Occupational therapy (OT) treatment focuses on helping people with a physical, sensory, or cognitive disability be as independent as possible in all areas of their lives. OT can help kids with various needs improve their cognitive, physical, sensory, and motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; kids, after all, do not have occupations. But a child’s main job is playing and learning, and occupational therapists can evaluate kids’ skills for playing, school performance, and daily activities and compare them with what is developmentally appropriate for that age group.
According to the American Occupational Therapy Association (AOTA), in addition to dealing with an someone’s physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. This approach makes OT a vital part of health care for some kids.
Use of technology with Early Learners’
Technology has transformed the way both adults and children live. Screens have dramatically changed the world of children’s play. Nowadays, little ones spend more time watching television than playing outdoors. Children’s interaction with technology includes large variations such as watching television, playing digital games, using video chats or apps to communicate, or using digital tools to create content, etc. The question for us, as parents, educators, and pediatric professionals is what, how much, and at what pace should we introduce children to the various faces of electronic media.
How to find out what is developmentally appropriate for your little ones when it comes to technology?
Determining when and how to use various technology-based on Three C’S
- Content—How does this help children learn, engage, express, imagine, or explore?
- Context—What kinds of social interactions (such as conversations with parents or peers) are happening before, during, and after the use of the technology? Does it complement, and not interrupt, children’s learning experiences and natural play patterns?
- The individual child—What does this child need right now to enhance his or her growth and development? Is this technology an appropriate match with this child’s needs, abilities, interests, and development stage?
David Elkind, author of “the power of play” explains media content as hot and cold depending upon the level of participation it can allow. For example- The sketch invites more participation than does a photograph. Now let’s consider several factors that make any content whether a computer game, TV program hot or cool. Additionally while considering what content is hot or cool for a specific child, every child would have varying responses and individual differences in their preference for hot and cool media.
· Less participation, decreased active learning opportunity · Stimulating, visually arresting, fast paced · Violent and entertaining TV shows · For e.g., For infants and young toddlers, TV shows utilizing attention getting strategies such as bright colors, high pitch sounds and liberal use of repetitive large movements. Infants would prefer to watch such hot media but more likely to be entertained than to engage in active learning
· More participation, increased learning opportunity · Quiet, slow paced, visually interesting · Educational TV shows · For e.g., For infants and young toddler’s TV shows with less intrusive visuals, soothing music, scan be used by parents and caregivers during their normal routine activities like diaper change, getting dressed etc.
- Results of a longitudinal study conducted on adolescent to find out the effects of their television viewing as preschoolers on their academic performance showed that adolescents who preferred watching educational programs (cool) earned higher grades, read more, had better creativity and were less aggressive as compared to the adolescents who watched entertaining and violent television shows as preschoolers.
- Another research study conducted on two- to-three-year kiddos showed that kids who watched cool TV shows such as sesame street were better academically when tested on their reading readiness and vocabulary as compared to kids who watched hot entertaining TV shows.
The most imperative factor to be considered while understanding the importance of technology usage with young children is, the context in which the technology is used. It should help in increasing learning opportunities in children.
Passive and Active use of technology
Passive use of technology– It occurs when children are consuming content, such as watching a program on television, playing a game on a computer, without any active participation, accompanying reflection, imagination.
Active use of technology– It occurs when children use technologies such as computers, devices, and apps to engage in meaningful learning and active engagement. Examples include sharing their experiences by documenting them with photos and stories, recording their own music, using video chatting software to communicate with loved ones, or using an app to guide playing a physical game. These types of uses are capable of deeply engaging the child, especially when an adult supports them.
Examples of active use of technology
- Co-viewing with children
Families can promote the exchange of ideas and expand the child’s imagination by viewing various programs with young children and maximizing their learning opportunities. Most research on children’s media usage shows that children learn more from content when parents or early educators watch and interact with children, encouraging them to make real world connections to what they are viewing both while they are viewing and afterward.
- Strengthen and promote relationships
Amid a global pandemic, the use of video-chat interactions has helped to promote relationships. Schools are virtual which gives an opportunity for children to connect and build positive peer relationship via video chats as well as with educators. While video chatting can be done at any age (as interactions tend to be brief and guided by an adult), new evidence shows that infants and toddlers can attend to and engage in joint attention during video-chat interactions but do so more effectively after approximately 16 months of age and with parental support.
THE INDIVIDUAL CHILD
Every child is unique and so would be their choices. Considering the fact that nothing can replace the face to face interactions and the benefits of natural play for children, there are specific recommendations put forward by American Pediatric Association for various age ranges from 0-8 years with regards to technology usage in children.
Under the age of 2
The American Academy of Pediatrics(AAP) has advised parents against television by children under two years of age. It can be used as a platform to support relationships such as video chatting with family members as a form of social interaction. Parents who are interested in using media with their children can start around 18 months with high-quality content but should always co-view content and use technology with their children.
New recommendations in the American Association of Pediatrics AAP’s 2016 Media and Young Minds Brief suggest that one hour of technology use is appropriate per day, inclusive of time spent at home and in early learning settings and across devices
Technology should be used as a tool for children at this age to explore and become active creators of content. If they are using virtual learning at school and have more than one teacher, those teachers should be aware of how much screen time is being used across subject areas and at home. Students should learn to use technology as an integrated part of a diverse curriculum. At home, parents should set limits they feel are appropriate for their children, understanding the differences between passive and active technology use as well as the benefits of using technology with an adult versus solo use. Parents should also be aware of how much technology is being used in the classroom, what is needed for homework, and how this fit into an overall picture of technology use for their child throughout the day. The AAP has created an interactive Family Media Plan Tool on HealthyChildren.org to help parents be thoughtful about media exposure for their children.
Clumsiness or more?- Developmental Coordination Disorder
What is it?
- According to American Psychological Association, Developmental coordination disorder (DCD) is a common neurodevelopmental disorder characterized by deficits in both fine and gross motor coordination which have a significant impact on a child’s activities of daily living or school productivity.
- Children with DCD exhibit these deficits in the absence of identifiable medical or intellectual or visual impairment, or another motor disability, such as cerebral palsy.
- It is thought to affect around 5% of school-aged, but despite its high prevalence, it remains one of the less well understood and recognized developmental conditions in both educational and medical settings. The prevalence rate is 5-6%, which is approximately 1 in every 20 children.
- It is often co-morbid with other childhood disorders including attention deficit hyperactivity disorder (ADHD), dyslexia, speech/language impairment.
- Frequently described as “clumsy” or “awkward” by their parents and teachers, children with DCD have difficulty mastering simple motor activities, such as tying shoes or going downstairs and are unable to perform age-appropriate academic and self-care tasks.
Signs and Symptoms
Parents are the initial evaluators to spot signs and symptoms of DCD in their child before anyone else. When they notice their little one is struggling, having challenges or lacking behind other children in movement skills, such as sitting up or learning to walk. However, sometimes signs and symptoms of DCD are not caught until a child starts school. Teachers may see that the child cannot play at recess or in physical education classes in the same way that other children do. They also may observe that it takes the child longer to complete schoolwork. Children with DCD show a lack of interest in playing with other children.
Children with DCD may have difficulty when they try to:
- Run, skip, jump, hop on one foot, do jumping jacks, or perform other physical activities.
- Use hand-held objects such as crayons or scissors.
- Throw or catch a ball accurately.
- Follow directions for movements that involve more than one step. (When they make a mistake or can’t do the next step, they will start all over again rather than with the most recent action taken.)
- Know where their bodies are in space.
DCD at specific ages.
Preschool Has trouble throwing a ball Plays too roughly or often bump into other kids by accident Has difficulty sitting upright or still Grade K-2 Has trouble holding and using a crayon, a pencil, or scissors Doesn’t form or space letters correctly Struggles with going up and downstairs Frequently bumps into people by accident Has trouble with self-care, like brushing teeth Grade 3-7 Takes a long time to write Has trouble cutting foods Has difficulty with basic routines like getting dressed Struggles to line up columns when doing math problems
Role of professionals in the treatment of DCD
Historically, parents have been told not to worry about their child’s clumsiness because the child will outgrow the problem. However, current researchers in the area of DCD report that the children do not outgrow clumsiness and that, without intervention, they will not improve. A key treatment for DCD is occupational therapy (OT). There are many examples of how occupational therapists can work on challenging motor tasks. They might have kids trace letters on sandpaper to build handwriting skills, for example. Or use a lacing board with different colored laces to practice shoe tying. Kids with DCD may also work with physical therapists on balance and muscle tone. Occupational therapy and Physical Therapy assist with helping the child with DCD develop movement strategies that increase coordination, motor planning, balance, strength and body awareness resulting in a decrease in overall clumsiness and increased ability to perform functional activities at home, school and in the community. Speech and language therapy may also be required to help the child with the oral motor skills required for swallowing, chewing and speech.
Harrowell, I., Hollén, L., Lingam, R., & Emond, A. (2018). The impact of developmental coordination disorder on educational achievement in secondary school. Research in developmental disabilities, 72, 13-22.
Kirby, A., & Sugden, D. A. (2007). Children with developmental coordination disorders. Journal of the royal society of medicine, 100(4), 182-186.
When one sound is substituted by another sound in a systematic fashion
|Affrication||Fricatives are replaced by affricates||3;0
(Peña-Brooks & Hedge, 2007)
|[dɔr] -> [jɔr]|
|Alveolarization||Non alveolar sound is replaced with an alveolar sound||5;0
(Peña-Brooks & Hedge, 2007)
|[ʃu] -> [tu]|
|Backing||Sounds are substituted or replaced by segments produced posterior to , or further back in, the oral cavity than the standard production||No information available||[sɪp] ->[ʃɪp]|
|Deaffrication||Affricates are realized as fricatives||4;0
(Peña-Brooks & Hedge, 2007)
|[tʃɪp] -> [ʃɪp]|
|Depalatization||Palatal sounds are realized as sounds produced further forward in the oral cavity||5;0||[fɪʃ] -> [fɪt]|
|Fronting||Velars are realized as sounds produced further forward in the oral cavity||3;6
|[go] -> [do]|
|Gliding of liquids||Liquids /l,r/ are replaced by a glide /w,j/ or another liquid||5;0
|[lif] -> [wif]|
|Labialization||Nonlabial sound is replaced with a labial sound||6;0
(Peña-Brooks & Hedge, 2007)
|[taɪ] -> [paɪ]|
|Stopping||Fricatives and/or affricates are realized as stops||5;0
|[piʧ] -> [pit]|
|Vocalization||Liquids or nasals are replaced by vowels||/f/&/s/ =3;0
/v/ & /z/ =3;6
|[teɪbəl] -> [tebo]|
|Denasalization||Nasals are replaced by homorganic stops||2;6
(Peña-Brooks & Hedge, 2007)
|[naɪs] -> [daɪs]|
|Glottal replacement||Glottal stops replace sounds usually in either intervocalic or final position||No information available||Tooth->|
|Prevocalic voicing||Voiceless consonants in the prevocalic position are voiced||3;0
|[teɪbəl] -> [debi]|
|Devoicing of final consonants||Voiced obstruents are devoiced in final position||3;0
|[dɔg] -> [dɔk]|
When one sound in the word becomes similar to another sound in the word
|Assimilation (consonant harmony)||One sound is replaced by another that is the same or similar to another sound within the word||3;0
(Peña-Brooks & Hedge, 2007)
|Velar Assimilation||A nonvelar sound is assimilated to a velar sound because of the influence, or
dominance, of a velar
(Peña-Brooks & Hedge, 2007)
|[dʌk] -> [gʌk]|
|Nasal Assimilation||A non-nasal sound is assimilated and replaced by a nasal because of the influence, or dominance, of a nasal consonant||3;0
(Peña-Brooks & Hedge, 2007)
|[læm] -> [næm]|
|Labial Assimilation||A nonlabial sound is assimilated to a labial consonant because of the influence of a labial consonant.||3;0
(Peña-Brooks & Hedge, 2007)
|[bɛd] -> [bɛb]|
|Alveolar Assimilation||Non-alveolar sound is changed to an alveolar sound||3;0
(Peña-Brooks & Hedge, 2007)
|[tos] -> [tot]|
Syllable Structure /Patterns:
Phonological processes that affect the syllable structure
|Consonant Cluster Reduction||Deletion of one element of the cluster||4;0
|[stɑp] -> [tɑp]|
|Epenthesis||A segment, often the unstressed vowel, is inserted||8
(Peña-Brooks & Hedge, 2007)
|[blæk] ->[ bəlæk]|
|Reduplication||A syllable or a portion of a syllable is repeated or duplicated, usually becoming CVCV||3;0
|[dæd] -> [dæ dæ]|
|Weak/Unstressed Syllable Deletion||Deletion of the unstressed syllable||4;0
|[tɛləfon] -> [tɛfon]|
|Final Consonant Deletion||Deletion of the final consonant in the word||3;3
(open and closed)
|[kæp] ->[ kæ]|
|Consonant Cluster Simplification||A consonant cluster is simplified by a substitution for one member of the cluster||4;0
|Metathesis||There is a transposition or reversal of two segments (sounds) in a word||No information available||[bæskət] -> [bæksɪt]|
|Coalescence||Characteristics of features from two adjacent sounds are combined so that one sound replaces two other sounds||No information available||[swɪm] ->[ fɪm]|
What should my child be able to do?
|Hearing and Understanding||Talking|
|7 Months-1 Year
||7 Months-1 Year
• Babbling has both long and short groups of sounds such as “tata upup
|One to Two Years
||One to Two Years
|Two to Three Years
||Two to Three Years
|Three to Four Years
||Three to Four Years
|Four to Five Years
||Four to Five Years
Note: “bilingual” refers to someone who speaks two languages; “monolingual” refers to someone who speaks one language
The Facts: What We Know About Bilingualism
Our world is becoming increasingly multilingual. Consider some of the following statistics:
- 11.9 % of the population speaks a language other than English or French at home (1). In Toronto, 31% of the population speaks a language other than English or French at home (2).
In the United States….
- 21% of school-age children (between ages 5-17) speak a language other than English at home (3). This number is projected to increase in the coming years (4).
Worldwide, it is estimated that….
- there are more second language speakers of English than native speakers (5).
- there are as many bilingual children as there are monolingual children (10).
These trends mean that many children are being raised as bilinguals. Sometimes bilingualism is a necessity, as a child’s parents may not be fluent in the majority (dominant) language spoken in the community. Therefore, the child may learn one language at home and another at school. But sometimes bilingualism is a choice, and parents may wish to expose their child to another language, even if they do not speak a second language themselves. This could be due to the many benefits of being bilingual.
Benefits of Bilingualism
- Bilingual children are better able to focus their attention on relevant information and ignore distractions (7, 8). For more information, click here for our article “Are Two Languages Better Than One?”.
- Bilingual individuals have been shown to be more creative and better at planning and solving complex problems than monolinguals (9, 10).
- The effects of aging on the brain are diminished among bilingual adults (7).
- In one study, the onset of dementia was delayed by 4 years in bilinguals compared to monolinguals with dementia (10).
- Bilingual individuals have greater access to people and resources (9).
- In Canada, employment rates are higher for French/English bilinguals than monolinguals (7).
- Canadians who speak both official languages have a median income nearly 10% higher than that of those who speak English only, and 40% higher than that of those who speak French only (7).
The cognitive advantages of bilingualism (e.g . with attention, problem solving, etc.) seem to be related
to an individual’s proficiency in his languages (10). This means that a person will benefit more from his
bilingualism (cognitively) if he is more proficient in his languages.
How children learn more than one language
Bilingual acquisition can take place in one of two ways:
- Simultaneous Acquisition occurs when a child is raised bilingually from birth, or when the second language is introduced before the age of three (10). Children learning two languages simultaneously go through the same developmental stages as children learning one language. While bilingual children may start talking slightly later than monolingual children, they still begin talking within the normal range (11). From the very beginning of language learning, simultaneous bilinguals seem to acquire two separate languages (10). Early on, they are able to differentiate their two languages and have been shown to switch languages according to their conversation partner (e.g. speak French to a French-speaking parent, then switch to English with an English-speaking parent) (12, 13).
- Sequential Acquisition occurs when a second language is introduced after the first language is well-established (generally after the age of three). Children may experience sequential acquisition if they immigrate to a country where a different language is spoken. Sequential learning may also occur if the child exclusively speaks his heritage language at home until he begins school, where instruction is offered in a different language.
A child who acquires a second language in this manner generally experiences the following (10):
Fiction: Some Myths about Bilingualism
#1. Bilingualism causes language delay.
FALSE. While a bilingual child’s vocabulary in each individual language may be smaller than average, his total vocabulary (from both languages) will be at least the same size as a monolingual child (10, 15). Bilingual children may say their first words slightly later than monolingual children, but still within the normal age range (between 8-15 months) (11). And when bilingual children start to produce short sentences, they develop grammar along the same patterns and timelines as children learning one language (5). Bilingualism itself does not cause language delay (10). A bilingual child who is demonstrating significant delays in language milestones could have a language disorder and should be seen by a speech language pathologist.
#2. When children mix their languages it means that they are confused and having trouble becoming bilingual.
FALSE. When children use both languages within the same sentence or conversation, it is known as “code mixing” or “code switching”. Examples of English-French code-mixing: “big bobo” (“bruise” or “cut”), or “je veux aller manger tomato” (“I want to go eat..”) (10). Parents sometimes worry that this mixing is a sign of language delay or confusion. However, code mixing is a natural part of bilingualism (17). Proficient adult bilinguals code mix when they converse with other bilinguals, and it should be expected that bilingual children will code-mix when speaking with other bilinguals (5).
Many researchers see code mixing as a sign of bilingual proficiency. For example, bilingual children adjust the amount of code-mixing they use to match that of a new conversational partner (someone they’ve never met before who also code mixes) (5). It has also been suggested that children code-mix when they know a word in one language but not the other (13). Furthermore, sometimes code-mixing is used to emphasize something, express emotion, or to highlight what someone else said in the other language. For example, “Y luego él dijo STOP” (Spanish mixed with English: “And then he said STOP!”) (10). Therefore, code-mixing is natural and should be expected in bilingual children.
#3. A person is not truly bilingual unless he is equally proficient in both languages.
FALSE. It is rare to find an individual who is equally proficient in both languages (16). Most bilinguals have a “dominant language”, a language of greater proficiency. The dominant language is often influenced by the majority language of the society in which the individual lives (6). An individual’s dominant language can change with age, circumstance, education, social network, employment, and many other factors (16).
#4. An individual must learn a second language as a young child in order to become bilingual.
FALSE. There is a “Critical Period” theory that suggests that there is a window of time (early childhood) during which a second language is most easily learned. This theory has led many people to believe that it is better to learn a second language as a young child. Young children have been found to achieve better native-like pronunciation than older children or adult second language learners. And they seem to achieve better long-term grammatical skills than older learners (10). But other findings have called the idea of a critical period into question. For example:
- older children (in middle elementary school) have been shown to have advantages when learning “academic” English. “Academic” language refers to the specialized vocabulary, grammar, and conversational ability needed to understand and learn in school (10). This is likely easier for older children because they learn their second language with more advanced cognitive skills than younger children, and with more experience with schooling and literacy (10).
- older children and adults seem to be advantaged when initially learning vocabulary and grammar (10, 16, 18).
Therefore, while younger children seem to become more “native-like” in the long-term, older children may pick up vocabulary, grammar, and academic language more easily in the initial stages of language learning.
#5. Parents should adopt the “one parent-one language” approach when exposing their child to two languages.
FALSE. Some parents may choose to adopt the “one parent-one language” approach, where each parent speaks a different language to the child. While this is one option for raising a bilingual child, there is no evidence to suggest that it is the only or best way to raise a child bilingually, or that it reduces code mixing (10). Parents should not worry if they both speak their native language to the child or if they mix languages with their child (19), as it has been recognized that children will mix their languages regardless of the parents’ approach (10). Many approaches can lead to bilingualism. Parents should speak to their child in a way that is comfortable and natural to them.
#6. If you want your child to speak the majority language, you should stop speaking your home language with your child.
FALSE. Some parents attempt to speak the majority language to their child because they want their child to learn that language, even if they themselves are not fluent in the majority language. This can mean that conversations and interactions do not feel natural or comfortable between parent and child. There is no evidence that frequent use of the second language in the home is essential for a child to learn a second language (10). Furthermore, without knowledge of a family’s home language, a child can become isolated from family members who only speak the home language. Research shows that children who have a strong foundation in their home language more easily learn a second language. Children are also at great risk of losing their home language if it is not supported continually at home.
How to Support your Bilingual Child
There are many ways to support your child’s bilingualism:
- Do what feels comfortable for you and your family. Don’t try to speak a language with your child if you are not comfortable or fluent In that language
- Don’t worry if your child mixes his two languages. This is a normal part of becoming bilingual Provide your child with many opportunities to hear, speak, play, and interact in your home language.
- If you think your child has a language delay, consult a speech language pathologist for advice regarding the best ways to help your child learn more than one language.
You may have seen someone write in a notebook to answer a question. Maybe you have seen people using sign language or other gestures. You may have seen someone push buttons on a computer that speaks for them. These are all forms of augmentative and alternative communication, or AAC.
AAC includes all of the ways we share our ideas and feelings without talking. We all use forms of AAC every day. You use AAC when you use facial expressions or gestures instead of talking. You use AAC when you write a note and pass it to a friend or coworker. We may not realize how often we communicate without talking.
People with severe speech or language problems may need AAC to help them communicate. Some may use it all of the time. Others may say some words but use AAC for longer sentences or with people they don’t know well. AAC can help in school, at work, and when talking with friends and family.
Do you or your loved one have difficulty talking? There are options that might help. There are two main types of AAC—unaided systems and aided systems. You may use one or both types. Most people who use AAC use a combination of AAC types to communicate.
You do not need anything but your own body to use unaided systems. These include gestures, body language, facial expressions, and sign language.
An aided system uses some sort of tool or device. There are two types of aided systems—basic and high-tech. A pen and paper is a basic aided system. Pointing to letters, words, or pictures on a board is a basic aided system. Touching letters or pictures on a computer screen that speaks for you is a high-tech aided system. Some of these speech-generating devices, or SGDs, can speak in different languages.
An SLP will test how well you or your loved one can speak and understand. The SLP can help find the right AAC system for you. You may use a basic system first and may need it for only a short time. This may happen if you had mouth surgery or a stroke and your speech comes back.
It may take some time to get a more high-tech system, if you need one. Not every device works for every person, so it is important to find the right one for you. The Information for AAC Users webpage has more information about finding the best AAC system. Insurance or other funding can help you pay for your AAC device.
See ASHA information for professionals on the Practice Portal’s Augmentative and Alternative Communication page.
The ability to hear is essential for proper speech and language development. Hearing problems may be suspected in children who are not responding to sounds or who are not developing their language skills appropriately. The following are some age-related guidelines that may help to decide if your child is experiencing hearing problems.
It is important to remember that not every child is the same. Children reach milestones at different ages. Talk your child’s healthcare provider if you are suspicious that your child is not developing speech and language skills correctly. The National Institute on Deafness and Other Communication Disorders and other experts list the following age-appropriate speech and language milestones for babies and young children.
Milestones related to speech and language
|Birth to 5 months||
|6 to 11 months||
|12 to 17 months||
|18 to 23 months||
|2 to 3 years||
|3 to 4 years||
|4 to 5 years||