature has done.

One of the most difficult parts of being a therapist is in talking to parents of special needs children, and explaining that I could help ameliorate the symptoms, and improve some of the movements, but I couldn’t cure their child.

I have seen firsthand how often a parent believes that the right medicine or the correct therapy will cure their child. In cases of developmental delay without a secondary diagnosis, this could be true.

Many children who are not meeting their milestones receive therapy and treatment and catch up in their development.

 But when there is a significant diagnosis, the outcome may not be as positive. The goal of therapy is to help the child 100% of their potential. The key is in understanding their potential. I thought it would be helpful for me to go over some common conditions and discuss what type of treatment can help, and what kind of outcome to expect.

Cerebral Palsy- Babies born with CP usually experienced a brain bleed or oxygen deprivation pre-natally or peri-natally. Some developed seizures in-utero. It is very common with preemies and with multiples with low birth weight. Depending on the level of the bleed, or how severe the anoxia/seizures, there is usually some residual damage to the brain. Some damage may resolve without lingering problems. If there is enough damage to the brain, it usually causes problems with muscle balance. Some muscles get too much of a signal, and other muscles do not get enough. The actual process is a little more involved, but my description is adequate for purposes of discussion. When muscle imbalance cannot be corrected by the brain, movements cannot be controlled normally. No amount of therapy can reverse or cure this condition. What therapy can do is work with the child’s movement patterns, and try to improve the level of control. Children’s brains have plasticity, which means that they have potential to develop other parts of the brain to help with dysfunction. Many studies have shown that speech can still develop even when there has been damage to the speech center. Unfortunately, this does not happen with damage to the motor neurons. However, some treatment protocols can get huge improvements in quality of movement and ability, although they cannot make it perfect. Constraint induced therapy, motor learning theory and pattern based treatment are most effective.

Spina Bifida –This is considered a neural tube defect. In lay terms, the spinal cord is exposed at some point and the nerves are damaged. The level of disability is related to where the problem occurs. The more the cord remains intact down the length of the trunk, the better the outcome. Therapy plays a tremendous role in skill development. A good strengthening program will help develop the upper body so the child can walk with crutches and braces, or can propel their own wheelchair. When therapy is started very early and very aggressively, weak muscles can improve significantly.

Seizure Disorders – It is important to determine the cause of the seizures. In some cases, they disappear on their own. But in many cases, there are underlying neurological conditions. Seizures can also cause brain damage resulting in Cerebral Palsy and/or cognitive impairment. If the seizures have caused brain damage, the therapy can’t reverse the damage. What it can do is improve both gross motor and fine motor skills. The earlier the therapy is started, the better the result.

Autism Spectrum Disorder – I’ll always remember what a parent said to me many years ago. What made this diagnosis so difficult for her to accept is that her child looked so perfect. With genetic conditions like Down Syndrome and physical problems like Cerebral Palsy, the outside world can immediately see that something is wrong. Autism is not so obvious. However, it also cannot be cured -at least not at this time. Good therapy can make a huge impact regardless. My personal choice for treatment is a combination of ABA and sensory integration strategies. The ABA addresses the behavioral and social component, and the sensory works on organizing and calming the central nervous system.

Down Syndrome – There are a number of treatment protocols which best serve this diagnosis. The most important symptom to address is the low tone and joint laxity. This can be done with core strengthening exercises, ball therapy and NDT activities. The next important thing to treat is behavior. Generally, what sets Down’s children apart and makes them noticeable in public situations is their behavior. Their social and emotional skills need work right from the start. A good behavior modification program can have a tremendous effect. Good physical skills and good social skills will help them to be accepted by other children.

There are many more conditions that I did not touch on today. I wanted to speak about these in particular because the families of these children often expected a cure. While I hope that there is a cure in the not too distant future, for now there is not.

 What is available is good treatment that can maximize the child’s potential and help them to be as independent as possible.

Cerebral Palsy is a neurological disorder which affects communication between the brain and the muscles. The disorder results in uncoordinated movement and abnormal muscle tone. The consequence is that children with this disorder have difficulty achieving their developmental milestones and performing ADL’s (activities of daily living).

This particular developmental disorder is hard to treat. Cerebral palsy can take different forms, and it affects each child to varying degrees. At its worst, spastic tone (muscle stiffness) dominates in all the extremities. Children with spastic quadriplegia are often wheelchair bound.

The goal of therapy is to strengthen the core (trunk) muscles and even out the tone as much as possible. When CP is not treated, the affected muscles have either too much tone on movement or too little tone. This inequality of tone causes the limbs to be forced into positions and postures which don’t allow normal function to occur.

In order to treat properly, the therapist needs to somehow facilitate the use of the weak muscles while inhibiting the spastic tone. This requires keeping the child in good alignment while performing the exercises. As anyone who has every tried to inhibit spastic tone is aware, this is a monumental feat.

I have written about CIT (constraint induced therapy) and motor learning and NDT treatment protocols. Since writing about these treatment options, I discovered Therasuit Method. Although I have not seen the results personally, the principles underlying the treatment are sound. I watched a few videos of the treatment, and it looks like Therasuit accomplishes easily the exercises which are so difficult for a therapist to do manually.

Here is what the website has to say: TheraSuit Method® utilizes various tools and exercises. One of them is the soft dynamic proprioceptive orthosis called TheraSuit®. TheraSuit® aligns the body as close to normal as possible. Reestablishing the correct postural alignment plays a crucial role in normalizing muscle tone, sensory and vestibular function.

Universal Exercise Unit is used to train one the abilities to isolate the desired movements and strengthen the muscle groups responsible for that movement. Universal Exercise Unit allows to gain range of motion, muscle and joint flexibility, as well as functional skills.

The key to strengthening and facilitating muscle function is to isolate the specific muscle or group of muscles and provide exercise to that muscle. When factors such as muscle spasticity, tonal issues (low tone or high tone), and postural control influence movement, the therapist has the very difficult task of managing these issues while working toward the goal. As I indicated above, this is a monumental task.

Rather than describing the entire process, please watch the video and see for yourself. Then you can decide if Therasuit Method is right for your child.

If you knew that pollutants in the air had a direct link topremature deaths, asthma, decreased lung function, autism, ADHD and developmental delays, would you do something about it? If you had the opportunity to take measures which would improve the air quality for your unborn child or newborn infant, would you grab hold of that opportunity? Or are you the kind of person who thinks something should be done, but would rather leave the solution to others who are willing to get involved?

I am a pediatric occupational therapist with more than 16 years of clinical experience. I also have a 6 year old with ADHD combined type. In the years since I started working, there has been a marked increase in children diagnosed with asthma, autism, cerebral palsy, respiratory problems, ADHD and more. Recently I attended a panel discussion by some of the worlds’ leading experts on ADHD. They unanimously agreed that although it might seem like ADHD is currently over-diagnosed, in actuality it is probably under-diagnosed.

No one really understands the impact of these diagnoses until they have a child who has a developmental problem or who must be on life –saving medication their whole life. I understand not only because I have a son who has ADHD, but also because I treated so many of these children. Some of these problems are insidious. Children with autism and ADHD have behavior problems, socialization issues, sensory issues and cognitive issues. The child may have the diagnosis, but everyone is affected. Therapy and medical care is time-consuming, expensive and emotionally draining.

Think about this for a minute. During pregnancy, a developing fetus receives nutrients and oxygen via the mother. Everyone knows that smoking, drinking and taking drugs can cause birth defects. Pollutants can reach a developing fetus in much the same way. Early in the pregnancy, a developing fetus is very vulnerable. Life starts as a few cells, and becomes a neural plate and then expands to become the head and brain, trunk and spinal cord. It is vitally important to protect the young fetus at this time. An incident which damages the neural plate can end up as a problem with the brain, or limbs, or nervous system, etc.

Research indicates that there is a higher incidence of premature and low birth weight babies in urban areas. Pollution in urban areas is generally much greater than in suburbs and rural areas. More traffic and more industry create more air pollution. There is also a greater concentration of lower socio-economic women in cities. Drugs, smoking and lack of good health care contribute to the problem.

In itself, this is serious. But it is also important to know that babies who are born prematurely have incomplete development. Once out of the womb, they are stimulated by lights, sounds and sensations in the NICU that their nervous systems are ill-equipped to deal with. Almost all the preemies I ever treated had sensory issues. Most were ADHD. All of them had developmental delays.

Your concern and worry can’t stop even if you have a healthy, full-term infant. As soon as the baby leaves the hospital, they are breathing polluted air. Imagine the effect those toxins can have on an infant and will continue to have as the child develops.

When I wanted to find out if air pollution had a relationship to autism spectrum, asthma, ADHD and more, I did an internet search. I found article after article indicating at least a causal relationship. These articles were from the National Institute of Health, Web MD, the National Institute of Environmental Health Sciences and more.

Personally, I don’t need more information than this to want to get involved. I have treated enough babies with developmental disorders and I have a son who is ADHD. I know that more and more children are diagnosed with autism spectrum disorder than ever before. And I know that air pollution is unhealthy and may be at least partially responsible for these issues. What can be more compelling than that? If every mom wants the best for her unborn child or developing child, then clean air should be part of that goal. Jump on the MCAF bandwagon and demand clean air for the future of our children.

It arose out of our growing understanding of the brain and how the brain’s electrical activity, as measured by an EEG readout, plays a role in the creation of symptoms, such as anxiety or inattentiveness. Put another way, our brainwave patterns reveal the brain’s functioning and the field of neurofeedback is looking at how that functioning can be altered to alleviate symptoms. For example, the brainwave patterns of individuals with ADHD will be different than in those without ADHD.

From the point of view of neurofeedback– or “brain training” as some call it—we see that with certain conditions such as ADHD, Post Traumatic Stress Disorder or anxiety disorder, the brain is habitually making maladaptive choices. Those maladaptive choices are visible in EEG patterns.

One way of explaining this habituation is to say that the brain is not reading the environment accurately and therefore, not responding in a way that is appropriate for the individual’s here-and-now needs. Often it is just repeating a “then-and-there” need, a response that was helpful long ago but no longer useful. We have come to understand that the brain gets habituated, in an attempt to be efficient—why reinvent the wheel each time?—not realizing that it is not being effective! Many of our current mental health conditions we could describe as the result of the brain’s misperception of what it needs to do in the present in order to be efficient and effective.

With the latest research on the brain and the brain’s ability to adapt and change (neuroplasticity), we realize that the brain is much more flexible and, given the right conditions, has the ability to re-organize itself to some degree. What it needs in order to do this is 1) to see what’s maladaptive or not working (i.e., it needs a mirror) and 2) to practice shifting its functioning away from what used to work (but no longer does) to what does work.

To give a simple example, if you look in the mirror and see that your head is tilted you will straighten it. If your brain sees that it is expending energy needlessly it will stop. The brain is an efficient system and doesn’t want to waste energy, but it doesn’t always know that that is what it is doing.

How does neurofeedback work?

There are a number of different neurofeedback technologies used to help with the cluster of behaviors we have come to call ADHD. NeurOptimal neurofeedback works by training the brain to use the present moment to decide what to do next, rather than old, often maladaptive patterns. It does this by triggering what’s called the orienting response, which is the brain’s ability to sense change in the environment and take in new information about what is different. (This is the mirror mentioned above.)

More specifically, during a neurofeedback session, EEG sensors are placed on the head and ears to collect the information about the brain’s activity, which gets fed into the technician’s computer. You sit and listen to music (often children watch a movie or listen to their favorite music). When your brain is about to do something new, i.e. change states, it does a certain kind of “electrical dance”, which the software identifies. When that “dance” is detected the computer program stops the music in milliseconds. What the stopping of the music does, is trigger the orienting response and the brain “comes into the present” and sees what it was about to do and also takes in information about the external environment. And all of this it does in milliseconds and outside of your conscious awareness.

A good analogue is like when you are daydreaming and in a daydream you (your brain) are not aware of what is happening, not until someone calls your name (the music stopping in neurofeedback) and you simultaneously realize that you were lost in a daydream, and recognize the quality of that daydream, as well as take in information about the here-and-now.

How does triggering the brain’s orienting response lead to alleviating ADHD symptoms?

When the brain orients it sees what it was about to do habitually and whether it is an efficient and effective response to the here-and-now. Some of our habits are efficient and effective–the brain won’t shift that functioning– but some of our habits, such as those that are labeled ADHD, aren’t. The brain sees what it is doing that is not effective or efficient, and because of its design—to function optimally—the brain starts to shift its behavior. It also learns that the best way to function is by relying on the present moment to gather information, rather than using old, out-of-date information.

NeurOptimal neurofeedback is “diagnostically agnostic” meaning it trains every brain the same way and lets the individual’s brain decide how to shift its functioning to perform more optimally. So while parents of children with ADHD are hoping to increase attention and focus, have fewer outbursts etc, they may also notice improvement in other areas controlled by the brain. For example, parents often notice their children seem more relaxed and cheerful, sleeping better, getting along better with siblings, or reaching new levels in sports or musical pursuits.

The child’s conscious experience doing neurofeedback is getting to watch a favorite movie or listen to their music, and the brain’s experience is training in coming back into the present and seeing what it is doing habitually and then making shifts in its behavior accordingly.

What about side effects?

With drugs, a substance to your system, you can have unwanted side effects. NeurOptimal neurofeedback is not adding anything; it is only “adding” getting your brain’s attention. Sometimes with training, as it progresses and the brain becomes more efficient, if the child is on medication, they can experience the effects of being over-medicated. So it is important when adding neurofeedback to a drug therapy regime, to inform the prescribing doctor so signs of over-medication can be noted and responded to appropriately.

This post was written for Milestone Mom by Natalie Baker LMHC. Natalie is a licensed psychotherapist and certified neurofeedback trainer in New York. Having worked for over 10 years as a psychotherapist treating clients with conditions such as PTSD, trauma, anxiety, depression, and relationship issues, she was thrilled to discover neurofeedback. ”Living with conditions such as anxiety and depression is hard enough. I was so happy to be able to offer clients another tool in the neurofeedback training that has really sped up–sometimes effortlessly–their healing process.” Find out more about Neurofeedback and Natalie at NeurofeedbackNY.

Some proponents of the treatment say that it helps foster speech, improves ability to make eye contact, decreases sensitivity to noise and makes kids on the spectrum more sociable. Currently there is not enough research to make a definitive claim, but some studies suggest that as a complementary treatment, HBOT helps.

According to the Mayo Clinic –

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. Hyperbaric oxygen therapy is most commonly used to treat decompression sickness, serious infections, bubbles of air in your blood vessels, and wounds that won’t heal as a result of diabetes or radiation injury.

In a hyperbaric oxygen therapy room, the air pressure is raised up to three times higher than normal air pressure. Under these conditions, your lungs can gather up to three times more oxygen than would be possible breathing pure oxygen at normal air pressure.

The increased oxygen dissolves in your blood during hyperbaric oxygen therapy, and circulates throughout your body. Oxygen-rich blood stimulates your body to release substances called growth factors and stem cells, which promote healing.

Advocates of HBOT believe that children with autism have areas of the brain with less blood flow.

 They contend that by delivering greater amounts of oxygen and blood to the brain via HBOT, neurological function is improved.

I am always skeptical when it comes to alternative treatments. There are many factors which sort of cloud the results. Faith, belief and conviction can strongly influence the way someone views a subject. The placebo effect is well documented. It is the beneficial effect in a patient following a particular treatment that arises from the patient’s expectations concerning the treatment rather than from the treatment itself. What I am saying is that families may think behavior has improved because they expect it to improve after an HBOT treatment.

Another issue which may confound the results is that the child is getting a lot of one to one time as a result of participating in the treatments. There is commuting time to get to the clinic, time in the chamber and then commuting time to get home. Literature suggests 30 – 40 hours in the chamber per month is beneficial. Even without commuting time, that’s a lot of “attention time” focused on the child. Most children respond positively to increased parent-child interaction.

In addition to these factors, I wonder if the fact that the child is confined to a small space for up to 40 hours per month might be inadvertent behavior modification. Repetition is powerful reinforcement in changing behaviors. While in the chamber it is not possible to run around. The child has to stay relatively calm and quiet.

Although I am skeptical, I am open to hearing more about the potential of HBOT as a complementary treatment. Patrick Elliot, a physician and father to twin boys on the autism spectrum, added HBOT to his sons’ treatment protocols. One of the boys was mainstreamed, and the other is able to read and write at grade level despite being in a special education school.

No one is saying that HBOT should replace currently accepted treatments for autism. From what I understand it is considered a complementary treatment. Studies also indicate that children with mild autism are the best candidates for the treatment and experience the most noticeable results.

Hyperbaric oxygen therapy (HBOT) is not generally recognized by insurance companies as a treatment for pervasive developmental delay disorder.

Some insurance may reimburse part of the fee, but most will not. For those who are able to afford the expense, this might be worth trying. The rationale sounds logical and reasonable, and there doesn’t seem to be much of a downside other than time and money. And whether it is the hyperbaric treatment or the factors mentioned earlier, if the result is improved symptoms, then you have a win-win situation.

Healthy eating is essential in order for a baby to thrive and develop and achieve milestones. Refusal to eat or avoidance of food by a baby or child can be a seemingly endless nightmare for parents. The source of the problem can be difficult to determine. It could be related to swallowing problems (dysphagia) or motor planning problems (dyspraxia) or sensory problem or sucking problems or all of the above. Children who were preemies, children with autism, children with SPD, children with ADHD, children with genetic disorders and normally developing children can all make their parents anxious over their refusal to eat or their food pickiness.

Cheri Fraker and Laura Walbert are speech pathologists who specialize in the treatment of pediatric feeding disorders.

They wrote a great article on therapy techniques and suggestions for introducing new foods. Click here to read the article.

 Many children meet their milestones, and have no cognitive delays, but are challenged when it comes to anything sports related. I am talking about kids with coordination issues which can interfere with their ability to swim, dance, hit a ball, catch a ball, etc. Lack of coordination can be a symptom of motor planning problems (dyspraxia), proprioception (knowing where the body is in space) or processing problems.

My son is one of those kids who can’t seem to integrate movement patterns that are demonstrated. For example, swimming has been very hard for him to learn. The instructor will show him how to reach forward and elongate his body so he can use his arms and legs properly, and inevitably he either moves his arms or his legs, but not both at the same time. He needs hand-over-hand assistance and many repetitions before he is able to form the motor memory.

There are a variety of programs which address these types of developmental coordination issues. 

The programs use movement patterns and auditory (sometimes visual) feedback to help the child improve bilateral integration and improve timing and accuracy of the movements. Motor learning and memory occur after many repetitions of movement patterns. The idea is to teach your child to move in a specific pattern and use both sides uniformly so that a precisely timed and accurate pattern emerges. Clapping hands is a pattern which requires hands to move away from each other and then come together at exactly the same time. If timing is off, the hands don’t meet in the middle and clapping isn’t successful. I have treated many children who clap more to the left or more to the right. Jumping jacks is also a good example of the kind of exercise that is difficult for a child with poor coordination.

The programs I am referring to help the child become coordinated by having them repeat specific movements with their hands and feet, and to have the movement terminate in measured intervals.

A few programs use a metronome along with a visual aid to reinforce the correct patterns. These programs generally require that the child attend sessions with a certified practitioner. This can be very expensive for the family.

While doing a little on-line investigation, I found a description with clear and easy to follow instructions so you can try this at home with your child. All you will need is to buy a metronome. You can purchase one for as little as $20. The Sabine Zipbeat-6000 offers a loud, clear sound and can be easily adjusted. It also has a sweeping LED display which will provide visual feedback. There are other metronomes which will do the job nicely as well.

Here is a description of a few sessions:

The first 6 exercises are: Clapping hands, preferred hand, non-preferred hand, both toes, preferred toe and non-preferred toe. Start by setting a slower beat on the metronome and then increase the speed as the child improves. The goal is to end the movement at exactly the same time as the sound of the beat.

- Clapping hands: Make sure you are not bringing your hand straight back and forth as you clap, since it’s hard to keep a rhythm with this motion. For a more rhythmic feel, use a circular motion of about 10 inches in diameter with each hand. The hands should come together at the same time as the beat of the metronome and the circular path should be continued, without stopping after the beat.

- Preferred hand: With a similar circular motion as above, tap the preferred hand on leg.

- Non-preferred hand: Same as above, but with non-preferred hand.

- Both toes: Sitting on a stool or chair, tap both toes on beat with the metronome. Tapping on a hard surface will help, since the sound of the tapping will give some feedback on how close you are the metronome beat.

- Preferred toe: tap just the preferred toe. You can sit or stand for this one.

- Non-preferred toe: same as above with non-preferred toe.

Here is a sample of the remaining exercises:

- Preferred hand and Non-preferred toe simultaneously

- Alternate 4 beats of clapping hands with 4 beats of preferred hand for 250 beats

You can get creative and have your child stand and move one leg out, bring to center, move the other leg out, and bring to center. Then they can move forward and back, and then move backward and bring to center. They can also jump up and end with legs wide, then jump up and end with legs together. Remember that you are working on teaching your child to work with hands/legs simultaneously and also alternating.

Coordination can be improved.

These activities can be adapted for many disabilities. They are good for kids with cerebral palsy, Down syndrome, ADHD, autism spectrum and more. Many children with disorders such as ADHD have coordination and processing problems. With persistence and reinforcement, they can excel at sports. Michael Phelps, who earned a record 8 gold medals for swimming at the Olympics, is ADHD. No matter what the underlying reason for the coordination problem, sequenced, timed, repetitive movements will help. Give it a try.