By Katelyn Bentel, MSW, LSW          
Social Worker at Easterseals DuPage & Fox Valley

Mental health is at the core of human interaction and is the foundation from which individuals navigate their world. Mental health can be difficult to understand because it does not manifest in the same way across the human population—let alone in an individual on a day-to-day basis. We all respond differently!

In healthy individuals, the upstairs brain (prefrontal cortex) is fully developed by the age of 25. This part of the brain is responsible for executive functioning skills (e.g., decision-making/impulse control, problem-solving, working memory, attention, emotional regulation, etc.). With this, adults possess an ability to discern emotions and process their own mental distress through self-reflection, which can potentially lead to them seeking out additional support—if deemed necessary.

Children instinctually operate from their downstairs brain (cerebellum, brainstem, and limbic system); responsible for basic, life-sustaining processes (e.g., breathing) and the fight-flight-freeze response in moments of perceived stress/danger. Their ability to identify, understand, and control their emotions is limited due to an underdeveloped upstairs brain, making it difficult to monitor and communicate struggles with their own mental health, thus, emphasizing the need for extra support.

Signs that your child may need additional support:

• Aggression/increased fighting
• Increased emotional sensitivity
• Frequent temper tantrums/uncharacteristic mood swings
• Stomachaches, headaches, physical complaints
• Loss of interest in previously enjoyed activities/self-isolation
• Inattentiveness
• Difficulty separating from caregivers
• Noticeable change in appetite
• Noticeable decrease in sleep quality
• Lack of self-confidence

These signs can temporarily appear during a child’s typical developmental process as they learn to adjust to inevitable stressors in their environment. However, these signs can also evolve into maladaptive coping skills—negatively impacting the child’s overall mental health. It is important to take notice of the presence of these signs, their frequency, duration, and impact on the child’s ability to function daily.

Understanding why your child is responding this way

Sometimes a child’s response to stress is misinterpreted as “bad behaviors.” A healthier and more sensitive way to interpret these responses is to reframe “bad behaviors” as communication in an attempt to express an unmet need.

For example, a child may be acting in ways that appear “attention-seeking” (e.g., whining/crying, temper tantrums, wanting help with simple tasks, etc.) when, in reality, they are having difficulty communicating that they are trying to seek out connection.

How to respond with Connection:

• Nurturance
  · Respect and acknowledge child’s feelings
  · Talk and act so child feels seen and safe
  · Be Gentle
  · Offer affection (verbal or physical)
  · Encourage!
  · Allow for mistakes
  · Be consistent with developmentally appropriate rules and expectations
  
• Validation of emotion
  · Respect and acknowledge child’s feelings
  
• Shared quality time with caregiver
  · “Special Time,” just you and child
  · Include child in your activities
  · PLAY!

Another example of a misinterpretation is when a child is viewed as “manipulative” while, in reality, the child could be acting in ways that give them some semblance of control. Children are reliant on their caregivers to have their needs met. This has the potential to come with the repercussion of the child feeling as though they have lost their voice when (well-intentioned) decisions are made on their behalf by caregivers.

This lost voice may make a child feel uneasy, urging them to act in maladaptive ways as a coping mechanism to satisfy that lack of a sense of control. A simple way to instill a child’s sense of control is by offering the child options to choose from to complete the caregiver’s desired task/end goal. These examples are not to be confused as excuses for a child’s behavior or to invalidate a caregiver’s frustration, but rather, to serve as a potential explanation and encourage caregivers to pause and be curious about the why behind these actions. (Chart 2)

Seeking Additional Support

Seeking additional mental health support from a professional is a great use of resources if these dysfunctional responses/signs become a consistent presence in a child’s everyday life. Everyone can benefit from support. For instance, if an individual is recovering from a weakened ankle from a sports injury, it is common to receive physical therapy to rebuild that muscle. We should do the same for someone struggling with emotions/adapting to stressors.

There is no better time to create a strong foundation for mental health and foster resilience than during childhood. The Mental Health & Family Support Team at Easterseals DuPage & Fox Valley provides a safe and inclusive space for children and their families to receive support. Learn more about our mental health services here.

By: Kristin Roemer, MS, OTR/L

The Importance of Vision

As a first grader, I got my first pair of eyeglasses at age 7. My school had an acuity screening, which showed that I could not see clearly from a certain distance. Getting glasses made seeing the board and all the materials within my classroom so much sharper and brighter. While many of us are familiar with the big “E” chart and understand the need for glasses for an acuity problem, we may not think as much about the other aspects of a person’s functional vision and how that impacts their participation in daily routines.

The Vision Clinic screening at Easterseals involves consultation with a developmental optometrist and an occupational therapist to screen for visual concerns and to discuss how these may be impacting a child’s participation in the classroom or at home. First and foremost, the developmental optometrist assesses the overall health of the eye structures and the need for a prescription. Two more areas, visual efficiency skills and visual processing skills, round out what makes up our vision.

Visual Efficiency Skills

Visual efficiency skills consist of three categories:

1. Oculomotor skills (or “eye tracking”):

• Fixation – the ability to maintain one’s gaze on a single image
• Smooth pursuits – the ability to keep one’s gaze on a moving image
• Saccades – quick movements between different visual targets

2. Accommodation (or “eye focusing”):

• The ability to sustain focus for an extended length of time
• The ability to change focus from far to near and back again

3. Binocularity: (also called eye teaming or coordination)

• Convergence and divergence: the ability of the eyes to move closer or farther and to keep a single image, not see double

Visual Efficiency Examples

If you think about your child sitting at their desk at school, each of these areas are put into play for them to be successful. Your child must use smooth pursuits to follow their teacher around the room and to follow along while reading. They must fixate and complete saccadic movements to look from one part of the board to another, such as when comparing two math equations. When they shift their gaze from up at the board back down to their desk, they are converging and diverging their eyes.

Keeping the information that they are looking at crisp and clear without “spacing out” and letting words get blurry involves their focusing system. When something about any of these systems is off, it can cause great difficulty in completing schoolwork. Even if a child is able to successfully hold each of these things together to complete a quick acuity screen, it may not show the bigger picture of how these skills have an impact on a full day in school or at home.

Visual Processing Skills

Visual processing skills refer to the brain’s ability to interpret visual information in different ways. These skills include:

• Visual discrimination – the ability to recognize details/differences among similar objects
• Form constancy – the ability to recognize an object in different contexts or in different sizes/colors/orientation
• Visual closure – the ability to visualize the whole picture when given a partial picture
• Visual figure-ground – the ability to perceive and locate an object in a busy visual field
• Visual-spatial relationships – the ability to perceive the position of objects in relation to each other and to oneself
• Visual memory – the ability to remember for immediate recall certain characteristics of an object
• Visual sequential memory – the ability to remember forms/characters in the correct order

Visual Processing Examples

Let’s imagine your child, now at home, is helping out with their chores and getting ready to get out the door. A child with a visual discrimination concern will have trouble matching up socks when they’re helping to sort laundry. When you ask your child to grab their homework off the messy kitchen counter, they may have difficulty locating it if they have poor figure ground skills. A child with form constancy problems may have trouble recognizing letters or words in different fonts or in different contexts, such as reading off a cereal box or from their assignment notebook. Let’s say you’ve asked your child with a visual closure problem to find their shoe, but they are unable to find it because it is partially obscured by a coat strewn halfway over it.

Maybe you show your middle schooler a neighbor’s address and ask them to drop off a letter down the street, but your child has difficulty with visual sequential memory and can’t remember the order of the house number. Your child, who is consistently clumsy, knocking over cups of water when reaching for the ketchup at the dinner table, may be having problems with visual-spatial relationships and be unable to adequately judge the distance between items. A child with visual memory difficulties may have poor reading comprehension, which can make for a frustrating situation when following a recipe or gathering up items from a list.

Vision Clinic Details and What to Expect

Who knew so much went into the way you take in information visually?! The occupational therapists on our team understand that the different sensory systems in our body affect how we navigate the environment and participate in various parts of daily life. If your OT feels that a developmental optometrist should be consulted to screen your child’s visual skills, they will first complete some screening activities themselves to grossly assess your child’s visual efficiency skills. If appropriate, they will also conduct some standardized assessments to get a baseline number for different visual processing skills. This information, along with identifying functional activities that may be difficult, is shared with the developmental optometrist before the clinic so the doctor can get a broader picture of how things have been going.

Our Vision Clinic typically takes place on the last Wednesday of the month. If possible, your child’s treating therapist will be present and able to share from her perspective how vision has impacted participation in therapy sessions based on what she has observed and in conversation with you. If s/he is not able to attend, she will touch base ahead of time with the OT running the clinic, who will then be able to share information and ask questions during the clinic. Information gathered from the screening will be shared informally with the treating therapist as well as a full report scanned into your child’s chart and emailed out for your records. In any case, if further consultation is needed with the optometrist, our therapists are able to contact their office and discuss strategies or action plans in more detail.

Recommendations and Additional Steps

Recommendations from the clinic may vary – the developmental optometrist may identify a few areas that need particular attention over the next few months. You will receive a list of activities to try at home, as well as toys and games that help promote visual development, and your therapist will also incorporate different activities into their therapy session. Sometimes, addressing these areas at home and in OT is all that a child needs to improve their visual skills adequately.

Other times, it may be recommended to go into the optometrist’s office for a more thorough evaluation. Some problems can be fixed with a pair of glasses (either performance lenses during tabletop tasks, glasses to address near or farsightedness, or specialty glasses with prisms), while others may require more intensive work in vision therapy. If this is the case, you will receive a packet of recommended providers in the area along with information about the typical vision therapy focus and progression. It is recommended that all children see an optometrist yearly to monitor vision development, regardless of suspected problems.

How to Get Started

If you feel that much of this information resonates for your child, ask your treating therapist about attending the Vision Clinic at Easterseals DuPage & Fox Valley. You can also contact our Clinic Coordinator, Christy Stringini, at 630-261-6216 or cstringini@eastersealsdfvr.org to facilitate this process. We look forward to *seeing* you!

By: Kelly Nesbitt, MOT, OTR/L  

What is executive functioning?

Executive functioning refers to organizing, problem-solving, working memory, sequencing and efficient execution of ideas to complete a task. Executive functioning is a complex process involving good sustained attention, organization of ideas, inhibiting impulses, time management, and problem-solving (Calderon, 2011).

General functioning would be tough without these skills in everyday life. There are many strategies that Occupational Therapists can help a child improve their executive functioning skills to better participate in their daily routines, which will be discussed below.

When do kids need to use executive functioning skills?

As an OT, I look at executive functioning specific to how kids can execute their daily “occupations,” such as getting dressed, packing up their backpacks, completing their self-care routines, or completing a craft.  Almost all tasks kids do during the day involve some executive functioning skills. For instance, when they encounter a problem, they must come up with a new idea, organize how to execute a plan, gather supplies needed, and adjust their plan if something new arises. Take the example of getting dressed in the morning, for example. When you tell your 7-year-old child, “Go get dressed before school,” your child must… 

1. Be regulated enough in their body to understand and process the verbal directions given to them. Do they know what “go get dressed before school” means?
2. Have an idea of what they want to wear- Do they need shorts? Leggings? Jeans? Once they realize it’s cold outside, do they know the necessary steps to take?
3. Visualize what supplies they need on a cold day: socks, shoes, underwear, a shirt and pants. They need to know where to go in the house to find all these supplies.
4. Once they have this “list” of what they need, they need to gather these materials. Your child must be able to draw on their memory to know where do I find my clothes? My dresser? My closet?
5. Then find all these articles of clothing in their room, keeping in mind everything they need and staying focused on this task (sustained attention) and getting it done in a reasonable amount of time before mom calls them to get in the car for school.
6. If they find every article of clothing but realize that they cannot find their jeans, do they have a strategy to solve this issue? Can they ask Mom? Can they look in the laundry room if mom or dad has washed their jeans and it just hasn’t been put away yet?
7. Once your child finds out that their jeans were just in their brother’s room, can they then sequence the steps accurately of dressing in their school clothes? (take off PJs, pull on their underwear, then pants, then their shirt)
8. Be able to evaluate to see if the task was completed correctly. Did they forget a sock? Did they miss a step? Did they complete the task on time?

Needless to say, a lot of brain power actually goes into what seemingly is a simple task to most adults.  

How do I know if my child has executive functioning difficulties?

A diagnosis like attention deficit hyperactivity disorder (ADHD) or autism can certainly be a factor, but there are many neurological, mental health and behavioral disorders that can affect a child’s executive functioning skills. An Occupational Therapist, Speech Pathologist or Social Worker, can help you determine if their difficulties are from executive functioning difficulties or if there are other sensory, postural, mental health, and/or motor planning issues underlying. Some signs that executive functioning may be hard for your child include (but are not limited to)…. 

• You have to constantly prompt kids to get dressed in the morning or walk them step-by-step through daily routines that you know they know how to do 
• Your child consistently forgets their homework assignments at home, or their binder is so disorganized that they cannot find what they need in it 
• Your child consistently forgets to do chores (not just avoiding them) or does them incompletely (when you know they understand what to do)  
• They get distracted easily. You ask your child to do something, and you consistently find them doing something completely different (watching tv, playing with a different toy) 
• Homework tasks are really hard (especially around 2^nd grade, where the workload increases) 
• Teachers have described them as “disorganized” or “getting distracted in class.” 

Strategies to help: 

Environmental setup: 

• Keep the environment at home decluttered (as much as possible). Have designated spaces where toys belong that are denoted with labels (for kids that read) or pictures (for children who are not yet reading). I recommend taking literal pictures on your phone of what goes in the bin and printing it out so that your child makes the connection of what actual items go in that bin.  

• For homework completion, you can have two bins at the table where the child does their homework, labeled “to do” and “done.” You can put all the papers the child must complete in the to-do bin, and as the child finishes each, they can move them to the “done” bin. Sometimes this concrete step helps a child’s brain visualize what is left to complete and what is already complete.

Visual schedules: 

• Have a visual schedule of activities you want your child to complete. This schedule has small pictures that go in see-through sleeves. Once an activity is completed, the child can take the picture out of the sleeve and put it in a pouch at the bottom. Again, I’d recommend you take pictures of the child’s literal tasks/them doing the tasks to help improve comprehension of what the picture represents.  

Timers: 

Count “ups”/ Clocks– For children who both do and do not know how to tell time, I recommend using a clock to help them manage time. If you have an analog clock with a glass or plastic face, use Expo markers to draw pie segments on the clock face of what task you want the child to do.  

For this example, if you need to be out the door by 3 o’clock, tell the child that they need to get dressed while the big hand is in the orange area. Children who can read can have more complex segments delineated on the clock for multi-steps.  

Countdowns/timers: 

Time Timer clocks count DOWN how much time is left, which can be helpful for children when it’s almost time to transition away from the TV or leave for school in the morning.  

Executive Functioning Support

If you feel like your child is struggling consistently with executive functioning tasks, an Occupational Therapist can specifically look at these skills in an OT evaluation.  Our skilled therapy team works across ages and diagnoses and can help create a personalized plan to help your child.

To learn more about services at Easterseals DuPage & Fox Valley, call us at 630.282.2022 or email info@eastersealsdfvr.org.

References: 

Executive function in children: Why it matters and how to help – Harvard Health by Johanna Calderon, PhD 2011  

By: Kelly Nesbitt MOT, OTR/L & Certified DIR Floortime Therapist

DIR Floortime is a multidisciplinary, developmental treatment approach that has profoundly shaped my clinical practice as an Occupational Therapist. I have personally seen a variety of children thrive with this approach. I have been lucky enough to learn all about DIR Floortime at Easterseals. While DIR is a very complex model, I wanted to have an overview of this model that parents can refer to and start off on their journey of learning and growing with their child.

Author’s Note: I use both identity-affirming language “autistic children” and person-first language “children with autism” throughout this post, as these are two schools of thought within the autism advocacy community regarding how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”

Dr. Stanley Greenspan and Dr. Serena Wieder explain their model, DIR Floortime ®

What is DIR Floortime?

DIR, which stands for Developmental Individual Differences Relationship Model, is the theoretical framework that works to promote the relationship between the child and parent, looking at the unique individual differences (sensory processing, motor, neurology, developmental, cognitive, and social-emotional skills) of the child and using playful, child-led strategies to support engagement and development.

All these Individual differences and the Relationship you have with your child all help catapult your child forward Developmentally. Floortime is the practice or application of DIR theory in which you literally “get down on the floor” with the child and “get into their world,” exploring their interests through affective, playful engagement in order to help them grow. The most important part of DIR Floortime is the “R,” which stands for “Relationship;” your relationship with your child drives all the development and meaning they derive from the world. DIR Floortime is, at its core, a parent coaching model.

Growing research is showing that this developmental, multidisciplinary approach is an effective treatment option for working with children with Autism Spectrum Disorders. Multiple randomized-controlled studies have been published since 2011 identifying statistically significant improvement in children with autism who used Floortime versus traditional behavioral approaches.

How Therapists Are Involved

Your therapist will help coach you on how to use your child’s strengths and interests to accomplish your child’s goals. It aims to empower parents, who are the “experts” in their child, to trust their instincts, follow their child’s lead, and fundamentally look at the child’s capacities in a strengths-based approach. Essentially, this model looks at and bases treatment decisions around all the wonderful things a child can do and what strengths they already possess.

What I love about DIR Floortime:

It Respects the Parent’s and Child’s Knowledge

As an OT, I hold the core assumption that every parent and child is trying their best based on their mental, emotional, and physical capacities at that moment. This model coincides with that belief on a profound level. Since DIR Floortime is a strengths-based model that presumes competence of both the parent and child, this approach really helps me go into a session with an empathetic heart and help you use “what is going well” with your child and expand from there.

Because this approach is centered upon relationships, it’s incredibly important that all families feel comfortable with their therapist as a cheerleader and coach and are able to be vulnerable in sessions. Parenting is incredibly complex, hard, and rewarding, and your therapist rides all those ups and downs with you, not as an “expert” in DIR, but as someone who is in your and your child’s corner. Even if a session is really hard, there is always something positive that can be found together, and growth can occur from there.

It is Neurodiversity-Affirming

I also love DIR Floortime, as it is neurodiversity-affirming. Neurodiversity-affirming practice refers to celebrating the unique diversity of neurological functioning that makes humans beautifully complex. It honors the interests and experiences of the neurodiverse child (children with Autism, ADHD, sensory processing differences, OCD, anxiety, and more). This approach assumes that children “don’t need to be fixed or cured,” just supported where they are developmentally and accepting their uniqueness; We see the child as inherently good the way they are. This model doesn’t see, as some may say, “unusual interests” in Autism but rather sees a child with a passion that can teach us more about something we may have never thought twice about.

It Encourages Interests and Doesn’t Label

I remember hearing an adult with Autism explain how when he was little, he always saw profound beauty in light reflecting off droplets of rain or in suncatchers on windows. He described how he would flap his hands in excitement as the droplets slid down the window or light danced through the glass and onto the floor, his body unable to contain the excitement at witnessing something so wondrous.

I wonder if, as a child, this boy may have been described as having an “unusual interest” in windows and “stereotyped behaviors” rather than someone with a unique sensory system and neurology who is having a joy-filled sensory experience. I have also heard of some Autistic advocates reporting that it must be sad that “neurotypical” people don’t get to experience the profound joy of stimming and seeing the beauty that surrounds us in everyday experiences.

I think this is a wonderful way to look at neurodiversity- what can these children show us about experiencing the world with a newfound sense of wonder and excitement. How can we reframe pathologizing neurodiverse children and instead amplify their voices and experiences to learn something exciting and new?

DIR Floortime looks at a child as a human being, not a diagnosis or label, who has great ideas that should be honored.

DIR Therapy at Easterseals

Lucky for us all, Easterseals has many certified DIR Floortime Therapists in the Occupational Therapy, Social Work, and Speech Therapy departments! You can request a therapist who has this specialization. However, if one is not currently available at the time your child needs therapy, don’t worry! Easterseals has an environment of constant collaboration and clinical supervision, so a non-certified Floortime therapist can still provide a strengths-based, child-led approach with mentorship and consultation from a certified DIR Floortime therapist.

Easterseals provides an environment that celebrates neurodiverse children’s experiences and, through the DIR Floortime model, allows parents to help their children gain skills and grow!

If you are interested in getting started with DIR therapy for your child at Easterseals, we have many qualified therapists to guide you through the process!

Learn more here to get started.

Where can I learn more? DIR Resources

Websites:

Profectum Parent Toolbox (this is a wealth of videos, webinars, worksheets, and educational materials to help walk parents through all aspects of this model. Available in English and Spanish)

Profectum.org and ICDL.org are the two large organizations of DIR Floortime. Both websites have a wealth of information and training opportunities for professionals and parents.

ABA vs. DIR Floortime? This is a look at these two different approaches to help you decide which is a better fit for your family

 DIR Floortime Quick Fact Sheet   (This link is a list of clinical research and evidence supporting this model)

Affect Autism Podcast What is it? – Affect Autism: We chose play, joy every day (this is one of my favorite podcasts about DIR Floortime, exploring a range of topics within this model)

Books about DIR Floortime and Related approaches:

• Brain-Body Parenting by Mona Delahooke PhD (2022)
• Beyond Behaviors by Mona Delahooke PhD (2019)
• Visual/Spatial Portals to Thinking Feeling and Movement by Serena Wieder PhD and Harry Wachs O.D. (2012)
• Engaging Autism by Stanley Greenspan, M.D. and Serena Wieder, PhD (2007)
• The First Idea: How Symbols, Language and Intelligence Evolved from Our Primate Ancestors to Modern Humans by Stanley L. Greenspan, M.D. and Stuart G. Shanker, D. Phil (2004)
• The Secure Child by Stanley Greenspan, M.D. (2001)
• The Irreducible Needs of Children by T. Berry Brazelton, M.D. and Stanley L. Greenspan, M.D. (2000)
• Building Health Minds by Stanley Greenspan, M.D. (1999)

By: Kelly Nesbitt, MOT, OTR/L

One of the trickiest parts of a child’s daily routine for families is sleep, going to sleep, staying asleep, and finding consistency in the bedtime routine. Below are some helpful tips to make your child’s bedtime restful and not stressful.

Author’s Notes: I use both identity-affirming language, “autistic children,” and person-first language, “children with autism,” throughout this post, as these are two schools of thought within the autism advocacy community of how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”

Also falling asleep and staying asleep is a complicated process. Both environmental modifications as well as your child’s physiological processes impact sleep. Don’t be afraid to bring up sleep to your child’s pediatrician if you are worried that even with good sleep hygiene, your child is still not sleeping well.

Steps for a Child’s Bedtime Success

First, ensure your child’s room is set up in an optimal sleeping environment. Physical set-up includes:

1. A Quiet Room: If it can be helped, having children not share a room so that if one child wakes up in the household, it does not wake up your other children. If you have two children sleeping in the same room, you can try having music or a white noise machine playing in the background so that the children can get used to having noise present in the room.
2. A Dark Room: Also, ensure that the room is dark (with the exception of a nightlight if a child needs it), which helps a child’s brain know it is time to sleep. Trial blackout curtains if a lot of light creeps in the windows, if your child is going to bed when the sun is setting, or if there is ambient street light coming into the room.
3. A Cool room:  A cool room is optimal for sleep. A room between 60 and 68 degrees is cool enough for children to sleep well. (Best Temperature to Sleep: Research and Sleep Tips (healthline.com)

Consistency is Key

One of the biggest keys to having good sleep hygiene is having consistency every night. This means a consistent bedtime, routine, and expectations for sleep. Give yourself and your child about 30-45 minutes to start the whole bedtime routine and keep it consistent every night.

As a family, you can decide what activities are calming for your child that you can work into your routine for bedtime (taking a warm bubble bath, changing into PJs, and listening to quiet music for a few minutes before you tuck them in).  It will take some trial and error to find what makes your child feel calm and sleepy.

 I recommend keeping a journal or note on your phone on what time you started the bedtime routine, what activities you chose, and what time your child got to sleep. This will help you find patterns of what worked in the routine and what did not work.  

Limit screen time to 1 hour (at least) before bed

This is a big one. Screen time is often very overstimulating for kids and sends signals to a child’s brain to stay awake! In fact, a review of many studies from the American Academy of Pediatrics shows that “In >90% of these studies, more screen time was associated with delayed bedtimes and shorter total sleep time among children and adolescents.” So how do we reduce screen time around bedtime?

About an hour before bed, turn off the electronics! That means tablets, iPhones, laptops, and televisions. There are parent control apps (check them out here: How to Check Screen Time on Different Devices (guidingtech.com). These apps can turn off children’s apps or even password lock the device at a certain time. It’s also recommended that children do not have access to devices in their rooms (no televisions or tablets in their rooms). You want your child to associate their bedroom as a calm space for sleep, not for sitting and watching shows.  Replace screen time with reading time, unstructured playtime with their toys, or quiet music and drawing time. This hour before bed can be explained to older kids as “a time to quiet our bodies and minds.”  The activities you do before bed with your child (discussed more below) should be quieter, organizing, and not high-energy activities.

This change to limiting screen time will likely be a tough adjustment for kids, as it’s difficult to beat the immediate gratification and fun of visually stimulatory ipads, iphones and TV. But consistency is key, and kids are resilient, so they will accommodate over time. Make it a challenge for yourself, too- take a break from electronics with the kids at night and don’t get them back out until they are asleep!

Find Out What Activities are Calming

Play around with what activities you try an hour before bedtime. Here are some quieter activities that can promote settling kids’ bodies for bed:

Heavy Work/Proprioceptive activities: Heavy work/proprioceptive input is compression to joints that sends calming signals to the central nervous system. Any activity that has “pushing, pulling or carrying” contains proprioceptive input. The trick with heavy work input around bedtime is selecting activities that are not going to be too active. Do these activities for about 10-30 minutes or until you notice that your child is looking tired or their body is regulated.  These activities could include:

• Doing wall push-ups
• Pushing a toy container around to pick up toys
• Pull a weighted blanket with their stuffed animals on it
• Lay on bellies on hardwood or linoleum floor and pull with their arms (you can put a towel on the floor for the child to lay on to get less resistance when they pull).
• Have the child fill a fabric bag with what bedtime stories they want to read that night and carry it to their room

Calming Bath time: Draw a warm bath for your little one with calming bubbles if your child enjoys that. There are also some cute light-up bath toys to play with along with having the overhead lights turned down (if it’s safe to do so). Always make sure that your child is supervised when in the bathtub.

Additional Sensory Supports

Here are some additional sensory supports that could be added to bedtime to help your child prepare their body for sleep:

OLFACTORY/SMELL:

• Use gently scented lotions with soothing scents (chamomile, lavender, vanilla, for example) for an olfactory signal for your child to get ready for bed.
• Trial essential oil diffusers (that are out of reach of children in their room) with calming scents

TACTILE/TOUCH:

•  Trial using a weighted blanket at bedtime or during quiet time. See this blog post for more information: The Benefits of Weighted Blankets – Easterseals DuPage & Fox Valley Blog (wordpress.com). To sleep with, a child’s weighted blanket be no more than 10% of their body weight!
• Rub your child’s back while they lay in bed with deep pressure, which is calming.
• Cuddle with deep squeezes to their body (think of swaddling a baby to sleep)
• Allow children to have access to their security blanket or toy (often children use these items to remind them of their parents’ love and literally take that with them as they look at that toy)

VISUAL/LOOK:

• If you can, dim the lights in your house or turn off a few lights so the house is a little darker before bed.
• Again, limit screen time
• Have a soft, warm night light in the child’s room
• Have the child’s toys “out of sight and out of mind” during bedtime. They can have their preferred stuffed animal if they are old enough, but other tempting toys should be put away.

GUSTATORY/TASTE:

• Have warm milk prior to bed
• Avoid a big meal or snack right before bedtime, as it’s hard to sleep when you are digesting a lot of foods.

AUDITORY/HEAR:

• Use a quieter, softer tone of voice to help signal to your child that it’s time to settle down.
• Play a white noise machine in the bedroom
• For children 3 and up, there are Children’s bedtime podcasts to listen to during getting ready for bed. Select stories that are slow-paced, and the narrators have a calming voice.
• Play soft music in the background during the bedtime routine

VESTIBULAR/MOVEMENT:

• If your child is soothed by being rocked, you can make a blanket swing with 2 adults holding the ends of the blanket and your child climbing in. Give your child slow, rhythmic movements which are calming.
• Read bedtime stories in a rocking chair

You can also talk with your child’s Occupational Therapist about what other activities and sensory supports can work for your child.

Cuddle and Connect

Once your little one is all settled into bed, use this opportunity to connect with your child with a special routine or routine that is important to you as a family. This can be reading a bedtime story, saying prayers together, reviewing the best parts of the day, saying what you are grateful for, or singing a bedtime song.

Feeling safe and connected with their parents is a good way to bond and send them to sleep. That being said, sometimes separating from mom and dad in order to go to bed is really scary and a normal childhood fear. Having this consistent shared time can help a child feel safe and secure prior to going to bed. You can also read some separation-themed stories to help them to ease this anxiety.  (Children’s Books about Separation Anxiety – Sleeping Should Be Easy)

A Note on Autism

I would be remiss not to mention that even with immaculate sleep hygiene, some autistic children still have difficulty falling asleep and maintaining sleep. There is a higher prevalence of insomnia in autistic children than in their neurotypical peers. There are some theories that gastrointestinal issues, possible sleep apnea, anxiety, restless leg syndrome, epilepsy, medication side effects and/or hormone imbalances can contribute to more sleep issues in children with autism (Wide Awake: Why children with autism struggle with sleep). It is recommended that parents who have concerns with their child with Autism’s sleep discuss this with their therapy team as well as the pediatrician. Their pediatrician may refer them for a sleep study to evaluate the quality of their sleep and what barriers contribute to them not sleeping well.

Wishing all a good and restful night!

References:

• “Digital Media and Sleep in Childhood and Adolescence” by Monique K. Le Bourgeois, PhD, Lauren Hale, PhD, Anne-Marie Chang, PhD, Lameese D. Akacem, PhD, Hawley E. Montomery-Downs PhD, Orfeu M. Boxton, PhD.  November 1, 2017. Link: Digital Media and Sleep in Childhood and Adolescence | Pediatrics | American Academy of Pediatrics (aap.org)
• Wide awake: Why children with autism struggle with sleep | Spectrum | Autism Research News (spectrumnews.org) by Ingfei Chen (Oct 7, 2015)
• Best Temperature to Sleep: Research and Sleep Tips (healthline.com) by Bethany Fulton (Dec 13, 2019)
• Children’s Books about Separation Anxiety – Sleeping Should Be Easy
• How to Check Screen Time on Different Devices (guidingtech.com)