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Abdi and Lunch Time

Abdi is a three-year old boy with some verbal language. At lunch time he sits down at the table and has little difficulty eating or drinking independently. Lately, he has been grabbing food from other children’s plates.

Does this story about Abdi at lunch time sound familiar to you – perhaps you have a child like Abdi in your classroom?

If so, then you’ve actually taken the first step of identifying a problem behaviour that may be putting a child at risk. In this case, Abdi’s problem behaviour is also interfering with his social development.

Deciding what to do next may be difficult. Here’s the 3-step approach we followed in Understanding and Changing Behaviour.

Step 1: Decide Where to Start

We’ve identified a problem behaviour. Let’s take a moment to describe exactly what we see or hear. Describing the behaviour will help us to be consistent when gathering information a bit later.

Abdi grabs food from the plates of children sitting next to him. He also reaches across the table for food.

In order to better understand Abdi’s behaviour, we’re going to use the Functional Assessment Interview by O’Neill. This functional assessment tool will help us to record our observations at child care and gather some information from his parents. We’ll try to find out how Abdi eats at home and if his parents have any concerns around mealtimes.

Now let’s move onto the next step.

STEP 2: Gather and Analyze

Here is some information we gathered from the Functional Assessment Interview which includes: what happens before the behaviour; the setting and time when the behaviour occurs; and what happens afterwards.

  • The behaviour occurs about 3 times a week. Abdi grabs for others food 2-3 times per meal.
  • Snack time is optional and Abdi does not usually come for afternoon snack.
  • The behaviour occurs when different teachers and peers are sitting next to him.
  • The behaviour results in Abdi getting immediate attention from the other children and teachers. Abdi is allowed to eat the food. Teachers tell Abdi to “stop grabbing”.
  • The food items that Abdi grabs include bread, crackers and sometimes bananas. We noticed that the behaviour occurs only when these items are present.
  • We also noted that Abdi communicates by using gestures, pointing or single words.

We spoke with Abdi’s mother to learn more about his eating routine at home. We found out that his favourite foods are bread and rice, and he also eats a lot of pureed or soft foods. Abdi’s mother mentioned that he has recently been grabbing food from other people’s plates at home, and believes that his appetite has increased.

The results from the Functional Assessment Interview suggest that the function of the problem behaviour is to obtain an object. He has learned that this behaviour will consistently get him his favourite food.

We have also suggested that Abdi’s mother have his teeth checked to assess any oral motor problems that may be contributing to the behaviour.

Now it’s time to move onto the next step and plan for change.

Step 3: Plan for Change

Planning for change involves making the behaviour irrelevant, inefficient and finally ineffective.

Making the Behaviour Irrelevant

We can make the behaviour irrelevant by preventing or controlling the things in the environment that happen before the behaviour.

Let’s take a look at some ways to prevent the behaviour from happening by changing the environment at lunch time, adapting routines, and using visuals.

Environment
Positioning and creating boundaries for Abdi during the lunch time will be important to help him understand what food belongs to him and others. We’ll try placing Abdi at the end of the table where there is only one child next to him – reducing his opportunities to grab food. Custom placemats will be provided for all the children to use during lunch to help establish visible boundaries.

Using Visuals
We can use a rules board to provide a visual representation of lunch time rules. These will be placed beside the table, and reviewed each day before lunch is served. Rules will include: keep hands to yourself; eat what is on your plate; and use words to ask for more food.

We will also use visual supports when teaching an alternative behaviour – keep reading for more details.

Making the Behaviour Inefficient

To make behaviour inefficient, we might choose to teach specific adaptive, educational and social behaviours. By teaching these types of behaviours, we eliminate the need for the problem behaviour.

At other times, we may teach an alternative behaviour. An alternative behaviour serves the same function as the behaviour being replaced but is seen to be more appropriate by other children, adults and the general public. To be successful, it requires equal or less physical effort and complexity but results in the same type of pay-off for the child.

In this case, we will teach an alternative to grabbing food. We’re going to help Abdi to request his favourite foods by using words.
For specific details on the strategies and other teaching techniques we used to teach Abdi to “request a food item” visit our “Teaching New Skills” section.

Making the Behaviour Ineffective

The last step is to make problem behaviour ineffective, meaning that it no longer works for the child. Behaviour may not change right away. It is very common for problem behaviour to increase before decreasing when implementing changes. The key is to be consistent with our plan.

If Abdi grabs other children’s food, the teaching team will respond by removing the food from him. Using visuals, he will be reminded of the rule: hands to yourself.

Next we need to look at changing the behaviour in every environment in which a child finds himself. We will talk with Abdi’s mother about teaching him to ask for more food or a specific food item. Our partnership with parents is the key to success.

If the problem behaviour persists then we will have to re-assess but it is important for us to give our plan time to work. Be patient! Some behaviours can take a couple of weeks to change.

How to use the “Checklist of Communicative Functions and Means”

by Amy M. Wetherby, 1995

Children who are not yet using much speech often communicate in many other ways. This checklist is useful in determining how and when your child communicates. Each “Communicative Function” or reason for communicating may be expressed using any number of “Communicative Means” or ways to communicate through actions and behaviour.

Communicative Functions (Reasons to Communicate)

The Communicative Functions (reasons to communicate) are divided into the following categories:

  • Behavioural Regulation: actions used to get, or refuse, something (e.g., child asks for a toy airplane by pointing to it)
  • Social Interaction: actions used to get another’s attention (e.g., child waves to say “Hello”)
  • Joint Attention: actions used to direct another’s attention to share information (e.g., child points to an airplane in the sky to show it to you)

Communicative Means (Ways to Communicate)

The Communicative Means (ways to communicate) are divided into two sections called Pre-verbal and Verbal. The following is a brief description of each way or action listed in the checklist.

Pre-verbal (ways of communicating other than using words)

  • Physical Manipulation – touching, trying to operate a toy
  • Giving – giving an item to another person for a specific purpose (e.g., to request help with activating the item, or to express an interest in it)
  • Pointing – pointing to an item for a specific purpose
  • Showing – showing the item, but not giving it
  • Gaze Shift – looking briefly in the direction of an item out of interest
  • Proximity – moving closer to the item out of interest, or away from it in protest
  • Head Nod/Head Shake – indicating interest in an object through nodding, or protesting by shaking head
  • Facial Expression – smiling, frowning, etc.
  • Self-Injury – hitting, biting, banging self
  • Aggression – hitting, biting, punching, kicking, scratching others
  • Tantrum – screaming, throwing self down on floor
  • Crying/Whining – to make needs known
  • Vocalizing – any speech-like sounds that are not full words
  • Other – word approximations such as “bu-bu” for “bubble”

Verbal (ways of communicating using words)

  • Immediate Echo – child repeats what is heard immediately after hearing it
  • Delayed Echo – child repeats what was heard earlier in the day or on a previous day
  • Creative One-word – uses a single word not in imitation of something heard, (e.g., saying the word “milk” can be to request it, to comment on seeing or having it, or to ask if that is what is in a cup)
  • Creative Multi-word – uses two or more words not in imitation of something heard

How to use the checklist

To use the checklist, simply go through each Communicative Function and check off the Communicative Means that apply. For example, if your child requests objects by pointing, looking, and moving closer to them, you would check off all three of these pre-verbal means in the “request object” row.

Here’s an example:

Once you have completed the checklist, you will see which ways are most often used by your child to communicate. You may also notice ways and reasons for communicating that need work. For example, the child in the above checklist communicates gesturally (e.g., pointing, eye gazing, and proximity) to request objects. Therefore, communication goals for him could include using head nod or vocalizing to request objects. We always want to expand both the ways and reasons that your child communicates. Remember that once you know how your child communicates, it is easier to figure out what the next step should be.

Circle Time

Circle time is a great opportunity for children and teachers to come together as a group and share a special time of their day. The shared experiences at circle time might include exchanging information on daily events, completing calendar and weather boards, reading a story, singing, playing games, exploring through music and movement, and much more.

All of these experiences provide children with an opportunity to develop a variety of skills such as interacting with others, sharing, taking turns, and expressing feelings. Children can also learn to pay attention, to listen and follow instructions, and to make decisions.

Circle time should be carefully planned by incorporating activities that are responsive to the children’s needs and interests, and are developmentally appropriate. The following considerations might help you to adapt your circle time.

Getting ready for circle:

  • Plan the circle time as a specific part of the daily program: allow for flexibility in case of unexpected events like visitors, environmental changes, or illness.
  • Discuss the circle time rules with the children: keep the rules short and simple. Use photos, line drawings or picture symbols to help describe the rules and if possible, keep them posted near the circle time area.
  • If possible, implement the circle time in small groups: children who are not familiar with group activity may need to begin in small groups perhaps as small as two or three children. As children gain competence in small groups in a variety of situations, the groups can gradually be enlarged.
  • Create a routine and keep it consistent: consider the number of children, time of day, duration of the activity, physical space, and hello and good-bye songs. This is especially useful with children who have difficulty dealing with changes.

During the circle:

Seating arrangements

  • Have the children sit in a circle or semi-circle: this arrangement allows children to see each other and the person leading the circle.
  • Ensure that all the children sit at the same level: you might want to assist a child in a wheelchair to sit on the carpet with appropriate support, or you might choose to provide chairs for the other children to sit on.
  • Become part of the circle by sitting at the children’s level.
  • Ensure a space for each child in the group: use individual mats, or any kind of visual/tactile sign like tape or rubber to define the individual space. Allow for about one foot of space between each child.
  • Provide a variety of seating accommodations: some children may require or use specialized seating, or other pieces of furniture to stay focused and involved in circle time (e.g., beanbag chair, rocking chair, rice/bean-stuffed cushion).
  • Consider a child’s physical position: children with hearing impairments may benefit from sitting directly across from the teacher. This can help a child see the teachers face, mouth, gestures, and signs more clearly. Children with problem behaviours may also benefit from sitting close to the teacher to stay focused and participate in activities.

Accommodating the Needs of the Children

  • Eliminate distractions: ensure that other toys near the circle time area are put away. Cover toy shelves if needed.
  • Use fidget toys: some children might need extra support to relax and stay focussed. Consider providing a child with a fidget toy to hold or squeeze (e.g., squishy balls, small bean bags, twisty snakes, stuffed animals) during this time.
  • Use visual supports: use picture symbols to facilitate choice making, or introducing activities especially with songs and games. Create a song board with pictures that represent the various song choices and have the children select the next song to sing.
  • Keep it short: avoid activities that require sitting and listening for an extended period of time.
  • Try to ignore small disruptions.

Using Props, Materials, and Resources

  • Use props and materials as part of your planned circle time activities (e.g., puppets for a story, toys or objects for a song, scarves for creative movement). Let the children use the props as much as possible. This will help them to take part in the activity and to focus for a longer period of time.
  • Keep all the circle time materials and props in a bin. Rotate the materials in the bin on a regular basis to stimulate the children’s ongoing interest.

Consider making circle time a more focused and important aspect of your program as all children enjoy music and movement. Remember, above all to have fun.

REFERENCES:

Gould, P. & Sullivan, J. (1999). The inclusive early childhood classroom: Easy ways to adapt learning centres for all children. Gryphon House Inc.

Lerach, H. (1990). Storytime handbook for daycare workers. Regina Public Library.

Mulligan, S. et. al. (1992). Integrated child care: Meeting the challenge. Communication Skill Builders, Tucson, Arizona.

Anxiety for Young Children

It is natural to become anxious when we do not understand what is expected in certain situations or settings. In other words, when environmental and/or situational demands become unclear, it can generate anxiety in many of us.

All children experience some anxiety; this is normal and expected. For example, when left alone at child care or kindergarten for the first time, many children will show distress. Some children may also develop a fear of the dark. Dealing with changes in the daily routine can bring about anxiety in some children. Such anxiety becomes a problem when it interrupts a child’s normal activities, like attending school, making friends or sleeping.

Supporting the Child

Entering into a new child care arrangement can be an emotional experience for both parent and child. However, careful planning, and the knowledge that some separation anxiety and tears are normal, can make the transition from parent to caregiver as pleasant as possible. How quickly the child adapts depends on a number of factors including: the child’s age and stage of development; the child’s past experiences in the care of others; the skills of the new caregiver and appropriateness of the new setting; and the parents’ ability to prepare themselves and the child for the separation. Here are some strategies that you can pass on for parents to consider before the child starts child care or if the child is having difficulty upon arrival to the centre.

How parents can help:

  • Be enthusiastic about the upcoming change. If you are excited and confident, your child will be, too.
  • Prepare yourself. Take note of how your child reacts to separation. If possible, visit the new setting with your child. Introduce your child to the new teacher or early childhood professional in advance.
  • Arrange a play date (if possible) with another child from the program, preferably one-on-one, so that your child will see a familiar face when she walks in.
  • Start daily routines that will add to continuity. Let your child become involved with packing her backpack or laying out clothes. Also, begin an earlier bedtime several weeks before.
  • Explain when and where you will be picking her up. For example you might say to your child “After lunch and sleep, I will come. You will probably be playing outside then. I will know where to find you”. A common fear is that you will not return or that you will not find each other. If another family member or caregiver will be picking up the child be sure to let her know.
  • Always say good-bye to your child. Regardless of how tempting it may seem never sneak out while the child is distracted. This destroys trust and will encourage the child to cling more on future occasions. But remember not to prolong the good-bye. If the child whines or clings, staying will only make it harder.
  • Your stress level can contribute to separation anxiety. Anxiety about child care arrangements or guilt about leaving may add to your child’s distress. Make sure that you feel confident about the child care arrangements that you’ve made. And remember, some time spent apart can be good for you both.

How early childhood educators can help:

  • Make sure activities are developmentally appropriate. Interesting and challenging activities will help a child feel comfortable in her new setting.
  • Get to know the child as quickly as possible. Parents can provide information about children’s likes, dislikes, and special interests.
  • Welcome suggestions from families. Parents can offer specific suggestions they have found useful for their own child. Remember, a parent knows their child best.
  • Show the child around the child care centre and introduce her to other adults who are part of the child care program.
  • Develop a goodbye ritual with the family. Rituals are reassuring, especially during stressful times. Help the parent plan a special way to say goodbye, such as a wave through the window or a hug. You may also want to ask the parent who will be picking up the child or at what time. This information can help to reassure the child that her parent will be returning.

Sometimes, it may be more than separation anxiety. Consider other possible sources of stress in the child’s life. If a child continues to be inconsolable in a new child care or other setting for more than 2 weeks or stops eating or sleeping well, refuses to interact with others, and has an ongoing change in behaviour you will want to discuss the concern with the child’s family and consider seeking help from a professional.

Children, just like adults, need time to adjust to new people and situations. Experience can make transition a bit easier, but even with experience,
change can still be stressful. Patience and understanding on the part of parents and caregivers will help children learn how to approach new situations with confidence – a skill that will help them make successful transitions throughout life.

General Strategies for Dealing with Anxiety

Adjusting to a sudden or unexpected change or knowing that an unpleasant activity is next often poses a challenge for some children with special needs. Here are some strategies to keep in mind:

  • Make an effort to cut down on activities when you see signs of stress in a child’s behaviour. Allow each child to go at her own pace.
  • Teach a child tricks for calming herself, such as taking deep breaths, thinking of a quiet place, counting to ten, etc.
  • Plan plenty of time for play. Inform the child when there will be transitions or changes in the child care curriculum. For example, provide a visual cue like turning the lights off to indicate that a change is coming and say, “Two more minutes, then circle time”.
  • Give a child a special toy for comfort or allow her to bring one from home.
  • Teach the child to recognize which situations or events are stress-inducing and how to manage her anxieties.
  • Use visual aides to help describe the upcoming events, or strategies that a child may use to deal with her anxiety (e.g., storybooks, personalized social stories, daily schedule).

Let’s take a look at an example:

Jaspal is a young girl with autism and always hides behind the art shelf before going to the gym. While in the gym room, Jaspal does not participate in
activities and constantly runs towards the door or covers her ears. After observing and gathering some more information, her teachers believe that she is trying to escape the loud and echoing sounds she hears in the gym. This may explain why Jaspal hides or gets anxious, and tries to avoid gym time.

In this case, we can help Jaspal recognize what aspects about gym time make her anxious. We can also write a Social Story using picture symbols that describes the situation and what Jaspal can do in this situation. We can read the story every day and role play the scenario giving her a chance to practice and recall what to do when it is gym time. For example, the story might say:

My name is Jaspal.
Almost every day our class goes to the gym to play.
When it’s time to line up for gym, I can take a deep breath.
Sometimes, children play and shout in the gym and it gets very loud. This is OK.
My teacher will try to tell me when a loud activity is coming.
When I hear the loud sounds I can cover my ears, or ask to leave the gym.

Helping a child deal positively with events that cause anxiety, prepares her for a healthy emotional and social development. Parents and early childhood professionals share a role in making children feel safe and secure. If you are concerned that a child has difficulty with anxiety you should discuss this with the child’s family. Consultation from a child and adolescent psychiatrist or other qualified mental health professional may be recommended. Severe anxiety problems in children can be treated.

Glossary

Anxiety – is a state of being uneasy, apprehensive or worried about what may happen, or a concern about a possible future event.

Phobia – an uncontrollable, irrational, and persistent fear of a specific object, situation, or activity.

Separation Anxiety – when an infant or toddler is anxious about being away from her primary caregiver.
Infants can have this as early as 7 months, but separation anxiety usually peaks between a year and 18 months.

Stress – the physiological reaction of the body to life situations that can be both happy and unhappy.

References

Illinois Early Learning Project.

Please don’t go: Separation Anxiety and Children.

Tip sheet available at www.illinoisearlylearning.org/

Child and Family Canada.

Coping with Separation Anxiety.

Resource Sheet #41. Available at www.cfc-efc.ca/

Beidel, Deborah C. (2005). Childhood anxiety disorders: A guide and treatment. Routledge.

The Groden Centre – www.grodencenter.org/

Williams Syndrome

Fact Sheet

What is Williams Syndrome?

Williams Syndrome is a rare, congenital (present at birth) disorder characterized by medical, physical and developmental problems including an impulsive and outgoing (excessively social) personality, limited spatial skills and motor control, and intellectual disability (e.g., developmental delay, learning disabilities, and attention deficit disorders). Symptoms vary among individuals.

Most people with Williams Syndrome will have a mild to severe learning disability. Young children with Williams Syndrome often experience developmental delays. Milestones such as walking, talking and toilet training are often achieved somewhat later than is considered normal. Distractibility, a common problem in mid-childhood, appears to get better as the children get older.

Older children and adults with Williams Syndrome often demonstrate intellectual “strengths” and “weaknesses.” There are some intellectual areas such as speech, long term memory, and social skills in which performance is quite strong, while other intellectual areas, such as fine motor and spatial relations are significantly delayed. Scientists have learned that most individuals with Williams Syndrome have a deletion of genetic material on Chromosome 7 which includes the elastin gene.

How is it manifested?

Physical Indicators:

  • facial features “elfin” like
  • early problems: low weight, weight loss, below average growth
  • heart and blood vessel problems
  • hypercalcemia (elevated blood calcium levels)
  • low birth-weight/low weight gain
  • dental abnormalities
  • musculoskeletal problems
  • kidney abnormalities
  • hernias
  • hyperacusis

Behaviour Indicators:

  • irritability
  • feeding problems
  • overly friendly (excessively social) personality
  • developmental delay, learning disabilities, and attention deficit
  • high verbal ability
  • sensitivity to loud noises

Who is affected?

It is estimated to occur in 1 in 8000 births. It is known to occur equally in both males and females in every culture.

How is it diagnosed or detected?

Many individuals with Williams Syndrome remain undiagnosed or are diagnosed at a relatively late age. This is of concern since individuals with Williams Syndrome can have significant and possibly progressive medical problems. When the characteristics of Williams Syndrome are recognized, referral to a clinical geneticist for further diagnostic evaluation is appropriate. The clinical diagnosis can be confirmed by a blood test. The technique known as Fluorescent In Situ Hybridisation (FISH), a diagnostic test of the DNA, detects the elastin deletion on Chromosome 7 in 95% to 98% of individuals with Williams Syndrome.

Additional Resources:

Williams Syndrome Association (WSA) – www.williams-syndrome.org
The WSA is the only group in the United States devoted exclusively to improving the lives of individuals with Williams Syndrome and their families. The WSA supports research into all facets of the syndrome, and the development of the most up-to-date educational materials regarding Williams Syndrome.

Canadian Association for Williams Syndrome (CAWS) – https://www.williamssyndrome.ca/
The Canadian Association of Williams Syndrome (CAWS) was founded by a group of parents in 1984. CAWS is a national federation of the provinces in Canada that provides support to Williams Syndrome individuals and their families.

Books and Literature:

Williams Syndrome: Approaches to Intervention
By Eleanor Semel and Sue R. Rosner

Journey from Cognition to Brain to Gene: Perspectives from Williams Syndrome
By Ursula Bellugi and Marie I. St. George

Fulfilling Dreams – The WS Parent Handbook
By Barbara Scheiber

Articles:

Williams Syndrome Information for Teachers
By Karen Levine
Available at www.williams-syndrome.org/teacher/information-for-teachers

Visual Impairment

Fact Sheet

What is a visual impairment?

A visual impairment is the consequence of a functional loss of vision, rather than the eye disorder itself. Eye disorders, which can lead to visual impairments, can include retinal degeneration, albinism, cataracts, glaucoma, and muscular problems that result in visual disturbances, corneal disorders, diabetic retinopathy, congenital disorders, and infection.

The effect of visual problems on a child’s development depends on the severity, type of loss, age at which the condition appears, and the overall functioning level of the child. Many children who have multiple disabilities may also have visual impairments resulting in motor, cognitive, and/or social developmental delays.

How is it manifested?

The terms partially sighted, low vision, legally blind, and totally blind are used in the educational context to describe children with visual impairments. They are defined as follows:

  1. Partially sighted indicates some type of visual problem has resulted in a need for specialized consultation.
  2. Low vision generally refers to a severe visual impairment (not necessarily limited to distance vision). It applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting or the size of print, and, sometimes, Braille.
  3. Legally blind indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point). Totally blind students learn via Braille or other non-visual media.

Who is affected?

The rate at which visual impairments occur in individuals under the age of 18 is 12.2 per 1000. Legal or total blindness occurs at a rate of 0.06 over 1000. According to the World Health Organization, an estimated 19 million children under age 15 are visually impaired. Of these, 12 million children are visually impaired due to refractive errors, a condition that could be easily diagnosed and corrected.

How is it diagnosed or detected?

Some disorders will be discovered at birth if the vision impairment has observable characteristics such as cataracts or congenital glaucoma. Many, however, go undetected until the child does not meet certain visual milestones.

Generally, if the child is not meeting typical vision milestones by around three or four years, they can be referred to an ophthalmologist. Proper diagnosis cannot be made without a thorough exam from an ophthalmologist.

Additional Resources:

Canadian National Institute for the Blind (CNIB) – www.cnib.ca
The CNIB provides relevant, specialized services nationwide. They support and/or conduct research about vision to ensure the continued development of services. The CNIB also supports medical research and influences public policy, and the development of technology that helps people who are blind or visually impaired lead independent lives.

Vision Institute of Canada – https://www.visioninstitutecanada.com
The Vision Institute is a not-for-profit optometry clinic. Regular and specialized eye care services are provided to the general public and to persons with special needs. All funds raised support services to persons in chronic care facilities and to persons with visual impairments, brain injuries, developmental disabilities and unique vision problems.

Persons with Disabilities Online – www.pwd-online.gc.ca/
It provides access to services and information for persons with disabilities, family members, caregivers and all Canadians.

Books and Literature:

Essential Elements in Early Intervention: Visual Impairment and Multiple Disabilities
By Deborah Chen

Children with Visual Impairments: A Parents’ Guide
By M. Clay Holbrook

Using the Online Stories to Share Experiences

Each of the on-line stories highlights one of the three areas in “Skills for Success”. Each area contains a wide variety of tips and activities that you can use to help prepare your child for school.

Stories are an excellent way to develop your child’s literacy skills. To learn more about literacy and young children, take a look at the workshops “Family Literacy 1: Building Self-Esteem” and Family Literacy 2: Reading and Storytelling.” As you watch the stories together, talk to your child about the pictures he sees on the screen. Continue reading for suggestions on bringing these stories to life for your child.

Let’s Bake a Cake

In this story, the class works together to bake a cake. Each child shares in the chores as well as the fun of making and eating the cake. This story teaches children about waiting, taking turns, and co-operating in a concrete way. For example, the class has to wait for the cake to bake before they can eat it.

  1. Practice identifying and naming foods with your child by creating a grocery list together. Get a supermarket flyer and ask your child to circle or cut out items you need to buy.
  2. Create picture sequences to show your child the steps to making simple snacks such as fruit salad or a sandwich.
  3. Teach your child how to name and use dishes such as plates, spoons, bowls, and cups. For example, he can eat with a spoon or use it to stir like Abby and Akbar do in the story.
  4. This is a good time to talk to your child about kitchen safety. Remind your child not to go near the stove or use a knife.
  5. Try singing the song, “This is the way we….” when teaching your child a new skill.

The First Snow

Although Jing –Mei makes a few mistakes when she is taking her snowsuit off, she receives help and encouragement from Greg and Mrs. Patel. Your child will learn that it is O.K. to make mistakes when learning a new skill.

  1. In the story, Jing-Mei walks to school with her grandmother. Talk to your child about how he gets to school.
  2. Help your child identify his belongings and where they go in your home when he is not using them. For example, his clothing goes in a drawer and his jacket goes on a hook near the door.
  3. Teach your child to identify and name different types of clothing. You can also emphasize action words such as “on”, “off”, and “pull” when he is getting dressed.
  4. Talk to your child about the seasons. In the story it is winter. What will it look like outside in the spring, summer, or fall?
  5. Talk to your child about dressing for different types of weather. In the story it is wintertime. What will Jing-Mei wear in the summer? What should Jing-Mei wear if it rains?

Play Time

In this story, Zack uses his communication book to communicate with his friend Costa. When he watches this story, your child will get an idea of what kindergarten is like. For example, sometimes he will be able to choose what he wants to do and other times he will be expected to join the group.

  1. In the story, Zack plays with blocks and the sand table. Ask your child what activities he likes.
  2. Zack uses his communication book to ask Costa to play with him. Show your child what he can do to ask someone to play with him.
  3. Zack and Costa built a block tower together. Invite your child to build a tower with you. Talk about the colours and number of the blocks you use.
  4. In the story, Mrs. Kim asks Zack and Costa to tidy up. Show your child what he can do to help tidy up at home.
  5. When Zack needs to use the washroom he lets Costa know by pointing to a picture in his communication book. Show your child what he can do to let other people know when he needs to use the washroom.

Tourette Syndrome

Fact Sheet

What is Tourette Syndrome?

Tourette Syndrome (TS) is a neurological disorder which becomes evident in early childhood or adolescence between the ages of 2 and 15 years. Tourette Syndrome is defined by multiple motor and/or vocal tics lasting for more than one year. Tics are defined as sudden, intermittent, repetitive, unpredictable, purposeless, non-rhythmic, involuntary movements or sounds. Many people with TS have only motor tics or only vocal tics. The first symptoms usually are involuntary movements (tics) of the face, arms, limbs or trunk. These tics are frequent, repetitive, and rapid. The most common first symptom is a facial tic (eye blink, nose twitch, grimace), and is replaced or added to by other tics of the neck, trunk, and limbs.
These involuntary (outside the person’s control) tics may also be complicated, involving the entire body, such as kicking and stamping. There are also verbal tics. These verbal tics (vocalizations) usually occur with the movements. Later, they may replace one or more motor tics. These vocalizations include grunting, throat clearing, shouting, and barking. The verbal tics may also be expressed as coprolalia (the involuntary use of obscene words or socially-inappropriate words and phrases) or copropraxia (obscene gestures).

How is it manifested?

Simple:
Motor – eye blinking, head jerking, shoulder shrugging, and facial grimacing
Vocal – throat clearing, yelping and other noises, sniffing, and tongue clicking

Complex:
Motor – jumping, touching other people or things, smelling, twirling about and, although very rare, self-injurious actions including hitting or biting oneself
Vocal – uttering ordinary words or phrases out of context, echolalia (repeating a sound, word, or phrase just heard), palilalia (repeating one’s own words) and in rare cases, coprolalia (vocalizing socially-unacceptable words)

The range of tics or tic-like symptoms that can be seen in Tourette Syndrome is enormous. The complexity of some symptoms often confuses family members, friends, teachers, and employers who may find it hard to believe that the actions or vocal utterances are “involuntary”.

Who is affected?

While once thought to be rare, TS is now seen as a relatively common disorder affecting up to 1 person in every 2,500 in its complete form and three times that number in its partial expressions that include chronic motor tics and some forms of obsessive-compulsive disorder. One in 100 Canadians has Tourette Syndrome. TS is a genetic condition. Studies indicate that a person with TS has a 5-15% chance of having a child, sibling, or parent with the condition.

How is it diagnosed or detected?

A diagnosis is made by observing symptoms and by evaluating the history of their onset. No blood analysis, X-ray or other type of medical test exists to identify TS. A doctor may, however, wish to order an EEG, CAT scan or certain blood tests to rule out other ailments that could be confused with TS.

Additional Resources:

Tourette Syndrome Foundation of Canada (TSFC) – www.tourette.ca
The Foundation disseminates educational material to individuals, professionals and agencies in the fields of health care, education and government through its local affiliates. These Chapters, Resource Units and Contact Representatives across the country help TS patients and their families cope with the problems that so often occur with a diagnosis of TS.

Life’s A Twitch – www.lifesatwitch.com
“Life’s a Twitch” is a website based on Tourette Syndrome and associated disorders from the study and clinical work of B. Duncan McKinlay, Ph.D., C.Psych., a Canadian Psychologist registered to work with children and adolescents in the areas of clinical and school psychology.

Tourette Syndrome – Now What? – http://tourettenowwhat.tripod.com/
This site raises awareness about the full spectrum of Tourette’s Disorder, with support and accurate information based on the latest research.

Books and Literature:

Children with Tourette Syndrome: A Parents’ Guide
By Tracy Lynn Marsh

Kids in the Syndrome Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar and More!: The One Stop Guide for Parents, Teachers, and Other Professionals
By Martin Kutscher

Tourette’s Syndrome: Finding Answers and Getting Help
By Mitzi Waltz

The content contained in this document is for general information purposes. It is not the intention to diagnose or treat a child.

Talking Matters

A guide to communicating with your child

Toronto Preschool Speech and Language Services: A community partnership designed to deliver speech and language services for infants, toddlers, and preschool children. This tip sheet tells you how most children learn to communicate and respond to language at different ages.

Babies (0-24 months) learn to communicate by listening to voices and sounds. A baby soon learns to make sounds to tell you how they feel or what they want. Babies develop at their own rate. Some babies do things at a young age; some will take a little longer.

Which language should I use with my child?

Many children grow up in homes where languages other than English (or French) are spoken. Parents often wonder which language they should use with their child. The research shows that it is important to maintain family and cultural connections with the child’s home language. Therefore, parents should use the language or combination of
languages that they would typically use at home.

If your child’s first language is not English, please use the suggestions in this brochure in the home language of your child.

When determining whether your child has a speech and/or language delay, your child’s skills in their first language should be used.

BY SIX MONTHS

Does your child:

  • startle in response to loud noises?
  • turn to where a sound is coming from?
  • make different cries for different needs (hungry, tired)?
  • watch your face as you talk to her/him?
  • smile/laugh in response to your smiles and laughs?
  • imitate coughs or other sounds such as ah, eh, buh?

Call for help if your baby

  • Does not react to your voice or other sounds.
  • Does not smile or make sounds when awake.
  • Does not seem to enjoy interacting with you
  • Does not look at you or try to get your attention

What you can do:

  • Pause in the middle of a song. Watch for your baby to ask for more; finish singing the song.
  • Name objects your baby touches or looks at (“Oh, a diaper. You’ve got the diaper.”).
  • Shake noise makers in front of your baby, then stop. See if your baby asks for more by looking for it or by imitating the action. Then shake it again.
  • Sing lots of songs or nursery rhymes (Peek-a-Boo, Pat-a-Cake, Up & Down, tickle games).
  • Talk to your baby when you are washing, dressing or feeding them.
  • Use gestures with your words (eg. hands up when saying “up”)
  • During bath time, name each body part as you wash it. Play games like “This Little Piggy Went to Market”; “Head and Shoulders, Knees, and Toes”.
  • Put a favourite toy in front of your baby just out of reach. Wait and see how they show you they want it.
  • Show your baby picture books and talk about what you see.
  • Make fun sounds with your baby, like “shhhh”, “boom”, “uh oh” and animal sounds
  • Exaggerate your facial expressions and tone of voice
  • Get down on the floor and play with your baby

BY 12 MONTHS

Does your child:

  • follow simple one-step directions (sit down)?
  • look across the room to a toy when adult points at it?
  • consistently use three to five words?
  • use gestures to communicate (waves hi/bye, shakes head for no)?
  • get your attention using sounds, gestures and pointing while looking at your eyes?
  • bring you toys to show you?
  • perform for social attention and praise?
  • combine lots of sounds together as though talking (abada baduh abee)
  • show an interest in simple picture books?

Call for help if your child

  • Does not make sounds or babble.
  • Does not show interest in you or other people.
  • Does not actively take turns in familiar games with adults (handing something back and forth, knocking down stacked blocks, dumping out containers, banging on pots).
  • Does not try to show you things by looking or reaching.

What you can do

  • Talk about things you see and what people are doing during the day and as you look at books.
  • During everyday activities, talk about what you are doing using short sentences.
  • Name pieces of clothing and body parts for your child (“shoe off”, “hat on”).
  • Play: “Where did you go?” when putting clothing over your child’s head.
  • Sing simple songs with actions. Help your child to copy your actions and sounds (“Ring Around the Rosie”, “Row, Row, Row Your Boat”).
  • Sing children’s songs in the language that you use at home.
  • Talk in short sentences (“Want some milk?” or “Whoops! Fall down”. “Oh, baby is crying.”).
  • Play Peek-a-Boo by taking turns hiding behind your hands, a towel or blanket. Move it away saying: “Where’s Daddy?, Here I am,” or “Peek-a-Boo.”

BY 18 MONTHS

Does your child:

  • understand the meaning of in and out, off and on?
  • point to several body parts when asked?
  • use at least 20 words consistently?
  • respond with words or gestures to simple questions (Where’s teddy? What’s that?)
  • demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)?
  • make at least four different consonant sounds (p ,b, m, n, d, g, w, h)?
  • enjoy being read to and sharing simple books with you?
  • point to pictures using one finger?

Call for help if your child

  • Is not trying to talk.
  • Does not make gestures or sounds.
  • Started to use words, but stopped.

What you can do:

  • Take turns with your child. Bang on pots and pans, blow bubbles, push toy cars and trains, feed the baby doll.
  • Get down and play like your child does.
  • Use action words like “roll ball,” “drink milk,” “wash hands”
  • Go for a walk. Talk about what is happening.
  • Show your child picture books and talk about what you see. Remember that you can make up words to the story and read to your child in the language you use at home.
  • Visit places like the grocery store, Early Years Centre, library, and zoo and use these trips to teach your child new words

BY TWO YEARS

Does your child:

  • follow two-step directions (Go find your teddy bear and show it to Grandma.)?
  • use 100 to 150 words?
  • use at least two pronouns (you, me, mine)?
  • consistently combine two to four words in short phrases (Daddy hat. Truck go down.)?
  • enjoy being around other children?
  • begin to offer toys to other children and imitate their actions and words?
  • use words that are understood by others 50 to 60 per cent of the time?
  • form words or sounds easily and without effort?
  • hold books the right way up and turn the pages?
  • read to stuffed animals or toys?
  • scribble with crayons?

Call for help if your child

  • Lacks awareness or interest in others.
  • Cannot be understood by you at least half the time
  • Does not put two words together.
  • Does not use a variety of words (actions, descriptors, locations, etc)
  • Stutters

What you can do

  • Take your child to an Early Years Centre, a library, and/or other places with fun programs for children.
  • Take turns tickling, feeding, and rocking dolls or teddy bears.
  • Sing simple songs with actions (Eensy Weensy Spider, Round and Round the Garden).
  • Repeat back what your child is trying to say with the correct grammar (Child: “Mommy work.” Adult: “Yes. Mommy is at work.”).
  • Talk about what you are doing during daily activities.
  • Use two to four word sentences when talking (“Look up! I see a cat.”)
  • Expand your child’s world by introducing new people and new places. Talk about the experience before you go, while you are there and when you get home.
  • Hide objects under/behind pillows, blankets, furniture. Ask: “Where’s the ball?” or “Find the teddy.”
  • Point to and talk about people and things when looking at books
  • Remember to tell stories from your home language and culture.
  • Look at your child when you are talking to each other.

Between the ages of two and four years a child’s speech and language develops quickly. The number of words they can say increases rapidly and they put together longer and longer sentences. They begin to ask many questions during their everyday activities. They enjoy listening to stories and music. Often they will ask you to read the same story over
and over again. Sometimes they will remember the words in the stories so well, it will seem like they can almost read.

BY THREE YEARS

Does your child:

  • understand who, what, where and why questions?
  • create long sentences using five to eight words?
  • talk about past events (trip to grandparents house, day at child care)?
  • tell simple stories?
  • show affection for favourite playmates?
  • engage in multi-step pretend play (pretending to cook a meal, repair a car)?
  • talk in a way that most people outside of the family understand what she/he is saying most of the time?
  • have an understanding of the function of print (menus, lists, signs)?
  • show interest in, and awareness of, rhyming words?

Call for help if your child

  • Acts frustrated when trying to communicate.,
  • Does not put more than three words together.
  • Does not seem to understand what you are saying.
  • Is not understood most of the time by others.
  • Stutters

What you can do

  • Describe things that are happening using sentences (“I’m really HUNGRY. That’s a HUGE bite.”).
  • Talk about how things are the same or different.
  • Arrange times for your child to play with other children his/her own age.
  • Repeat what your child says using correct sounds and sentences (Child: “Me want doose.” Adult: “I want juice too. I like juice!”).
  • Play games together.
  • Add information to what your child says (Child: “There are flowers” Adult: “That’s a daffodil and a tulip. They grow in the spring.”).
  • Ask your child to be a helper and give them small jobs to do.
  • Read books with pictures and take turns telling little stories about the pictures.
  • Play make-believe with or without toys (pretend to go shopping, dress-up, play with pretend toy garages/kitchen sets,).
  • Sort pieces of clothing together while doing laundry (sort by colours, who they belong to, where they go, type of clothing).

BY FOUR YEARS

Does your child:

  • follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy.)?
  • tell stories with a beginning, middle and end?
  • try to solve problems with adults and with other children using words?
  • show increasingly complex imaginary play?
  • talk in a way that he/she is understood by strangers almost all the time?
  • generate simple rhymes (cat-bat)?
  • match some letters with their sounds (letter b says buh, letter t says tuh)?

Call for help if your child

  • Is not understood almost all the time by others.
  • Does not use complete sentences.
  • Stutters.

What you can do:

  • Talk about what you and your child are doing/interested in.
  • Play simple board games/card games helping them to match and name colours/shapes, count, and follow directions (Snakes & Ladders, Go Fish).
  • Repeat clearly words and sentences your child has difficulty saying (Child: “Him “wunning” outside.” Adult: “Yes, he is. He is running outside.”).
  • Let your child make up and tell stories using puppets, toys, objects, books or pictures
  • Read longer stories to your child.
  • Give your child opportunities to regularly play with children his/her own age.

This material has been adapted from First Words (Ottawa-Carleton Preschool Speech and Language Service) and The Language Express (Preschool Speech and Language Services System of Lanark, Leeds and Grenville).

For Help

For help call the Central Referral and
Information Line
416-338-8255
416-338-0025 (TTY)

Or call your local Quadrant
East Quadrant 416-281-7445
Rouge Valley Health System Centenary Site

North Quadrant 416-491-1230
North York General Hospital

South Quadrant 416-921-4498
The Hanen Centre

West Quadrant 416-622-8315
The George Hull Centre

French Language 416-491-1230
Services (En Français)
North York General Hospital

Sensory Processing Disorder (SPD)

Fact Sheet

What is Sensory Processing Disorder (SPD)?

Sensory Processing Disorder (SPD), previously known as Sensory Integration Dysfunction –SID, is a complex disorder of the brain that affects developing children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, seek out intense sensory experiences, or have other symptoms.

“Sensory processing” refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For most people, this process is automatic. When we hear someone talking to us, or a bird chirping, our brains interpret that as speech, or an animal sound, and we respond to that information appropriately.

Children who have a Sensory Processing Disorder (SPD), however, do not experience this process in the same way. SPD affects the way their brains interpret the information that they take in and also how they act on that information in terms of emotional, behavioural, motor, and other responses.

How is SPD manifested?

There are several types of Sensory Processing Disorder. Each one may result in a number of different behavioural and sensory patterns. Some of the most common behaviour patterns are described below:

Sensory-Avoiding Children

Some children with SPD are over-responsive to sensation. Their nervous systems feel sensation too easily or too intensely, and they feel as if they are being constantly bombarded with information.

Consequently, these children often have a “fight or flight” response to sensation. This condition is called “sensory defensiveness”. They may try to avoid or minimize sensations, such as by avoiding being touched, or being very particular about clothing.

These children may

  • respond to being touched with aggression or withdrawal
  • fear movement and heights, or get sick from exposure to movement or heights
  • be very cautious and unwilling to take risks or to try new things
  • feel uncomfortable in loud or busy environments, such as sports events or malls
  • be very picky eaters and/or overly sensitive to food smells

These children may be diagnosed with Sensory Over-Responsivity.

Sensory-Seeking Children

Some children are under-responsive to sensation. Their nervous systems do not always recognize the sensory information that is coming into the brain.

As a result, they seem to have an almost insatiable desire for sensory stimulation. They may seek out constant stimulation or more intense and/or prolonged sensory experiences, such as taking part in extreme activities or moving constantly.

Some behaviours seen in these children include

  • hyperactivity as they seek more sensation
  • unawareness of touch or pain, or touching others too often, or too hard (which may seem like aggressive behaviour)
  • taking part in unsafe activities, such as climbing too high
  • enjoying sounds that are too loud, such as a very loud television or radio

These children may be diagnosed with Sensory Under-Responsivity.

Motor Skills Problems

Other children with SPD have trouble processing sensory information properly, resulting in problems with planning and carrying out new actions. They have particular difficulty with forming a goal or idea, or developing new motor skills.

These children may have

  • poor fine motor skills, such as handwriting
  • poor gross motor skills, such as kicking, catching, or throwing a ball
  • difficulty imitating movements, such as when playing “Simon Says”
  • trouble with balance, sequences of movements, and bilateral coordination
  • a preference for familiar activities or play, such as lining up toys
  • a preference for sedentary activities, such as watching TV, reading a book, or playing video games

These children may get frustrated easily and may seem manipulative and controlling. Some may try to compensate with an over-reliance on language and may prefer fantasy games to real life. They may also try to mask their motor planning problems by acting like a “class clown” or avoiding new group activities.

These children may be diagnosed with Dyspraxia (sensory-based) Motor Planning Disorder.

Who is affected?

Studies show that as many as five percent of all children suffer from SPD or approximately 1 in 20 children. Yet despite this high rate, information and help for those with this disorder is still very limited. This lack of resources, combined with the fact that SPD often looks like other disorders, often results in misdiagnosis and inappropriate treatment for many children.

How is SPD diagnosed or detected?

While many children display the above behaviours, consider whether a child shows them more often and more dramatically than other children of the same age. Behavioural signs include

  • over- or under-sensitivity to touch, sounds, sights, movement, tastes, or smells
  • intense, out-of-proportion reactions to everyday experiences
  • resistance to changes in routines and moving from activity to activity
  • unusually high or low activity level
  • difficulty handling frustration
  • impulsivity, with little (or no) self-control
  • difficulty paying attention and staying focused
  • dislike of getting “messy” (food, sand, glue, paint, lotion), especially on hands or face
  • discomfort with certain clothing fabrics, seams, tags, waistbands, etc.
  • resistance to grooming activities such as brushing teeth, hair washing, or nail cutting
  • avoidance of touch or needing it more than other children
  • unusually high or low pain tolerance
  • fear of movement activities (e.g., swings, see-saw, etc.)
  • avoidance or excessive cravings for slides, swings, bouncing, rocking, jumping
  • poor balance, frequent falls, or awkward running
  • weakness or less coordination than other children his age
  • walking on tiptoes
  • touching of walls or furniture when walking
  • pushing, hitting, biting, or banging into other children although he is not aggressive
  • overly sensitivity to noise (e.g., sirens, vacuum cleaner, etc.)
  • hearing things you do not hear
  • not responding to you, although you know he can hear
  • getting dizzy easily, or never at all
  • squinting, blinking, or rubbing eyes frequently
  • having trouble reading
  • withdrawing, “tuning out,” or crying in group situations
  • avoidance of foods most children of same age enjoy
  • craving or avoiding particular food textures (e.g., chewy, crunchy, slippery, etc.)
  • frequently chewing on clothing or hair
  • difficulty with fine motor tasks (e.g., writing, buttons, stringing beads, using scissors, etc.)
  • poor handwriting and drawing skills
  • speech-language, motor skill, or learning delays
  • inconsistent sleep and hunger patterns

Many children show these signs for a variety of reasons. Some of these behaviours are appropriate at certain ages. Most toddlers can be impulsive (i.e. the terrific but “terrible” two’s). However, a 10-year-old who acts on every little impulse is a different matter. A strong dislike of wool clothing, discomfort making eye contact with strangers, or fear of a goat at the petting zoo that bleats loudly and unexpectedly all fall within the range of so-called typical sensory sensitivity for a child so long as these sensory experiences do not interfere with his/her day-to-day function. A child with sensory problems usually has maladaptive responses to everyday situations and consistently displays behaviours that are not age-appropriate and that cannot be dismissed.

Additional Resources:

STAR Institute for Sensory Processing Disorder – www.spdstar.org
This is a network for families and professionals with resources that can help you learn more about SPD and find effective treatment.

Books and Literature:

Parentbooks – www.parentbooks.ca
Parentbooks offers the most comprehensive selection of resources available anywhere – from planning a family, to everyday parenting issues for special needs of all kinds. The selection of resources for caregivers, counselors, therapists, educators, and clinicians serving the everyday and special needs of families is unequaled. It can help you find exactly what you need for a specific client or situation, and also help you build your professional library.

Building Bridges with Sensory Integration
By Ellen Yack, Shirley Sutton, & Paula Aquilla

Sensory Integration and the Child
By Jean A. Ayres

SenseAbilities – Understanding Sensory Integration
By M. Colby Trott, M.K. Laurel & S.L. Windeck

The Out-of-Sync Child
By Carol Stock Kranowitz

Sensational Kids: Hope and Help for Children with Sensory Processing Disorder
By Lucy Jane Miller

The content contained in this document is for general information purposes. It is not the intention to diagnose or treat a child.

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