The Jason Miller Better Health Podcast

If your child struggles with messy handwriting, then you as a parent might have more than sloppy handwriting to worry about. Kids who struggle with handwriting tend to worry more about the legibility of their words and forming letters rather than forming ideas and getting them on to paper. It's the formulation of ideas and properly expressing those ideas that's important. With Technology in schools becoming so prevalent, it's easy to let good handwriting fall off of the educational radar. However, good handwriting is still very important. If you have a child who struggles with their handwriting, I encourage you to seek help from an occupational therapist quickly.

Today, I want to talk to you about Echolalia. Many kids on the Autism spectrum, and sometimes children who are not on the spectrum, present this. While you may not have heard the name Echolalia, you have likely encountered it, especially if you have regular involvement with a developmentally delayed child or a child with special needs. Echolalia is a term that is used when a child repeats what you say without there being any function or purpose to it. A parent of a child who is speech delayed may be very excited to hear their child repeating words back to them. However, parents of these children often become discouraged when they realize that their child doesn’t understand what they are saying, and doesn’t appear to know the meaning of the words being spoken. It often starts with parents labeling various objects such as animals or vehicles. For example, a parent will say “cow” and the child will say “cow” right back. The parent notices that when he or she names any object, the child will say it right back. Sometimes, the child may pick up phrases and say them. “Here we go! or “Time to eat” and use them constantly, however, often without any type of purpose. It’s then that parents realize, that their child doesn’t really understand the meaning of the phrases they are saying. There are various approaches with which speech therapists address Echolalia, and the advice they give to parents often varies. Some say to extinguish it because it’s not purposeful speech. Some will encourage it because it is “speech”, and the words were learned in an appropriate context. I try to do a little of both. I find that the process is easier this way, although quite a bit of patience is required. In order to address Echolalia and progress it into to meaningful speech, you will need two different pictures of the same object. For example, two different drawings of a cow. In addition, I use music and video for kids who like music. I like using the classic “Old MacDonald Had a Farm.” I have a book and a video of the song. I begin with the song. I let the song play until we get to “cow.” I stop it and point to the cow and say “cow.” A child with echolalia will typically look at it and say “cow”, repeating what they just heard me say. Next, I take an Old MacDonald book, and turn to the page that has the picture of the cow. All I do, is simply point to the picture of the cow. I don’t say the word “cow” because then the child would just be repeating it. The goal is to get the child to verbally label the other picture of the cow his or herself. I’m not afraid of silence, so I wait. If the child doesn’t say anything, I go back to the original picture of a cow and say “cow” again. Then, I return to the book and point and wait. Waiting is the key! I give it about 10 seconds before I tell them the word. The goal is to link the word not just with the object, but with various forms of the object. Try this at home. However, don’t spend ages waiting for the child to say the desired word. Cue it and move on. Do it as long as they show interest, using several different animals. You want it to be enjoyable! Don’t turn it into therapy! Don’t be surprised or discouraged if your child doesn’t get it the first time. Time and consistency are needed for this approach to work. Once the child does get it, you’re onto something and you’ve got more work to do! I hope this helps. Remember each child is different and this strategy might not work for every child. My goal was to share a strategy with you, that works well for me, as I work with many different types of children to correct this problem. If you have any questions for me I encourage you to reach out to me. Thanks!

This is a clip from an interview I did from a radio show. The question spurred me to address it more fully in a video/podcast

Recently, I received an e-mail from a mother in which she included a picture of her son's bedroom door. On his door, her son had posted a hand written sign saying, "I hate you mom." She explained that her son has some developmental delays, and because of those delays, his behavior can be off at times, causing reactions such as his posting such an emotionally charged sign on his bedroom door. I felt awful for her because, as a parent of 3 myself, I know how gut wrenching it can be to hear your child utter the words "I hate you". I remember having an argument with my son when he was approximately 5 years old, over picking up his toys. I remember gettin on eye level with him and telling him to "pick that up". He, of course, refused and instead stomped off. About 10 minutes later, he came back with a folded piece of paper which he handed to me. I opened it up, to see "Daddy" written in large letters. Then he had taken a red marker and put an large "X" over the word "Daddy". I was stunned that he would have, what I felt to be, such a strong reaction to my asking him to pic up his toys. But I remember this moment so well, because I feel that this was the moment that my kids started saying "I hate you" when things weren't going their way. Of course, we correct that type of behavior at our house by reminding our children that "hate" is a very strong word that needs to he used very carefully, but it still stings. The son of the woman who sent me the picture is considerably older than my five year old, and in addition he has developmental issues that make getting through daily life a challenge for him as well as his mother. I would imagine that it is much harder to hear the words "I hate you" from an older child, especially when you have to devote so much attention to him and her to work through the developmental delays. However, parents should always keep in mind that hearing the words "I hate you" from a child, should be interpreted as a statedment of extreme frustration from that child. Nothing more. That statement in no way reflects your child's feelings about you. Most kids don't have the vocabulary to express their feelings aside from using the words "love" or "hate". Before you take to personally the "I hate you" statement, reflect on other conversations that you have had with your children. Most likely, you'll realize that they always talk about either "loving" or "hating" things or situations. Very few children will respond with statements such as "this was a very unpleasant experience" or, "I didn't like it when you did that." It is our job as parents to help them learn to better express themselves. Brainstorm other words with your children that might express what they're feeling in a better way. Talk to them about how strong the meaning of words like "love" and "hate" can be. Often children don't realize that words can have lasting effects. So, next time you are presented with that dreaded phrase, take a moment, let your child calm down, and then go and help your child find a better way to express his or her feelings.

Last week, I discussed the importance of being informed about what is happening in your child’s treatment room. I decided to address this particular question, since I have received multiple e-mails and facebook messages, asking for advice in this area. However, there is a second question I often get asked by parents. “How does my child progress, if I am never given anything to reinforce at home.” If you are asking this question, then you are the type of parent I love to work with! It shows that you are taking a lead in your child’s development, and no amount of therapy can trump that. So give yourself a pat on the back. Job well done! What should you be doing at home? This is a very simple question, but it has a very complex answer. I can’t speak for every therapist, just for myself. So, here is an example of how I work with parents of children, whom I treat in my clinic. I don’t often give a lot of “homework”. Depending on the child’s developmental level, the way I reach a goal is often through a very intricate process. Repetition and consistency are paramount! I can control the way I, myself, deliver a cue to a child, but I can’t control yours. It is so essential that that cue to be given the same way every time. Then, once the child has reached a certain level of mastery of a skill, the consistency of giving the same exact cue isn’t needed anymore. In fact, it can be harmful. I don’t want a child to be able to respond to a question only when it is presented by me, the therapist, in a certain way. I often tell the parents that I don’t need their child to learn how to communicate with a 42-year-old man. They have to learn how to communicate with mom and dad, brother and sister, friends, and grandparents. Another reason I don’t like to give a lot of “homework” is that the skill the child and I are working on is often extremely difficult and frustrating for the child. It’s strenuous for them to speak, and even though I try to make it as much ‘fun’ as I can, it is still work. Because of the difficulties of learning something new, often children rebel and fight back, or they shut down. When those resulting behaviors are directed at me during therapy, I have the training and endurance to work through those behaviors with the child. However, I don’t want the parents to have to battle with their children on a daily basis merely to reinforce a skill we are working on. I tend to tell the parents to let me be the “bad guy”, so that they can focus on just being mom or dad. I don’t want any of the children I see in therapy to feel as if every time they want to talk to their parents, they will have to work. I’m very protective of that parent-child relationship! Parents should be able to talk to their children as parents, not as therapists. Parents should always be the safe place for children to come and communicate in whatever way they feel the most comfortable! This is why knowing what is happening in therapy is so important. You definitely need to reinforce what is done in therapy in your home! Play the games your child played in therapy. When speaking with your child, use words that emphasize the sounds your child was working on with his or her therapist. But keep in mind that you do not need to “teach” a skill. The “cueing” and “teaching” should be done by your child’s therapist, in order to avoid confusion.

I have received many responses regarding my last post about whether or not you, as the parent, should be in the therapy room with your child. Many of you emailed me asking two questions. The first question many of you asked was "how do I know what is happening in therapy, if I'm not able to watch?" And the second question many of you asked was "if I'm not observing my child's therapy session, then how will I know what to do to reinforce therapy at home?" Let's talk about the first question. How do you know what is happening in your child's therapy session? Your child’s therapist should be giving you regular updates. He or she should have a scheduled time set aside to sit down and discuss with you what skills they have been working on during each session. Your therapist should also explain how they have been working on those identified skills, and share with you what progress your child has made. My biggest frustration when I supervising a new therapist or therapist in training, is when they inadequately explain what they are working on during their therapy sessions. Having a therapist say “we blew bubbles, played with blocks and colored" is simply not providing adequate information for the parent. Explaining therapy sessions in that way, makes it sound as if anyone can provide therapy, and a professional is not needed. What the therapist should have said was “we blew bubbles to try to get your child to make his mouth move to form the /f/ sound. In addition, we alternated stacking blocks in order to emphasize the importance of taking turns. Taking turns is essential for effective communication. And lastly, we colored pictures for the picture book we are creating in which we are featuring the /f/ sound that we have been working on." This way of explaining therapy is not complex ore hugely involved, but it shows that goals were set and the activities used to reach those goals had a clear purpose. If your child's therapist is not providing you with this type of information after your therapy sessions, ask questions! Having your child tell you what he or she did in therapy, does not give you enough information to provide adequate reinforcement at home. You need to know the goals that have been set for your child, and the reasons for using the chosen activities. Next week I'll discuss what you should be working on with your child at home and why you may not be hearing what you think you should.

When I evaluate a child for the first time, one of the first questions parents ask me is if they should attend the therapy session as well. Parents often find themselves awkwardly standing in the waiting room, uncertain if they should go with their child, wondering if they're allowed to go with their child, or if they should just wait in the waiting room while the child attends his or her therapy session. As a therapist, this is what I tell parents. For the first visit, parents should absolutely attend the therapy session! For all of the following visits, that decision needs to be made on a case by case basis. During the first therapy session the therapist will perform an evaluation of the child, and for this evaluation, parents need to be present. The purpose of the evaluation is to gather as much information about the child as possible, and much of that information has to come from the parents. Therapists need to know what behaviors you are seing or not seeing at home. Of course, therapists are also watching and talking to your child and most likely also administering some type of standardized assessment, but personally, I have never found the initial meeting with the child to be a good indicator of what his or her abilities are. It tends to be overwhelming for children to be in a new room, meeting a new person who is asking them questions, many of which they aren't really sure how to answer. Therefore, the most useful information from comes from the parent. The second question is whether or not you should attend the following treatment sessions. That entirely depends on your child. Some children do better by themselves, some do better with mom or dad in the room. Some children are so dependent on the presence of a parent, that they don't know how to function or communicate without them present. In that case, the therapists goal will most likely be to have the child directly communicate with the therapist without going through the parent first. At a certain age, it is no longer appropriate for a child to cling to his or her parent, constantly seeking confirmation from mom or dad before answering. The goal of communicating independently, will most likely not be reached, if the parent remains im the treatment room during therapy. However, I'm also not in favor of taking a child from his or her parent in the waiting room, and spending the next 3 or 4 therapy sessions listening to him or her scream and cry. It's not good for the child or the parent, and frankly, not good for me. Separation from the parent has to occur gradually. I often have mom or dad come to the therapy room to attend the session, but during that session, the child and I will leave the room for brief periods of time. We'll go to the swing room before returning to the therapy room to "check" on mom or dad. Then we might go to the play room for a while, before again, returning to the therapy room to check on mom or dad again. Eventually, mom sits out in the hallway, moving further away each session . But there certainly does not have to be a permanent removal from the therapy room. So my answer to the posed question is plain and simple. It is your child! If you prefer to attend therapy sessions with your child, you certainly can. However, think very carefully about whether your presence during therapy is helping or hindering your child's progress. But more importantly, please don't be offended if a therapist suggests that you leave the room. The therapists are trying to meet goals, some of which might be easier to meet without parental interference.

I wanted to share an email with you, that I received from a parent a few days ago. In this e-mail, the parent talks about her son who is on the autism spectrum. He is verbal and communicates very well but, by her own admission, he can be quite challenging in terms of his behavior. The reason she decided to contact me, was because she is concerned that her son's speech therapist doesn't like him. She said the therapist tends to be short and irritable with him and always appears frustrated, sometimes even coming across as "cold". As a parent, she is unsure how to handle this particular situation. On the one hand, she wants a warm and nurturing environment for her child, but on the other hand, she realizes that his therapist is a professional who knows how to achieve the goals they are trying to achieve. I have a feeling that there are many other parents out there who have come across a teacher or therapist who appears to dislike their child. As a therapist myself, it saddens me that any parent would have to feel that way, especially if those feelings are pertaining to a professional who is supposed to be helping their child reach his or her full potential. I believe, parents need to consider two things. One, therapist are human and just like everyone else, they can get annoyed. Bad behavior is bad behavior, whether it's coming from a normally developing child or a special needs child. Those same behaviors that drive you crazy as a parent, can drive therapists crazy as well. I can recall several instances where I have become annoyed with a child's behavior, especially if that behavior is getting in the way of his or her progress. And in rare instances, I have had to work with a child who caused me to stop and take a deep breath before I went to get him or her from the waiting room. Having said that, I need to stress that I have never ever disliked a child, and the odds are, that your child's therapist doesn't dislike your child either. Therapists have the difficult job of trying to get a child to achieve something that is very difficult for that child to do. They are constantly having to try new approaches to therapy, evaluating and adjusting what works and what doesn't work. In addition, it is most often done under the watchful eye of your child's health insurance carrier who can deny coverage at anytime, if required progress isn't being made. This means, there is a lot at stake and a lot to be accomplished, in what is often a short amount of time. That being said, therapy should be a positive and fun experience for your child. It isn't school. Your child should be engaged. A skilled therapist should be able to put on a positive face for your child and guides his or her behavior with a patient and affirming voice. There are times when it's perfectly acceptable for a therapist to let a child know that his or her behavior isn't acceptable. However, a true professional will never let a child feel that he or she is not liked as a person. Getting frustrated is acceptable, but reflecting an air of dislike is not! Always keep an open line of communication with your child's therapist. Talk to him or her. If you still feel that the therapist dislikes your child, then you may need to look at making some changes. I hope all of you are building great relationships with your children's therapists, and as a result, are achieving the goals you have set! If you have any questions, please feel free to reach out to me at any time.

Are you trying to improve your child's language development? Are you wanting to speed it up? There is a lot of research out there as to what type of book is best and I've read most of it! I'll share my thoughts in tis episode.

In this episode I discuss my recent completion of our churches sensory friendly vacation bible school. I offer tips to help you implement a program at your church!

If you want to help kids who struggle with sensory issues enjoy vacation bible school, you'll want to keep your groups small. In this episode, I explain what I did to help the kids in my group learn and have fun!

In this episode, I explain how we started our own sensory friendly VBS!

I was talking to a friend of mine yesterday whose two children are borderline special needs children. One of them is on the autism spectrum and one has a sensory processing disorder. This friend was explaining to me some of the behavior problems that her middle child is dealing with and some of the defiance and impulsive activity that he has. As she was illuminating some of the things with which she was dealing, I caught myself attempting to make her feel better. I came back with a response that I knew better than to use. I told her that I have three children and I see mine doing the same things. Even as the words came out of my mouth, I realized that it was not the correct thing to say. One of the most annoying and irritating things for the parent of a child who is on the autism spectrum or who is dealing with a sensory processing disorder to hear is, “well my child does that too. I think that’s just normal.” I was frustrated with myself for what I had said, because I always advise others not to compare the behavior of normally developing children with special needs ones. We think that we understand, and yet we really don’t understand at all. No two children are the same. Despite what we see on the outside, kids with SPD and autism are not behaving the same way that normally developing ones are. The behavior that you are dealing with in your children who are typically and normally developing is not the same as that of a mother with a child on the spectrum. One of the biggest differences is when we’re talking about defiance and tantrums. I, as a parent, am tempted to say that my children behave like that all of the time. When I say “all of the time,” it means at the most once or twice a day. It may seem like “all of the time” to me and I may feel like I have to deal with it “all of the time,” but to the mother of a child on the spectrum or with SPD, it probably is about 400 times a day. The behavior is over and over and over again, to the point of being exhausting. It is very much a different thing with which to deal. So, whenever you are talking to a parent and they are venting or explaining some of their frustrations, it is best not to come back with the response that it’s normal and that all children have those problems. While it’s true that they all may behave this way some of the time, they don’t do it on the scale that a child with sensory processing disorder or autism does. If you have any questions you'd like addressed on this podcast, please reach out to me on my website, www.jasonmillerhealth.com

If you have a child that is constantly on the move and is always seeking physical input, I would like to recommend something to you. You may have heard of this in conjunction with adults and yet never considered it for children. What am I referring to? CrossFit. I have been involved with CrossFit for a long time now and I recently spoke to one of the coaches at a gym near me. She said that she has a couple of autistic children who are participating in weekly workouts, which made me think about children who are sensory seekers and how this would be beneficial to them. For one thing, it’s just good movement. The workouts require constant motion. However, CrossFit has 3 movements that I think give a lot of proprioceptive and vestibular stimulation where needed. The first movement is the burpee and that covers the entire body. You start from a standing position and then fall down to the floor in a push up position. From this position, you pull your feet up toward your hands and jump up in an explosive movement to a jumping jack clap. The second one is the box jump. This is simply jumping from the floor onto a box over and over again. The third movement is the slam ball. Young children especially like this. You take a heavy , weighted ball, hold it overhead and then slam it down as hard as you can. There are many other movements in CrossFit that are beneficial to the children, but these are the three moves that I have found to be the most useful to those on the spectrum and those who are sensory seekers. CrossFit is great for children who aren’t particularly good at sports, but want to be involved. Although it appears to be an individual activity, CrossFit has a very supportive community that will give a sense of belonging to these children who have a difficult time “fitting in.” CrossFit gyms are everywhere and most of them have a CrossFit program for young ones. Stop by for a visit and get to know this supportive community.

Why do we fight with our kids while we are supposed to be helping them with it? I work with kids all day, but struggle to be patient with my own children when it comes to helping them with their homework. Please listen for some easy to implement tips!