Question: What can I do for an infant who has a fixed thoracic kyphosis? The child’s spine is curved forward in all positions, and can't be straightened. The child is seven months old, but is functioning more at a 2-3 month level. He is very weak and has a diagnosis of muscle weakness. He likely has a genetic syndrome of some sort that hasn't been identified yet. Should I stretch the muscles? What kind of positioning is best?

Answer: Generally I like to use positioning and handling to do stretching with little ones. That means that in the process of helping him move from prone to sitting up, I might help him move through his full range of motion in his trunk, including rotation. Or in the process of helping him get some weight bearing through his arms, I might help him rotate to the side to put his hands down on the floor (and teach his parents to do the same). Another activity is facilitated rolling (with his arms up above his head to stretch the shoulders) while lifting up his body a little so that he gets a stretch through his trunk into extension and rotation.

Reaching is the best way to try to get active trunk extension. Even facilitated (hand over hand) reaching with some support at the trunk to get extension may be helpful.

Try putting him in prone with a roll under his chest, and help him prop on his elbows over the roll. He will likely need some help to hold his head up, but it will be a good opportunity for him to practice. That way you get passive trunk extension, and an opportunity to practice head control, plus some weight bearing through his elbows. If he won’t tolerate prone, you may want to try having him in sitting with anterior support to his chest, and getting him to look up at you, and to reach if possible. He can also prop on his hands in that position to get some weight bearing.

The more you can do to get him moving (in any direction!), the more he will learn about where his body is in space, and will be motivated to move more himself. He will also gain strength to help him move.

Question: What is a Developmental Disability?

Answer: A developmental disability is a severe, chronic disability that:

• Is a mental and/or physical impairment that starts before age 22, and is likely to continue throughout life,
• Substantially limits functioning in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self sufficiency; and
• Results in a need for individualized, interdisciplinary services of extended duration.

Some examples of disorders that would be classified as developmental disabilities include mental retardation, autism, cerebral palsy, and Down syndrome.

Question: What is Developmental Delay?

Answer: Developmental delay is a diagnosis given to young children (under 8 years of age) who are slow in developing skills in motor, communication, social, or other areas. These delays may become a developmental disability as it becomes clear that the child has persistent disabilities, or they may fade as the child grows and catches up with other children.

Question: How can I work with a shy child?

Answer: Answer: Shy kids can be difficult. This will be a good experience for you. Some ideas to approach a shy child are:

1. Have the others who are with you wait outside, and only you go in. (So he doesn’t get overwhelmed with so many people).
2. Talk to his mom and ignore him at first. Bring fun toys that he would be interested in, and at first put them near him so he can play with them without interacting with you, then move them closer and closer to you so he has to come nearer to play with them.
3. Find out from his mom what he really likes to do and bring toys that he likes, and do activities that he likes.
4. Figure out some REALLY fun activities that he will not be able to help himself and will have to join in. Ideas for those might be finger painting, water play (boats in a basin or pool), or singing and dancing.
5. As he gets more used to you, you can introduce other activities such as reading books or coloring, that he will need to do WITH you.
6. Allow enough time for the visit, and don’t be discouraged. He will come around. Be prepared for him to ignore you and cling to his mother for at least 2 more visits.
7. Don’t expect anything from him, and explain to his mother that you just want him to get used to you. If you can visit him often, that would be good.
8. Use the time to develop a relationship with his mother, and find out what her concerns are.

Question: We have a pair of twins who have recently been diagnosed with mild autism. They are five years old. They can imitate simple words and produce some speech sounds but with different pronunciation of words. Their language appears made up because they use different kinds of words, or maybe they just pronounce the words differently. The children are difficult to understand. They can understand receptively but have a hard time expressing their feelings or ideas verbally. There’s no problem with gross and fine motor areas. The twins can grasp and hold small or big objects purposefully. They have problems holding onto things for more than a few minutes since they want to change activities every minute and tend to destroy whatever they touch. Their attention span is very short, they act impulsively and are not afraid of strangers. It’s hard to tell if they can recognize or identify letters or numbers since they cannot tolerate any activities. They can imitate pointing to a letter or number but when asked it’s hard for them to identify or say it out loud. It depends on whatever is presented but they like most to interact with manipulative activities.

How can we help them with language and communication, and with paying attention to tasks? (Henry Y., Yap)

Answer: Identify a routine for the day, and routines for specific activities throughout the day at school and at home. For example, when the children get up in the morning, their routine might be: 1) wake up, 2) wake up older sister or brother to take them to the bathroom, 3) use the bathroom, 4) wash hands and face, 5) dry hands and face, 6) clean up sleeping area- fold up mats, put away, 7) get dressed, 8) eat breakfast.

A communication board can be made with each of these steps on it- and a picture as well as simple words to describe each step. Then the board can be used to reinforce language skills as well as to reinforce the routine of the day. Parents, teachers, and brothers and sisters can prompt the children using the board about what the next step will be, and reinforce their language skills too.

Boards can be made for lots of other routines during the day, for instance snack time at school, reading time at school, bathing, meals, etc. The children can be coached about what will happen next during the day, or during an activity, by looking at the communication board. If they need to communicate to other people, the board may be helpful to express themselves. The content of the boards needs to be decided by people who have the most interaction with the children (parents, brothers and sisters, teacher, etc.). If you are able to laminate the board(s), they will last longer. This kind of structure can be really helpful to children with attention problems.

Question: How can I intervene with a child that has a behavior problem?

Answer: There are six steps to in planning and carrying out a program to modify behaviors.

1. Be very clear what the behavior is that you are concerned about. Saying that the child is rude, or that she runs away, or that she is too active are all too vague. Try to be more specific. Some examples are: George touches all the food before selecting his own, Julie hits her sister, Jon throws his plate, or Sylvia leaves school and goes home in the middle of the day.
2. Measure the behavior before trying any intervention. Be very specific about a measurement that will capture the behavior that you are concerned about. For example, rather than saying Julie hits her sister, measure how often Julie hits her sister during the hour before dinner (the worst time of day). In another example, Sylvia stayed at school for 45 minutes today before she went home. In another example, George touched everyone else’s food before a meal twice today, or he touched three pieces of food in the bowl before getting his own at dinner. Both of these are different measures of the same behavior. You will have to determine which measure is the most important.
3. Identify the A-B-C pattern. Look at what occurs before (antecedent) and after (consequence) the target behavior. For example, when Julie sees her sister playing with the blue stuffed monkey (antecedent), she hits her (behavior). After she hits her, her sister gives her the toy (consequence). Or when Sylvia is asked to do something that is too hard for her (antecedent), she leaves school (behavior). Her parent yell at her when they get home at the end of the day, but no one makes her go back to school (consequence).
4. Change the consequences. Julie’s sister is instructed NOT to give her the toy. Sylvia’s auntie takes her back to school right away.
5. Change the antecedent. Julie’s sister is instructed not to play with the blue monkey when Julie is nearby. The teacher at school makes an effort to find out what Sylvia’s skills are and gives her work that she can handle.
6. Continue to measure the behavior. After you change the consequences and the antecedents, continue to measure the behavior. That way you can tell if your intervention has made a difference. Make a chart and give your intervention enough time to make a difference. Try different interventions if the first doesn’t work.