Activities of Daily Living (ADLs) are defined as “the things we normally do including feeding ourselves, bathing, grooming, dressing, work, homemaking, and leisure. Dressing tasks are part of the ‘Basic Activities of Daily Living’ within the self-care functional skills category.
The news of a snow day is one of the best surprises! More than one day off is beyond exciting! By the 3rd day off, cabin fever is likely settling in. Click the link to check out some fun, cheap and engaging snow day activities!
Ice and snow accumulation continue to be a concern in Charlotte and the surrounding areas. For the safety of our clients and staff, Child & Family Development will be opening at 10:00am on Friday, January 19th. We look forward to seeing you!
Topics: C&FD Office Locations
We are aware of the potential for inclement weather in and around the Charlotte area this evening. In the event that our office closes due to poor weather conditions, we will post our closing on WCNC and WBT. Our phone lines will also be updated with a closing message. Stay warm out there!
Topics: C&FD Office Locations
The holidays are a time for giving. Chances are your child has been doing quite a bit of receiving as well. Taking the time to write thank you notes is a great way to help kids show their appreciation for the gifts they have received this holiday season. However, not all children are quick to grab a pencil and get started. Here are some tips for helping your "reluctant writer" compose a note of thanks.
PAIN IN CHILDREN AND TEENS
Pain in children and teens is complex and may be difficult to diagnose. In kids, the nervous and musculoskeletal systems are still developing. A child’s perception of pain is different from an adult. Children may be unable to differentiate or describe types of pain (I.e. sharp, dull and intense). Some types of pain are straightforward (i.e. post-injury) and other types require more analysis and research (i.e. pain from migraines, pain following a virus, pain after surgery, fibromyalgia, chronic pain and Complex Regional Pain Syndrome (CRPS).
Pain in children and teens is broadly referred to as Amplified Musculoskeletal Pain (AMP). Complex Regional Pain Syndrome (CRPS) is another name for AMP. AMP can impact physical activity, mood, school performance, sleep and many other areas. It is chronic pain.
WHAT IS CHRONIC PAIN?
The simple description is pain that lasts longer than 3 months and interferes with a person’s ability to participate in activities of daily living.
WHAT IS CRPS/AMP?
Either is a condition of severe localized pain. It is difficult to diagnose and is usually diagnosed by ruling out other possible conditions or diseases. Its prevalence is probably under identified in children and adolescents. It occurs in girls more often than boys. It involves the lower extremities more often than upper extremities. It can move from one extremity to another.
INDICATORS OF AMP/CRPS:
- A known cause or event that starts the pain cycle, but not always in children
- Severe pain with light touch or skin, pain response which is disproportionate to injury or continuous pain
- Changes to the area affected such as swelling, blood flow, hair growth or skin color
- No other clear cause of pain or inability to move
- No obvious nerve damage
EVIDENCE BASED TREATMENT
Elusive pain disorders can be very upsetting for families. Traditional medical care may fail when there is no designated reason for the pain, customary techniques are not beneficial or medications cannot or should not be sustained over a period of time.
A multidisciplinary approach is often recommended, including:
- physical therapy
- occupational therapy
- psychological intervention
- Physician-prescribed mild medications
Treatment strategies include:
- child and caregiver education
- relearning normal use of the affected body part
- strengthening of the affected body part
- coping skills to manage emotional components such as relaxation and mindfulness
- mobilizing community resources
- restoration of function
- pain relief
- reduced school absenteeism
- social inclusion, not isolation
- improved self awareness
HAVE A CONCERN?
Child and Family Development physical therapists, occupational therapists and psychologists can help your child get back to his/her healthy, happy self. You will be amazed at the ability to retrain the brain and body! Click below to learn more about each of these services:
Click here for a printable page about pain.
Parents are faced with managing a child's seemingly inexplicable behaviors that are greatly impacting the way they function within their family unit, at school, and in the community. Some behaviors are environmental and may be influenced by parenting or discipline. Other times behavior may be emotional and related to anxiety or depression. Behavior can also be related to a diagnosis such an ADHD or a learning disability. However, these are not always the explanation of for behavior problems in children. These behaviors may occur due to Sensory Processing Disorder or Sensory Integration Dysfunction.
Child and Family Development is pleased to expand our services to include: Multidisciplinary Feeding Evaluations & Clinic Services
This specialty clinic offers both multidisciplinary evaluations and treatment services for children, ages 4-16 years old, with feeding disorders and/or extreme picky eating. This service is appropriate for children or adolescents who have been formally diagnosed with Avoidance/Restrictive Food Intake Disorder (AFRID).
This clinic occurs at our Pineville office with an expert diagnostic team including:
• psychologists and counselors
• occupational therapists
• speech therapists
Feeding problems are characterized by:
• A restricted range or variety of foods, usually less than 20 items
• Resistance to adding new foods
• Refusal of categories of food textures, temperatures or appearance
• Long feeding/ meal times (more than 30 minutes)
• Frequent gagging or vomiting
• Taking a few bites and then refusing more food
The Sequential Oral Sensory Feeding Approach™ (SOS) model will work to expand children’s food repertoire, improve oral motor skills, and develop socially acceptable feeding behaviors. It is designed to help increase a child’s comfort with eating both in the home and community. The focus of treatment will be on food exploration in a comfortable and sensory supportive environment and will also include a parent education component. Many of our speech therapists and occupational therapists have specialty training in both the sensory and motor aspects of a feeding or swallowing problem. Treatment for feeding disorders can help a child become a functional eater. Treatment strategies include work on oral sensory awareness, motor execution and motor planning tasks, social modeling, structured meal and snack times, positive reinforcement and home programming. These services are designed to provide parents with the training they need to target their child’s eating strategies outside of the clinic and produce positive outcomes.
EVALUATIONS: The evaluation would include an examination of the structures and movements in the mouth, observation of feeding behaviors, observations of the influences of respiration and posture, and informal assessment of nutrition. Food and drink trials are often included in an assessment. Review of medical history form and other records which are shared prior to first appointment. Standardized behavioral questionnaires are provided for parents and teaching/daycare staff to gain information on skills in the home/school settings and to identify any psychological symptoms which warrant specific treatment (e.g., anxiety). Consultative time is an essential portion of this specialty service and is an out of pocket expense.
• Intake 1-hour diagnostic interview with psychologist for parents only
• Testing Session: 1 ½ hour evaluation with both speech therapist and occupational therapist. This allows comprehensive observation of skills and represents a best-practice approach to evaluation services for feeding therapy.
• Interpretive Parent Conference (IPC): 1 hour appointment with parents and members of the diagnostic team during which parents are able to thoroughly understand their child’s development and feeding therapy plan. A written report includes findings, diagnostic impressions and recommendations.
Estimated evaluation cost: $2,381.00 (partially billable to insurance); may be billable to insurance ($1,205.00) and out-of-pocket only ($270.00).
FEEDING CLINIC SERVICES: The clinic starts with a parent interview with a psychologist or counselor to review the child’s medical history and gather detailed information about the child’s feeding history, mealtime environment, and related behaviors. A behavioral questionnaire is provided to parents and teachers/childcare providers to gather information from both settings. The feeding clinic provides a 12 week structured curriculum to provide parents with all of the skills and knowledge they need to continue to produce positive outcomes after the clinic ends.
The clinic services are a 2-pronged approach that provides individualized intervention. Parents meet with psychologists and counselors without their children present to learn detailed strategies that work to change their child’s behaviors and approach to food (approximately 8 sessions). Parents and children also participate in several joint sessions to learn effective interventions to learn coping strategies and reduce anxiety (approximately 4 sessions).
Children work 1:1 with a feeding therapist using the (SOS) model with a focus on safe food exploration in a comfortable and sensory supportive environment. This evidence-based program includes a comprehensive parent education component, and parents are expected to participate on all feeding sessions in order to understand their child’s feeding behavior and effective management interventions.
A parent only summary session is provided at the end of the 12 week course with both feeding therapist and psychologist/counselor to review progress and provide a specific plan for next steps.
Both rehabilitation and psychological treatment is billable to insurance. Psychologists and counselors are in-network with Aetna and BCBS. Deductibles and copays apply. An out of pocket charge is included in the registration for services which covers consultative time for treatment team members to meet to discuss each case in detail.
Estimated clinic services cost: billable to insurance – 12 weekly therapy sessions for both psychology and rehab services and self-pay only - $ 336.00
Read more about the C&FD multidisciplinary feeding clinic here.
Many moms and dads who contact Child & Family Development report that their child is “a little clumsy”. In many instances, it can be difficult to recognize if this is simply part of development and adjusting to a growing body or an area to be explored more specifically. The explanation may be developmental dyspraxia.
The physical therapy team provides this explanation.
Developmental dyspraxia is a motor learning difficulty that can affect planning of movements and coordination as a result of brain messages not being accurately transmitted to the body.
Do you describe a child in these ways?
· Bumping into things all the time, or accident-prone
· Inability or difficulty with skipping, jumping rope or climbing
· Strong but not very coordinated
· Falling out of chairs, knocking things over or messy
· Awkward or difficulty walking or running
· Difficulty playing, participating, or insecurities with sports or games
Children with dyspraxia have particular problems learning new motor skills and activities and coordinating the upper and lower limbs of the body. To efficiently move through the environment and learn new skills, the body relies on sensory systems- tactile (touch), vestibular (movement) and proprioceptive (how muscles perceive actions). If these systems are not properly integrated, a child appears clumsy.
Some characteristics of developmental dyspraxia are:
· Awkward gait movement
· Decreased sense of body awareness
· Emotional lability, sensitivity or appears distracted
· Difficulty judging distances
· Difficulty imitating body positions
· Poor balance
· Poor sequencing of activities
· Poor short and/or long term memory
· Slow movement planning and reaction times in both fine motor gross motor
Even if only a few of these characteristics are noted in a child, an evaluation could be the first step to address the issue. While there is no cure for dyspraxia, a trained pediatric occupational therapist or physical therapist can assist the child in learning ways to improve their motor planning abilities and becoming more successful with gross motor learning and performance.
Current data notes that 6% of all children ages 5-11 have a developmental coordination disorder. It is important to note that motor difficulties are likely to coexist with several other diagnoses, including:
· Auditory Processing Disorder
· Executive Function Disorder
· Low Birth Weight
· Sensory Processing Disorder
There are treatment options for developmental dyspraxia. There are several types of praxis (movement) that may be addressed in therapy. These types include: oral, sequential, postural, constructional, and praxis on verbal command.
Research shows that a combination of strength and coordination goals, as well as work on specific functional skills (climbing stairs, skipping) is most effective. A therapist can, through play and exploration of new motor activities, address the affected area(s) of praxis and improve overall motor planning and abilities.
Advanced training and techniques are used in treatment of developmental dyspraxia:
· E-Stimulation (E-Stim)
· Neuro-Developmental Treatment (NDT)™
· Sensory Integration
· Total Motion Release (TMR)®
A child’s first steps bring a lot of excitement. It is a huge developmental accomplishment and certainly should be celebrated. Often times, parents see walking as the first big milestone, The physical therapists and occupational therapists at Child and Family Development know that there are many important motor skills that infants should learn and do long before they walk.
One of these important pre-walking milestones is independent crawling. Sometimes, when babies skip crawling, it seems as if they are “advanced.” The truth is that crawling first is strongly preferred since it provides important input to the entire body with long-lasting benefits. Here are some of the main reasons why it is important to encourage and allow a child to crawl:
Crawling works on coordinating the two sides of the body:
- When a baby crawls, it is the first time they are required to coordinate the two sides of their body to move in a different way. Crawling activates both hemispheres of the brain in a balanced and reciprocal way.
- The first time that a baby is able to independently move in a forward direction is during crawling. The eyes must scan the environment and in order to do so, the baby must look across the mid line of their body. This helps to develop eye-hand coordination.
Crawling helps to develop trunk and extremity strength and flexibility:
- One of the requirements of crawling is for a baby to be able to hold their body off of the ground against gravity for an extended period of time. This requires a lot of core strength! Crawling is definitely a full body strengthener- it helps to build the muscles of the neck, the stomach, the back, the arms, and the legs.
Crawling provides the ability to see the environment in a different way:
- Crawling enables exploration and manipulation of the environment. The eyes are required to look in all directions to scan the environment. All of this exploration and discovery leads to brain development, and can help to improve cognition.
Crawling works on the development of the arches in the hands and strengthens the wrists and shoulders:
- When babies crawl, it is the only time they are naturally bearing the weight of their body through their arms. This is important for developing strength in the shoulders, wrists, and hands. As a child gets older, they will need hand strength in order to use utensils and to hold a pencil to write. One of the first questions our occupational therapists ask when a child comes in for an evaluation due to poor handwriting is “did the child ever crawl?” Lots of times poor handwriting can be due to weakness in the hands and wrists, and crawling helps to strengthen all of these muscles in preparation for the development of fine motor skills.
Crawling can help to integrate sensory information that is coming into the body:
- Crawling provides lots of tactile (touch) stimulation through both the hands and the feet. This kind of stimulation helps improve body awareness, or the ability to recognize where the parts of your body are in space without having to look at them. As babies continue to grow, it becomes more and more important to be able to move the parts of the body without having to look to see where they are. Being able to experience different sensations coming into the brain from the arms and legs helps the child to integrate sensory information.
Although crawling is not the only skill that helps to develop all of these areas, it is unique because it provides the many benefits all at once. Encourage crawling and enjoy it while it lasts. You can feel confident in the fact that it is good for not only the body, but also for the brain!
Topics: C&FD Physical Therapy Services
Topics: Marie Arrington
Kristin Lyman MA CCC-SLP is pleased to offer SPEECH & LANGUAGE SOCIAL SKILLS GROUPS at the Pineville office of Child and Family Development. Speech therapists work with kids and teens to improve social skills. When there are shared goals, groups can be formed to expand opportunities for practice and friendships.
Objectives Social skills groups are for children who struggle during interactions with others. Participants focus on practical conversational skills, such as:
- Expressing yourself
- Initiating and maintaining conversations
- Social awareness
- Reading nonverbal language from others
- Problem solving difficult situations
In the group setting, speech therapists facilitate the interactions to help children understand how to navigate various social situations. Sessions involve a variety of activities including lessons, turn-taking games, social stories, and role-playing for application of skills. Groups are typically formed by age, but communication skills are considered too:
- 6 years old and under
- 7-14 years old
- 15+ years old
Here's what some parents say about these groups:
- “<My child> has achieved a refreshing confidence and a fearless daring spirit in his language skills.”
- “<Our teen> has not only increased his speech abilities substantially, he has made a great friend!”
Scheduling These groups are ongoing, so new clients may join in at anytime. Typically, up to 4 participants are in a group.
Cost Families may use available insurance benefits. Regular deductibles and co-pays apply. Prior Authorization, medical necessity approval and evaluations are required, as applicable by funding source. Families may also pay privately. Group services are $54/ session.
Kristin Lyman, MA CCC-SLP, Speech-Language Pathologist, 704.372.9653 ext. 213
Click here to view and print the information page.
We are pleased to expand our services to include: Multidisciplinary Developmental Evaluations for children ages 24 months-4 years
Our multidisciplinary infant-toddler diagnostic team offers these specialty evaluations at our Midtown Child and Family Development office. The diagnostic evaluation assesses domains for language and communication skills, early cognitive development, adaptive functioning, play skills and symptoms associated with autism spectrum disorder (ASD).
Expert diagnostic team:
• Psychologists, Ashley Kies PhD or Devon Redmond PhD
• Speech-Language Therapist, Melinda Schatz MA CCC-SLP
Usual and customary tools:
• Autism Diagnostic Observation Schedule, Second Edition (ADOS-2®)
• Autism Spectrum Rating Scales (ASRS™)
• Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III®)
• Preschool Language Scales, Fifth Edition (PLS-5™)
• Vineland Adaptive Behavior Scales, Third Edition (Vineland-3™)
Estimated cost: $2,381.00 (partially billable to insurance)
Read more about multidisciplinary evaluations.
Reading disorders or learning disabilities, and specifically dyslexia impact approximately 20% of the population. The NC and SC public school systems have resources in special education to identify individuals with learning disabilities however, procedures and guidelines are such that most children are not identified with learning disorders until 2nd or 3rd grade and in order to be identified their delays must be significantly impacting their educational performance. Therefore, many children with mild delays simply “fall through the cracks” as their mild delays turn into moderate and severe delays without appropriate intervention. Research indicates the children make the greatest gains in learning to read in grades K through 2nd. Research has also shown that if the reading gap is not remediated by the 3rd grade, it is very hard to close. Therefore, it is imperative that professionals in the medical field collaborate with parents and educators to help identify individuals with learning disabilities.
Learning Disability sub-types:
- Dyslexia is a phonological based reading disorder which shows in an “unexpected difficulty” with reading tasks such as fluent word recognition, reading decoding, spelling and likely reading comprehension.
- Dyscalculia is a mathematics disorder in which functioning in either arithmetic calculation; math concept formation and/or speed of execution are substantially below a student’s expected level for age, ability and educational experience.
- Dysgraphia is a developmental written expression disorder in which the complex set of motor skills and information processing skills required to produce writing are delayed in handwriting, spelling and the organization of the written word on paper.
- Nonverbal Learning Disability Is not presently a diagnostic condition but rather refers to a syndrome characterized by significant deficits in motor, visual spatial and social skills resulting from an individual’s difficulty interpreting nonverbal information.
Pre-academic/Pre-school Warning Signs of Learning Disabilities:
- Late speech development
- Late development with learning alphabets letters and sounds (late is considered by 5 to 5 ½ years)
- Inconsistent development and learning of the alphabet and sounds
- Poor rhyming skills
- Avoiding drawing/coloring, pre-writing tasks
- Weak fine motor skills
- Late established hand dominance
- Immature or muddled speech (says aminal for animal)
- Difficulty with word retrieval (says ummm and thing)
- Advanced vocabulary in comparison to development of reading skills
- Late color recognition
Warning signs for school aged children:
- Oral reading is slow or labored
- Reads with substitutions, adds words or guesses at words
- Poor decoding skills (not able to properly “sound out a word”)
- Poor spelling skills (often individuals with dyslexia will spell words correctly on a spelling test ,but are not able to generalize into other day-to-day writing assignments)
- Poor fine motor skills, handwriting
- Trouble with recall or retrieval of math facts, especially quick retrieval
- Writes or reads letters and/or numbers reversed
- Doesn't enjoy reading and/or writing
Often, teachers do not pick up on signs of learning disabilities until later grades as letter reversals and poor handwriting are often times viewed as developmental concerns. However, if a parent has any concern it is best to at least speak with an educational specialist and psychologist to determine the need for evaluation. Early intervention is the key.
Click here to read more about educational testing and tutoring services at Child and Family Development.
Click here for a printable page about learning disabilities.
The John Crosland School recently held a community wide event to show the documentary, Dislecksia: The Movie. Our very own Mo Froneberger, lead the discussion after the film. According to the Yale Center for Dyslexia & Creativity, Dyslexia affects 20 percent of the population and represents 80–90 percent of all those with learning disabilities. If you have questions about Dyslexia, our educators can help.