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Chaining and Shaping Behaviour – Mastering and Motivating the Child to Learn the Steps

What do the terms mean?

Any skill can be thought of as a chain of small steps. These small steps are identified by completing a Task Analysis. Each step, or link in the chain, serves as a cue to do the next step. By building one step onto another learned step in the sequence, a strong chain can be created. This is called CHAINING. There are two kinds of chaining, forwards and backwards, and you’ll learn more about these later.

Here’s an example: Simithy doesn’t like to wait for you to serve the other children and then spoon-feed her. She often cries and throws her bowl. You decide that it would be helpful to teach her to use a spoon to feed herself. A task analysis is completed and five steps in the spoon-feeding chain are identified.

  1. pick up the spoon
  2. put spoon into the food in the bowl
  3. Scoop food onto the spoon
  4. lift spoonful of food from the bowl
  5. put the food into the mouth.

As Simithy begins to learn the steps, each one prompts the next one. When she has the spoon in her hand it helps her to know that the next step is to put it in the bowl. The spoon in the bowl prompts her to scoop the food. The food on the spoon prompts her to lift the food, and holding a spoonful of food prompts her to put it in her mouth. Of course the big pay off is the spoonful of her favourite food.

The actual steps in the task are taught through SHAPING. This is where the child is rewarded for approximating or getting close to the steps that we want to see in the end. Like playing “Hot and Cold”, you reward any movement that takes the child closer to the prize—doing the step correctly. If the prize is under the couch and the player is moving toward the couch, every time the player takes a step toward the couch, you are yelling “hotter” (reinforcing the behaviour). If the player moves away from the couch, you would say “colder” (not reinforcing). In shaping a skill, the child is rewarded when part of the skill is done well. Initially, if Simithy touches the spoon you might reward her with praise. Gradually, that will not be good enough to receive praise, and praise will only be given when the step of picking up the spoon is done a little bit better. The rule for giving reinforcement, changes as you expect more independence and greater accuracy.

As mentioned earlier, there are two kinds of chaining – forwards and backwards. The difference between the two is the point at which you begin teaching the steps in the chain. With forwards chaining, you would start by teaching Simithy to pick up the spoon. With backwards chaining, you would begin by teaching her to put the food in her mouth. Both are perfectly good approaches in this case.

How do you decide whether to use forwards or backwards chaining?

It is best to teach the sequence of steps from the beginning to the end (forwards chaining) when:

  • The child understands the final end product. (e.g., Simithy understands that she will end up with a spoonful of food in her mouth.)
  • The child is somewhat motivated to learn the new skill (e.g., She really wants the food, and now!)
  • The child displays little resistance to following instruction and can tolerate possibly being prompted through several steps of the task analysis.

In some cases, it is best to use backwards chaining (e.g., teach the child the last step first, then the second last step, etc.) You might choose to use this when:

  • The child does not understand the final end product (e.g., a mouthful of food) and needs to be quickly taken to the end result.
  • Motivation to learn the new skill is initially low and the child needs to very quickly receive an effective reward for cooperation and completion of the step. This will help to draw an association with the end product. Over time, as the child is required to complete more steps, she learns to tolerate delays in being rewarded.
  • The child shows resistance to instruction, prompting, etc. and needs the instruction sessions to be very short, initially, so that she can experience a quick reward for her efforts. This will reduce future resistance, as the child understands that rewards are coming soon.

What does it look like when you teach, using chaining and shaping?

Simithy is motivated to learn this new skill, understands what a spoonful of food in her mouth feels like, and is cooperative while being instructed. Forward chaining might work well in this case.

You will want to teach either the:

  • Whole Task – Prompting and rewarding Simithy throughout most or all five steps in the task analysis, or
  • Partial Task – Prompting and rewarding only a single step until it is mastered and doing the rest yourself. You will start by modeling and prompting Simithy to pick up the spoon and then complete the final four steps yourself . Using the shaping technique, you will reinforce increasingly-closer approximations until she is able to pick up the spoon independently. Once she can do this on her own without reward, you’ll move on and have her put the spoon in the bowl. Only reward her for approximating this new step in the chain. Over time, she will have to do more and more steps to get rewarded. Finally, the reward (praise, etc.) is only given when the whole new skill is completed as independently as Simithy’s abilities allow.

Gradually reduce the amount of assistance needed in each step until it is learned. As each small step is mastered, stop rewarding it and only reward the new steps that still need some work. Over time, the amount of assistance needed on each step will be reduced. Eventually the reward will come only when the whole skill has been completed independently.

Tips to Ensure Success

Minimize frustration, mistakes, and the need for correction:

  • Don’t go through the steps too quickly or the child will start to make a lot of mistakes and might get frustrated.
  • Gradually reduce the amount of prompting and assistance needed to master the step. Always use the LEAST amount of assistance needed so the child does not become dependent on your prompts.

Maximize acceptance of instruction, motivation, and accuracy in performing the steps:

  • Give instruction clearly, and simply using visual supports where necessary.
  • Model the steps.
  • Find the right rewards for the child.
  • Gradually reduce and delay the rewards given for completing the steps.
  • Provide some encouragement when learning the newest steps. Remember the biggest reward occurs at the end, once the child has demonstrated the learned steps independently.

A Quick Note on Generalization

Children need to know that a new skill can be applied in many places, with many people, and under many conditions. For some children, learning to feed themselves at the child care centre does not necessarily mean that they are going to demonstrate this skill at home (with spoons other than those used during instruction, or with anyone other than the care provider who taught them).

To promote the use of new skills in as many ways as possible, a few tips include:

  • Use similar but different items to teach the same skills (e.g., several different types of spoons and bowls).
  • Have other caregivers teach the same skills BUT be certain that there is communication as to what strategies are being used to teach the skill, and what steps have been mastered, and what steps are being taught.
  • Teach the skill in several different locations around the childcare centre and at home.
  • Teach the skill during different times of the day, where appropriate.

With a little practice, you will find that chaining and shaping are quite easy and useful techniques for teaching all children new skills.

Calming Strategies to Use with Children

photo of angry girl

Learning to regulate our emotional responses, especially during times of stress, can be difficult. Most children have some natural ways of self-regulating, but may also need to learn appropriate ways to respond when experiencing anxiety. Calming strategies can help a child to work through strong emotions. When calming strategies are practiced regularly throughout the day, the possibility for use at times of anxiety is increased.

Tips on setting up a calming routine

When setting up a calming routine in your home or program, here are the first things you need to consider:

  • Take an inventory of the calming strategies your child is already using and select the ones you want to reinforce. Start with strategies that are familiar to your child and are appropriate for their developmental level. This may help build on their existing resources and increase the likelihood of success. Later, once your child is familiar with practicing the strategies, you can introduce new ones.
  • Choose the best times for your children to practice these activities. Calming strategies are best introduced during the least stressful times.
  • Try to make the activities fun by including props and visuals, such as pillows, squeeze balls, and pictures. For example, Robin is waiting for a turn with his favourite toy truck. He is starting to pace back and forth. His caregiver brings the “stress ball” that is kept in the book/quiet area. Robin takes the ball back to the quiet area and looks at his relaxation book, which shows him how to use the stress ball. His caregiver calls him to play with the truck when his friend is finished and praises him for his efforts.

Calming Activities

When choosing a calming activity, keep in mind your child’s developmental level. For example, a child will need to have good language skills and be able to express themselves in order to use “problem solving and brainstorming.” Here are some examples:

Breathing Exercises:

Breathing exercises can help to remind your child to stop and count out deep breaths at a time of upset. You can also use visuals as a non-verbal reminder, posting them in a quiet area of the room or where the exercise is most likely to be practiced.

  • Blowing Out Birthday Candles – Have your child hold up one hand; their fingers are the “candles”. Count out the five “candles” together. Then blow out each “candle” with a long breath. Curl your finger down slowly while you are blowing.
  • Blowing up Balloons – Pretend to pull a balloon out of your pocket and encourage your child to do the same. Cup your hands together and hold them in front of your mouth. Take a deep breath and as you exhale slowly expand your hands as if inflating a balloon. When you are finished take a deep breath and slowly close your hands back together as you exhale to “deflate the balloon”. Repeat this five times.

Physical Activities:

The following physical activities use the body to bring a sense of calm that can be instantly felt. Tensing and relaxing our muscles is a great way to relieve tension and stress.

  • Sticky Hands – Pretend to have “sticky” hands and then press them together. Now push hard for 20 seconds. You can count it out with your child. Now tell your child to slowly allow their hands to come apart and see if they can feel the stickiness. Repeat this sequence two or three times.
  • Stretching – Have your child do simple stretches such as touching their toes and reaching up to the sky on their tip toes. Have your child lie on their backs and make letters with their bodies. Try “X” (spread out their legs and arms) and “T”, (put their legs together while keeping their arms stretched out). Be creative and add your own! Remember to move slowly from stretch to stretch.
  • Tense and Relax – Have your child form their hands into fists and bring their shoulders to their ears. Count to five with them and then relax. Repeat five times. Try using props such as “squeeze balls” to help exaggerate the motion.
  • Yoga
    There are many books and websites with yoga positions for children. Using visuals and showing by example will help your child get into the various positions. Here are a few examples:

    • The Leaf – Sit with spine straight, soles of feet together, hands on ankles. Gently round spine and then return to sitting straight. Repeat several times.
    • The Flower – Sit with spine straight, soles of feet together, hands on ankles. Gently bounce knees toward floor 10 to 20 times.
    • The Starfish – Lie on back, arms and legs comfortably stretched. Raise one arm at a time toward ceiling and lower. Next, lift one leg at a time toward ceiling. Later, try lifting one arm and the opposite leg at the same time.

Sensory Play:

Sensory play has a calming effect by allowing your child to focus on one sense (often touch) and “block out” others. Make sure to have sensory materials such as play dough, sand, or water available at all times. Other ideas include:

  • Feeling Box – Put together a variety of different materials to touch, such as felt, leather, smooth stone, feather, fur, etc.
  • Listening Centre – Have available calming music with headphones or quiet instruments such as a rain stick.
  • Visual Centre – Provide a dimly-lit area or box and have glow-in-the-dark stickers and toys that light up.

Imaginative or Creative Thinking:

Imaginative or creative thinking can help your child to better understand stressful situations and to practice solutions.

  • Personal Stories – Personal stories describe a social situation and show how to cope with it successfully. They are effective teaching tools because they can be personalized to a particular child or group. For tips on creating personal stories, follow the link “Creating Personal Stories” in the For More Information box below.
  • Story Books – Story books that highlight social situations can be used to promote conversation, understanding of emotions and empathy. It’s a great way for your child to identify with characters in stressful situations and to understand how the story character copes. Stories can be chosen or adapted to fit the needs or developmental level of your child or group.
  • Role Play – Role playing gives children an opportunity to explore a situation, concept or social skill through play and to find different ways to handle stressful situations. The experience can be enhanced by using puppets, dress-up, and toys.
  • Problem Solving/Brain Storming – Talking about problems or concerns in a group of peers can provide opportunities for your child to express ideas ask questions and arrive at possible solutions in a safe environment. The process generally begins by posing a question, problem or topic. The children are then encouraged to contribute to the free flow of ideas. The ideas can then be written down or drawn in a picture. It’s a great way for your child to learn from and to build positive relationships with their peers. The caregiver’s role is to establish a warm and supportive environment for this process and to emphasize the importance of listening.

Positive Self Talk:

Positive self-talk may help to increase your child’s self esteem and, therefore, the ability to deal with anxiety. The following are examples of activities designed for the classroom to help promote positive self talk. These activities can also be adapted for home. You can also follow the link below to the “Kids Have Stress Too!” website in the For More Information box to get more ideas.

  • “I Can” Flower – Start by handing out paper flower petals to each child. In the center of the circle put the core of the flower with the words “I Can” on it. Have each child say something they can do, write it on their petal and then have them add it to the flower. The game is easily adapted for a wide variety of children by having them select from a few photos or by giving a few examples or choices. To expand this game, try using different themes, such as “I can” to help at home, “I can” with my friends.
  • “I Can” Project – Give each child a personal can or box and help identify a goal they would like to achieve. More difficult skills can be broken down into smaller, more easily achievable steps. As a child demonstrates the steps, help acknowledge their achievement by writing it down on a small piece of paper. The child then puts the paper into their can. Start with a skill that is developmentally appropriate and achievable. For example, a child is working on snipping with scissors. At each step of learning the task write down the success, such as “I can cut on the line,” and help them put it into their can. When a child says “I can’t do it” you can use this method to help guide them through the problem.

Tips for Infants and Young Toddlers

For infants and young toddlers, having a soothing and responsive caregiver as well as a calming environment increases the young child’s ability to handle stress and begin to self-regulate emotions. The following may help calm a young child:

  • Motion – Rocking, walking, dancing or using swings can help a child to breathe more regularly.
  • Music – Calm, quiet music, either sung or using a tape or CD can help soothe a child.
  • Changing position – The way that you hold or carry can help calm a very young child. Try changing positions and to see how a child will respond.
  • Reduce Stimulation – Try dimming the lights and reducing the amount of noise in the room.

Benefit and Work Information

According to the World Health Organization, health is a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity. The definition of disability varies greatly, but it is generally agreed that about 16 per cent of the Ontario population have some form of disability. This represents almost 2 million individuals, many of whom are ready, willing and able to work. The number of people with disabilities is slowly rising as the population ages.

Many people find that they are no longer able to function competitively in their past workplace due to their disability, and look to be retrained to preserve their dignity and to make a contribution to the economy. Other people with disabilities are hopeful of finding a niche in today’s improved economy. It is difficult to be objective when considering an individual’s potential to work. Often, diseases are cyclical. Medical doctors may not be in the best position to evaluate the labour market. Employability assessment is not a pure science. Every job searcher soon discovers that finding employment is a combination of preparation, motivation and good luck.

If you are looking for work while collecting income support as a disabled person, it is best to contact the people who provide your support and see what services or opportunities are offered. The policy of government disability programs is to provide services as a “last resort”, meaning you must provide evidence that you are ineligible for programs through your last employer, Worker’s Compensation or through a private insurance company.

All vocational services require that you have an updated medical from your doctor endorsing your decision to explore vocational options, and explaining that you have the ability to undertake competitive work. There are few options for people who can not work competitively. Options for them can be found under the Developmental Services Act.

The Ontario Disability Support Program offers several benefits under their Employment Supports Services:

  • help with developing an employment plan
  • employment preparation support and training
  • technical aids ranging from mobility devices and reading aids to adapted computers and the training to use them
  • Interpreter, reader, note taker, and intervener services
  • travel, route, and orientation training
  • job placement support
  • job coaching and help with job searches
  • on-the-job training
  • transportation assistance while training for a job

Employment Action Plan

You will receive an application package which includes an application form, information about the program, and a Verification of Disability Form.

Complete and mail the application with the Disability Verification Form (if not on ODSP income support) to the Employment Supports Office. You will receive acknowledgement of your application within five days. You will then be contacted to determine initial eligibility. An Employment Plan may be drafted with the help of outside agencies, which identifies the employment goal, barriers to employment and steps required to achieve a competitive employment goal.

An action plan, outlining steps to employment and required disability-related supports, must be documented in a prescribed format. The Toronto ODSP office will refer you to suitable vendors who can help with this plan. Time frames and estimated cost, along with expected outcomes must be fully detailed. Options for training or utilizing community agencies including estimates of costs must accompany the plan. Requested goods and services over $500.00 must be submitted with at least two written quotes. The Interactive Training Inventory [ITI] is invaluable in researching training and costs. It is essential that you understand the plan, feel comfortable about your ability to follow through with the actions and are confident that the plan can lead to competitive employment.

The Verification Form is for individuals applying who are not receiving ODSP Income Support and must be completed by a professional person who knows your disability.

Under the Supports to Employment Program (STEP) Program, you are entitled to retain much of your earnings when starting employment. You may also be eligible for drug benefits, depending upon your budget. In addition, an employment start-up allowance can be issued when you begin employment or a job search.

ODSP Employment Supports will assist eligible participants in their program to access job trials, job coaching and some employment accommodation as approved. They may provide job specific training and worksite modifications (including technical aids and interpreters / interveners). Training courses which are OSAP eligible cannot be funded. (You should contact the Special Needs Office at a College or University or an OSAP Office for funding assistance). Often a combination of individualized services are used to help someone adjust to the world of work.

For an application form for ODSP Employment Supports:

Call: 416-750-0666 or email: jobplacement@cltoronto.ca

Resume Template

Resume

Your name: _______________________________

Your address: _____________________________

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Home phone: _____________________________

Employment goal: __________________________

Education:

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Name of School: ___________________________

Description of Program: ______________________

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Name of School: ___________________________

Description of Program: ______________________

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Special training/volunteer:

_ _ _ _- _ _ _ _

Name of Agency: __________________________

Description of Experience:____________________

______________________________________

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Employment history:

_ _ _ _- _ _ _ _

Name of Agency: __________________________

Description of Experience:____________________

______________________________________

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Name of Agency: __________________________

Description of Experience:____________________

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______________________________________

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Name of Agency: __________________________

Description of Experience:____________________

_______________________________________

_______________________________________

Activities and Interests:

Description: ______________________________

References:

Available on request.

ABC Functional Assessment Card

Whether you are a parent, teacher or early childhood professional, understanding and changing your child’s behaviour is never simple. However, describing the behaviour that concerns you, and gathering good information about when it occurs and under what conditions, is the first step to success.

The ABC Functional Assessment Card is a recording system that is extremely valuable in helping you gather and analyze information you need to help change behaviour.

The first step is to carefully select and “define” a specific problem behaviour – the one you are concerned about and would like to change. Defining a behaviour requires that you describe exactly what you see and/or hear. Your definition should be specific, observable, and measurable. You may find it helpful to print the definition of the behaviour right on the top of the ABC card before copying the cards.

The next step is to fill out a separate ABC Card each time the defined behaviour occurs. The example below shows you how to do this. If the behaviour often occurs, you will want to have a greater number of cards handy. Other adults can also fill out the cards.

On a busy day, you will sometimes miss recording an occurrence. Do not worry about it. Just complete the cards as often as you can.

How do I complete the cards?

The cards are quite simple to complete. Here is how to do it:

ABC Functional Assessment Card

For example, Amanda is having great difficulty with the hand washing routine and her tantrums are very disruptive. The problem seems to be getting worse. We will begin by defining the problem behaviour (e.g., screaming and stomping of feet). Next, we will gather the information about each incident using the ABC card.

Here is what it looks like when one incident is recorded:

ABC Functional Assessment Card Example

You will need to record at least 5 or 6 incidents to make sure you have enough information. It also helps if other people record the incidents as well. At this point, you will probably have enough information to analyze.

What should I look for when analyzing the cards?

It is important to look for any patterns or common trends, such as patterns in the days of the week, or times of the day when the problem behaviour occurs. You will also want to think about when the behaviour does not occur. This may give you additional clues about contributing factors.

Questions to ask include:

  • Is the behaviour happening during the same activity and/or with the same materials?
  • Does the behaviour occur with specific people? (e.g., mom, child care teachers)
  • Are there certain events or conditions that lead up to or happen ¬before the behaviour?
  • Is there a consistent consequence?
  • Does the behaviour stop after a particular consequence? If this is consistent, does this mean anything about the function or purpose of the behaviour?
  • Consider other personal factors that may be influencing the behaviour such as illness, tiredness, or hunger.

Analyzing all the information that you gather and record using the ABC Assessment Cards will allow you to make a “best guess” regarding the function or purpose of the behaviour. Your next task will be to plan for change!

blank ABC template

Worried About Starting School

photo of mother and child looking out window

While you can’t always know what your child is thinking, chances are he is both excited and nervous about starting school. Think back to your own thoughts and feelings when you started school for the first time. Here is a list of some worries children may have.

  • Who will play with me?
  • What if I get lost?
  • Who can I ask for help?
  • Where do I put my coat and bag?
  • I miss my Mom and Dad.
  • What if the bus driver forgets where I live?
  • What if the teacher asks me a question and I don’t know the answer?
  • I’m afraid to use the washroom.

Children with special needs may find it difficult to express their fears and worries about starting school. As a parent, you can help your child by making him familiar with what school will be like and all the things he can look forward to learning. You can also put plans in place to deal with his fears and anxieties. If your child becomes so anxious about school that his typical eating, sleeping, or washroom routines are disrupted, please contact a professional.

Parents often have their share of worries as well. This is understandable as having a child start school can bring changes to the whole family’s routine. Parents who were previously at home with their child may be returning to work. After school child care arrangements may have to change as well. As a parent of a child with special needs you may also be concerned about how your child will “fit in” at school.

It is important to remember that it’s impossible to prepare your child for every new experience he will encounter at school. Much of our learning in both childhood and adulthood occurs when we face the unexpected. Your child will have days when he comes home buzzing with excitement, eager to show you a picture he has painted, or how he can print his name.

Your child will also have days when he comes home frustrated by things he finds difficult to learn. At these times, it is important to acknowledge your child’s frustration and praise him for his efforts. You can let him know that everyone learns at a different pace and it’s OK if he needs more time to practice a new skill. If you find that your child is frustrated more often than not, you may want to meet with his teacher to figure out what the cause may be. Regardless of exceptionalities, all children still differ from one another to varying degrees. Every child has a unique combination of abilities and needs, interests and fears, and successes and failures. These individual differences are present throughout our lives and are a part of human nature.

Finally, always take time to relax and have some fun with your child and his brothers or sisters. When you visit the park, prepare a meal together, or rent a movie, you are showing your children that your love is not based on their academic achievement.

When your Child is Diagnosed with Special Needs

Parenting a child is perhaps one of the most challenging tasks we will face during our lifetime. Whether we consider it a job, art, or craft there are few experiences in life that prepare us for the many ups and downs that come with this unique responsibility. Nonetheless, most parents manage to raise their children remarkably well.

In addition to the usual stresses and strains of parenthood, parents of children with special needs face other pressures and must learn to cope with problems in ways that will enhance, rather than, hinder the growth of their child.

Diagnosis

Children are diagnosed at different ages. Parents may learn about a condition prior to a child’s birth, immediately after birth, or they may identify concerns more slowly as the child matures.

Regardless of when your child receives a diagnosis, your reaction may be strong and often traumatic. No parent is prepared for this news. Upon learning that your child may have special needs, most parents react in ways that have been shared with all parents before them who have been faced with this challenge.

The following is a look at some commonly reported reactions to parenting a child with special needs:

Reactions

A common first reaction is denial. Denial, in fact, may act as a protective device, giving parents additional time to adjust to and absorb information. Denial quickly merges with anger. Anger may be directed at the medical professional giving the news, a spouse, family members, and the child himself. At times, the anger will seem so intense parents feel that the world is against them. Parents may avoid medical professionals, family, friends, and even neighbours who confront them with a reality they are not ready to accept.

Fear and guilt may also be present. Fear may arise if parents are unsure of the diagnosis, the implications of it, and what the future holds. When a parent is given information about a diagnosis, it is common to only take in bits and pieces of that information. Large chunks of a discussion can disappear. You are unsure of what you have heard, or what it means. A medical or developmental professional may use jargon or terminology that is completely unfamiliar to you. You may be overwhelmed and unable to ask questions or clarify the information you do not understand. You may fear the reactions of your family members to this news and you may fear that your child will be rejected by society.

Parents may also feel greatly alienated or separated from others. You believe that no one else is coping with a situation like yours. Guilt is often associated with feelings that you could have done something to prevent this. Parents ask “Why us?” and search for explanations. Much self-reproach and feelings of remorse, or sorrow can stem from questioning the causes of your child’s special needs.

Guilt may also lead to confusion during this traumatic period. As a result of not fully understanding what is happening and what will happen, confusion may reveal itself in sleeplessness, inability to make decisions, and general overload. As with fear, confusion is often related to being forced into a world that is unfamiliar to you. Medical or developmental terms are feeling like a new vocabulary and you find that you cannot make sense of it.

Feeling helpless to change what is happening can occur. You may recognize that you cannot change the nature of the diagnosis and it is very difficult to rely on the judgments and opinions of the professionals with whom you have had contact. You are interacting with people who are basically strangers to you and with whom no bond of trust has yet been established. Helplessness is often accompanied by disappointment. Disappointment related to your expectations being changed can create a roadblock or barrier to acceptance of your child.

Rejection may also be present. Rejection can be directed toward your child, a medical professional, or toward other family members. Rejection and depression are often linked to one another.

Many families reach a stage of adaptation where they can accept their child, the diagnosis, and themselves. At this stage, families begin to find, or pull together resources to adapt to the situation and to help cope with what is to come.

Not all parents go through these stages, but it is important for parents to identify with all of the potentially overwhelming emotions that can arise and know that they are not alone. The impact of a child’s diagnosis affects different families in different ways. Keep in mind that there are many actions that you can take immediately to help you and your child.

After the Diagnosis

  1. Request Information
    Your first visit with the doctor may leave you emotionally drained and just not capable of taking in any more information. Try not to do everything
    in one visit. Set up a second or third visit with the doctor who diagnosed your child.Before you go for the next visit, write down a list of questions you want to ask, or write down questions during the visit.A few questions to consider asking the doctor can include:

    • Does my child need additional testing, blood work, and assessments by other specialists?
    • If so, when will the tests be scheduled and when will we know the results?
    • How do you know my child has__________?
    • Are there other names for my child’s condition?
    • How will this affect my child’s development?
    • What needs to happen next?

    If you do not understand the doctor’s response to your questions, ask him to explain in greater detail. Write down the responses, or bring a tape recorder. Don’t rely on your memory! This is an emotional time for you and you may forget key things the doctor has said. Ask the doctor to give you a list of books on the diagnosis and related support services in your community. Get the information in writing and if you need a referral to another doctor or agency, request that the doctor do it immediately in your presence.

  2. A Second Opinion
    If you have any doubts about the diagnosis or the professional who gave it to you, seek out a second opinion. Do not feel that you have only one option when it comes to having your child assessed. If a medical professional is unable to answer your questions in a manner that you find reasonable and clear, move on. You need to establish a comfort level with a medical professional who may be involved with your child for some years to come. You want to develop a sense of trust with this person and be recognized as a contributing and valued source of information about your child. You are in the best position to observe and report what your child is doing. Be confident that you know your child better than anyone else.
  3. Parent and Family Counselling
    This unique service can assist parents and other family members to help understand the meaning of a child’s diagnosis, and assist them in developing realistic expectations for their child.Counselling sessions also provide an environment in which parents can openly express and work through their feelings. Sessions offer coping self-help skills, group relaxation, self-praise, and self-instruction. Siblings (brothers and sisters) of a child with special needs are often included in counselling sessions. These sessions help siblings work through their feelings and emotions concerning their brother or sister with special needs. It is normal for your other children to feel resentment, fear, embarrassment, and guilt. These problems, if not acknowledged and expressed in appropriate ways, may cause long-term issues.
  4. Talk to Another Parent
    Have your doctor provide you with contact information for parent support services. He should be able to connect you with another parent who has had the same experience as you.Pilot Parents is an example of a parent support group with chapters across Canada and the United States. The program was developed by parents of children with special needs in order to offer support to parents of newly-diagnosed children. You may also be able to locate a support group in your area through organizations dedicated to your child’s particular special needs.
  5. Talk to Your Family and Friends
    When you feel comfortable, share the information about your child’s special needs with your family and friends. You may find that you have a support network already available that you did not expect. Keep them involved and up to date with any important information about your child and family. Family and friends usually want to assist, or help you any way that they can, so let them. For example, you could have them watch your other children when you take your child with special needs to an appointment.
  6. Services
    As stated in the first point, get your doctor to make referrals for services that will provide support to you and your child. Ask for a listing of these resources and get a contact name of a person who can provide you with more information. Feel free to call them on a regular basis to inquire where your child is on their wait list and if there are other services you can access that will benefit your child. Keep a binder at hand to hold information that is sent to you and requested of you. Write down important phone numbers and appointments that your child may have. Get written copies of all documentation from doctors, early interventionists, and therapists regarding your child.Families often represent the only long-term, responsible, and caring people in the life of a child with special needs. The family is very important. Interaction with family members deeply influences the child’s opportunities and barriers, challenges and expectations, ambitions and frustrations, and general quality of life. Whether your family is two-parent, single-parent, or extended, it plays a powerful role in your child’s social, emotional, behavioural, and intellectual development.Getting help is a key step in understanding what your child and family needs during this time. Support from professionals and social services agencies can help you build a relationship with your child, and help you recognize your child’s individuality and unique contributions to the family.

Additional Resources:

Healthy Babies, Healthy Children Toronto – https://www.toronto.ca/community-people/children-parenting/pregnancy-and-parenting/pregnancy/during-pregnancy/prenatal-programs/healthy-babies-healthy-children/
The Healthy Babies, Healthy Children Program (HBHC) is a prevention and early intervention initiative to provide support and services to families with children from before birth up to six years of age. Public health nurses determine what services are needed and make sure the family is linked to the most suitable resources in their community. The family home visitor is an experienced parent who comes to the home to provide support and information to new mothers.

Parent Outreach Program – www.woodgreen.org
The Parent Outreach Program provides free in-home support to parents of children who have been diagnosed with one or more developmental delays. Specially- trained home visitors are all parents who have children with developmental delays. Weekly visits by the home visitor will assist parents with ongoing support and guidance in raising a child with developmental delays, develop programming in the areas of self-help and socialization skills and provide information on additional community resources.

FamilyLink – FamilyLink group on Facebook
FamilyLink is a parent directed support group for parents and caregivers of children with an Intellectual Disability. Each member can pose questions, vet concerns and share through this program. We are here for sharing, support and friendship.
Contact: Sarah Winter swinter@cltoronto.ca 647-968-6214

Books and Literature:

When Your Child has A Disability: The Complete Sourcebook of Daily and Medical Care, Revised Edition
By Mark L. Batshaw

Answers to frequently-asked-questions follow the chapters to clearly address common parent concerns like behaviour, medication, and potential complications. New and expanded chapters have been added to explore the latest care issues including prematurity, early intervention, legal rights, attention-deficit/hyperactivity disorder, learning disabilities, genetic syndromes, and changes in health.

You Will Dream New Dreams: Inspiring Personal Stories by Parents of Children With Disabilities
By Stanley Klein and Kim Schive

The authors have collected stories by parents of children with special needs from all over the world. You Will Dream New Dreams is a remarkable parents’ support group in print. The shared narratives come from those with newly-diagnosed children and adults with special needs. These experiences offer hope and encouragement and serve as a reminder that there are others out there who can help.

Changed by a Child
By Barbara Gill

Parenting is always tough, but parenting a child with disabilities, serious injuries, or chronic illness can be a life-changing, profoundly disrupting experience. In Changed by a Child, Barbara Gill provides brief meditations and passages about the challenges, grief, faith, hope, and other feelings and experiences of parents who have a disabled child. Gill’s son has Down Syndrome, and she writes with the authority and credibility of a parent who has been through it herself.

What is Specialized Equipment?

Seating

There are several types of specialized seating. Wheelchairs and specialized strollers are used when a child’s temporary or permanent physical condition makes walking impossible, when walking is so difficult that it leaves no energy for other activities, or when the child needs to develop the motivation to get around.

photo of specialized seating

There are many types of wheelchair designs: manual and self-propelled chairs can be light-weight or heavy-duty, have one-armed drive, or be lever-operated. Battery driven wheelchairs can be conventional, scooter-type, heavy-duty, or all-terrain.

Stroller/travel chairs are a type of specialized seating in which the child is pushed by another person. These strollers are sturdier than young children’s strollers and offer more head and neck support.

Other Mobility Aids

Mobility devices can provide support for a child to crawl, stand, or walk.

Crawling: Scooter boards can be propelled by the child’s arms as he lies across the board.

Standing: Many children with balance issues are unable to stand independently but can play if they are supported in a standing position. Sometimes children who cannot hold their heads up while lying down are able to hold their heads up when they are in a sitting or standing position.

Walking: A child with weak leg muscles may require braces to help support the joints. Even with bracing, a child may require a walker for trunk balance. Young children usually require walkers with front wheels as they require less energy to use than walkers without wheels.

Rolls and Wedges

Rolls

For children who require support in developing control of the head, shoulders, arms, and hands, a small roll may be used. When placed under the chest, the roll makes lifting the shoulders or raising the head easier. Some children keep their arms close to their body because they don’t have enough control and balance to reach out their arm(s). The roll can also assist children to move their arms forward and reach out.

Wedges

A wedge provides slanted support to help children work on head, shoulder, and arm control. The height of the wedge depends on the child’s needs. Lower wedges allow the child to lift up onto the elbows, while a higher wedge encourages arm and shoulder movement.

References:

Based on Parent Articles for Early Intervention, 1990, Communication Skill Builders, Inc.

What is Bullying?

photo of girls bullying a boy at school

Bullying can occur in any environment and is defined as exposure repeatedly and over time to intentional negative actions on the part of one or more people. It happens, on average, every seven minutes on elementary school playgrounds. It most often occurs while others watch and it does not stop when victims are left to deal with it themselves.

Forms of Bullying:

  • Physical – hitting, kicking, pushing, pinching, shoving, etc.
  • Social – insulting, teasing, threatening, excluding, making fun of others, gossiping, spreading rumours, ganging up on others

Why Children Bully:

There are many reasons why children bully others. Sometimes the bully feels like s/he doesn’t fit in and so they bully others to become popular with a particular crowd. Many bullies engage in bullying behaviour because it makes them feel stronger, smarter, or better than the victim. Bullying can make the bully feel more in control. In some instances, the bully feels that this behaviour is the normal way to interact with others since they have been treated this way themselves.

Warning Signs:

A child may be a victim of bullying if s/he:

  • Has unexplained torn clothing or missing belongings
  • Suddenly complains of headaches, stomach-aches, or nightmares
  • Has difficulty making friends
  • Is often alone
  • Suddenly is more withdrawn and/or aggressive toward self or others
  • Does not want to go to school
  • Is more easily upset than usual
  • Avoids certain situations

A child may be a bully if s/he:

  • Behaves aggressively with people and animals
  • Is easily angered and frustrated when playing cooperative games
  • Believes violence is an acceptable way to solve problems
  • Hangs around with other children who appear to be bullies

What can teachers do if children are…

Victims:

  • Listen to what the child says, believe what they say, try to understand their feelings
  • Assure child that it is not their fault
  • Involve children in prosocial activities with peers that are more supportive
  • Provide specific strategies for child to use next time bullying happens

Bullies:

  • Let the child know by your words and actions that bullying is not okay
  • Teach children to act in ways that show respect for others and themselves
  • Acknowledge what is happening and provide help

Bystanders:

  • Talk to children about bullying and listen to what they think about it
  • Help children plan what they will do if they see someone being bullied
  • Stress the difference between telling and tattling

What Can Centres Do to Promote a Bully-Free Zone:

  • Develop an anti-bullying policy which is shared with families when children are admitted to the centre
  • Provide information and workshops for parents

Resources:

Vision Assessment

photo of a girl getting her vision tested

What is vision assessment?

A vision assessment is an organized procedure for gathering information about the health and function of the vision system. Assessments can be done at home, school, and during regular examinations with the doctor. A child with a known visual impairment should be assessed by a paediatric ophthalmologist, a teacher for the visually impaired and an orientation/mobility specialist. Observations made by caregivers and the above mentioned specialists are a very important piece of the assessment.

Why assess?

  • To understand how the child uses vision to gather information.
  • To share information with family, friends, and other professionals working with the child.
  • To promote development based on the findings of the vision assessment.
  • To determine whether the child will learn more effectively through auditory, print or tactile media.
  • To evaluate the child’s ability to move safely in the environment.
  • To determine whether a child is eligible for services.

What information is needed?

Parents and caregivers observations provide valuable information that helps interpret a child’s use of vision. Family members and caregivers have the greatest opportunity to observe children over time and in a comprehensive way. Research shows that families’ observations of their children have been accurate even when those observations contradict
formal testing results.

The child’s medical history is an important part of the assessment. Medical issues such as seizures, motor impairments, respiratory difficulties and other health issues may affect the child’s functioning and ability to see. Medications have side effects, such as blurred vision, that could affect the final outcome of a vision assessment. Medications may also affect the child’s responsiveness, including visual function.

How to assess?

Many professionals use a variety of tests to assess vision. Vision information from each child will determine the tests and methods used. Before decisions are made about evaluation methods and materials, it is important to establish the following:

  • What the family and others familiar with the child have observed.
  • Materials and activities used in the assessment are developmentally appropriate for the child.
  • Materials and activities are of interest to the child.
  • Whether the child requires extra time to respond.
  • It is important to observe the child in familiar and unfamiliar settings.

The diagnosis of some eye conditions is dependent on the use of additional tests such as:

  • MRI (Magnetic Resonance Imaging) examines soft tissue structures inside the body not seen with X-Rays.
  • CT Scan (Computerized Axial Tomography) creates pictures of cross sections of the body. These images of tissues are produced by passing X-Ray beams at various angles through the area of the body to be studied.
  • Lighting and Illumination: type of light, the intensity and position of the light and the child’s adaptation to light and glare are important considerations. Some children require strong, bright lights and can see better when the light is positioned at specific angles. Others may be sensitive to light.

Questions for the Ophthalmologist

A visit to the ophthalmologist can be busy and overwhelming for everyone. It is helpful for families to have some or all of the following questions ahead of time.

  1. What caused my child’s vision problem?
  2. Is the eye condition hereditary?
  3. Is my child’s condition stable?
  4. Is there any surgery that would help my child’s vision?
  5. Should there be restrictions on my child’s activities?
  6. Will glasses or contact lenses help? If so, how much will they help?
  7. Will low vision aids help when my child is a little older?
  8. What is my child’s best viewing distance?
  9. How does the eye condition affect my child’s mobility?
  10. Are my child’s eyes sensitive to light?
  11. What kind of lighting will help my child?

Glossary

Optometrist: A licensed specialist (O.D.) trained to examine eyes and related structures to determine vision problems. S/he may prescribe eyeglasses, contact lenses, or other vision aids.

Orientation and Mobility Specialist: A teacher trained to teach people who are visually impaired how to move safely around the environment.

Paediatric Ophthalmologist: A medical doctor (M.D.) who specializes in treating children’s diseases of the eye. This doctor may perform surgery or prescribe other types of treatment, including eye glasses and contact lenses.

Resources:

INSITE MANUAL (1988). Ski-Hi Institute, Logan, Utah. Topic 4, p.35.

Coleman, J. (1993). The Early Intervention Dictionary Woodbine House, Bethesda, Maryland

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