Make bedtime a fun routine

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Child getting ready to sleep

As a doctor for children, I often talk about sleep during wellness and sick visits.

Sleep is an important life skill. It teaches children how to calm themselves and rest. Parents have an important role in helping children to healthy sleep habits. Improved amount and quality of sleep affect children’s behavior and abilities to think.

Below I will discuss some tips that parents can practice for healthy sleep habits.

  • Decide with your family when is a good time to start sleep training.
  • Decide how many hours of sleep your children need. Infants sleep for 12-14 hours. Hours decrease gradually as children get older. On average, children need 10 hours of sleep. If they nap during the day, do not forget to account for nap time to the total daily sleep time. For example; 2 hours nap in the afternoon will leave your children with only 8-10 hours of sleep at night. That can be a reason why children go to bed late at night or wake up very early and refreshed.
  • Talk to your children about (tonight’s plan). For example “we will take a bath, read a story, and then it is bedtime”. Change the language based on your children’s understanding. Young children would benefit from (first…then strategy). For example “first we take a bath then we read a story”. Use picture books to share stories about sleep.
  • Use a reward system. Rewards can be increased or spaced out. Rewards can be an activity the children will enjoy, for example spending play time with parents, or reading a favorite book together.
  • Do not get discouraged quickly if some attempts are not successful. Experimenting is a key. Some plans do not work the first time or at all. Try different things. For example, some children may prefer bedtime stories and some may prefer bedtime song. Other different options parents can try; white noises, a night light, a security object/blanket or all of them.
  • Avoid high affect games or TV before bedtime. Bath and stories can help to relax your children.
  • Remind your children that bedtime is soon. For example “5 more minutes to bedtime”. Some children do not tolerate transitions quickly. You can use a fun or colorful alarm clock as a reminder.
  • Increase their Melatonin Dark room, with no TV or electronic devices.
  • Create sleep associations. Children like their routines. It is ideal if they go to sleep in similar conditions every night (same bed, room, lights off etc.).
  • For younger children, put them to bed semi-awake. Allow time for them to calm themselves. This way they learn to go back sleep if they woke up the middle of the night.
  • If your children cry in the middle of the night, attend to their needs. Comfort them, but avoid picking them up or bringing them to your bed.

Helpful Resources

The Human Service Workforce Crisis in Massachusetts

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Hello, my name is Cheryl Dolan and I work in human services.

I moved from the UK in 1999, when many humans service agencies could not find staff and went overseas to hire them. We still have this problem today. We need to look at why this is and what we can do to change it.

Why is there a shortage in staff?

  • More people need support and services than before so need more staff
  • Wages are low and not too many ways to get promoted
  • Lack of people who are trained to do the job well

How does this affect people?

  • People have high turnover or unqualified staff working with them
  • People not getting the best care
  • Programs have to close, People  are losing services or are on wait lists
  • Families become stretched and have no help

What are human service agencies doing to address the issue?

  • Looking at how technology can be used to support people and reduce some staffing needs
  • Working with local and federal government to support them by applying initiatives for state employees to human service agencies
  • Looking at how to attract, train, and retain skilled employees.

How can you help fix this?

  • Make your voice heard! Make the people you vote for know you want to see increase in funding for wages
  • Support agencies seeking increased funding to provide higher wages for staff
  • Join advocacy movements like The Caring Force     

"The Caring Force logo"

Additional materials

Who Will Care? The Workforce Crisis

The Caring Force

Boston Herald: Opinion  Workforce Crisis Threatens Community

Chicago Tribune:  Article– Care Worker  Shortage

My child does not want to go to school

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Children walking to school

Children walking to school

As a doctor for children, I often talk to parents about school refusal. There are many reasons  why children do not want to go to school and the reasons change with age.

Here I summarize a list for the most common causes of school refusal. Some are typical for age and some require help and support.

Separation anxiety. Children who become very sad and worry when their parents leave. It can start at 6-7 months of age. Peaks at age 15-18 months. Most children cry when parents leave, but can calm fast and they are happy to see their parents at pick up time. Children who cannot calm down, refuse to play with other kids, may need help.

Light bulbWhat parents can do;

  • Talk to your children about school in simple words “its School time, play time”.
  • Remind them of things they like to do at school.
  • Use rewards. A reward can be a fun activity that you do together.

Performance Anxiety. Definition: Children who escape certain class activities. Examples are; reading in front of the class or being called on to answer questions.

Light bulbWhat parents can do;

  • Talk to teachers, they will give important information about how your children are doing in the classroom.
  • Work with the teachers to make a plan, for example; allow time for them to raise hand or practice reading before the class starts.
  • Use stars reward system for “reading out loud”.
  • Tell them you are happy with their hard work, even if they were not successful.

Learning Disability (LD). Definition: difficulties with school academics. Difficulties can be in; reading, writing, math or in more than one topic.

Light bulbWhat parents can do;

ADHD. Definition: It is a medical condition that makes it difficult to listen and pay attention. It is due to changes in the brain chemicals. ADHD is more noticed when children move to higher grades. Children with ADHD can be misunderstood. As a result, making friends can be hard.

Light bulbWhat parents can do;

  • Talk with the teachers. Ask if your children act same at home and school?
  • Talk to your doctor. ADHD is very common and can be treated with medications and some additional help at home and school.
  • Schools can help and support children with ADHD. Know your rights, students with ADHD

Bullying. Definition: when a person or a group repeatedly harm someone. It can be; physical, calling out names or using the social network to post bad things.

Light bulbWhat parents can do;

  • Ask Children if they ever get hurt in school or called names.
  • Ask the school counselor and the teacher to help you find out more if you have any reason to think about your children being bullied.
  • Get children help through therapist, share with your school and your doctor.

 

Depression. Definition: low mood and loss of interest in fun activities. It is more common among older children/teenagers. Depressed children can be irritable or angry not sad. It is important to notice any other changes to your children mood and behaviors at home.

Light bulbWhat parents can do;

  • Talk to the school counselor, your doctor or someone in your community to help you with resources.
  • Always look for expert help.

Resources:

Make the Morning Run Smooth Strategies for Developing a Morning Routine

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As a pediatrician, I work with all children including those with disabilities. I hear how difficult it can be to get out the door in the morning. In this blog, I share tips for creating a morning routine to get out the door on time and with less stress. Most children do better when there are routines that are predictable and consistent, including children with Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorders.

Learning a morning routine can be especially challenging for children with disabilities. They often need more directions, practice, and patience to learn these skills.   Each family will need to change these tips to work in their home.

Plan Ahead:backpack

  • Have your child pack his/her backpack and place it by the door at night. Make sure homework and projects are in the backpack. Creating a homework folder makes this easier.
  • When possible, pack lunches the night before.
  • Help your child pick out clothes the night before. This helps stop disagreements about what to wear.

Wake Up

  1. Start backwards. Figure out what time you need to leave.  Decide how long the morning routine will take. Give 10 to 15 minutes of extra time. That amount of time determines when to wake your child up.
  2. Pleasant wake up. Have the alarm play a favorite song or wake your child up gently with a hug and cuddle. Harsh alarms or abrupt wake ups can start the day off poorly.

Getting ready

  • Create a get ready routine: Wake Up, Get dressed, Eat breakfast, Brush teeth, Review the day and backpack, Leave for school.
    1. Get dressed first as this is often the biggest hurdle in the morning
  • Post a visual chart or checklist of each step. Laminate it or hang it in a plastic folder. Your child can use a dry erase marker to check things off when done.
    1.  Can use pictures of your child doing each step
  • If your child is more interested in music, create a playlist of songs. Each song goes with a different task in the morning routine.
  • Use a timer showing your child the time left for each step.

Getting Out the Door

  1. Use a silly sound (a wolf howl) to warn your child 5 minutes before it is time to leave.
    1. At first, you will need to use the sound and a warning “five more minutes”. Eventually just the silly sound will work.
  2. Use a different silly sound (duck quacking) for when it is time to leave.
    1. At first, you will need to use the sound and a warning “Time to go”.

Make It Funreward ribbon

  • Praise your child for completing steps in the routine. At first, the praise should be IMMEDIATE.
  • Create rewards for following the routine.  This can be a sticker chart or small prizes.
  • Your child can do a favorite activity as a reward if finish early.  This can be very motivating.
    1. No TV or tablet until your child is dressed and ready for school. If your child is ready early, he/she could watch a short clip.

Stick to It

    • Creating a new routine or habit takes 3 weeks.  Work towards the same goal for 3 weeks.
    • Once you have mastered the morning routine, create a bedtime or homework routine.

Additional Information and References:

Fair Wages

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Many workers living with a disability receive low pay from their 2 people advocating for fair wagesjobs. There is a law called the Fair Labor Standards Act or FLSA.  The FLSA helps protect workers from their jobs. Most people do not know that the FLSA has a section called 14 (c).  Section 14 (c) lets jobs pay low wages to people living with disabilities

Many people living with a disability in the United States are paid under $4 an hour.  Workers who are paid low cannot afford to pay rent.  They cannot afford to pay their bills.  They cannot afford to buy the things that they need.

Activists and lawmakers are working together to change the FLSA law by:

  • Fighting for higher pay
  • Fairness in the workplace
  • Better benefits
  • More jobs

The costs in America are going up every year to live here.  People living with disabilities have a right to fair wages

If you would like to know more about the Fair Labor Standards Act, please click below

Many people with disabilities are being paid low wages and its perfectly legal

ABA Therapy

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child pointing at a chartHello, my name is Felisha Thomas and I work as a behavior therapist in a public school.

Therapists and teachers use ABA to help work with children.  ABA stands for Applied Behavioral Analyst.  This means the science of behavior.  ABA is not just for children with autism.  ABA is used to help all children with their behaviors.

Therapists and teachers learn ABA in school.  They learn about the 3 ABCs of behavior.

  • Antecedent: what are they doing before the behavior?
  • Behavior: what are they doing?
  • Consequence: what are they doing after the behavior?

Therapists and teachers use ABA for lots of things.

Help children make better choices throughout the day.

  • Help children who are sad.
  • Help children who are mad.
  • Play with children at the playground.
  • Keep children safe.
  • Help children follow directions in class.
  • Help teach children the rules.
  • Help children learn the class lessons.

Therapists and teachers go other places outside of school to help children too.

  • We go to museums.
  • We go to zoos.
  • We go to parks.
  • We go to the pool.
  • We try to help children anytime there is a need.

Therapists and teachers are friendly.  We let children know that we are their friends who like to help.

For more information on ABA therapy, see ABA in Classroom Settings.

Assistive Technology for Attention Deficit Hyperactivity Disorder (ADHD)

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What is ADHD?

How many types are there?Boy leaning on a stack of books

What are challenges people with ADHD may have?

What can families and teachers do to help a child with ADHD?
Overview

In ADHD, children have a hard time making and keeping friends. They also may not do well in school. Some children with ADHD have low self-esteem. ADHD affects millions of kids around the world. Adults have it too. Treatment can help people with ADHD feel better. But, it does not cure ADHD. Treatment is either medicine, behavioral interventions, or both. It happens more in boys than in girls.

There are three main types of ADHD (according to the Mayo Clinic).

  1. Hyperactive (Over-active). This happens more in boys.
  • Talking too much.
  • Difficulty waiting for their turn.
  • Difficulty staying seated in the classroom.
  1. This happens more in girls.
  • Short attention span.
  • Difficulty staying on task.
  • Making careless mistakes.
  • Difficulty staying focused.
  • Appearing not to listen, even when spoken to directly.
  • Difficulty with organizing tasks.
  • Easily distracted.
  1. (both overactive and inattentive). This is the most common type in the United States.

Other challenges in children with ADHD

  1. Learning disabilities.
  2. Understanding difficulty.
  3. More car accidents and injuries.
  4. More poisoning and choking.

 What can teachers do to help CHILDREN with ADHD?

 Teachers can help children with ADHD to stay focused by putting them in a quiet space. By doing this, there are fewer noises and other distractions.  Also, white noise helps kids concentrate and pay better attention while learning.

Other helpful ways to help kids focus is to use a timer. There are different kinds, such as kitchen timers and dual timers. They help kids with ADHD manage time wisely. They help improve concentration. Some people prefer kitchen timers or timer apps. Many therapists think a timer app works for only a short time before a kid with ADHD tunes it out. (See Timer Visual Productivity / Android version.)

Routines and rules in the classroom can make a big difference.

Audiobooks, talking books and text to speech (TTS) will enable kids with ADHD to listen carefully to text. TTS helps kids with ADHD understand what they are reading. It also helps them recognize words.teacher helping student

Children and adults with ADHD can use a smart-pen, such as LIVESCRIBE, to take notes in class and record the classroom. After school, people with ADHD can read notes they took and listen to a recording at the same time. (See the YouTube video, “5 Students Share smartpen Lecture Techniques”.)

Other useful resources for people with ADHD:

Explore Simple Math, Basic Math, and more!

Three Components of Successful Programs for Children With ADHD.

Tremor and smart phones

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In this blog, I would like to discuss briefly three main issues.typing on a smartphone

  1. Define tremor, types of tremor, and diseases that may cause it.
  2. What is the importance of smartphones in the lives of people with tremor?
  3. How software helps people overcome shaky hands.

The smart phone has become an important tool for people. They help us talk to our families and have fun. The following are some ways smart phones can improve the health and lives of people with disabilities.

Tremor is an uncontrolled movement of the body. Some people call it “shaky hands”. Here are two types.

  1. Resting Tremor (RT) is part of Parkinson’s Disease (PD). In 2004, there were about 5 million people with PD in the world. There will be 40 million in 2020. There tends to be less Resting Tremor when the body is moving. Resting Tremor is worse when the body is at rest.
  2. Essential tremor (ET) is another uncontrolled movement of the hands. ET is the most common tremor. The World Health Organization says 4% of people are affected by ET. Essential Tremor is worse when the body is moving, and better when the body is at rest.

Other causes of tremor:

  • brain tumors;
  • side effects of some medicines;
  • caffeine; and
  • stress

Smart phones have become a tool to transmit and store data from people with tremor. They are also used to learn about tremor and to see how good a treatment is.

Below are some free apps with brief explanations:

  1. Lift Pulse App is available for Android and IOS. It can identify your tremor and measure its degree. You can set your baseline readings (on a normal day) and compare them with results from other days. You can find this app at:
    1. Lift Pulse App download link / Android version
    2. Lift Pulse App download link / IOS Version.
  2. Parkinson’s Central App is available for Android and IOS. It is a great free app for people with Parkinson’s Disease. It answers general questions to improve the lives of people with shaky hands. It gives information on health insurance and local resources near you. You can find this app at:
    1. Parkinson’s Central App download link / Android Version
    2. Parkinson’s Central App download link / IOS Version.
  3. Essential Tremor App is available for Android and IOS. It is a great free app for people with Essential Tremor. It gives you general information about symptoms and treatments. It lets you know about ET events near you. You can find this app at:
    1. Essential Tremor App download link / Android Version
    2. Essential Tremor App download link / IOS version.

Touch screens on smart phones could be a challenge for people with tremor.

Below are some helpful solutions.

Change the sensitivity of the touchscreen. Find Accessibility Options in Settings. Now you can adjust such options as:

  • Assistive Touch
  • Touch Accommodations
  • Switch Control
  • Keyboard Size
  • Shake to Undo

Review the options and play around with them to find what is best for your needs.

There are other free apps that would be useful as well. Also, many users with tremor prefer to use voice to text to overcome the challenges of tremor.

I encourage you to enjoy your smart phone, and not to let tremor hold you back.

 

Mindfulness and Children with ADHD – Tools for Parents

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children doing yoga

I am a pediatrician.  I often work with children who have attention deficit hyperactivity disorder (ADHD).  Medication often can help. But there are other ways to help too.  One is mindfulness.

What is Mindfulness?

The idea of mindfulness is to focus on what is going on in the moment, on purpose, with no judgement (Kabat-Zinn, 1994).

Research shows that these activities can help children with ADHD. This includes the following.

  • Focusing on important thoughts while ignoring others.
  • Help with the behaviors that get children into trouble.
  • Help with control over their emotions

How Can Parents Teach This To Their Children

There are lots of ways to learn to be more mindful.  One activity may work well for your child and others may not.  You might have to try more than one thing with your child.

Some schools teach mindfulness activities. But not every school does.  There are classes, such as children’s yoga, that can teach these skills.  However, classes can be costly and hard to find.  Below are some tools for parents.  Many can be done at home.

 Yoga

Yoga is a good way to help an active child focus.  For young children, I like books that show simple poses.

Older children and teens should start with a live class.  This is to make sure:

  • their form is correct;
  • they learn how to change a hard pose to make it work for their body; and
  • they know which poses should not be tried alone at home.

This helps lower the chance of injury.  You should always talk to your child’s doctor before starting a new exercise program.

There are low-cost options for yoga. These include non-profit studios and community classes.  These options will be different based on where you live.

Once children know how to do yoga safely, they can use online videos.  There are free classes on YouTube.  Do Yoga with Me is a free website.

Mindfulness Apps

Breathing exercises can also aid a child.  These can help calm and focus the mind.  Many only take a few minutes.

Common Sense Media has a list of apps for children.  You can sort them by age.

Other Ideas

These are some ideas that can be done without technology.

More info on the research behind mindfulness and ADHD is discussed in the article Exercising the Mind to Treat Attention Deficits. 

Works Cited

Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

Speaking with An Augmentative Device

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Person using agumentative deviceMy 25 years old son is non-verbal. He uses his phone as his speech output device. He has worked hard to learn the software on his phone.  This software speaks the words that he types into his device.  He has used a variety of other speech output devices in the past.  There are many more options for speech output devices available now.  And, there are places like MassMatch (1 ) which can help each user to find the best choice.

When he was younger, family members and teachers would always be with him and speak for him. These days he still always with someone when he is out in the community.  But, now, he is interested in speaking for himself.  He also has the vocabulary and skills to speak for himself.

So, how does it go?  Well, it depends… Let me describe a common situation that shows how much effort it takes for my son to communicate in public places. Ordering fast food or in a restaurant is something that we all do. For my son, it is a chore. He must get the waiter’s attention. Then, he will order his food.  Most of the time, he needs to repeat his order.  e needs to repeat it more than one time. If the waiter stops and listens, it is easier.  but, most of the time, he needs to repeat his order.

Speaking in public is hard for many people. It is more difficult for someone who uses a speech output device. He shows us that many strangers do not choose to listen.  Our public places, malls, restaurants, outdoor spaces are noisy.  here is music, talking, traffic, and other sounds.  My son cranks up the volume on his phone. On a good day, a stranger will listen to his computer voice.  The pride my son takes in talking with someone is worth the effort. This photo shows my son speaking to us.  You may be in a place where someone is trying to speak with a device.  Please take the time to listen and respond. It only takes a little bit more time and the rewards are great.

(1) MassMatch

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