We hope and pray all of our FOCUS families, therapists, and staffers are safe in the wake of Hurricane Ian. Our Fort Myers offices will be closed until further notice. We will be reaching out via text message to individual families once power and cell service have been restored to discuss our next steps. In the meantime, stay safe and take care of each other. We are in this together.
Kids aren’t born knowing how to blow their nose. In fact, it’s not uncommon in therapy centers, elementary school classrooms, playgrounds, and doctor’s offices to see kids with runny, booger-y noses that need blowing. It can be an especially tough skill for kids to master if they have sensory, fine motor, and executive functioning struggles. Fortunately, a FOCUS Fort Myers occupational therapist is here with tips to teach your little one the art of nose blowing.
Blowing your nose is a functional life skill – one that is especially important in a society that is increasingly hyper-vigilant about reducing the spread of germs and communicable illnesses.
Although many of us think about “blowing your nose” as a singular task, a Fort Myers occupational therapist can explain that there are actually numerous steps to being able to execute this skill – some more complex than others. When we break down the act into each of its most basic parts, it’s easier to recognize why kids might struggle with it.
Every time a person blows their nose, they must:
- Know that their nose is stuffy. This takes the interoception bodily awareness skills.
- Know to blow the boogers out, rather than sniffing them back up into their nose. This again is an interoceptive skill that requires bodily awareness.
- Hold the tissue at their nose without merely crumpling it up. This requires fine motor skills.
- Blow the air through their nose – (but keep your mouth closed)! This requires oral motor skills.
- Press one nostril down while blowing out the other. This requires both fine motor skills, as well as interoception.
- Be able to recognize when all the boogers have been successfully removed from the nose. This, again, is an interoception skill.
- Know how to carefully handle the messy tissue without spreading germs to others. This is both tactile skills as well as fine motor skills.
- Wash your hands after throwing away the tissue. This requires a number of skills, including executive functioning, problem-solving, sensory-processing, and fine motor skills.
On top of all this, kids are often expected to manage this self-care task while also still remaining engaged – or quickly becoming re-engaged – in whatever social event, learning, or other task they were doing before they realized they needed to blow their nose.
As your occupational therapist can tell you, this can be especially tough for kids with olfactory sensitivities, as they may often breathe through their mouth by default – which makes nose-blowing difficult.
Further, a child who struggles with interoception/bodily awareness, they may struggle to know when their nose is running, full, or stuffed. They may not realize after they blow their nose that they have a booger stuck to their face.
A child who has trouble with executive functioning may not realize that if they don’t stop what they’re doing in class to blow their nose, they’ll end up with a messy/runny nose – a situation that can lead to social awkwardness, as well as the spread of germs.
We recommend using unscented tissues, for starters.
Beyond that, there are a number of nose-breathing exercises we can do in our OT sessions (and that you can do at home) to help kids learn/practice breathing out of their nose. Some nose-blowing exercises:
- Teach nose-blowing before a child gets sick. Often parents don’t prioritize nose-blowing if there is no stuffiness or congestion because, well, we don’t really think about it when it’s not an issue. But if a child is learning to blow their nose when they’re all stuffed up or already have a runny nose, the experience of trying to breathe while holding their mouth shut and blowing out of their nose can be super frustrating and overwhelming. Try practicing when a child isn’t sick.
- Practice nose-blowing with the mouth (to start). Show them how blowing air out of their mouth moves the tissue. Then we can move to “using our wind power” to move the tissue with nose air.
- Use water. Teach a child to practice blowing air through their nose (alternating nostrils) to see how their “wind power” can cause ripples to move across the water.
- Use a small, crumpled-up tissue piece or cotton ball. Give them a short straw they can put up to their nose to have them hold one nostril down while they use the other to engage in a “cotton ball race.”
- Use a mirror. With a small mirror, ask the child to pinch one of their nostrils and blow air from their nose onto the mirror. Observe the condensation that builds up from their “wind power.”
- Overexaggerate. The breathing, the closing mouth, the blowing through the nose without a tissue – make it super-exaggerated to make your point. Turn into a game like Simon Says to help them learn to copy skills like taking deep breaths, holding our deep breaths in, closing their mouth, and blowing through their nose.
- Teach your child about the spread of germs. Sometimes spending a little extra time to help kids understand why we’re trying to help them learn this skill can go a long way. Your Fort Myers occupational therapist can help by creating a nose-blowing social story – both to explain germs as well as all the steps needed to know when/how to blow our nose.
Remember, these skills aren’t likely to be mastered overnight. But with practice – your child WILL succeed! If you try these tips and still find your kid is struggling, our occupational therapy team at FOCUS Therapy can develop a strategy specific to your child to help them overcome whatever specific element of the task they’re finding especially difficult.
FOCUS offers pediatric speech therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
How to Teach Your Kid to Blow His Nose, January 14, 202, By Aleksandra Weber, Parents.com
More Blog Entries:
Tantrum or Sensory Meltdown? Fort Myers ABA Therapists Explain, July 31, 2022, FOCUS Therapy Fort Myers Blog
FOCUS Fort Myers ABA and Occupational Therapists on Expressing Feelings vs. Energy on the Autism Spectrum
As our FOCUS Fort Myers ABA and occupational therapists can explain, lots of kids with autism and ADHD have difficulty recognizing or describing their emotions. There’s actually a name for this: Alexithymia.
It’s not a medical condition in its own right, but lots of neurodivergent people describe it as very real, characterized by substantial and continued difficulty with emotional awareness. It was detailed in a recent study published in the journal Frontiers in Psychology.
Some neurodivergent people who experience alexithymia say that it’s easier to discuss feelings as levels of energy, which can seem a bit more tangible than emotions.
Our FOCUS Fort Myers ABA therapists and occupational therapists recently came across a resource created by the therapy consultants at AutismLevelUp.com that describes the various energy levels, and it inspired us to create our own visuals/explainer.
This idea of identifying energies versus feelings closely relates to the Zones of Regulation that our therapy team uses frequently. (i.e., Blue Zone 🔵 = Sad, Tired, Bored, Sluggish; Red Zone 🔴 = Mad/Angry, Scared, Out-of-Control; Yellow Zone 🟡= Frustrated, Worried, Wiggly, Silly, Excited; Green Zone 🟢= Happy, Calm, Focused, Relaxed).
Every person may have their own unique manifestations of these various zones or energy levels (i.e., one may become hyperactive when they are overly-tired – perhaps because they’re overstimulated).
The bottom line is that any time we can help kids better identify their feelings and/or energy level, the better able we are to help them learn the most effective self-regulation strategies.
Self regulation plays a key role in relationships, well-being and overall success in life. People who are able to manage their emotions and control their behavior are more prepared to manage stress, deal with conflict and achieve their goals.
If you have questions about the Zones of Regulation, identifying energy levels, or setting self-regulation goals for your child with autism and/or ADHD, our FOCUS Fort Myers ABA therapists and occupational therapists are here to help.
FOCUS Fort Myers offers ABA therapy, occupational therapy, speech therapy, feeding/swallowing therapy, and physical therapy to kids throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
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FOCUS Therapy Only Schedules Evaluations if We Have Space to Treat Your Child, Aug. 1, 2022, FOCUS Fort Myers Therapy Blog
The symptoms of sensory processing disorder may depend substantially on the type of sense that is impacted, how it’s impacted, and the severity experienced by each individual.
Sensory processing disorder occurs in each of our sensory systems:
A person might have just one sensory system that is affected, or they could have all eight, with various different subtypes. That’s why our FOCUS Fort Myers occupational therapists drive home the message that each child with SPD needs to be individually assessed – and treatment for every child is going to look different.
Those with sensory processing disorders have difficulty interpreting the sensory input they get. They might feel overwhelmed by sensory information – or they might crave it. They might seem to be untuned to the sensory input or feelings of others. They might be described as “clumsy,” “awkward” or “delayed.”
Here, we explain the main SPD subtypes.
Sensory Modulation Disorder
Sensory modulation disorder is when a person has trouble regulating their responses to sensory stimuli. There are three types of sensory modulation disorder:
- Sensory over-responsiveness. This is when a person may respond too soon, for too long, or too much to a type of sensory stimuli that most people find pretty tolerable or normal.
- Sensory under-responsiveness. This is when a person might be unaware of certain sensory stimulation. They might have a delayed response to it, or their responses could be muted or with less intensity than most people might show.
- Sensory seeking. This is when someone may be compelled to seek out sensory stimulation, but once they do, they may be ultimately unsatisfied or it only results in disorganization. At the very least, it may be seen as socially problematic.
Sensory Discrimination Disorder
The second type of SPD is sensory discrimination disorder. This is when a child may have difficulty interpreting the subtle qualities of people, places, objects, or environments. This can include:
- Auditory discrimination disorder. This would be trouble interpreting auditory/heard stimuli.
- Visual discrimination disorder. Trouble determining or interpreting visual stimuli.
- Tactile discrimination disorder. Trouble interpreting stimuli that is felt or touched.
- Vestibular discrimination disorder. This is trouble determining or interpreting stimuli that is experienced through movement of the body against gravity or through space.
- Proprioceptive discrimination disorder. This is difficulty determining or interpreting sensory stimuli experienced through joints and muscles.
- Gustatory discrimination disorder. This is when someone has trouble interpreting or determining sensory stimuli that is tasted.
- Olfactory discrimination disorder. Trouble interpreting/determining smelled stimuli.
- Interoception. Trouble interpreting internal organ stimulation. (They may not feel the need to use the toilet or they might have frequent stomachaches.)
Sensory-Based Motor Disorder
Sensory-based motor disorder is when one has trouble with motor coordination, balance, and performing skilled motor tasks.
- Postural disorder. Someone with postural disorder would have a skewed perception of their body position. Therefore, they’d struggle with poorly-developed patterns of movements that depend on stability of the core. They would appear to be weak or have poor endurance.
- Dyspraxia. This is when the person would have trouble thinking of, planning, or carrying out skilled movements – especially new movements they aren’t familiar with.
FOCUS Therapy Treats Kids With Sensory Processing Disorder
If your child struggles with any type of SPD, our skilled team of occupational therapists can help!
FOCUS offers pediatric occupational therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
What is Sensory Processing Disorder? March 31, 2022, By Janice Rodden, ADDitude Magazine
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Fort Myers Feeding Therapy Tips for Picky Eaters, July 24, 2022, FOCUS Therapy Blog
At FOCUS, all of our Fort Myers therapies are play-based therapy.
Of course, play can be a lot of fun for as adults too – but the real reason we use a play-based therapy model in our speech, occupational, physical, and ABA therapy sessions is simply because: It works.
Study after study shows that when we engage kids in a play-based model of therapy, they’re going to be more engaged, excited about therapy – and they’re going to better remember the skills we’re trying to teach them.
“We never say, ‘Ok let’s go back and do some therapy,'” explains FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco. “No, we say, ‘Hey, are you ready to go play?’ Kids don’t even realize they’re doing ‘work’ – and that makes it more enjoyable – and ultimately more effective.”
FOCUS offers pediatric speech therapy, feeding/swallowing therapy, occupational therapy, behavior therapy, and physical therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Planning a Play-Based Therapy Session, Sept. 2, 2013, By Meredith Poore Harold, ASHA Wire
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FOCUS Therapy Take on New CDC Developmental Milestones Guidelines, Aug. 1, 2022, Fort Myers Play-Based Therapy Blog
Evaluations are an important step in the process of securing speech, occupational, physical, and/or ABA therapy for your child. But parents and caregivers should be wary of facilities that offer these evaluations while lacking capacity to immediately treat the child.
FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco explains that unless her team is being called on for a second opinion of an initial evaluation, they refrain from conducting formal assessments if unable to promptly provide treatment once the evaluation is complete.
“A standardized assessment is only a snapshot in time during the child’s development,” Voltz-Ronco said. “It’s like taking a picture of a child now, and then expecting it not to change in a few months. … If your child cannot access therapy within 1 or 2 months of that evaluation, the results are no longer going to be accurate. Kids develop new skills every few months. But the longer the child goes without therapy, the more significant that standard score comparison/discrepancy to same-age peers is going to be.”
Beyond this, families who rely on insurance to cover the cost of these evaluations (and they aren’t cheap) should be aware that insurers typically only cover one evaluation every six months or so. Even though clinics can utilize standardized assessments administered by another, it’s not ideal.
“Your child gets the most benefit when the team that directly observed your child’s abilities and deficits are the ones who ultimately formulate a plan of care and follow through with treatment,” Voltz-Ronco said. “In my opinion, it’s unethical for a clinic to profit from an evaluation that reveals a child is delayed or needs intervention – without providing that help.”
Types of Pediatric Evaluations FOCUS Therapy Offers
Children are usually referred to FOCUS Therapy and other therapy specialists by their primary care physician. Evaluations are typically ordered when a child is showing some developmental deficit, such as not sitting up or crawling, not talking or making regular eye contact, or red flags for a possible cognitive deficit. They could also be diagnosed with a condition that we can pretty well say for certain is going to require some combination of therapy services (such as cerebral palsy, down syndrome, vision impairments or hearing deficits).
Depending on the child’s condition and identified areas of concern, qualified therapists will be scheduled to conduct age-appropriate assessments to determine the need for therapy intervention services.
The specifics of the evaluation may vary, but they are generally going to include:
- A look at case history, including medical status, education, socioeconomic, cultural, and linguistic backgrounds, and information from other providers.
- Child and/or parent interview.
- Review of the child’s auditory, visual, motor, and cognitive status.
- Standardized and non-standardized assessments of specific aspects of speech, non-spoken language, swallowing function, cognitive communication, etc.
- Assessment of self-care and/or self-awareness.
- Skilled observation. This is where we keenly observe an accurately record a child’s abilities and behaviors.
There are several different types of standardized tests (including the ADOS test for autism screening, which FOCUS Therapy also provides).
“If a parent wants a second or third opinion after their child has been evaluated by a school or another provider, that’s one thing,” Voltz-Ronco. “But they’re most likely going to pay for that out-of-pocket – and they’re going to understand the purpose upfront. But if parents are looking for action, to get the ball rolling on the therapy interventions that a child needs, then the clinic conducting the assessment should be able to provide that.”
Not all of them do. Therefore, it’s incumbent on parents to ask the question before scheduling the assessment.
“We’ve gotten calls from parents of children who were evaluated other clinics, only to be told after the fact that the clinic did not have the ability to treat their child,” Voltz-Ronco said. “They were told to just call around and see what other clinics may be able to use the report generated from their assessment. That, to me, is not ethical.
“It’s a situation where parents need to be aware of this issue, and make sure they are asking the question upfront: ‘If I schedule this assessment and my child needs treatment, do you have the capacity to provide that treatment?’ If not, I would advise parents to move on and find a place with the capacity and willingness to do both.”
FOCUS offers ADOS testing and other standardized assessments in Fort Myers and throughout Southwest Florida for children who may need speech therapy, occupational therapy, physical therapy, or ABA therapy. Call (239) 313.5049 or Contact Us online.
Assessment and Evaluation of Speech-Language Disorders in Schools, American Speech-Language Hearing Association
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ADOS Testing, FOCUSFlorida.com
Earlier this year, the U.S. Centers for Disease Control & Prevention (CDC) updated its developmental milestones guidelines used to identify potential red flags indicating a child may need early intervention services. This process was initiated long before the pandemic, and finalized in February.
After taking some time to consider the impact of these new standards, our FOCUS Therapy team has some concerns that we hope parents and local providers will pay attention to when weighing whether a child may require early intervention, such as speech, occupational, physical, feeding, and ABA therapies.
What Are CDC Developmental Milestones?
The milestones guidelines put forth by the CDC are essentially a point-by-point list of activities or skills that most children can do or have mastered by a certain age (primarily between birth and age 5). It includes skills that fall under one of the following categories:
- Movement/physical development
Examples of identified milestones would be things like waving “bye-bye” or saying words besides “mamma or dada” or taking a first step.
The old milestones can be found here.
The updated milestones can be found here.
Why Did the CDC Update the Milestones?
The CDC, along with the American Association of Pediatricians (AAP) said that the updates were conducted by a group of its experts, with changes required because the standards had not been revisited since 2004.
A spokeswoman for the CDC told Reuters that the agency had been discussing revising the milestones back in 2017, and that the work began in 2019. Analysis of parent understanding and relatability was conducted in mid-2020.
The goal, say agency leaders, was to make the guidelines more helpful to families. The language contained in the previous guidelines was reportedly vague, with parents on many fronts urged to take a “wait-and-see” approach. That approach is now broadly understood to no longer be the best course of action when children are delayed on key developmental milestones.
The updated version now includes checklists for 15 and 30 months, and milestones that are considered “standard” when 75 percent or more kids can be expected to those skills. That differs from the previous standards, which were based at 50 percent mastery.
Why Our FOCUS Therapists Have Concerns About the New Milestones
Certainly, eliminating a wait-and-see approach to any concern regarding kids’ developmental milestones is important. We now know that prompt intervention therapies (speech, occupational, physical, and ABA) are the critical when there are concerns about a child’s development. Early intervention is strongly correlated with optimal long-term prognoses for these kids.
The CDC says that by resetting the bar, they are able to pinpoint kids whose delays are clinically significant and who unquestionably should be funneled into the pipeline for early intervention services. This is as opposed to “worrying families whose children may developing normally at a slower rate than average.”
Our concern at FOCUS Therapy, however, is that in moving the milestone bench marker from “this is the age at which 50 percent of kids have this skill” to “this is the age at which 75 percent of kids have this skill,” the CDC has effectively lowered the standard for who may qualify for early intervention. In turn, that could mean kids who truly need these services may end up waiting even longer than they are now to obtain them.
“We want parents – at the earliest sign of an issue – to start raising the question, pushing for answers from doctors, and getting the ball rolling for evaluations and early intervention therapy services,” said FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco. “This is especially important in regions like South Florida, where it could take months just to get an evaluation, let alone an appointment to see a pediatric developmental specialist and get therapies lined up from there. We don’t want them waiting any longer than they have to because it is already going to take many months to secure these services. All the while, they’re going to be falling further and further behind their peers. The concern with these updated developmental guidelines is that is exactly what’s going to happen.”
There’s also a worry that health insurance companies may not approve treatment for kids if they’re slightly younger than what’s identified in the new guidelines – even if we as parents, therapists, and other health care providers can clearly see the benefit and need for services.
“Our recommendation, if you have any concerns about your child’s development, is to raise them to your child’s pediatrician and press them for a referral to specialists who can conduct assessments,” Voltz-Ronco said. “The earlier we can intervene for kids who have a delay, the better the long-term outcomes.”
FOCUS offers pediatric speech therapy, occupational therapy, feeding therapy, physical therapy, and ABA therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
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A New Diagnosis: Pediatric Feeding Disorder & How Fort Myers Feeding Therapy Can Help, June 27, 2022, Fort Myers FOCUS Therapy Blog