Nine Key Points for Understanding Your Insurance Coverage

Parenthood is a rewarding journey, but it also comes with its fair share of responsibilities. One
crucial aspect of ensuring your family’s well-being is understanding your insurance coverage.
Here are key points parents should know about their insurance:

1. **Check Your Insurance Plan:**

Start by looking at your insurance plan to see if it covers speech and occupational therapy
for your child. This information is usually in the benefits section of your plan. Contact your
insurance if you have any questions about what is covered and what is not.

2. **Kid-Friendly Therapists:**

Find out if the therapists you’re considering are approved by your insurance. This helps you
save money because in-network therapists often cost less.

3. **Get a Doctor’s Opinion:**

Talk to your child’s doctor and ask them to make a referral. Sometimes insurance needs this
information before they allow for session coverage.

4. **Know the Limits:**

Some insurance plans have rules about how many sessions your child can have or the
length of time a child can attend. Check if there’s a limit so you’re not surprised later.

5. **Ask About Pre Approval:**

Before starting therapy, ask your insurance company if you need pre approval. It’s like
getting a green light before you go.

6. **Money Stuff:**

Check if you need to pay anything upfront, like copayments or deductibles, before insurance
kicks in. Knowing this helps you plan financially.

7. **Fixing Denials:**

If insurance says no to a claim, don’t panic. There’s often a way to fix it. Find out how to
appeal so your child can keep getting the help they need.

8. **School Services:**

Check with your child’s school. Sometimes they offer therapy too. It might be a good option
and could have different insurance rules.

9. **Keep Talking:**

Communication is key. Talk to your insurance, the therapists, and your child’s doctor.
Everyone working together helps make sure your child gets the best care.

Understanding insurance coverage for speech and occupational therapy might seem tricky at
first, but taking these steps can make it easier for you and your child to navigate. It’s all about
making sure your little one gets the support they need to shine!

By Shauna Oakes, Administrative Director

Valentine’s Day Activities for Speech and OT

As Valentine’s Day approaches, we’re excited to share some heartwarming and therapeutic activities that not only celebrate the season of love but also contribute to the growth and development of our clients. Join us on this journey of combining affection with effective therapy!

Speech and Language Therapy

Valentine’s Day provides a unique opportunity to explore the language of love. Speech and language therapy can be both educational and enjoyable as we engage our clients in activities that focus on expressing emotions, social interactions, and building meaningful connections through communication.

Activity Ideas:

  • Love Letter Writing: Encourage clients to express their feelings by writing or dictating love letters. This activity enhances language skills and emotional expression. 
  • Conversation Hearts Challenge: Use conversation hearts candy with words or phrases related to communication goals. Clients can create sentences or engage in conversations using these sweet treats.

OT- Sensory

Occupational therapy often involves sensory activities that stimulate and enhance sensory processing. This Valentine’s Day, let’s explore sensory-rich experiences that promote engagement and development.

Activity Ideas:

  • Scented Sensory Bins: Create sensory bins with Valentine-themed scents like roses, chocolate, or strawberries. Clients can explore different textures and engage their senses.
  • Heart-shaped Stress Balls: Make heart-shaped stress balls filled with different textures to provide tactile stimulation. This activity is great for hand strength and stress relief.

OT- Fine Motor Fun

Fine motor skills are crucial for daily activities, and what better way to practice than with Valentine-themed fine motor activities?

Activity Ideas:

  • Valentine’s Day Crafts: Engage clients in crafting activities like making heart-shaped cards, cutting out paper hearts, or creating tactile crafts. This enhances fine motor coordination.
  • Cupid’s Arrow Game: Use a bow and arrow game to target various objects. This activity improves hand-eye coordination and fine motor precision.

Valentine’s Day is not just about chocolates and flowers; it’s about fostering growth, connection, and joy through therapeutic activities. We invite you to join us in celebrating the language of love and the development of essential skills that make every day special for our clients. Happy Valentine’s Day!

By Amy Rawlings, MA, CCC-SLP

Holiday Gift Guide & Events

Tis the season for decking the halls and all the fa-la-las! With the holidays right around the corner, parents may be seeking gift suggestions to work on progressing therapy goals and bringing the fun of occupational and speech-language therapy to your home. While this gift guide may help to give your children presents that can help them practice their speech and occupational skills in a fun and unique way – the best gift for your children is quality time together. Ditch the toys with batteries, flashing lights, and loud noises and opt for something that encourages creativity and play!

Sensory Toys

Squish, build, mold, and play! Sensory toys are particularly enjoyable for children with autism due to their sensory processing needs. Sensorimotor toys can help alleviate these needs by stimulating or calming the senses and can facilitate communication and occupational success. In occupational therapy, you can expect to find toys and games that support development such as motor planning, coordination, balance, fine and gross-motor skills, and problem solving. Some of our occupational therapists’ favorite OT toys include:

Movement-Based Activities

Toys and activities that get us up and moving are great for facilitating language development and are especially wonderful for our friends with sensory needs! These toys can also be very useful for improving fine and gross-motor skills. We recommend small trampolines, swings, building blocks, and train sets to get our kiddos moving during at-home play. 

Pretend Play

Open-ended toys (more than one way to play with the toy) allow your child to build their imagination and creativity while targeting therapy goals. When you follow your child’s lead they will be more motivated to interact because it feeds into their unique interests and abilities.

Animal Toys

Some of the most engaging toys are centered around our furry friends. Animal toys and games are a fun and versatile way to target nearly therapy goals and help foster language development. Engage your child by making early developing sounds (moo, baa, woof, ink, grr), practice new words through play (dinosaur…hungry dinosaur…dinosaur eats), work on following directions (bunny is jumping, kitty is running), and modeling new phrases (cow says moo). This low pressure activity is functional and gives them endless possibilities for fun.

Sensory-Friendly SmallTalk Holiday Events

What: Sensory Santa East County

Where: SmallTalk Speech & Occupational Therapy, 260 E Chase Ave Ste 204 El Cajon, CA

When: Sat Dec 02 2023 at 9:00am to 1:00pm

What: Sensory Santa North County

Where: SmallTalk Speech & Occupational Therapy, 12030 Scripps Summit Dr, Suite A

San Diego, CA 92131

When: Sat Dec 09 2023 at 9:00am to 1:00pm

By Madison Trussell, M.S., CCC-SLP

How Should My Child Swing? Intensity of Vestibular Input    

Swinging, or any kind of movement, provides input to the vestibular system. There are a variety of types of vestibular input, as well as the impact that it has on a person. This can vary depending on how their sensory systems process the information. Our vestibular system gives us information about movement and where our head is in relation to gravity. The vestibular system provides us with information about the speed and direction of our movement. This system provides the foundation for our balance reactions and has a strong connection to our postural control. There is also a connection between the vestibular system and a child’s ability to self-regulate. Depending on the type of vestibular input received, the effect on a child’s brain can be calming, organizing, or altering. The more intense the type of vestibular input, the more alerting the input will be for the child. 

Depending on the child’s threshold for vestibular input, they may require a more intense type of vestibular input in order to register the input. For a child that is under-responsive to vestibular input, that child may need more intense vestibular input such as spinning or swinging in an orbital motion. Some children may also benefit from having their head inverted or being upside down for an increased registration of the vestibular input. For children who are over-responsive to vestibular input, starting with lower levels of input such as up and down (vertical) or front to back (linear) can help increase their tolerance of vestibular input.

Levels of Vestibular Input in Order of Increasing Intensity

1. Up and Down Movement

2. Front to Back Movement

3. Side to Side Movement

4. Diagonal Movement

5. Arc Movement

6. Spinning

7. Inversion (upside down)

High Level of Arousal Protocol: 

  • For children with high levels of arousal the goal of swinging is to provide the sensory system with calming input. 
  • Children with high levels of arousal often respond best to slow, predictable, and rhythmic movement. 
  • Giving your child the ability to self direct their vestibular input may be beneficial in bringing them to the optimal level of arousal.
  • Rhythmic front to back or side-to-side movement can provide calming input to the child.

Low Level of Arousal Protocol: 

  • For children with low levels of arousal the goal of swinging vestibular input is to alert the sensory system. 
  • Children with low levels of arousal often respond to vestibular input that is unpredictable, fast, and angular. 
  • Some children may respond best to input that is received in side lying, rather than in upright. 
  • Spinning can provide alerting input to the child to bring them to optimal level of arousal. 

By Erin Christensen, OTD, OTR/L

Tips for Stuttering and the Holidays

For many people, October-December is the most wonderful time of the year filled with good food and company. But for others, this time of the year can be busy and stressful, overfilling our internal buckets. This bucket analogy is frequently used by stuttering specialist, Dr. J. Scott Yaruss, and illustrates the idea that many factors can affect stuttering, including child factors (genetics, temperament), interpersonal stressors (life changes, fast-paced lifestyle), and communicative stressors (competition for talking time, frequent interruptions). We like to encourage families to try to lower the level of the bucket, since we all communicate best under the least amount of stress and pressure.


Here are some practical ways to try to pour out some of the bucket’s contents when it gets filled
with the uncontrollable holiday bustle:

1. Include some space and time for quiet as a family

When our homes are filled with family and friends, especially those we haven’t seen in a while, conversations can be found at every corner. This can take a toll on those who stutter who might not enjoy, and may even anxiously anticipate, constantly conversing. Before a big gathering…

  • Do: Enjoy leisure activities together that don’t require as much talking like coloring, reading, puzzles, legos, play-doh, etc.
  • Try to avoid: Activities that encourage pressure, speed, and are verbally taxing such as competitive board games.

2. Keep the joy, lower the excitement

Children may have a more difficult time speaking when worked up in either a positive or negative way. Still speak about the great time that will be had during the holidays, but try to limit ramping up emotions and building a lot of anticipation.

  • Do: Speak positively “I love getting to try so many different kinds of candy on Halloween.”
  • Try to avoid: Speaking to heighten emotions “Aren’t you excited to show off your new costume?!”

3. Practice stressful areas

You know your child best, and when and where they communicate their best. You know if your child is a perfectionist, and can anticipate that when other children come over, win games and take toys, yours may be very thrown off. Or, you may know your child to be on the shyer side making trick-or-treating a difficult activity. Practicing these scenarios with people that are familiar to the child and in a controlled environment can help transfer readiness and emotional preparedness for the more spontaneous encounters.

  • Do: Talk about emotions! Encourage losing and still having fun. Talk about how nice it feels when your child shares a toy with you. Practice knocking on bedroom doors and saying “trick or treat!”. Have your child switch roles with you in each scenario to be the winner/loser, sharer/taker, etc.
  • Try to avoid: Rewarding only winning and reacting negatively when things don’t go perfectly.

4. Encourage and advocate

Our children may be meeting visiting guests for the first time, who may bring up that they stutter. This is a great opportunity to advocate for your child and to address the situation head on. Speaking openly and positively about stuttering helps children feel empowered to be themselves, and reduces the chance of children developing avoidance behaviors.

  • Do: Learn about stuttering with your child (myths/facts, famous people who stutter, etc.) to build their confidence and eliminate negative associated feelings about stuttering. Acknowledge the stutter, acknowledge that he/she/they is/are trying to find strategies to speak smoother through therapy, talk about your child’s strengths.
  • Try to avoid: Avoiding the conversation of stuttering and using vocabulary that portrays it as negative such as “fixing” or “correcting” it.

Feel free to reach out to your Speech-Language Pathologist for additional suggestions relevant to your child and their plan of care. For more stuttering related-resources, check out stutteringtherapyresources.com.

By Mariel Manuel, MS, CCC-SLP

The Power of Play

How to Use Play to Help Children Learn and Grow

To the untrained eye, it may look like a speech therapist is just playing with your child.  You might wonder when the actual learning is going to start with worksheets, flashcards or drills.  But the reality is that children tend to learn more from play than through structured, adult directed activities.

Play can help to increase:

  • social-emotional skills
  • cognitive skills
  • self-regulation
  • language skills

It can promote:

  • problem solving
  • collaboration
  • creativity

The mutual joy and shared connection during play can decrease stress and increase the bond between the people involved. 

When I meet a child during their first speech session with me, it is my job to get to know that child, build rapport, and figure out the best way to help them meet their speech goals.  If I were to make them sit at a table while I proceeded to lecture them and drill them for 25 minutes, some older children might do okay, but most younger children would probably either protest or not pay attention to me because I am not creating any active engagement.  My top priority during my first few sessions with a child is to create trust and connection.  Without that, it is difficult to teach anything.  I do this by finding an activity that brings them joy:  bubbles, tickles, cause/effect toys, pretend play, board games, etc..  Depending on the child’s age and abilities, there are certain activities I know that child will probably enjoy based on my experience.  I start with those, and if they do not work, I try alternatives until I find something that creates joy and engagement.  It is only then that I begin to integrate the child’s speech goals into the play to facilitate learning and growth.  Let’s talk about the different types of play and how you can use them with your child at home to help expand their language skills. 

Types of Play:

1. Physical/Rough and Tumble Play 

Playing on the playground, tickle or wrestling games, pillow fights, lifting kids in the air, hanging them upside-down, using movement or dancing with music, etc.

I personally find this type of play especially effective with children who are difficult to engage (prefer to play alone doing their own thing) or who are sensory seekers (love climbing, jumping off things, crashing into pillows, etc.).   I only do this with children who enjoy this type of play and pay attention to their body language that indicates whether they are giving me permission to tickle them or hang them upside-down.  If a child is turning away or backing away in a non-playful manner, I stop, making sure to respect their boundaries to keep that aspect of trust.  And of course, I always play these games as safely as possible.   

Examples of using this type of play to facilitate language:

  • Hold your hands out like you are about to tickle the child and wait for them to communicate they want you to proceed either through a gesture such as moving closer to you or a word or phrase such as “tickle” or “get me”.
  • Incorporating music- singing a song where there is a part that you tickle them, squeeze them, hang them upside-down, etc.  One I use while bouncing the child on my knees is “horsy, horsy, go to town.  Better watch out or your horse will fall…… DOWN” then hang the child upside-down.  You can wait for the child to say, “down” or gesture they want you to hang them upside down by leaning back. 
  • On the playground while pushing a child in a swing, you can hold the swing/child up so they are about to swing forward or backward (make sure the child is secure) and say, “ready…set…” and see if they can say “go” (or sign or gesture) to indicate they want you to let go.

2. Using Cause/Effect Toys

These toys are simple in that when you push a button, wind them up, etc. they do something fun.  Some examples are wind-up toys, spinning tops, ball poppers, car ramps, bubbles, etc.  These toys are great to capture a child’s attention and increase engagement.  These kinds of toys work better to create engagement when the child needs you to help them operate it.  For example, if they can’t wind up the wind-up toys on their own or they don’t know how to blow the bubbles.  In this case, they will need to communicate with you every time they want you to activate the toy. 

Examples of using this type of play to facilitate speech and language:

  • Using “ready set….” and waiting for the child to say “go” for you to activate the toy, blow the bubbles, etc.  If the child is not saying “go” you can model sign language or model a gesture, then wait for them to use it to communicate they want you to activate the toy.
  • Model describing or action words:  while popping bubbles say, “pop…pop” every time you pop a bubble.  While the top is spinning say, “spin!”.  Always use lots of excitement in your voice to increase attention and engagement.

3. Pretend Play

Pretend play can be done with toys such as people, animal figures/dolls, or vehicles becoming the “characters” in play or the child or adult themselves can be a character such as when playing dress up, playing school, restaurant, etc.  Pretend play creates a safe container for children to explore different situations and emotions and is a great way to learn language.  The first pretend play skills to develop in toddlers usually involve pretending to feed a doll or stuffed animal, or pretending to put them to sleep, or alternatively for the child to pretend to eat pretend food or pretend to sleep.  They might also push a car or fly a plane while making sound effects.  As they gain more vocabulary, they can make the characters talk and have conversations with each other and act out different situations. 

 Examples of using this type of play to facilitate speech and language:

  • As a parent, while engaging in pretend play with your child, it is common to feel the need to ask your child a lot of questions.  For example, “where are they going”, “what are they doing?”, “what color is that?”, etc.  However, questions like this take the child out of the fun and magic they are creating with their pretend world into an interaction where their parent is quizzing or drilling them instead.  It is much more beneficial for the child to have the parent join them in this pretend world by grabbing a toy and also pretending to be a character and interacting with that child’s character.  Modeling language while engaging in pretend play is a great way to teach your child.  For example, if you want to teach your child what to do when you go to someone’s house, you could do this using dolls and a doll house.  Your character could knock on the door, and another character inside the house could say, “who is it?”, and the one outside could say, “it’s Billy”, and then your character inside could open the door and say, “hi!  Come in!”.  Even if your child is not talking yet, you can have your characters talk to their characters to model appropriate language for the situation. 
  • Children also LOVE to experiment with emotions within pretend play.  It almost never fails that when I make my character fall down and cry, the child smiles and indicates they want me to do it again.  Not because they like seeing people cry, but because I am showing them a safe way to play with difficult emotions such as sadness and anger.  In real life, when a child is feeling those emotions, they are in a state of distress which shuts down the logical brain and makes learning pretty much impossible.  By pretending to have characters outside of themselves feeling these emotions, they can play with the cause and effects of emotions, and as a parent you can model ways to deal with them.  For example, when my character falls down and starts crying, I can have another character walk up to them and say, “are you okay?”, and pretend to help them or give them a hug.  This helps with emotional regulation and using appropriate language for emotionally charged real life situations.  These are just a couple examples of the things you can teach children through modeling within pretend play.  The possibilities are as endless as your imagination! 

4. Board Games/Structured Games

These are games that have a set of rules.  It can be a physical game like a sport, or tag, or a board game that comes with a set of written instructions (note:  you do not always have to play with a game according to the given instructions.  You can always tailor these rules to accommodate your child’s abilities and things you want to teach them). 

Examples of using this type of play to facilitate speech and language:

  •  If you want to teach your child cooperation, collaboration, and negotiation skills, you can come up with the rules of the game together.  You can work on skills that these games address directly- such as working on describing skills with games like Guess Who or Headbands in which you must describe a person or noun so the other person can guess who or what you are describing.  Or you can have the child practice a skill before they take a turn in the game (i.e., before you roll the dice, make a sentence about this picture or tell me the opposite of up). 
  • The type of play you choose to engage in with your child should depend on their age and interests.  Watch your child when they play by themselves and see what they tend to gravitate towards and see if you can join them in a playful and fun way to help them learn and grow.

Side Note About Media and Electronic Toys:

Some TV shows, YouTube videos, and electronic toys market themselves as educational and lead parents to believe that if you put your child in front of the TV or hand them the toy and go do your own thing, they will learn something.  But the reality is that no television show or fancy toy is a substitute for engagement with a real live person.  Children learn best with adults who are present and give their full attention.  Speech and Language skills are particularly all about communication, human interaction, and connection, which is best achieved through your presence. 

Playing with your child will not only help them to learn and grow but will also increase your connection to your child and increase joy and decrease stress for both of you.  So, find your inner child and have some fun together!!!

By Hilary Dickey, MS, CCC-SLP

What in the World is Childhood Apraxia of Speech?

What is CAS?

Childhood Apraxia of Speech, or CAS for short, is a speech disorder that results in children being unable to form the words they intend to, even though they know what they want to say.  It is associated with very low intelligibility and is arguably one of the most frustrating speech challenges kiddos and their parents face.  CAS is also sometimes also called Developmental Apraxia, but unlike this name suggests, children do not often improve spontaneously; skilled speech therapy is required to treat it.

Origins of CAS

CAS is estimated to occur in only 1 or 2 of every 1,000 children in America.  Unlike acquired apraxia, which is most often seen in adults who have had strokes or traumatic brain injury, the cause of CAS is unknown.  Rarely are there any observable differences in the brain, though CAS can sometimes occur as a symptom of a syndrome, genetic disorder, or metabolic condition (e.g., galactosemia).  CAS is known to exist at higher rates in children who have other neurodevelopmental conditions such as ADHD, Autism, and epilepsy.

Mechanics of CAS

The act of speech is a series of incredibly precise fine motor skills that requires very refined movement of the lips, tongue, and jaw.  If the neurological planning of these movements is disrupted, as in the case of CAS, low intelligibility results.  Recent research indicates that children with CAS may have difficulties with sensory feedback loops required to learn and judge the accuracy of speech. Sensory feedback is important for the subliminal knowledge of proximity between speech structures (e.g., lips, tongue, teeth, palate) during speech, which plays a role in execution of movement.

What CAS is Not

CAS does not involve physical issues with the mouth, such as muscle weakness or muscle coordination difficulties. It also does not involve the brain itself, but rather nerve pathways responsible for planning speech movements.  

CAS vs Phonological Disorder

Many times, parents of children who exhibit very low intelligibility research causes online and conclude that Childhood Apraxia of Speech is to blame for their child’s unintelligible speech.  However, children with severe phonological disorders can be just as unintelligible, or even more so, than children with CAS.  Your speech-language pathologist will need to analyze your child’s speech to discern whether distinct error patterns (e.g., deleting or substituting certain sounds in various word positions) are present, as in a phonological disorder, or whether the errors are inconsistent or random, as in CAS.  CAS and phonological disorders can also coexist.

Errors related to CAS often change as a word is repeated, and these errors cannot be grouped into categories, unlike phonological errors.  Other characteristics of CAS which distinguish it from a severe phonological disorder include errors on vowels, prosodic errors (relating to stress and intonation), increased errors as utterance length increases, and increased errors in spontaneous speech over rehearsed speech.  When your child’s speech is evaluated, your speech-language pathologist will provide an appropriate diagnosis in order to follow with appropriate treatment methods.

By Kathleen Winger MS CCC-SLP

Gestalt Language Processing

Let’s unpack some buzz words that you may have been hearing lately:

“Echolalia” is the repetition of language spoken by others. It can be repeated either immediately or after some delay. With echolalia, language is stored as a “chunk”, or a whole unit.

“Scripting” is another term that refers to echolalia. “To infinity…and beyond!” is an example of a script from media. “See you later alligator” is an example of a script that may be heard in conversation. When children are “scripting”, they may be observed reciting dialogue from a TV show, singing lyrics from a YouTube song, or copying phrases they’ve heard other people use. The message is often identical to the source where they heard it, and has the same melody.

“GLP” stands for Gestalt Language Processing. This is a form of language development where children learn the meaning of language in chunks first, then over time learn to break the chunks down and formulate their own original language.

Let’s bust some myths:

Are most autistic children GLPs? YES!

Does being a GLP automatically mean a child is on the Autism Spectrum? NO! Some neurotypical children learn language via chunks as well. 

Unsure if your child may be a “GLP”? Here are some common signs:

1. They echo back what you say or the last part of phrases you say, without appearing to process the language.

2. They have difficulty answering questions in conversation.

3. They like to hum or sing songs rhythmically. 

4. They have a preference for intonation-rich sound input, such as music or videos.

5. They replay certain portions of video clips over and over.

6. They like to repeat play scenes in the same way over and over.

7. They like to play with the WHOLE set – if a figurine is missing, they are not pleased. They are seeing the world in a “gestalt” way.

8. They like to label objects they see around them and can recite their ABCs or count 1-2-3, though have trouble using their language to ask for help or communicate other important functions. 

I think my child is a GLP… Now what?

1. Find a Speech-Language Pathologist near you that has been trained in Gestalt Language Processing. They can help determine which stage of the Natural Language Acquisition framework your child is in and give tailored advice on how to support your child’s language development at home. 

2. Follow social media accounts such as @meaningfulspeech and @bohospeechie, which provide brief, useful posts related to GLP.

3. Take a look at free resources on the website www.meaningfulspeech.com. If you have extra time, consider taking Meaningful Speech’s parent friendly course. 

4. Check out Marge Blanc’s book, “Natural Language Acquisition on the Autism Spectrum. The Journey from Echolalia to Self-Generated Language.”

Things to Keep in Mind:

  • Echolalia is not just a “stimming behavior” that should be ignored, decreased or extinguished… Echolalia communicates. 
  • We should acknowledge children’s scripts by nodding our heads or repeating back what they say, even if we are unsure what they mean.
  • Speech therapists are here to help! 

By Julia Navarra MA CCC-SLP

The Top 10 Tools and Activities Used by Occupational Therapists

April is Occupational Therapy Month. This month is designated to celebrate the field of occupational therapy and what occupational therapists do to support their clients and families in living life to their fullest potential. In a pediatric setting, this includes supporting children with their participation in age appropriate activities of daily living (ADLs), play activities, feeding activities, educational activities, as well as any activity that is meaningful to the child and their family. Occupational therapists use a variety of techniques and activities to support their clients in building a variety of skills. In honor of occupational therapy month, here are the top 10 tools and activities therapists use during pediatric occupational therapy sessions. 

10 of Our Therapists Favorite Tools and Activities

1. Swings – Swings can be used in a variety of ways. Swings provide vestibular input which is sensory input that tells the brain and body how they are moving in relation to the environment.  Vestibular input can be calming or alerting to the child’s body depending on how the therapist directs the swing movement. Swings can also be used in a variety of ways other than for swinging movement. A swing can be a balance beam, or a surfboard, or a log. Using swings in a variety of imaginative ways can target lots of different skills. 

2. Climbing Items- Climbing uses a child’s muscles in ways that can help regulate their sensory systems and support their self regulation abilities. Climbing also supports a child’s gross motor skill development and helps them learn more about where their body is and improve their body awareness.

3. Arts and Crafts Materials- Paper, pipe cleaners, tissue paper, beads, you name it, we have probably used it in our sessions at some point. Whether it’s ripping, cutting, gluing, or stringing there are a variety of skills that can be developed through craft activities. While fine motor control and visual motor skills can be developed through the use of arts and crafts we can also work on executive functioning, motor planning, and attention skills through crafts that have multiple steps or parts. Arts and crafts can also be tailored to a child’s interest, getting the child excited about working on a lot of skills at once.

4. Putty/Playdoh- Playdoh and putty can be used for a wide variety of things. Therapists use these activities to build hand strength, work on tactile differentiation (the kids have to find items in the putty-feel the differences between the putty and the item), using both hands together, spatial awareness (the play doh has to be rolled big enough to fit the cookie cutter), and many other skills. 

5. Crash pads/Bean Bags- Kids can have the opportunity to crash or get under crash pads or get squeezed by bean bags. This can support a child’s sensory processing skills and therefore allow them to have greater self-regulation abilities. 

6. Games – Not only do games help therapists teach social skills through sharing and turn taking but they can often be paired with gross motor activities to support kids sensory processing skills and abilities while also incorporating a variety of skills that can be targeted depending on the game. Using games also allows the child some choice in the session activities and creates greater buy-in. 

7. Dressing tools/items- One of the things that OTs work on with children is their ability to dress themselves and tolerate a variety of clothing textures. Using button boards, zipper boards, as well as, socks, shoes, shirts, and pants are important tools to support building those skills. 

8. Crayons, Markers, and Pencils- One of the most common things people think occupational therapists work on is handwriting. While it is just one of many things that we address. Using crayons, markers, and pencils are important to help a child build an appropriate grasp. Using small markers, broken crayons, or writing on a vertical surface all help facilitate an appropriate grasp. 

9. Weighted Items- Using weighted items can support a child’s sensory processing and increase their attention, engagement, and regulation. Weighted vests and ankle weights can be worn during a variety of activities to provide the child with additional sensory input and therefore increase regulation. Therapists also use weighted blankets, lap pads or stuffed animals to help a child calm their body and attend to a task for a greater period of time. 

10. Balls- Balls of all shapes and sizes are wonderful tools to use in occupational therapy sessions. Balls can be used at chairs to allow the child to wiggle a little extra while sitting at the table. They can be used under a child’s belly to build their core, shoulder and hand muscles while they support themselves. A therapist can use throwing and catching a ball as a way to build the child’s hand eye coordination, as well as, their upper limb coordination. Balls can also be used to apply pressure to a child’s body through rolling over their back, legs or arms, to support increased sensory regulation. 

Bonus Number 11: Messy Play Activities- Messy play activities, such as shaving cream, water, slime, finger painting, etc., can be a great way for children to decrease their tactile sensitivities (or their resistance to having dirty hands) through exposure in a fun way. Messy play can also work on a child’s sensory processing abilities that support feeding skills. Therapists will sometimes use messy play for development of visual motor skills as well, drawing in shaving cream or paint can help a child learn the way to make letters and shapes without the added skill of needing to hold a pencil. 

Occupational therapists use a variety of activities in conventional and sometimes very creative ways to support the skill development of the kids they treat. The most important part of all the activities used by pediatric occupational therapists is to ensure that they are fun and that the kids are motivated by them. Sometimes that requires some really impressive imagination! Skill development through play is the goal of pediatric occupational therapists at SmallTalk. 

By Erin Christensen, OTR/L

Touchy, Feely

It’s the season of love! Everyone shows their love in different ways such as a hug or a kiss. However as Valentine’s Day rolls around the corner, it’s important to remember not everyone will be struck by cupid’s arrow. Some children have difficulty tolerating sensations such as touch that we often associate with this month of love. This aversion to touch sensations is called tactile defensiveness and may present in a child in a variety of ways. 

Our tactile system helps us learn more about the world around us and also serves as a protective system to alert us when touch sensations are dangerous. Children who have tactile defensiveness have trouble processing touch sensations which can lead to an over reaction of their nervous system. They may find everyday touch to be uncomfortable or lead to a fight or flight response (Chu, 1999). 

Ways tactile defensiveness may present in a child: 

  • Avoidance of certain clothing textures
  • Avoidance of having messy hands or engaging in messy play (shaving cream, fingerpaints, sand, etc)
  • Avoidance of being close to other people or children: May not like to stand in lines or be in crowded spaces
  • Avoidance of being picked up, hugged, or cuddled
  • Avoidance of activities of daily living (showering/bathing, finger nail cutting, teeth brushing, hair brushing, diaper changing, washing face)
  • Rub or scratch skin after being touched

If you have noticed your child has difficulty with any of the following, you are not alone and can rely on your occupational therapist to provide customized recommendations to best suit your child’s needs. Below are a list of general recommendations you can use to help your child better process tactile sensations.

Strategies to help your child with tactile defensiveness:

Provide deep pressure:

  • Give your child tight bear hugs or place hands firmly on shoulders or head
  • Ask permission or alert your child before providing these hugs or tactile input

Change environment:

  • Provide enough space for your child when in a crowded area
  • Give them a designated space for sitting with a bunch of children
  • Organize the waiting line to have your child stand first or last or shorten the amount of time they need to be in line
  • Prepare a calming area of your house to allow your child to have time to process sensory meltdowns

Adapt their wardrobe:

  • Find fabrics your child can tolerate such as soft cottons or athletic fabrics
  • Buy tagless clothing
  • Wash new clothing before wearing it to decrease stiffness of fabrics

Participate in heavy work activities that are calming and organizing to the body:

  • Encourage child to carry groceries, participate in chores such as vacuuming or moving laundry baskets
  • Play push/pull activities or jumping games
  • Walk like an animal

We all express our love in different ways, so it is important to be mindful of the cues children provide us. Children learn best through play. As parents, you can create routines to allow opportunities for children to participate in these activities and encourage small steps. Move at your child’s pace and applaud them for small successes they make towards tolerating touch. 

By Katherine Danella, OTD, OTR/L

Reference:

Chu, S. (1999). Tactile defensiveness: Information for parents and professionals. Dyspraxia foundation.

https://dyspraxiafoundation.org.uk/wp-content/uploads/2013/10/Tactile_Defensiveness.pdf

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