What Toddlers May Be Communicating Through Their Behavior

By Anissa C. Weimer, MS, CCC-SLP

Toddlers have a lot to say—often much more than they have the words to express.
 

They have opinions about which cup they want, ideas about what they want you to do, excitement they want to share, and very definite thoughts about what should happen next. The problem is that their ability to communicate those thoughts and others is still developing.
 

Sometimes, that gap between what a toddler wants to communicate and what they are able to express shows up through behavior. 

A toddler who pulls you across the room may be saying, “Come see!” A child who pushes something away may mean, “I don't want that.” Repeating the same word louder and louder may be less about refusing to cooperate and more about, “You're not understanding me.” Crying when you offer what you thought they requested may simply mean, “That's not what I meant.”
 

Of course, not every challenging toddler behavior is about communication. Toddlers become tired, hungry, overwhelmed, frustrated by limits, and upset by transitions just like the rest of us. But behavior gives us information. Sometimes asking “What might my child be trying to communicate?” can help us see a situation differently. 

When You Don't Understand, Try “Show Me”

 

I learned this lesson with my own daughter.
In the second book in my Little Voices Big Futures series, The Toddler Transition, I share the story of her running to me at about 30 months old, excitedly repeating what sounded like “turdee.” I couldn't figure out what she was saying. The more I asked, the more frustrated she became.
 

Finally, instead of asking her to repeat herself again, I said, “Show me.”
 

She grabbed my hand and led me to the garage—where she proudly showed me a turtle.
 

Her growing frustration hadn't been the message. It was the result of having a message she desperately wanted to share and not being understood. 
 

“Show me” is a simple strategy parents can try when words aren't working. Let your toddler point, gesture, bring you an object, or lead you somewhere. Once you understand, give them the language that goes with the message: “Turtle! You found a turtle!” or “You want me to open it. Okay!”
 

You're showing your child that communication is bigger than perfectly spoken words.
 

Create a Little Communication Opportunity
 

Play gives us another way to help toddlers discover that their communication matters.
 

Try creating a small, playful problem. Give your child a favorite toy in a container they need help opening. Put a desired toy slightly out of reach. Build a block tower and let it tumble down.
Then pause.
 

Instead of immediately solving the problem, watch what your toddler does. Do they look at you? Point? 

Make a sound? Hand you the container? Reach toward the toy? Say a word?
 

Respond to that attempt, then add simple language: “Help?” “Open!” “You want the car.”
 

As I discuss in The Toddler Transition, toddlers begin learning that communication has power when they make a sound and someone responds, gesture and someone reacts, or use a word and something happens. 
 

Look for the Message
 

The goal isn't to analyze every tantrum or eliminate normal toddler behavior. It's simply to become curious about what may be underneath it.
 

Sometimes a behavior is just a behavior, but often, there's a little voice behind it saying:
 

“I don't want that.” 
 

“Help me.”
 

“I'm overwhelmed.” 
 

“I need a break.” 
 

“I don't understand.”
 

When we look for the message behind the behavior, respond to what our toddlers are trying to tell us, and model the words they need to express it, we do more than help them feel understood in the moment. We give them the language to communicate more clearly—and show them that their voice matters.

 

Order your copy of "The Toddler Transition" book by clicking HERE! 
 

About the Author: 
Anissa C. Weimer, MS, CCC-SLP, is a speech-language pathologist, former educator, and author of the Little Voices Big Futures series. Her work focuses on helping parents and caregivers understand early communication development and use practical, everyday strategies to support their children’s growing communication skills. The Toddler Transition, the second book in the series, focuses on communication development from 18 to 36 months, including milestones, communication concerns, and play-based strategies families can use at home. Learn more about Anissa, the series, and additional resources at https://www.LittleVoicesBigFutures.com
 

Mindfulness for Children: An Excellent Resource!!!

Smell the Flower… Blow Out the Candle is a delightful guide to mindfulness for children! This book will help children pay attention to their bodies, understand their feelings, and make good choices. Every child can use the strategies covered in this book to calm themselves, boost their mood, and improve their focus, and the charming illustrations will definitely keep the children engaged! An added bonus is that it includes social emotional activities for children that can be used by parents at home as well as teachers in the classroom. 

 

As a pediatric occupational therapist with over 30 years of experience, I truly believe that teaching children mindfulness teaches them how to deal with stress, practice empathy, and live with peace and gratitude. This child-friendly introduction to mindfulness will help every child build a greater awareness of their body and emotions. It is a must have for parents, educators, and therapists!

Tummy Time Research!!!

Infant Positioning, Baby Gear Use, and Cranial Asymmetry

Anne H. Zachry · Vikki G. Nolan · Sarah B. Hand · Susan A. Klemm 

 

Study Objectives: This study aimed to identify predictors of cranial asymmetry. We hypothesize that among infants diagnosed with cranial asymmetry in the sampled region, there is an association between exposure to more time in baby gear and less awake time in prone and sidelying than in infants who do not present with this condition.

Methods: The study employed a cross sectional survey of caregivers of typically developing infants and infants diagnosed with cranial asymmetry.

Results: Caregivers of children who are diagnosed with cranial asymmetry report their children spending significantly less time in prone play than those children without
a diagnosis of cranial asymmetry. Side-lying and time spent in baby gear did not attain statistical significance.

Conclusions for Practice: Occupational therapists, physical therapists, pediatricians, nurses and other health care professionals must provide parents with early education about the importance of varying positions and prone play in infancy and address fears and concerns that may serve as
barriers to providing prone playtime.

Click on the following link to access the article: http://rdcu.be/ujm2

Research on the Wilbarger Protocol

Therapists, teachers, and parents often ask me if there is any evidence for the Wilbarger Protocol.  The Wilbarger Protocol, also called the Wilbarger Therapressure Program is a treatment approach for sensory defensiveness that is often recommended by occupational therapists.  Unfortunately, there is a lack of quality research to support the use of the Wilbarger Protocol.  My colleagues and I recently had a study published on occupational therapy practitioners’ sources of training in the administration of Wilbarger Therapressure Program.  The study, entitled "Delivery of the Wilbarger Protocol: A survey of pediatric occupational therapy practitioners" was published in The Journal of Occupational Therapy, Schools & Early Intervention in 2016.

We investigated the uniformity of administration and the diagnoses for which therapists recommend the protocol.  OTs from the United States completed an online survey investigating specifics related to training and implementation of the protocol.  Thirty-nine percent of the 153 respondents who reported using the protocol reported that they were trained by attending the workshop that the Wilbargers offer.  Slightly less than half (48%) learned how to administer the protocol through hands-on training from another occupational therapist, 7% learned through word of mouth from an OT colleague, 3% through online research, and 3% by other means.

The results suggest that practitioners utilize a variety of approaches related to the training and implementation of the Wilbarger Protocol.  All OT practitioners need to obtain the proper training before recommending and implementing program.  A standardized protocol for the protocol has not been published; therefore, therapists who wish to learn the protocol should attend the Wilbarger workshop.

Lancaster, S. L., Zachry, A. H., Duck, A., Harris, A., Page, E., Sanders, J. (2016). Delivery of the Wilbarger Protocol: A survey of pediatric occupational therapy practitioners. Journal of Occupational Therapy, Schools, & Early Intervention, 9(3), 2016.

Delivery of the Wilbarger Protocol: A Survey of Pediatric Occupational Therapy Practitioners

Our recently published article!

Delivery of the Wilbarger Protocol: A Survey of Pediatric Occupational Therapy Practitioners

ABSTRACT

The Wilbarger Therapressure Program is a commonly used treatment approach utilized by occupational therapy professionals for the treatment of sensory defensiveness. The purpose of the current study was to investigate occupational therapy practitioners’ sources of training in the administration of Wilbarger Therapressure Program, the uniformity of administration in practice, and the diagnoses for which therapists recommend this treatment approach. Occupational therapists from across the United States participated in an online survey investigating specifics related to training and implementation of the brushing protocol. A total of 153 respondents reported using the Wilbarger Therapressure Program in practice. Almost half of the respondents received their education on the Therapressure program by attending the workshop offered by the Wilbargers. Forty eight percent of survey participants reported learning how to administer the Therapressure program by participating in hands-on training provided by another occupational therapy practitioner, 39% by attending the course taught by the Wilbargers, 7% by information obtained through word of mouth from another occupational therapy practitioner, 3% by information obtained through online research, and 3% by other means. The results of this study reveal that a variety of approaches exist related to the training and implementation of the protocol. It is the responsibility of all occupational therapy practitioners to obtain the proper training prior to recommending and implementing the Therapressure program. Because a standardized protocol for implementation of the protocol has not been published, the optimal means of training is for practitioners to attend the Wilbarger workshop.

KEYWORDS: Assistive technology, special education, sensory processing, occupational therapy, paediatrics,

Evidence-Based Practice: Handwriting Intervention Study

khunaspix@Freedigialphotos.net

 

Purpose: To examine the effectiveness of two approaches used to improve elementary children’s handwriting.

Methods: New York city elementary school students engaged in two handwriting approaches. One group utilized handwriting practice group (Handwriting Club) and the other group engaged in visual–perceptual–motor activities. After 12-weeks, handwriting speed, legibility, and visual–motor skills were examined using multivariate analysis of variance.

Results:  Students who participated in the handwriting practice group demonstrated greater improvements in handwriting legibility than the students in the visual–perceptual–motor activity group. There were no group differences in handwriting speed and visual–motor skills.

Conclusions: The Handwriting Club (intense handwriting practice) is an effective approach for improving handwriting legibility.

Howe, T.-H., Roston, K. L., Sheu, C.-F., & Hinojosa, J. (2013). Assessing handwriting intervention effectiveness in elementary school students: A two-group controlled study. American Journal of Occupational Therapy, 67, 19–http://dx.doi.org/10.5014/ajot.2013.005470

The Effectiveness of a Handwriting Program

 

FreeDigitalPhotos.net-Arvind Balaraman

 

This study investigated the effectiveness of a handwriting program that was implemented in a school setting with 1st graders.  The Write Start Program involves teachers and occupational therapists working together implement activity-based handwriting instruction. 

Purpose: To examine the Write Start program with standard handwriting and writing instruction.

Methods: A nonrandomized trail comparing four classrooms that received the Write Start program with four classrooms receiving standard handwriting instruction.  In a 6-month follow-up, the Write Start group handwriting fluency was higher than the control group's fluency.

Results: The handwriting legibility and speed of the students who participated in the Write Start program were no different than the control group immediately after the intervention, but scored better 6-months after the intervention.  The students with decreased legibility who participated in the Write Start program made significant improvements.

Conclusions:  The Write Start Program may benefit students with writing problems as well as those at risk for handwriting problems.

Case-Smith, J., Weaver, L., & Holland, T. (2014). Effects of a classroom-embedded occupational therapist–teacher 
     handwriting program for first-grade students. American Journal of Occupational Therapy, 68, 690–698.  http://dx. 
     doi.org/10.5014/ajot.2014.011585

Evidence-Based Practice: Handwriting Intervention

Handwriting Intervention Research

freedigitalphotos.net-punsayaporn

An occupational therapist is the professional to call when an individual is having trouble with handwriting!  Writing on the lines, letter formation, legibility, and spacing problems are all issues related to handwriting struggles.  When handwriting is difficult, this can lead to frustration, anxiety, and low self-esteem, so it's important to seek help for this issue.

Here is one research study related to handwriting interventions and occupational therapy.  I will continue to add more article reviews!

Effectiveness of School-Based Occupational Therapy Intervention on Handwriting: 

A Comparative Study

Purpose: To examine the effect of school occupational therapy services on handwriting legibility

Methods: Improvements in handwriting legibility, speed, and in-hand manipulation skills in a group of students who received direct handwriting intervention OT services was compared to those of a control group who did not receive services.

Results: Handwriting legibility scores and in-hand manipulation skills in the treatment group improved significantly compared to the control group.

Conclusion: Direct occupational therapy services resulted in improvements with handwriting legibility and in-hand manipulation skills, but handwriting speed was not impacted by the intervention.

Case-Smith, J. (2002). Effectiveness of school-based occupational therapy intervention on handwriting: A comparative 

          study.  American Journal of Occupational Therapy, 56(1), 17-25.

Evidence-Based Practice: A Pediatric Constraint-Induced Movement Therapy Study

Efficacy of constraint-induced movement therapy for children with 

cerebral palsy with asymmetric motor impairment.  

Photo Credit: Prawny @ FreeDigitalPhotos.net

Purpose: The purpose of this study was to investigate the application of CIMT to children diagnosed with cerebral palsy (CP-hemiparesis).

Methods. A randomized, controlled clinical trial was conducted.  Nine children received CIMT therapy and 9 received traditional therapy.

Results. The children who received CIMT demonstrated significant improvements with motor skills in the affected arm completed to the children in the traditional group. The benefits were still present after 6 months.

Conclusion. Pediatric CIMT resulted in significantly improved motor function in children diagnosed with CP.

Taub, E., Ramey, S. L., DeLuca, S., Echols, K. (2004). Efficacy of constraint-induced movement therapy for children with
     cerebral palsy with asymmetric motor impairment. Pediatrics, 113(2).

Multicenter Randomized Controlled Trial of Pediatric 

Constraint-Induced Movement Therapy: 6-Month Follow-Up.

Purpose: The current study compared 6 hours per day with 3 hours per day of CIMT over a 21-day period to determine which client would demonstrate the most gains 6 months after the treatment was implemented.

Methods: This was a multisite randomized controlled trial.

Results: Both groups demonstrated significant upper extremity functional gains as a result of therapy.

Conclusion: The 6 hours per day and 3 hours per day treatments both resulted in gains.

 
Case-Smith, J., DeLuca, S.C., Ramey, S. L. (2012). Multicenter randomized controlled trial of pediatric constraint-induced  movement therapy: 6-month follow-up.  American Journal of Occupational Therapy, 66(1), 15-23.

Efficacy of Constraint-Induced Movement Therapy on Involved Upper Extremity Use in Children with 

Hemiplegic Cerebral Palsy

Purpose: This study investigated the effectiveness of a "child-friendly" constraint-induced movement therapy on the involved upper extremities of children diagnosed with hemiplegic cerebral palsy.

Methods: There were 20 children in the study ranging in age from 4 to 13 years, and the children were divided into an older group and a younger group.  Each participant wore a sling on the uninvolved arm for 6 hours daily over a period of 10 to 12 days.  Therapists who were blinded to the study details conducted assessments of motor skills at the points: after one week, one month, and six months.

Results: Both groups of children made significant motor skill improvements with their involved upper extremities.

Conclusion:  CIMT is an effective treatment for children (of various ages) diagnosed with hemiplegic cerebral palsy.

Gordon, A. M., Charles, J., & Wolf, S. L. (2006). Efficacy of constraint-induced movement therapy on involved upper 
     extremity use in children with hemiplegic cerebral palsy.  Pediatrics, 117(3), e363-373.