Follow up questions
What do you mean, ‘Self Regulation is the new IQ’?
What if the siblings are always around?!
What are some activities for children who have difficulty accepting different foods or textures?
Introduction
Hello, everyone. Welcome to our second series of “Kitchen Conversations.” This one is summer-style. So I’m outside in the spirit of the summer. Today, we have Carrie Alvarado joining us again to share some tips and tricks for us from her OT lens. And so we’ll introduce Carrie in just a minute. But first, I just want to go through some housekeeping things here.
OK. So many of you have found the chat function already. And I’m sure many of you are familiar with the Zoom platform at this point. But if you have some thoughts as Carrie is speaking, please feel free to share those on the chat. And we can have a conversation and get to know each other that way.
Also, the Q&A function– if you all could just click on that at this point and bring up the Q&A window, there you can type your questions. And we will keep track of those. And at the end, we’ll have some time for Carrie to answer questions for us. So you can just keep your questions there. And we will come to those questions at the end. So if you could pull that up and have that available, that would be wonderful.
We will be recording this session. And then we will have it up on our website with closed captioning and a full transcript. So you can reference it there after the fact. We’ll send you an email when that goes up. And feel free to share with your colleagues or other parents.
And then, finally, you will be muted during this session just so that we can get through all we want to get through. It is a quick, 30-minute session. So if you have something to share, please use those chat and Q&A functions.
So I won’t speak too much about Exceptional Lives. But I do encourage you to come to our website. If you’re not familiar with us, we provide disability information for families. And we do that through a few different formats. There’s guides, a resource directory [Louisiana Resource Directory/Massachusetts Resource Directory] that’s searchable, as well as blogs [English/Spanish].
And you can find us on social media [Facebook/Instagram]. So we update our social media platforms when we have new information coming to the site, which is always happening. So please check us out, and look around. And then get in touch if you have any questions for us.
So this is my son. And at Exceptional Lives, many of us are parents of children, many of whom have some special needs of their own. And we are all walking through this pandemic world wondering, how do we manage with all of our therapies and all that.
I bought this swing for him, or this hammock seat when I realized we would be spending all of our time at home this summer. And he really needed that feeling, as I’m sure many of you– I mean, I kind of always need that feeling. So that’s been helpful for us.
And we know that many of you who we’ve heard from are thinking, OK, what does this look like over the summer now that we’re continuing on with teletherapy, but we’re trying to infuse our days with summer fun? How do we do that?
So if you could answer this poll for us, let us know how it’s going for you. So are you working with an OT or not? How are you managing? And then we’ll turn it over to you, Carrie, after we hear from all of our participants.
Lots of providers, and a provider looking for tips on how to support families. That’s fantastic. And we run the gamut. So that’s perfect. I think your talk will be helpful here. So without further ado, I’m passing it on to you, Carrie.
Presentation
Wonderful. Thank you, guys, so much for having me again, Exceptional Lives. I so enjoy our time together. And welcome to all of you professionals and parents who are joining us from across the country. You will notice there’s a little bit of a chainsaw noise that’s just magically appeared outside my window. So one of the side issues to working from your home. But hopefully you’ll be able to hear me loud and clear. And if you have any questions at the end, I’m happy to resolve some of that for you.
So yeah, I’m Carrie Alvarado. I’m an occupational therapist. I work in San Antonio, Texas. So wish us luck. But we thought it would be a great idea to, like Julie said, really talk about how do you take some of the philosophies that we use in occupational therapy— even if it’s not within an occupational therapy session itself– how do you infuse some of the philosophies and the strategies that we use in OT to make the most of the time that you have with your child?
So today, we’re going to kind of break it down. We don’t have a lot of time. But we’re going to break it down into five tips to keep in mind when you’re planning for activities to do with your child and when you’re actually engaging in those activities.
So I’d like to talk about occupational therapy as being a work of heart. [CHUCKLES] It is a science. Obviously, the science of occupational therapy is really centered around helping adults and children function better in their everyday lives and their occupations. So for a child, obviously, those occupations center around play and learning social skills and self care and how to manage in a classroom with all the different tools they need to use and all those social learning and academic learning skills they’re going to need to be successful.
But it’s also an art. And so today, we’re talking a little bit more about the artful aspect of occupational therapy and how to incorporate some of that into activities with children that you work with or with your own children at home.
So the five tips that I came up with, kind of digging in my OT brain, thinking, what are the five things I want to tell you? They were these. Prepare your canvas. If we’re talking about art form of occupational therapy, prepare your canvas. That means make sure your child is in kind of a ready state, in that optimal state of arousal and is motivated by the activities that you choose.
That kind of leads into number two, select media that is meaningful to your child– and maybe even to you, too, so you’ll get more out of it as well. So does your child prefer watercolor or oil? Is your child really motivated by music or dinosaurs or imagination or letters or shapes? Whatever it is that drives your child’s interest is what you really want to think about incorporating into the activity.
Also, one of the biggest pieces, I think, that makes an OT activity really successful is finding the “just right” challenge for your child, making sure it’s not too difficult for them to achieve success, and not too easy so that they don’t feel like they’ve achieved anything.
Provide contrast. So an OT very often we pair something that’s a little bit challenging for your child with something they’re really good at. I think all of us really benefit when we’re able to do that for ourselves, even.
And then, remembering that the process in occupational therapy is really more important than the product. Obviously, there are some circumstances in which you want a product at the end to show off and kind of brag or share with someone else. But in OT, it’s really about finding success in little stages. And so we’re going to talk a little bit more in depth about what that means.
So for number one, preparation of your canvas, this is really all about kind of what we talked about in webinar number one that I did earlier in the summer, where we really talk about observing your child, knowing what your child’s sensory needs are in the moment, and thinking about, how do I create an activity with this child in this session or in this moment in the evening when I have a little playtime before dinner? How do I come up with an activity that’s matching my child’s need right now?
And you do that through observation, right. Is your child in a state where they’re a little bit more sedentary, a little under-aroused, and need to be kind of jazzed up and given a little bit more gas? You need an up-regulating activity.
So the activity you choose in that moment might be something really active where there’s a lot of movement, high impact, maybe add in some peppy music if your child is interested in music or can tolerate music and rhythm. Think about light touch, tactile activities– things like whipping cream– that would be delicious– shaving cream or rice and beans. Those kinds of activities that give that light touch texture are generally up-regulating to children.
Or on the contrary, is your child looking a little bit like they’re up here and running at 120 miles an hour and you need them to kind of come down a little bit and regroup and reorganize? In that kind of a circumstance, you might choose an activity that’s going to be down-regulating or as going to function for more of a brake for your child’s nervous system, right.
So these might be activities that are less dynamic, but are more rhythmical, repetitive, incorporate more heavy work into them, things that are done in a less visually distracting environment, with less going on, less people moving around, less things on the wall, less things on the table where they’re working with. And then working with music, if you’re going to use music, that’s a little bit more rhythmical, maybe lower volume, slower pace.
So we think about, when we’re looking at right activity for the child, does this match my child’s needs in the moment? Or is this a mismatch? Because if there’s a mismatch in your child’s canvas being prepared, you’re not going to have as much success moving forward with the activity that you’re choosing.
And this really boils down to regulation, right. And we spent a lot of time in our prior webinar talking about this, as well. Regulation is defined as the ability for children to be calm and alert, which means they’re open to learning, right. For some children, just working on self-regulation can be the summertime goal, right.
I had a professor in grad school who said self-regulation is the new IQ. And really, ever since then– I don’t know if Julie remembers– but we would like that to be emblazoned on a T-shirt because it’s so true.
If a child is not regulated, we can’t look in to that child’s mind and see what they’re capable of. What are they thinking about? What are their ideas? What are their real abilities? We can’t see through to what those real abilities and interests are if the child is in a disregulated state most of the time.
So for your child, working on regulation of its summer might just be it. And these activities that you probably play with your children without even thinking about all of the great skills you’re working on can be really helpful for supporting self-regulation.
So games like hide-and-seek, red light, green light, heavy work games like building the obstacle courses, pushing a sibling in a laundry basket, freeze tag, dancing, all those different games where there’s a lot of stop and start, kind of loose rules, lots of stimulation followed by not as much stimulation– these are all games that really target a lot of self-regulation skills for children.
So inhibition– not being able to move or only moving when you hear certain things, that auditory attention is you’re only moving if you hear the green light, right. The working memory– remembering the rules of the game, remembering where everybody hid last time and maybe might be hiding this time.
Intersubjectivity– that’s kind of thinking about what other people are thinking. I think that one comes out a lot in hide-and-seek. Where would my mommy hide? She would probably hide in the laundry room because that’s where her favorite places, right.
Flexibility– so it doesn’t always happen in the way that we expect for it to do. Right, we might not be the person who gets to say red light or green light. We have to listen and pay attention to what other people are needing from us.
Motor planning and organization– again, that’s really involved in a lot of these games where they’ve got to inhibit their body. They’ve got to sequence the movements of their body and maybe adapt the next time they hide, and hide somewhere else. So there are all these skills.
And then emotional regulation, as well– if it doesn’t go the way that we want it to, if we get tagged out, if nobody ever comes to find us and we have to sit there, and we’ve got to figure out a way to cope with that emotion and to keep moving and to keep the interaction going. So lots and lots of good work can be done. And these games, you probably play with your kids already if you’re doing it kind of with an intent of shaping some of these skills.
And then there’s co-regulation. Co-regulation is also really important to setting the canvas, getting the canvas ready. And these are games that are really built around two people supporting each other’s arousal state, right. So it’s probably you and your child, or your child and you as a therapist working together, to kind of interplay and coordinate each other’s activities and energy levels.
And there are a lot of games that are really great for building co-regulation. So imitation games. I don’t know if you’re familiar with Going on a Bear Hunt. But, (RHYTHMICALLY) going on a bear hunt. Maybe the adult is padding, and they’re going slowly. And then the bear chases them, and they run really fast. And then they’re going to tip-toe because the bear is sneaking up on them. So there are all these different opportunities for the child to grade– the speed and the intensity, monitoring and mirroring off of you– or vice versa, you really mirroring and monitoring off the child.
Sleeping/wake-up games are great for this– really basic for children who might be a little bit more challenged linguistically or attentionally, where we really get really excited, and then we fall asleep. And then the child kind of cues you in to when it’s time to wake up. And they’re ready to take a little bit more stimulation again. It’s this back-and-forth interplay, this coordination, where arousal states can be really well-managed and coregulated by the interactive partner, or even sometimes by the child, if they thing that level of support.
Physical play– so balloon activities. This is really cheap, really easy. Everybody’s got blow-up balloon leftovers from some birthday party that you didn’t use, right. So you can take a balloon. And your goal, if you’ve got a coordinated enough child, is to use your hands to keep it up. If not, you can use a bed sheet to keep it up.
And it’s a coordinated activity. “Whoa, whoa” You don’t have to even use any language with it. But it helps your child’s visual motor skills. And it also helps that coregulation. You’re working as a team to keep that balloon up, right.
You can play save-the-whatever. If your child is into dinosaurs or if your child is into numbers and they’ve got number pieces of a puzzle, your goal could be to open them from this container together. Let’s figure out how to get that off that shelf. It’s a collaborative opportunity where there’s a lot of social signaling and support going on from a regulatory standpoint.
And then, obviously, like a three-legged race– that’s another really physical play activity where you’re physically bound together. You’re physically coregulated, right. Just another way that you can join in with a child who needs maybe a little bit more heavy work, a little bit more movement involved in their coregulation activities.
Musical games– I think this is maybe the third or fourth time I’ve mentioned TikTok in a talk that I’ve given the summer. So my apologies if you’re not a fan of TikTok. But from an occupational therapy perspective, it’s a great tool because you can do it side by side with your child. It’s all about motor imitation and sequencing and inhibition and grading of movements.
And so there’s a lot of coregulation that happens when that child is trying to match that professional TikToker or when they’re trying to match their mom right next to them. I’ve done it a couple of times. And I kind of regret it. But it’s a really great OT activity.
Finger plays. Obviously, the itsy-bitsy spider. You can do it with finger puppets and have the child call out the name of the finger puppet as they present themselves. But it’s that coordinated, collaborative activity around something that’s really intriguing to the child.
Musical play with instruments, where you go fast and you go slow. Laurie Berkner Band is great for this. I love her. You can tell how old my kids are because she’s kind of an older artist. But a lot of her music is great because there’s that grading, there’s (RHYTHMICALLY) “stomp like a dinosaur.” And then the dinosaurs are sleeping. And then they’re eating. And there’s a lot of imitation also that goes along that’s incorporated with that musical opportunity.
And then semi-structured games can be great, too. So there are a bunch of games out by a company called Peaceable Kingdom that are cooperative games. And so for children who have a harder time losing or sticking to the rules, or who really need some practice in coordinated, thoughtful approaching succeeding with a task with another person, games from Peaceable Kingdom can be helpful– coordinated, cooperative games.
So Hoot Owl Hoot! is all about, we’re going to, together, figure out how to get these owls back to the nest before the sun comes up because they’re nocturnal. And so both partners, you and the child, the therapist and the child, can work together to help save the owls, right.
The floor is lava– that’s apparently a new show on Netflix that has taken over the world. I haven’t got to watch it yet. But my children are a fan. But there’s also a board game called The Floor is Lava. And you can also play it symbolically, where you’ve got to figure out, you’ve got to give cues and coordinate where do we jump to be safe from the lava? It’s hot on the floor.
We played that it’s wet, too, if lava is a little bit too scary. But there’s also a board game that provides a little bit more structure and visual support if your child needs that or is more interested in board games than physical play.
And then Jenga is another one, which is very stressful to me. But you can coordinate and try to time yourself. How long can you keep it up before the whole thing falls down? It might be a little stressful for these days, but it is one that’s used pretty regularly in therapy.
But really, the idea behind this coregulation that’s happening with these coordinated play activities with your child is that that coordination, that co-regulation is your goal. You want your child to really learn, another person can join me in play. And it’s fun. And it feels safe. And it feels organizing. You want them to walk away with that feeling when they’ve engaged in the activity with you.
So number two, the second tip is to provide meaning. The activities you choose– or, even better yet, your child chooses– need to be motivating and fun, right. So even if it’s something that you feel like your child really needs to work on– handwriting or something like that, that’s not the most exciting thing in the world– think about how to mix in your child’s favorite topics.
That’s what OT is really all about. It’s about finding the meaning, right. So what’s going to make this meaningful and fun for my child? Is it if Spiderman is also writing a note to Batman? Or if the markers that I get them are scented or they have some kind of a spinny thing on the top of it? There are ways that you can incorporate things that your child loves in order to support their motivation.
Also, look for opportunities to add symbolic play or humor to the play that you’re doing with your child or the activity you’re doing, right. Sprinkle in some imagination. Do something silly and unexpected. So if the child is trying to complete an obstacle course, like I said, it could be that the floor is lava. It could be that the floor is made out of water, and we have to swim over to where we’re going.
So there are lots of ways that, if your child has the capacity to think symbolically, you can layer that in there. And man, does that drive their motivation and their curiosity. They’re just so excited with the novelty that that presents to them.
And so this is really important, because children and adults, per research, have been shown to persist longer and to generalize skills better when they are meaningfully engaged with their tasks, right. So if it’s an activity that’s motivating to you, you’re going to pay attention for longer and you’re going to generalize it better. So that’s really important if we’re looking at something that’s therapeutic and not just doing it for the sake of doing it.
Yeah, can I just jump in for a sec?
Sure.
You’re getting lots of questions. And I just want to make sure we have time for that. So do you think that we could– will you be able to finish it in like two minutes or so? And then we’ll start with questions.
Yeah. I will try. I will go as fast as I can talk.
OK.
(LAUGHING) Sorry.
[BOTH LAUGH]
Yes.
So number three, this is a really important one. So providing the “just right” challenge. We want to make sure that we’re not trying to do an activity with a child that’s, like I said, way above their level– their skill level. And we don’t want to do it too below their skill level, either. We want to boost the self-esteem of the child.
And this is really especially important with children with special needs, because there are so many things that they come across in the day that they struggle with. Their bodies fail them. Their language fails them sometimes, right.
And so therapy is really therapeutic if it’s going to help that child shift from the self-image of, I’m a loser, I can’t get anything right, I should stop trying– or, even worse, starting to engage in fight/flight reactions– to feeling like it’s too safe– I need help always, I’m vulnerable, I won’t even try.
Because if we don’t have that “just right” challenge and the therapist or the parent isn’t supporting that child at that “just right” level, one of those messages could be what is interpreted instead of, man, I succeeded. I can do this. I can trust my body. I can trust my language. I can feel competent. And if the child experiences that, they can really swap out that negative self-image with a more positive one. That’s a really important goal.
Providing contrast. So this is all about really pairing the strength with the challenge, right. So for example, Tommy is a curious child who has trouble with handwriting, upper body control, upper body strength. But he has really good visual spatial skills, strong interest in magic and detective work.
So for example, for a child like him, we would pair, OK, let’s work on handwriting– let’s work on that upper body strength. But we’re going to embed it into something he’s really motivated and interested in, right.
So he’s going to climb through an obstacle course. Inside that obstacle course, there’s going to be a tube that he’s got to open. And in that tube, there’s a clue. And he’s going to read it. He might have something to unscramble that will give him an opportunity to practice some handwriting. He’s using his visual search skills that are strong for him.
He might be later on a scooter board on his belly. So he’s building that upper body strength while he’s really being motivated by his own imagination and interests, right.
So I won’t go into the second example for lack of time. But you see, you really pair them together so the child is motivated, but they’re also getting some therapy snuck in there.
Process is over product. It’s greater than product, right. The most important thing to ask your child or yourself at the end of a session is, did the child have fun? And did he learn a little something? It doesn’t have to be every box that you wanted them to learn in that session or in that activity, right. We want the activity to be joyful. We want the child to say, Mom, Dad, or therapist, can we do that activity again, or come into your gym and set it up again, and just spontaneously invite you back into the same play activity because it’s so rewarding.
If the product is important– you’re making a birthday card for Dad– think about the “just right” challenge. So if you want it to be a product, don’t have the bar so high that the child can’t meet it. Make sure it’s scaffolded down so that the child, instead of doing the better handwriting stuff, maybe they’re just doing dot art and stickers and writing “D” for dad, if that’s what your child’s skill capacity is, so they’ll be able to be successful. So the final work will be a masterpiece if your child is engaged in some therapy without even knowing it. They’re just having a really good time with you.
OK, so I’m going to stop talking. Thank you for the prompt, Julie. And I think we have about five minutes left for questions.
Questions and Answers
OK, so we’ll jump into it. Thank you, Carrie. That was fantastic. And just so everybody does know, the slides will be available as well. And we can answer any questions through email that we don’t get to right now. So the first one, Carrie, is:
Question: My son has sensory issues and hates wearing a mask. He’s eight. I would love some suggestions.
Answer: So this is a really common concern right now, right. I mean, the good news is that there are options. So some of them are masks. I have seen some that are hats that have the little shield that comes down in front of it. They do have the face shields that are made to be face shields. So there are options.
I don’t know your child well enough to kind of know what his skill set is, what his ability to kind of build up his tolerance to wearing that first, maybe. Maybe when he’s doing something he really enjoys, have him wear his mask for just a little bit and maybe put a visual timer in front of him so that he can see, oh, almost done. Great job. And then you do something really fun to kind of reward him for being so patient.
And play masks, if he has symbolic capacities. Put masks on his bears. Put masks on Superman, Spiderman. Everybody’s wearing masks these days. It becomes a little bit more normalized and
less scary that way, too. So I hope that helps. I don’t know your child well enough to individually tailor it more than that. But I hope that’s helpful.
That makes sense. This second one from Sarah–
Question: What to do when you don’t know what your kid needs? And the context is, we were exploring OT when the pandemic hit. So he hasn’t yet been assessed.
Answer: Ah, OK. Well, I mean, there is teletherapy. And I don’t know what your child’s diagnosis is or anything like that, what his needs are specifically. But teletherapy has been shown to be really productive. I think certain therapists are a little bit more creative. And it’s a little bit more conducive for them to use this media.
When I’m doing my therapy, I’ll retrofit retrospective videotape, because I work with little bitties who will sit in front of a laptop for an hour. So I have Mom take 10 minutes of video of them playing or working around a targeted skill that we need to accomplish together. And then Mom and I join for the session. And we use that 10 minutes of video to kind of reflect back on. And I build her skills from there.
So that might be another option for you. But I think there are a lot of places that are offering teletherapy right now. I don’t know where you live or what your resources are locally. But I know that most insurances and a lot of the state Medicaid and Medicare are continuing to pay for teletherapy during this time. So I would encourage you to seek that support out, even if they’re just giving you some strategies that you might be able to implement at home– make life more livable for everybody. I hope that helps.
That’s great, Carrie. Thank you.
Sure.
OK, so I’m going to squeeze one more in before we say goodbye.
Sure!
This is a question from Berlin.
Question: What are a couple of good sensory activities for a two-year-old?
Answer: Well, it depends on your two-year-old. So what we need to think about is your child’s specific sensory profile. And that’s why when you’re doing a webinar like this, sometimes it’s kind of hard. Because everybody’s child is a little different, right. So it depends.
You, first of all, would watch your child. Be a really good observer. What does he or she enjoy? Two-year-olds are generally pretty driven by movements, by pressure, feeling their bodies in space. So those kinds of activities.
So it depends on what your goals are, as well. Are you hoping for your child to become more socially connected with you, better able to self-regulate, like we were talking about? Because then those coregulative activities can be really great.
And it could be that at two years old, it needs to be really simplified where it’s a lot of imitation, a lot of turn-taking back and forth around the child’s interests. And that should promote the child starting to organize themselves, take in that sensation in a little bit more organized way.
Of course, if your child is over-responsive to sound or vision, you’ve got to think about and modify the way you’re interacting with them. It’s a child who’s really sensitive, you might have just kind of a small window. You may not use as much volume. You may not use as much inflection in your voice. You may not use any sound at all. Sometimes I work with children in that way if they’re that sensitive.
So it really depends on your child’s individual profile. And if you’re not getting support from– in Texas, it’s called “early childhood intervention”– if you’re not getting support from an early interventionist where you live for maybe helping to develop a little bit more skill around this for your child, then I would really suggest that that might be helpful.
There are also some really great books out there– Sensational Kids. The STAR Center in Denver has some really great resources, as well. So I would encourage you to explore online some other places that would give you some good strategies.
Conclusion
Great. OK, and we had a few more questions, but we will get back to everybody through email. And I will be posting on social and probably write some blogs, Carrie, with your advice.
So we just have a quick poll. If everyone could just take a second to fill that out and let us know how this was for you, that’s very helpful for us as we continue to think about how we can give you the information that you need to help you with your child. So thank you so much, Carrie, for joining us.
Oh, pleasure. Thanks for having me.
OK.
Wish you guys well. Have fun.
Thank you. [LAUGHS] Bye.
Bye.
