In the impulse control blog I wrote that for a child to control an impulse it requires them to hit the “pause” button (just like on the remote.  Kids have to learn to hit the pause button before acting on an impulse.  What is even harder than hitting the pause button is learning to hit the “stop” button.  They have to learn to pause and think about the consequences of acting on an impulse and whether or not it is a good or bad choice.  They then have to learn to hit the stop button and not act on that impulse if they realize that there are negative consequences that will come from their actions.  This is a lot harder than it sounds and I think that even us grown-ups can struggle with this!!

Quite often children who struggle with impulse control also struggle with a sense of internal timing.    In fact, there is an increasing amount of literature that says that children with ADHD, Dyslexia, Autism, Reading Disorders, Auditory Processing Disorder in addition to many other conditions have problems with this internal timing.  You see, our brains have an “internal clock” that keeps time.  That timing is important not only for impulse control but also for being able to focus and attend, for being able to switch attention from one thing to another, for reading comprehension, remembering information,  motor coordination, processing speech, for waking us up and putting our brain to sleep at bedtime, just to name a few.  Timing is also critical for communicating effectively and participating in group activities (sports, play, peer relationships, etc).  When a child is able to wait until just the right moment to act they will have greater success in these areas.  For many, though, they have a tendency to “jump the gun” and this can lead to problems.

This is where the metronome comes in.   Think about what musicians use metronomes for.  They use them to help  keep time.  Metronomes are not just for musicians anymore, though.  Metronomes work great in helping children who struggle with this internal clock.

What happens when you use a metronome during activities is that children learn to predict the amount of time that is in between each beat; it gives them a rhythm.  It makes them pause after one movement and wait until the next beat for their next movement. Did you catch that?  It makes them pause!!!!  Even after the metronome is turned off, children will often continue to work or move to the beat because they have gotten the rhythm or the sense of timing in their head.  Instead of just acting or doing things impulsively and “jumping the gun” children learn to slow down and work to the beat pausing in between instead of moving and acting impulsively; it makes them more intentional in their movements.

I will tell you exactly how I use this in the clinic but let me first tell you how amazingly this works.  I have 10 year olds who can’t skip, catch a ball, or do jumping jacks but when we slow it down and do these activities to the beat of a metronome, an amazing thing happens; they can skip, catch a ball, and do jumping jacks now.  I have kids who live in a state of “jumping the gun” but when we slow things down and make them work to a beat, they now stop and think before acting becoming more intentional about their actions instead of being in a constant state of moving from one thing to another.  I will have kids do activities to the beat of the metronome for about 10 minutes and then start working on handwriting.  It is the craziest thing but these kids who write impulsively with no thought behind it, actually start writing to a beat (even when the metronome has been turned off).  What happens is the rhythm gets stuck in their heads.  I had one ten year old boy tell me he was able to fall asleep better because he could still hear the beat 6 hours later as he was going to bed.  I sometimes like to call things like this “voodoo medicine” because of how crazy it seems but how great it works.

So, hopefully I have convinced you to try this.  You can incorporate a metronome in to so many activities but I will give you a few examples.  You can certainly use your own imagination on how to use this with your own child, though.  I try to incorporate some metronome activities for at least 10 minutes of every hour long treatment session I do with kids.  I especially like to do it before we sit down to do handwriting activities or other learning activities that require focus.

The amount of time it takes to see results does vary and does depend in part on the desired goal.   I can sometimes see changes right away in a child’s coordination as soon as I turn the metronome on.  All of a sudden, they can do jumping jacks to the beat.  When the metronome is not on, however, they still struggle.  It takes doing this over and over again for them to really gain that sense of internal timing to be able to do jumping jacks without the beat.  When my goal is to help a child learn impulse control, it can take doing this several times a week for a few months to see big changes.  Gaining that sense of internal timing does not happen overnight but it can happen!!  When my goal is to slow a child down during a handwriting activity, I simply turn the metronome on and within a short period of time I will notice that they are slowing down and focusing more on their work.  One mom told me that she started turning the metronome on while her son does his homework and she noticed a big change in his ability to attend and stay focused on his work.

To get started all you have to do is download a free metronome app on your smart phone (I  use the Steinway and Sons app.).    When you set your metronome, I typically use a slow beat (in the 35-45 beat per minute range).  The key is to find a beat that will slow your child down but also to find a beat that is not so painfully slow to work with or one that is so fast that they can’t keep up.  Also, metronomes have the capability of setting the beats per measure.  That means that on a certain beat, it will make a different noise signifying the start of a new measure.  That makes things more confusing.  I would encourage you to set it at 0 so there is no change in the sound made after every certain number of beats.  Now let me give you some ideas on how to use this:

• Ball activities-  I like to stand about 5 feet away from a child and bounce a tennis ball or kick ball back and forth.  The size of the ball I use depends on the child’s skill level with catching.  We will bounce the ball back and forth to the beat.  I usually say  “bounce—catch” to the beat of the metronome to help the child stay on beat..  When the child gets the hang of this, I like to make it more challenging.  We will do “bounce-catch-tap-tap”.  The “tap-tap” involves holding the ball in their right hand (if using a smaller ball) and tapping it to their left foot and then holding it in their left hand and tapping it to their right foot.  Once we master that, we will add a behind the back component, or switching the ball from one hand to another, or tapping their forehead with the ball.  Honestly, be creative with this.  Just don’t make things more challenging until your child has mastered the first component.  They key to this it staying on beat with each move.
• Jumping activities- I will set a swimming pool noodle on the floor and have kids jump forward and backward over the noodle to the beat.  Then I will have them jump side to side over the noodle.  I will say “jump-jump-jump” along with the beat to help them keep time.  You don’t need a noodle, however.  Pick any crack in the sidewalk line on the tile or hardwoods, use a yardstick, or put a piece of tape on the ground.

They can do jumping jacks to the beat, as well.  Have them jump with their legs out and putting their arms overhead on one beat and then jump to put their hands at their sides and feet together on the next beat.

• Right brain/left brain activities- I love using activities that require children to use both sides of their bodies together in a coordinated way because this means they are using both sides of their brain.  Doing it to the beat of the metronome helps with the coordination aspect of it and makes the activity all the more beneficial.  Some ways I like to do this are:

1. 1.     Have them tap their right foot with their left hand and then their left foot with their right hand to the beat.  I like to say “tap-tap” to the beat to help with them keep to the beat.  I usually repeat for about 30 reps.
2. 2.     Have your child raise their right arm and point their right toes forward (with the foot slightly in front of the left foot).  Have them do a slight hop to switch, bringing the right arm down and right foot back and bringing the left arm up and left foot forward.  Continue to switch to the beat.  I usually repeat this for about 30 reps.
3. 3.     When kids have mastered number 2, you can make it more challenging.  Do this by having them raise their right arm and putting their left foot forward then switching to then bring their left arm up and right foot forward.  I usually repeat this for about 30 reps.

• Step-hop- This is a great one for any kid to do but especially those who are having trouble learning to skip.  I will have them step with their left foot (keeping their right foot off the ground) and hop. Then they step with their right foot (keeping their left foot off of the ground) and hop.  Continue like this doing each movement to the beat of the metronome.  This is basically slow motion skipping but breaks it down for them and they get the added help of the metronome.
• Marching in place- You can simply have your child march in place, marching to the beat.   I will also use the swimming pool noodle or that crack in the sidewalk or yardstick to have kids side step over it.  I will have them line up with their right foot parallel to the noodle and step over with their right foot and then left foot and then step back across with their left foot and then right foot.  I say “step-step” as they step with each foot.
• Handwriting- I like to softly play my metronome while kids work on their handwriting.  This is because most kids need to slow down a bit while writing.  I will play around with the beat I choose but normally do about 50 beats per minute.  On occasion, however, kids need a little help to speed up.  In this case, I will use a faster beat.

So you can see you can use a metronome in many different ways making it as simple or complicated as you would like.  Again, this is great to use prior to having your child sit down to focus on school work,  to have them do for about 10-15 minutes several times a week during an activity that coordination, or to simply play in the background while doing schoolwork.  I promise that I would not share this with you if I had not seen such amazing results with my own eyes.

I want this to work for you so please feel free to email me if you have any questions.  I would also love to hear about how you use a metronome to help your child or any other great tried and true strategies that you use.  Again, please email me if you have any insight that may help others out there.

There is a therapeutic intervention called Interactive Metronome that Occupational, Speech, and Physical Therapists can get certified in.  If you feel like your child could benefit from more intense work on their “internal timing” you can find a therapist in your area who is certified in IM by looking on www.interactivemetronome.com.

If you like our site and the content of what you read, please consider “liking” us by clicking on the facebook button.  Doing so helps us to get the word out to others who may benefit from the content on our site.  Also, please consider signing up for our monthly e-mail newsletter which will include more tips and tricks on how to build your child’s sensory foundation.  Thank you!

Are you sitting down?  If not, you better have a seat before you read what I am about to say; ADD and ADHD are “fictitious diseases”.  Well, at least that is what some are saying and what it is being said that the “father of ADHD” admitted to.  Let me explain more.

I recently ran across an article on-line saying just that; that ADD and ADHD are “fictitious diseases”.  The article that I read is from The DC Clothesline.  I would encourage you to read the article in full and you can do so at http://dcclothesline.com/2013/05/25/father-of-adhd-admitted-in-final-interview-that-disease-was-fictitious.  The article is based on the final interview that Dr. Eisenberg (who is often referred to as the “scientific father of ADHD”) gave before his death in 2009.  The original interview was printed in the German weekly Der Spiegel.  The headline is “Father of ADHD Admitted in Final Interview That Disease Was “Fictitious”” with the claim being that Dr. Eisenberg admitted that “ADHD is a prime example of a fictitious disease”.  Let me give you a few excerpts from the article:

Yes, it was even admitted that they are his THEORIES. The medical industry is using the guise of helping children to depersonalize and disconnect our children from a healthy, normal upbringing. Parents are placing their children on these drugs and subjecting them to what the world has to offer, when in fact all these children are looking for is their parents in hopes of being the blessing that God intended them to be.

In the United States, 1 out of 10 boys among 10-year-olds takes medication for ADHD on a daily basis … with increasing tendency. And with the help of Teen Screen surveys in public schools, they are attempting to set up the student for the fall.

…U.S. pharmaceutical industry spent 24.4 percent of the sales dollar on promotion, versus 13.4 percent for research and development in 2004. That is almost twice as much money on pushing their drugs on the people than research to make sure it is safe!

“ADHD is fraud intended to justify starting children on a life of drug addiction.”

The “attention deficit” lies in the responsibility of the parents, not the child. Scripture tells us that the parent is to “train up a child in the way he should go: and when he is old, he will not depart from it (Proverbs 22:6),” not the other way around.

Anybody’s blood boiling yet?  Now, let me tell you about an article titled “Work of Fiction” that was written in response to this.  This article can be found at http://www.snopes.com/politics/quotes/adhd.asp if you are interested in reading it.  In a nutshell, this article is saying that there were some misinterpretations when this article was translated from German to English and perhaps words were taken out of context.  The argument is that Dr. Eisenberg wasn’t saying that ADD an ADHD are “fictitious diseases” instead they are overdiagnosed.

I want to give my opinion in response to all of this now because this is something that parents ask me about on an almost daily basis.  My opinion is based on my own research in addition to years of working with children, listening to parents, teachers, and caregivers, and advice and opinions from great therapists who have been mentors to me over the years.  I believe that ADD and ADHD do exist but I also strongly agree that they are grossly overdiagnosed.

Why do I believe these diagnoses exist?  Because I see it and hear about it all of the time.  I hear parents who say that they saw the biggest difference in their children after starting medication.  I see children who despite every effort cannot focus or attend.  I hear adults who say that they finally got diagnosed and speak wonders of the differences that medication made in their lives.  I work with children and their parents on trying to exhaust every option before starting their children on medication.  However, for some children it is just inevitable and once they find the right medication we realize that it was a vital adjunct to everything else they are doing to try to help their child.

Why do I think ADD and ADHD are overdiagnosed?  Well, because I see and hear about that all of the time, as well.  Let me give you a quick example of a scenario I hear about frequently:

“Johnny’s teacher says that she think he has ADD.  She says that he fidgets with anything he can get his hands on during class time, has a hard time sitting still in his seat, seems to be day dreaming and not focused, and has a hard time staying organized.”

So, what do Johnny’s parents do? They take him to the pediatrician like the teacher recommended.  They tell the pediatrician about the behaviors that Johnny is exhibiting in the classroom and, for a lack of knowing what else to do and in an attempt to keep the peace and make everybody happy, the doctor prescribes medication to treat Johnny’s symptoms and help him focus in the classroom better.

I am going to get on my soap box for a minute here so forgive me.  What happens next is what really saddens me.  So Johnny starts his medication.  Voila!  He focuses better and everybody is happy (for a little while at least).  Well, the fact of the matter is that these meds will help anybody focus better; they are not an indicator of proper diagnosis.   Another fact is that these meds have side effects and often times kids start to struggle because of them.  So then the medication is altered or more meds are added to control the side effects.  It can (and I’m by no means saying this is always the case) turn in to this horrible snowball effect of med changes and additional meds given all the while a child’s neurological system is being shaken up making life an even bigger challenge.

Do I believe Johnny has ADD or ADHD?  Not necessarily.   When you take a close look at Johnny, he may be doing those things that the teacher spoke of, but the question comes down to why.  Quite often, when you take a close look at Johnny and compare his “quirks” (the quirks that led the teacher to make this claim) they all fall under the sensory processing umbrella.  Johnny fidgets with everything in his desk because he is craving tactile input.  He has a hard time sitting still in his seat because he is craving movement input (vestibular and/or proprioceptive input) .  He may be day dreaming, lack focus, and lack organization because he is having a hard time filtering and processing all of the sensory input that he is receiving every second of the day.  The air conditioner blowing, kids in the hall yelling, the feeling of his clothes on his body, other kids in the class making noises, the feeling of the chair against his legs and back, knowing how much muscle control to use to sit upright in his desk, knowing how much force to use when writing, processing the directions to the assignment that the teacher gives, and the crazy and over stimulating ride to school on the bus or time spent in the cafeteria can all be very stressful on children.  Can you imagine trying to focus and stay organized if you had to pay attention to all of those things and were unable to filter all of that input?

Not to mention, Johnny may be just like a lot of other kids and requires movement.  Sitting in a desk for a majority of the school day is not cutting it for him.  I don’t have to tell you how much the school day has changed since we were kids and had 3 recesses plus gym class.  Now it is gym class one day a week and 1 quick recess (if it is not raining outside).   Johnny may just need to move to learn.  Can you blame him?  I know that when I have to sit in a long course, I fidget with whatever I can find, snack on crunchy food, drink coffee or cold water to stay awake, tap my foot, and quite frequently even do a little day dreaming myself.  Poor little Johnny is being asked to do something he is just not developmentally ready to do-sit and focus for long stretches without movement.  If you add to that the fact that Johnny may be a sensory seeker or avoider or have an immature sensory system with an improper foundation for his building blocks of learning, he may very well show symptoms consistent with  ADD or ADHD but really it is just him requiring movement in order to learn or struggling with his sensory foundation.

Do ADD and ADHD exist?  In my opinion, they do.  Are they over diagnosed?  Again, in my opinion they are.  My feeling is to always start by looking at the sensory system (you can use the sensory check list to help with this) and realize that children need to move to learn.  Sometimes medication is the answer.  Just be sure to make sure you are helping your child to build the sensory foundation and giving them opportunities to move while they learn as an adjunct. (In case you are wondering how to do that, please check out the exercises listed under Step 3 of the BWF Process.)

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• The tendency to act on a whim
• Displaying behavior characterized by little or no thought or consideration of consequences
• Inclined to act on impulse rather than thought

Did anyone come to mind as you read those definitions?  My guess is that we all can think of someone who fits this description.  Many of us may have a kid just like this living under our roof!  Helping our children learn to control their impulses is important for many reasons but here is one very important one; according to Sandra Aamodt and Sam Want, who co-authored Welcome To Your Child’s Brain , “childhood self-control is twice as important as intelligence in predicting academic achievement.”

Impulsiveness, or poor impulse control, is something I see all too often in the clinic, in classrooms, and with my own children and it is something that comes up quite often when I talk to parents.  For that reason, I wanted to offer a little insight into impulse control and give you a few tips on how to help your children gain this skill; a skill that will only get more and more important as they get older.

When I talk to kids about impulse control, I like to explain that it is much like pressing the “pause” button on the remote or their video game.  This is because there is a pause, or a gap, between the moment when a child first feels the impulse to do something and the moment when he or she actually acts on that feeling.   What we expect to see is that as children grow and mature, they will learn to hit the “pause” button before acting on an impulse.  We want to see our children stop to think while on pause if the impulse that they are feeling is a good idea and something they should act on or if it isn’t and they need to hit the “stop” button.

Learning the art of impulse control develops over time with no magic age at which it all of a sudden appears.  Toddlers only hit that “pause” button very briefly, if at all.  They do not fully understand cause and effect, have the ability to calculate risk, have the communication skills needed, or the attention and memory skills required for impulse control.  If they want that toy that someone else has, they are going to take it.  They don’t quite understand yet how their actions are going to effect the other child.  If their ball rolls out in the street, they are going to run right after it with little “pause” to assess the risk involved.  (This is why we tend to chase our toddlers around and stick to them like “white on rice”.)

Around the age of 4 or 5 we expect to see children gain the ability to hit that “pause” button long enough to stop and think before acting on an impulse.  It is around this time that children start to develop some control over their behaviors.  This is when we start to see children learn to take turns, ask for something instead of grabbing it from another child, and not hit or throw a tantrum to get their way.  Verbal impulse control (such as not blurting things out and learning to take turns in a converstion) can take longer to develop.  Throughout grade school, children will continue to learn how to express themselves verbally but it is not until the middle school years that we can expect to see our children develop control over what they say and when they say it.

When children have issues with impulsivity and hitting that “pause” button and/or the “stop” button, they may start to struggle in many areas including academics, peer relationships, socialization, task completion, safety awareness, focus and attention, and the list goes on. Biology, as well as, how we guide our children and manage their behaviors as parents and caregivers can all play a role in the development of impulse control.  We can’t change our children’s genetic make-up, but we can help teach our children to have self-control.

So, how do we encourage children to pause before they say or do?  It doesn’t happen overnight but with consistent communication, boundaries, consequences, etc kids will learn the art of impulse control.  I always tell parents that it is often not what we see but what we realize that we have not seen happen for a while.  What I mean by this is that after months and even years of consistently using strategies to help our children learn to control their impulses, we will all of a sudden one day realize that we have not seen them act as impulsive lately.

Let me give you some tips that I like to use when working with kids in the clinic and then give you some other tips that I have found through some research (some may sound so simple but I think we can all use little reminders every now and then):

• Encourage your children to “stop and think”.  This is something I say a lot to kids when I work with them.  When they are blurting things out or doing things that they shouldn’t be, I always remind them to “stop and think” of whether they are doing what they are supposed to be doing, if what they are doing is the right thing, if they are following the rules, etc.
• Ask your children how they think their behavior is.  I like to ask kids how they would rate their behavior on a scale of “not so good” to “fair” to good.  Kids are often very honest and realize when their behavior is “not so good”.  This gives them self-awareness of their behavior and then the chance to self-correct in an effort to gain self-control.
• I like to use activities that require children to think-say-do.  I use visually guided motor activities (or VGMA) for this.  Check these out on the website for specific examples and ways of doing this but the idea is to make kids look at something, think about what it stands for, say what they need to do, and then do it.  Basically, a lot has to go on between the time when they see something and actually act on it.  For example, the cat, dog, duck VGMA.  The cat stands for clap, the dog stands for jump, and the duck stands for raise your hands.  They have to think about what motion each activity represents, say the motion that they will need to do, and then do it.  It makes them slow down, think about what they have to do, and say it out loud before they ever do it; much like self-control!  I love watching kids do this because you honestly can almost see their brains at work as they slow down to complete this activity.
• The metronome is one of my absolute favorites to use.  That is a whole blog in itself so stay tuned to next week when I will explain this in much greater detail.  I want to tell you, though, that I have seen some amazing results come from using a free metronome app on my smart phone.
• Give your children plenty of opportunities for exercise.  Studies are finding that exercise can help to control impulsivity.  Often times children are acting impulsively in an attempt to gain sensory input and fill their sensory cups.  They may touch everything in an attempt to get tactile input.  They may have a hard time controlling their impulse to move because they are seeking out proprioceptive and vestibular input.   You can check out the exercises listed on the site under Step 3 but, above all else, make sure your children are running, jumping, climbing, swinging, etc and getting lots of time to exercise.  I don’t think anyone would argue that their children show more self-control and better behavior after opportunities to get their wiggles out.
• Demonstrate impulse control.  I think this is a big one that we often times forget about (and I will admit that I am horribly guilty).  I will admit that I can be quick to yell at my kids for something they have done wrong.  I don’t think through it first.  I just start yelling.  Why is that?  Because my impulses get the best of me.  When I “stop and think” through it first, I can take a deep breath, think through what just happened, figure out the consequence if any, and handle things in a much calmer way.  I catch myself quite often fussing at my kids for flying off the handle at each other.  Hmmm!!   As I fuss at them and make them try to figure out a better solution than just yelling at each other, I hear a little voice in my head say “Cindy, they are just doing exactly what they see you do!”
• Children need to know that there are a set of clear and consistent consequences for demonstrating a lack of self-control.  Encourage them to think about how they will feel afterwards and after having to pay consequences for their actions. I often remind my kids that even grown-ups have to pay consequences when they show a lack of self-control or impulse control (and grown-up consequences can be a lot tougher than kid consequences).  It is important from an early age that kids know poor choices will lead to negative consequences.

An obvious example is kids running out into the street without looking.   My son, got this concept, no problem.  My daughter (who struggles a little more with impulse control), not so much.  She has run out in the street a million times without looking for cars.  In her mind, she has not been hit by a car yet so there is no real obvious consequence to her.  It wasn’t until she lost her “big girl privileges” of getting to go ride her bike and play with friends outside without me by her side that the “look before you cross” lesson started to sink in.  She needed to pay a consequence in order to learn this lesson and me just telling her over and over to look for cars wasn’t going to do it.

Knowing that there are consequences to poor decisions and lack of impulse or self-control continues to be very important as children grow older and face bigger and bigger challenges and peer pressure.  Knowing poor choices and poor self-control lead to negative consequences can help children learn to self-monitor their behavior.

• Remind your children that what may feel good to do right now may not feel so good later on.  This will encourage them to learn the art of deferred gratification.  This is a hard concept to learn and it takes lots of practice.  Maybe eating that whole candy bar right now tastes so good but they aren’t going to feel so good in a little while.  Or, maybe it sounds good to spend all of your money right now to buy that new toy, but they may be sad later when they have spent it all instead of saving for that big new toy that they wanted.   Boy, this is probably something that many of use grown-ups should work on (me included).
• Teach your children to take deep breaths, count to ten, step back from the situation, or ways to find healthy distractions when they do find themselves in a situation where it is hard to show self-control.  How many of you ladies have found yourself impulse shopping?  I know that if I can make myself walk out of the store, I usually never think about whatever it was I wanted to buy again.  Kids can be taught to do the same thing whether they are teenagers taking a step back or a deep breath during a time of peer pressure or a young child learning to take a deep breath or walk away from a situation where they feel like showing aggression toward another child.
• Above all, don’t forget to praise your child when they do show good self-control!

If you like our site and the content of what you read, please consider “liking” us by clicking on the facebook button.  Doing so helps us to get the word out to others who may benefit from the content on our site.  Also, please consider signing up for our monthly e-mail newsletter which will include more tips and tricks on how to build your child’s sensory foundation.  Thank you!

Since I can’t come up with anything of my own, I decided to share with you a picture that I saw on Pinterest this week.  It comes from the website www.commercialfreechildhood.org.  This is an organization, that among other things, has a goal of reducing the time children spend watching TV and increasing the amount of time they spend engaged in creative and active play.

The reason why I like this picture so much if that I think it so wonderfully depicts the message that I try to share through my work and my website.   I think that we as parents worry so much and spend so much money filling our kids’ playrooms with all of the latest and greatest toys.  The problem with this is that many of these toys really don’t do much to help our children develop and require little to no imagination or skill on their part.  Running around outside, climbing trees, getting their hands dirty, riding bikes, playing hopscotch, digging in the garden, playing in the leaves, swinging or climbing monkey bars at the local park, etc are some of the best activities that kids can do to develop their sensory systems, gain motor coordination, gain body awareness, gain the ability to sit still and focus on schoolwork, gain self-esteem, and the list goes on and on.  The best thing about those activities-they are all FREE!!

The organization Campaign for a Commercial Free Childhood (where this picture came from) encourages families to do “screen-free weeks”.  Oh my!  I don’t know about you, but that would be really hard in my house.

My husband and I limit our children’s TV time, but my kids really like their TV time and miss it when they don’t get it.  I’m just wondering, though, how many more family game nights we could have, how much more time we could spend sitting around the table working on crafts and activities that involve imagination and fine motor skills, how many more games of charades or dance parties we could have, or how much more time my kids would spend playing on the playset in the backyard, how much more time we would spend reading books before bed, and just how much more time my kids would spend in imaginative and active play (the kind of play that builds a child’s sensory system and foundation for learning)  if we watched no TV at all.   Can you even imagination all of the cool things your children could do if they went a whole day without video games?

Gosh!  Maybe we should try it.  I’m scared, though.  That is a big commitment.  Maybe we will start with a screen-free day and then go from there!  Stay tuned.  I have talked myself into it and will let you know how it goes!   If you are brave enough to try it, let me know how it goes and what fun activities you filled that screen time with.

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I have had some great experiences with these kids in the clinic to help them learn relaxation skills and I wanted to share those with you today.  It is so amazing to me to see the smile on their faces and the sense of calm that comes over them (even if it is only temporary) when I guide them through some deep breathing exercises and meditation.  OK, I know meditation may sound kooky and may not be your thing but please keep reading because it is so easy and the results are amazing.

There is a long list of the benefits of meditation but I want to hi-light just a few of the proven effects of meditation:

• Meditation lowers stress
• Meditation  improve grades
• Meditation reduces anxiety
• Meditation improves attention
• Meditation permanently reduces emotional reactivity

I don’t know about you, but I’m sold.  You had me at “lowers stress”!  Now, the question is how do you teach an adolescent boy to meditate?  I promise it can be done and not just with adolescent boys.  The meditation I am going to talk about works for any child over the age of 7.  Let me give you some tips to get you started:

1.  Find a quiet and relaxing spot to sit or lie down.
2. Dim the lights.
3. Use a calm voice and begin with a dialogue that goes something like this (making sure to use nice long pauses in between each sentence):

• Sit comfortably
• Listen to the sound of the room until it softens into silence
• Watch your breath as it goes in and out.  Watch it at the nose, the chest, the belly, or watch the whole breath.
• Breath normally, paying attention to the feeling of the breath.
• Notice when you lose awareness of the breath and start thinking, daydreaming, worrying…Let those thoughts go…
• Relax your mouth, feeling any tension release from your jaw muscles.
• Relax your shoulders and arm, letting all of the tension that is in them go.
• Relax your hands, feeling any tension release from them.
• Relax your back, feeling all of the tension release from throughout your back.
• Relax your legs, letting all of the tension go that is in your legs.
• Relax your feet and toes, feeling all of the tension release from them.
• Let your whole body feel nice and loose like Jell-o (I like to give the kids a visual of what it looks like to be nice and loose.)

(Nice long pause here)

• Bring your attention back to your breath

1. Make this as brief or as long as you see fit.

If you can get your child to stay focused in on you through this dialogue, then they have meditated.   I will be honest and tell you that it brings tears to my eyes after I do this with a 10 or 11 year old boy and they tell me when we are done how awesome they feel.   I can literally see a different child walk out that day than the child who walked in feeling like they had the weight of the world on their shoulders.

What I like to explain to these kids is that they don’t need to be sitting in a dark and quiet room to meditate.  I like to encourage them that they can use this same mindfulness of their breathing while sitting in their desk and feeling anxious or unable to focus.  They can do it on the bus in the car on the way to or from school.  They can remove themselves from a difficult situation for a minute to do some mindful breathing or they can do it their bed at night to help them relax and fall asleep.

Along with meditation I like to walk kids through some yoga poses or simple stretching.  There is a great website http://www.namastekid.com/learn/kids-yoga-poses/ that shows many examples of yoga poses that you can do with your kids.  I like to pick 3 or 4 and just spend a few minutes doing them for relaxation prior to our meditation.   It is important to remind them to breathe slowly, inhaling and exhaling as they hold each pose; the breathing is the most important part of yoga and relaxation.

Teaching your children meditation and mindful breathing can have such a great impact on them for the rest of their lives.  It empowers them to know they can do something to help themselves feel better, feel less anxious, and to be able to focus better.  You will have to help them with this as first but work with them at being able to do this by themselves whenever they feel they need it.  Not only will this have a great impact on them for years to come but it is great one on one time to spend with your child as you relax together and then you get all of the same great benefits that meditation, mindful breathing, and relaxation have to offer.

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When we can help children gain automatic functioning of their sensory systems through the experiences we provide them, we are helping them to have the foundation off which to build new skills; therefore, we help increase their chance of success at learning new skills and building self-esteem at the same time.  When the sensory system is not functioning automatically as a result of an inadequate foundation, children have to focus too much attention and put too much effort into the things that should be automatic.  Consequently, children’s ability to develop new and more complex skills will suffer resulting in frustration and poor self-confidence.  In the same way people who are hungry have a hard time working until their hunger is satisfied, so do children whose sensory needs are not satisfied have difficulty taking on challenges that lie ahead

Let’s take a minute, then, to define sensory integration since that is what is occurring at all times as we receive information from our senses.  First, let’s define integration.  Integration, by definition, is the act of combining or adding parts to make a unified whole.  So then Sensory Integration is what happens when the brain receives input from the eight senses and then uses that information efficiently and accurately to formulate a plan.  It is combining or adding the parts (the info gathered through the senses) to make a unified whole (the whole person including emotional and behavioral regulation and motor performance).  The brain must take in sensory information from the world around us, sort through and organize it, and then act on it appropriately.   When this takes place as it should it enables children to develop motor skills, regulate their emotions and behaviors, have appropriate social interactions, and focus and attend in order to learn.  You can imagine though that with all that that has to place, there is a lot of room for error

After writing my last blog, Logic and Reasoning, it got me thinking more about the way we communicate with our children and teaching them to be good thinkers.  It also got me thinking more about the way we can use communication to teach our children to have the SELF’s (self-awareness, self-motivation, self-control, and the ability to self-monitor and self-correct).  You see, the problem with bribery is that when we bribe our children to behave appropriately we are teaching them to do the right thing for an extrinsic  reward verses for the intrinsic reward that comes from doing the right thing and being self-motivated to do so.  Let me give you a few reasons why bribing may not be the best approach to take:

• Bribes can produce short-term results (like getting your child to behave in the store or restaurant) but can also “up the ante,” setting up a continuous cycle of bad behavior, according to Elizabeth Pantley, parenting educator and author of Kid Cooperation: How to Stop Yelling, Nagging, and Pleading and Get Kids to Cooperate.  Basically, the more you bribe, the more you will have to bribe.
• Typically the behavior that we are bribing our children for is one that we want to last for the rest of their lives, right?  We want them to always eat their veggies, always behave in a restaurant or store, always do well in school, or clean their room.  When we bribe them we are encouraging the desired behavior only for the here and now in order to receive the bribe instead of teaching them that this is a behavior they need to exhibit on an ongoing basis.
• Bribing fails to teach children that they need to show respect and that they are responsible for their own actions; this should be non-negotiable and not bribe-worthy in my opinion.  I give my kids some room for compromise and to make decisions when I feel it is something I am willing to compromise on, however, showing respect towards others is not one of those.  That is a must.  Teaching our kids that THEY (and only THEY) are responsible for their actions is a big one in my mind.  They need to behave in the store or at school because it is the right thing to do and they are responsible for making good choices and doing the right thing!
• Bribing deprives children of gaining the internal satisfaction that is received from a job well done (and we all know the feeling that we get when we know we have a good job).  Working for a reward (or having external motivation) can damage a child’s ability to self-motivate and I don’t think that I have to have to tell you how important the ability to self-motivate is.  We grown-ups don’t need someone to bribe us to do a good job or go above and beyond (well at least not most of the time J).  How do you think things would go at work if you told your boss you would only do something extra that is being of asked of you if he or she promised to give you some extra money?  You probably wouldn’t keep your job too long if you did that.  To teach our children to be givers, take responsibility, take initiative, and be accountable for their actions, we need to allow them the opportunity to feel an internal sense of reward for a job well done or for good behavior.  In fact, studies have shown that internal motivation is more powerful than any other kind.

There is a famous study from the 1970s called the Magic Marker Study that examined just this.  There were 3 groups in this study with one group of children who liked markers being asked to draw pictures for a reward, one group for nothing at all, and one group for a reward that they didn’t expect.  The group of children that were drawing for a reward showed decreasing interest in the markers during free play at school and produced lower-quality drawings than the control group or the group with the surprise reward.  It seemed as though knowing they would be rewarded worked against then and made something that they previously enjoyed less fun for them.

You may be wondering if there is a difference between bribing and rewarding.  I am not going to go there in this blog because, again, I am no parenting expert.  The way I look at, though,  is bribing is offering an external reward for a behavior that a child should be doing anyway and rewarding can be looked at as giving something in exchange for doing something that goes above and beyond.  The great thing about rewards is that they can be internal.  Such as “Are you so proud of yourself for getting good grades and working so hard?” or “That makes mommy so happy that helped me out today? Does it make you feel happy to be able to help?”, etc.  Rewards can also be things such as extra time to play outside, a big hug, praise, or extra one on one time; things that don’t require money.  I am not above external rewards for my children but I do think helping them to feel the intrinsic reward for good behavior goes a long way.  I want to mention a statistic from Jim Fay is the co-founder of loveandlogic.com.  He says that as parents we spend 500% more on our children these days then the generation before us did (and that is not adjusted for inflation).  Wow!!  That says a lot right there!  I know I am driving those numbers up every time I am in Target and my “mother’s guilt” kicks in and I give in to all of the “Can I have this’s?”.

So, what do you do instead of bribing?   I am going to offer a few suggestions that I found from digging around and that I use with my own children and children whom I work with in the clinic.

1. 1.     Encourage your children to judge their own behavior-  I talked a little bit about this is the Logic and Reasoning blog and using open-ended questions and predictive computing.  Ask your children questions like “How do you think you are behaving?”,  “Do you think you are making good choices?”, “Are you trying your hardest?”, “How do you think that makes so and so feel?”, etc.  By doing so, you are encouraging some of the SELF’s (self-awareness, self-correction, self-monitoring).  When you let them judge their own behavior you are encouraging them to visualize and think about what is right and wrong, anticipate your response to their behavior, and then take responsibility for their actions. 

Then allow your child to self-correct by asking “What could you have done differently?”  or “What could you do next time to do better?”.  Again, this takes visualization and requires them to take responsibility for their actions, and come up with their own plan to do better next time.

Just an example of how I go about this personally, is by explaining to my children and the children I work with that there are always consequences to pay for bad behavior but good behavior gets rewarded  (I mentioned that I am not above rewards!).  As I mentioned earlier, rewards don’t have to be extrinsic, though, they can be intrinsic.  I ask them “Are you making good choices?” or “On a scale of great to OK to not so good, how do you think you did?”.  I find that I am quick to say “good job” when instead I should ask “How do you think you did and why?”; make them self-aware and self-correct.  I am also quick to tell them when they are doing something wrong instead of asking them to tell me what they are doing wrong and giving them a chance, again, to show self-awareness and then self-correct.

1. Praise good behavior and be specific and focus on the process when doing so- For example, if you are going to tell your child they did a good job, tell them what specifically they did a good job on.  Instead of telling them that they did were good at the store, tell them that you are proud of them for staying by you, not fighting with their sibling, and not yelling or crying while in the store.  When they bring home good work from school, tell them specifically what you are proud of them for doing a good job on (their handwriting, coloring inside of the lines, using their imagination, working so hard on the project, etc).
2. Instead of if-then rewards give now-that rewards- Instead of saying if you clean your room I will give you $5, tell your child that now that they have cleaned their room their can go outside to play or watch a TV show or get ipad time.  This takes away the contingency factor which is a form of control (according to Daniel Pink in his book “Drive”).
3. Communicate- Dr. Deci, a professor of psychology at the University of Rochester, suggests a three-step method.  He says to first be clear about why what you are asking them to do is important.  Second, be interested in their point of view.  “If it’s something they hate doing, acknowledge that, tell them you understand it’s not fun, yet the reason they need to do it is as follows,” he said.  Finally, communicate in a way that is not controlling.  . “Don’t use words like ‘should,’ ‘must’ and ‘have to,’ ” he said. “All of those things that convey to them you’re a big person trying to push around a little person

I hope those ideas help a little.  At the end of the day, there are just going to be times when bribing your kids is necessary.  We all have those moments of desperation.  However, this should not be our “go-to” method of encouraging good behavior.  By encouraging children to do a good job or behave in the desired way for the intrinsic value, we can raise children who are self-motivated to do a good job, who have self-control, and who can self-correct when they realize they are not doing what they are supposed to be doing.  It doesn’t happen overnight, but I do think over time the results speak for themselves.

Reasoning involves high level skills such as recalling information, forming concepts, critical thinking, and creatively forming ideas.  I probably don’t have to give you a long list of reasons why these skills are important but I do want to give two very important ones.  The first reason being that our children are required to use reasoning skills to be successful in school.  The second reason being that reasoning and the skills involved with reasoning are becoming important skills for those who will enter the workforce in the twenty-first century to possess.  The information age that our children will be entering will require them to be flexible, dynamic, resilient, and creative.  What all of this means for us as parents, caregivers, and educators is that in order to prepare our children for the future we need to facilitate in them the ability to reason, form concepts, think critically, think abstractly, and be creative.

In my opinion a large part of the reason that our children are struggling with reasoning and abstract thinking is that many of them struggle with visualization.  I don’t mean they struggle with their vision but instead with visualizing.  Visualization means forming a mental image and requires that you remember  people, places, and things previously learned.  This process of representing something abstract in your mind as an image (or envisioning) then helps you to understand or derive the meaning of it.  How do children gain the skill of visualization?  They gain this through  EXPERIENCES and the SENSORY INPUT they receive through these experiences!!! 

In the blog titled “Where Am I…” I talked about how important it is for children to have a clear understanding of where their bodies are in space in order to be able to visualize and conceptualize. I also talk about how important visualization and the ability to form concepts arevfor academic skills such as reading, math, and spelling.  In that same blog I stress how important proprioceptive and vestibular sensory inputs are in helping children gain that knowledge of where they are in space.  It is the input that we get through our senses (sight, smell, taste, movement, touch, etc.) that is then processed by our mind which then allows us to create a mental image of the world.  To make sense of that information and to understand the workings of the world, we need to use reasoning skills to help us see the bigger picture and put all of the pieces of the puzzle together.

So how do you help your children gain abstract thinking and reasoning skills through visualization?  You provide them with lots and lots of chances to explore the world with their senses.  Make sure that their days are filled with opportunities to get proprioceptive input, tactile input, and vestibular input.  By doing so, you will help them to get the experiences that they need in order to form those mental images of the world.

There are other ways in addition to sensory input to promote reasoning and abstract thinking in our children.  They include:

• Predictive computing- In simple terms, predictive computing is the ability to anticipate the next step or the next move.  This is done by following the flow, order, or pattern of something and then being able to anticipate what will come next.

To give you example of this let’s look at a child’s morning routine.  If your child’s morning routine is to get dressed, then eat breakfast, then brush their teeth, and finally get their shoes on to leave for school then they can predict that the next day after they brush their teeth it is going to be time to get their shoes on.  They can anticipate the next step using reasoning skills because of the pattern that has been established throughout the school year.

Giving children the opportunity to use predictive computing allows them to visualize the next step or the next move.  By this I mean allowing children to predict or anticipate what comes next instead of telling them gives them the opportunity to form a mental image and pull from past experiences.  This allows them to visualize which we know promotes abstract thinking.  How do you do this? You encourage predictive computing by asking questions and allowing your children to do the problem solving.  For example, instead of telling your child that they need to go put their shoes on after they brush their teeth, ask them what they think they need to do next after they brush their teeth.  Allow them to visualize the next step through recalling past experiences and help them figure out how to logically get to the right answer themselves.  Let me give you some examples.

1. Let’s say your child spills a cup of water.  Ask your child “What should I do now?”  Instead of automatically telling your child to go get some towels, let them anticipate the next step and come up with the solution.
2. Instead of telling your child to go put their coat on because it is cold outside, tell them that it is cold and then ask them what they think they need to get before they leave the house.   Based on past experiences, they will be able to predict that they need to put a coat on before leaving the house.
3. This is one that that drives me crazy!  My kids get in the car and then fuss at me because I didn’t bring a drink or snack for them to have while we are out running errands.  A good way for me to remedy this and create good thinkers is for me to ask them what they need to get to bring with them before we leave the house.  Based on past experiences and knowing they will want something to eat or drink while we are out, they can predict that they will need to get a water bottle and a snack to bring in the car with us and then gather these items for themselves.
4.  One of my favorites if using predictive computing to help children learn to self-regulate, self-monitor, and control their impulses.  Instead of telling a child that they did a good job or a not so good job on a task, ask them how they think they did.  Or, instead of telling them that their behavior was good or unacceptable, ask them how they think they are behaving.  Ask them if they think they are making good choices.  Children need to learn to grade their own performance or behavior and to control their impulses and one way to do this is by allowing them the opportunity to predicatively compute.  Encourage them to anticipate the feedback they are going to get regarding their performance or behaviors and then make necessary adjustments without someone else always having to tell them.
5.  One of the more simple ways I use predictive computing in the clinic is during an activity such as balloon volleyball.  I tell children that when I say “L” I want them to hit the balloon with their left hand.  I then ask them what they think I want them to do when I say “R”.  I let them figure it out based on the information they have already been given.
6.  Some great games that encourage predictive computing are tic tac toe, Connect Four, or Checkers.  In order to play defense in these games, children have to use predictive computing to try to figure out their opponent’s next move in order to stop them from winning.  They have to visualize where their opponent is going to go or play next and plan their moves accordingly.

• Ask open-ended questions- Ask your children lots of questions throughout their day as this gives them a chance to describe things (which encourages visualization).  Open-ended questions are a great way to encourage children to think and use descriptive language as they comunicate.  Open-ended questions are those that cannot be answered with a simple “yes” or “no”.  For example, instead of asking children if they had a good day, ask them what their favorite part of the day was.  That will encourage them to mentally envision everything that happened in their day to choose their favorite thing.  Start your questions with how, what, and why instead of can, are, is, and should.

Let me give you another example.  Instead of asking your child “Should you be doing that?” or “Is that a good idea?” ask them “Why is that a bad idea?” or “What could the consequences be from you doing that?”  Encourage your child to think about, visualize, and describe the consequences of their actions or of other’s actions instead of telling them or letting them simply answer “yes” or “no”.

• Inductive reasoning- There is more than one way to arrive at an answer and making our children think in ways that they are not used to encourages them to use creativity, visualization, be flexible in their thinking, and use their higher level reasoning skills. We commonly use deductive reasoning to arrive at a solution.  Deductive reasoning is considered “top-down” reasoning.  Deductive reasoning involves being given information and then coming up with the solution (or moving from a broad spectrum of information and working towards a solution).  Another way to look at deductive reasoning is that you are given the problem and have to come up with the answer.  For example, I have the peanut butter, jelly, and bread out so what am I about to make?  You conclude that I am going to make a PB&J because of the ingredients that I have  taken out.  You moved from general information to come up with a conclusion.

Inductive reasoning, on the other hand, is referred to as “bottom-up” reasoning and involves moving from a specific observation to broader generalizations.  With inductive reasoning you start with a conclusion and then begin to formulate how to arrive at that conclusion (in other words you move from the specific to the broad). Another way to look at it is you are given the answer or conclusion and then have to come up with how to get to that answer.  For example, I am going to make a peanut butter and jelly sandwich so what do I need?

Typically, we gather all of the details and then come up with the solution.  It is a great idea, though, to change this up, and make children think differently than they are used to thinking; give them the solution or the specifics and ask them to come up with the details.  It is all in the way you word things and here are some examples of ways you can encourage inductive reasoning:

1. In the clinic I like to have school-aged children do math problems while jumping on a trampoline.  To encourage inductive reasoning, I will give them the sum or product and they have to give me two numbers that can be used to arrive at that number.  For example, I will say “36” and they have to come up 6×6 or 18×2 or 9×4.
2. Instead of asking your child what season it is, ask them how they can tell it is spring.  You gave them the answer “spring” and they have to come up with the generalizations for how we derive at the fact that it is spring.  Some of those may include the fact that the grass is turning green, flowers are blooming, pollen is everywhere, Easter just passed, etc.  You can conclude it is spring because those same things have occurred every other spring so it is logical to assume that it is spring based on those observations.
3. If your child tells you that they want a ham sandwich then ask them what ingredients you or they need to get out of the fridge in order to make the sandwich.  Help them to recall that every time you make a ham sandwich you need bread, ham, cheese, and mayo so in order to make this sandwich this time you will need the same ingredients.
4. If every time you eat too much candy you get a stomach ache then you can reason that next time you eat too much candy the same will happen.  So, if your child gets a stomach ache every time they eat too much candy, then next time they ask for more candy help them to reason why this is not a good idea by helping them to remember what happened the previous times they ate too much candy.

Raising our children to be good at reasoning involves allowing them to explore their environment with their senses in order to facilitate good visualization skills.  It also involves using meaningful and purposeful communication when speaking with them.  I think that all too often we (and by “we” I also mean “I”) fill in the blanks for our children.  We give them the answer without giving them time to come up with it themselves.  We limit their use of descriptive language by asking closed-ended (yes or no) questions.  We comment or give feedback on their behavior without giving them the chance to self-monitor and realize the effects of their behavior. We don’t give them the opportunity to visualize, describe, and reason.  If we change the way we communicate and encourage them to reason and think abstractly through asking open-ended questions and allowing them to use predictive computing and inductive reasoning, we may just be able to raise children who understand gray and not just black and white!

Cursive handwriting got dropped from the curriculum in many school districts when the Common Core standards were implemented.  North Carolina, along with 45 other states, adopted the Common Core standards for teaching language arts and math in an effort to provide uniformity in what is being taught in classrooms. Not only did cursive handwriting get dropped from the curriculum but good old fashioned memorization of multiplication tables also became a thing of the past.

Well, not any more.  The bill passed without a single “nay”.  Other states such as California, Georgia, Idaho, and Massachusetts have already reinstituted cursive handwriting as a requirement and now North Carolina will follow.   NC public schools are not only bringing cursive back, but they are also bringing memorization of multiplication tables back.

While cursive handwriting may seem unimportant in this day of technological advances, we cannot forget how important it is for children to be able to express themselves through written language and that many children simply do better with cursive then print.  Cursive can be easier for some to learn and can also be more motivating to learn.  As an OT who works with children on handwriting skills, I have to say that I am ecstatic to see that our lawmakers were also able to realize the importance of cursive instruction.  At least now our children will be able to sign their pay checks when they enter the real world!

I like to use these schedules in the clinic for children who jump from one activity to the next and need the structure that comes from knowing that the next activity is already planned and they have to control their impulse not to just jump on to whatever activity they want to do next.  I find these work great with kids who are sensory seekers and will run all over the place, jumping, touching, swinging, sliding, etc if they don’t have visual structure to their time with me.

I also love to use these schedules with children who need motivation to participate or carry out an activity and to follow rules.  It helps because there is always a reward for these children after they complete all of the activities on the schedule; typically the reward is for them to get to pick a fun activity that they really want to do at the end of the session.  I had one very profoundly autistic young man who didn’t want to do anything with me in the clinic.  We created our picture schedule at the beginning of each session and this helped him to follow through with each activity knowing that when he completed the last activity it was time to go home and he got a Pepsi (that was the reward his mom chose to give him for cooperating in therapy).   It helped him to know what came next, how many activities he had to do each day, and know which activity signaled that we were done and it was time to go home.

These schedules also work great in the clinic for children who have a hard time with transitions.  When I know I have a child is going to be all over the place and getting into things that they shouldn’t be getting into while we are transitioning to the next activity and I am preparing for it, the schedule works great because they now know what comes next and realize that they can’t run around wildly and freely in the meantime.   

Schedules also help to give kids a sense of control.  I give them the opportunity to make some choices.  I may give them a few options to chose from but I let them pick from those options to chose which activity they want to put down next on their schedule.  Nothing makes kids happier than getting to be active participants in making choices!

The schedules are very easy to do and can be done in several different ways.  In the clinic, I do them in one of two ways typically.  For very visual children or children who cannot read yet, I have pictures of all of our activities and then put them in a photo sleeve that is magnetized (in order to stick pictures on the fridge).  You can buy these at most drug stores that have photo departments.  We simply pick out each activity that we are going to do and then arrange them in order on a large dry erase board (because they are magnetized).  That also helps me to be able to write anything in that I don’t have a picture for and to write in their reward at the bottom of the board.

The other way I do these schedules is much simpler.  As we pick out the day’s activities I simply write them down on the board in the correct order and may even draw a little picture to go with it if I feel that I need to.  With both the written and picture schedules, it is important that if any changes need to be made, you allow the child to help you or watch you make those changes so that they have a clear understanding of at what point there will be a change in their schedule.

So, the question is how do you do this at home?  It is quite simple.  You can either do it just as I described I do it in the clinic or make it a little simpler.  You could use a little photo album and place each picture in the sleeves in the order you are going to do them that day and keep it with you as you go about your day referring to it frequently and allowing your child to help you make changes if need be.  Have your own dry erase board that you write the day’s activities on at home or make it real simple and do it the old fashioned way and just use paper and pencil.   For a higher tech option, you could use an old smart phone that is deactivated and that your child keeps up with or use your own phone and put the day’s schedule on the calendar app on the phone.  Again, those are quite easy to make changes to when the need arises.

This is great to use in the classroom, as well.  Teachers can make sure that the day’s activities are clearly listed so the children know what to expect out of the day (especially if anything out of the ordinary will be occurring) and know what comes next to help with transition periods.  Make the necessary changes to the schedule as needed making sure that the children are award of the changes.  I’m sure it would be challenging to find a classroom with a child who doesn’t struggle with changes in routine or transitions so this is a great way to help those children to have some predictability in their day so they can prepare themselves and their sensory system in advance for what comes next.

Let me list a few ways other ways you could use these schedules:

1.  Have a picture or written schedule of the morning activities your child has to do before school.  My son had the hardest time getting his stuff done in the mornings without me nagging him.  I took a picture of his toothbrush, the laundry basket, his clothes, and his bed and taped them to a poster board and put it in his room in a very visible place.  This was to remind him that he has to brush his teeth, put his clothes in the laundry basket, put his clothes on, and make his bed.  He had four things to do and he knew that until he had completed all four things he was not ready to come down for breakfast.
2. I have also tried this one with my own kids and in the clinic.  I have taken a picture of whatever the motivating factor was (for the autistic young man I mentioned earlier it was Pepsi) and cut it into the same number of pieces as activities we had to do that day and put a piece by each activity picture.  What this young man had to do then was complete the activity on the first picture we had chosen to get the first piece of his Pepsi picture.  Then the second activity for the second picture and so on and so forth.  Once he had all of the pieces of the picture put together, he knew he was done and he earned the Pepsi.
3. For the families that I work with who need to fill their child’s “sensory cup” either before school or after school, I urge them to create a picture or written schedule with their child’s input.  Their child then knows that they have to complete those (let’s say) 5 activities prior to leaving for school or prior to earning other privileges (such as video game or TV time) or prior to homework time.  Again, it helps for children to have a clearly defined start and stop point and predictability.  I also find that with my own kids if I merely suggest “Hey, why don’t you go do____?” it is easy for them so say no and shrug it off.  If it is a written or visible part of their daily routine, they are much more apt to do it.
4. If your child struggles while out running errands, have a schedule of each errand clearly marked for them so that they know what comes next and when errand running time is all done.
5. If your child struggles with getting over stimulated or with meltdowns after certain events or activities, have pictures of the things that they can do to help them calm themselves available.  Maybe prior to that event have them pick out the pictures of the activities that they can do afterwards to help them calm down.  If you don’t do it prior to the event, have them pick as soon as they get home or get in the car so they know that there is something readily available to them that they know will help them to calm down.  I like to ask kids what helps them to feel better when their “brains are going too fast”.  They will often choose stuffed animals, a soft blanket, a bean bag chair, time in their room alone, or music.  For my kids it is back rubs with the ball, Theraputty, or the dry rice bowl (for more info look under proprioceptive and fine motor activities on www.buildingwritefoundations.com) that helps them when nothing else will.
6. If it is a struggle in your house while you are trying to cook dinner and your kids start running wild during that time, have a schedule of activities that they can do while you cook dinner.  This helps them to understand that it is not a free for all while you are occupied with dinner but gives them some input in choosing what they are allowed to do.  Again, this is a great time for the rice bowl, Lego’s, or other table top activities that provide sensory input or work on fine motor skills.  In our house, this is when my kids like to do pop-beads, coloring, beading (with beads and pipe cleaners), making things with popsicle sticks and those little fuzzy pom-poms etc.  They are only a few feet away from me, but I know that they are not getting into any trouble and they are getting great sensory input at the same time.
7. One last way you could use these schedules to help your child to understand the routine for the day, realize what comes after activity, and understand that there is an endpoint at which time it is time to sit down and do homework, eat dinner, take a bath, etc.  For example, after school you and your child can make their schedule together that may look something like this: outside play time until 5:00, come in and wash hands and have a snack, do homework until 6:00, dinner at 6, bath, TV time til 7:30, then bedtime.  Again, when it is clearly spelled out for them either with a written or visual schedule this helps avoid the arguments, breakdowns, and negotiations.

Be creative.  I’m sure you can think of a lot of different ways in which this is applicable in your house and with your children.  I am always amazed at how much smoother things run in the clinic when I have a schedule with the kids verses me just knowing the schedule in my head but the kids not knowing what to expect after each activity and not having a clearly defined routine and end point.  This takes a little planning ahead but the time and breath you save in the long run is worth it!