Most of us have no idea what creatures of habit and patterns we are, nor how stuck we can be in these behavior patterns. I have three dogs that keep reminding me of what a creature of habit I am. If I’m watching TV in the evening and pick up the TV remote, my dogs notice; and if I turn off the TV, they all jump up ready to go. Which way they go is determined by the direction of my first step when I stand up. In the morning if I pick up my cup from the coffee machine and if I turn left, my dogs run down to my office. If I turn right, they go about their business because there are too many options as to what I might do. You probably put the same foot into your pant leg first most every day. The point is that we humans create hundreds of behavior patterns, most of which we are oblivious to.

When dealing with children, particularly children with developmental issues, the connection between the child and the parents and caregivers is amazing. This connection leads to each learning each other’s patterns. Patterns can become ruts, ruts that both parent and child can get stuck in.

One very common pattern or rut that creates problems involves what children will eat. In a very significant percentage of children who come to us, ranging from severely involved children to those who are gifted, a common problem is picky eaters. Back in the early ‘70s when we created a program specifically for children with autism, I worked with a teenage girl who had eaten no food other than apples for virtually her entire life. To compound the mystery of this child, she also had pica—she would put most anything in her mouth and eat it. This included everything from dirt to bugs and her dog’s feces from the yard, but not food. The issue with her eating a greater variety of foods was obviously not an issue with taste or smell, although this can be an issue for many children, particularly those on the spectrum. It was simply a matter of an established pattern, a habit. It should be noted that food cravings that come from eating a lot of some specific foods can also be a contributing issue. Kids are not simple.

In a previous article (Independence and the Developmentally Challenged Child) I discussed how important and vital independence is for the overall development of the child or young adult. The child’s and the parent’s patterns and habits often have a very negative impact on the development of independence.

An example of a common pattern that slows down the development of independence in many children is helping them dress themselves. Most parents who assist their child in dressing and undressing assist in virtually the exact same way every time, and the child participates, or does not participate, in exactly the same way. As an example: Mom approaches Johnny with a T-shirt. Johnny sees it and waits for Mom to put it over his head, at which point he lifts his arms and she helps put his arms in the sleeves. Then she pulls the shirt down. Every day they follow the same pattern. If Mom doesn’t do something to change her pattern, the odds are great that Johnny doesn’t either; and Johnny’s development of independence in dressing himself goes nowhere. Parents need to become acutely aware of the hundreds of such patterns, habits that have been created by them and their children, and consciously work to break them.

It’s helpful when trying to grasp the significance of patterns to see how differently children perform with different people and in different places. Children who work with their parents, caregivers, therapists, and teachers are often going to react and perform differently with each person, or in each place, because patterns and habits are created together and are often person and place specific. Each adult establishes a new pattern, and to some extent the physical space helps establish a new mental picture and a new pattern as well. Most children on the spectrum are strong visualizers, creating mental pictures and videos associated with many aspects of their lives. For these visualizers anything that changes their picture (or habit) can lead to them becoming upset, with the net result being that family members and caregivers avoid upsetting the apple cart and work hard to maintain and reinforce the habits.

One of the most devastating and pervasive problems associated with patterns negatively impacting many of our children with developmental issues is prompt dependency. Prompt dependence is actually taught through creating a patten by which the child is prompted, generally verbally through virtually every step of what they are being instructed to do. Some children, after years of such instruction, develop such a strong pattern that they will do almost nothing without a prompt, requiring someone to guide them through most everything they do, creating greater dependency and stifling independence.

Referring back to the picky eater problem, parents often discover that their child will eat foods at the grandparent’s house that they won’t eat at home, or in a restaurant, or even outside. This is because a new place helps change the pattern.

The teenage girl with autism I met had her eating problem largely resolved within the week she and her family spent with us. Guess what we did to fix it? Almost nothing. The child had spent her whole life at home, eating by herself in the same kitchen at the same table and given the same food—apples—because her family been convinced that she wouldn’t eat anything else, and had established a very strong behavior pattern. When the family flew across the county, stayed in a hotel and at our offices, and ate at restaurants together, they broke the pattern. My little suggestion was to not have any apples nor bring apples to the restaurant and to simply order her the same food the parents were eating and tell her they didn’t have apples. She ate the food and within the week established a new behavior pattern, which was to eat what the family ate.

Patterns and habits affect all of our lives to amazing degrees. Having healthy diets for most people means establishing a new behavior pattern or habit. Exercising regularly for most people requires establishing a new behavior pattern or habit. Many people realize how difficult it can be to break an old pattern and create a new one and realize it doesn’t just happen. You have to very consciously work to create that new behavior pattern; and the longer a pattern exists, the tougher it is to change it, whether it is a good or a bad habit.

Typically developing children are neurologically changing rapidly, and that neurological change pushes them to do new things; and in the process it tends to break many previously established patterns of behavior. Typical children and their parents can certainly fall victim to habits. But when you slow down the developmental process, life tends to become just a series of pattens that essentially rule the child and the family’s life and can significantly and often dramatically inhibit change, development, and expectations. These patterns can affect all areas of development and function. An example is children learning patterns of communication. If whining works to get attention, and Mom interprets that as the child wanting something and becomes trained to start offering the child options until the whining stops, then the odds are good that the child will maintain that pattern of communication even though they neurologically are ready to start verbally communicating. In a similar vein there are children who develop a functional vocabulary of only a few words, who may go years without expanding that vocabulary. It becomes their pattern, and if the expectation is that it’s all he or she can do, then it becomes the perception of what can be, and it is accepted. A child who has a vocabulary of three words is demonstrating that they have the cognitive ability and the oral motor ability to think in words and produce words, why not ten words or twenty words or a thousand words?

If a child lacks mobility, the ability to move either through crawling, creeping, or walking to get to something, and learns to simply lay on the floor and space out, cry for attention, or whine until someone brings something to them, then often these become patterns and the child has no perception that they could move to go somewhere or get something. These children may have the cognitive and physical pieces that would permit them to move, but they are stuck in a pattern.

Looking at pieces of the child in isolation makes it very difficult at best to determine what is a reflection of the child being stuck in a pattern vs. what can, could, and should be. The perception of what can be is then easily limited to what has been, and doors are closed not based on the innate potential of the child, but rather on what patterns have been and are in place.

If, however, we view the “whole child,” the gestalt of the child, we can then see what could be and what pieces need to be put together to break the habits or patterns and move forward.

For example, one vital piece of the “whole child” is cognitive function. If we have understanding, auditory sequential processing, that says the child mentally has the ability to use language functionally and put two or three words together, as well as adequate oral motor skills for speech, but they only use a few words, then we know we have a child who today could be speaking much more, if not for being stuck in a pattern. If, however, we have the cognition, but not the needed oral motor function, then we know we need to work on the oral motor function hard, as well as working behaviorally to create the internal need to communicate. Conversely, if the child has sufficient oral motor function, but not the cognitive function, then the primary focus becomes the cognition.

Looking at a child as their isolated pieces and not understanding their patterns and habits can produce misdirected efforts and priorities, and more often than not turn the focus toward alternatives that lead to poor, low, or limited expectations that can negatively impact the child’s ultimate potential.

Not understanding the “whole child” or the impact of patterns can lead to pursuit of poor alternatives. For the child with limited language, the alternative may be an augmentative communication device that for the vast majority of children fails. If full mobility is deemed to be improbable, then putting the necessary developmental pieces together gets scrapped, and the therapy gets directed toward a child who will spend the rest of their life in a wheelchair. Or a child with unresolved behavior issues ends up being medicated, rather than having his pieces put together and patterns broken.

Habits and patterns impact all of our lives. For our children with developmental problems, these habits and patterns, both theirs and ours, can have devastating consequences. Every child needs to be viewed through the lens of the “whole child” and seen as a creature of habit if we are going to begin to provide them with a real opportunity to realize their innate potential.

Lack of function needs not and should not be viewed as a prognosis or predictor of potential.

Reprinted by permission of The NACD Foundation, Volume 34 No.5, 2021 ©NACD

The post How Patterns of Behavior Affect Your Developmentally Challenged Child appeared first on NACD International | The National Association for Child Development.

National Association for Child Development

One of the areas of parental concern for the development of any baby is the area of mobility. Watching a baby learn to crawl, creep, stand and walk are thrilling to all parents. As a parent we can see our child learn to better explore their world and move from dependence to independence sometimes in the time span of the first year.

As a parent of a DS child, you may have a special concern about your child’s development of mobility. Cardiac conditions can slow down the emergence and development of mobility. The potential or reality of low muscle tone and poor tactility can also slow down development in this area drastically. Parents are often tempted to skip mobility developmental stages in an effort to reach the coveted skill of walking more rapidly. The consequences of this strategy can be very long lasting and impact other developmental areas as well.

Why stomach crawl? Crawling on your stomach on the floor in a cross pattern is hard work. Aside from people training in the military, few of us have spent any time past our first year of life utilizing this movement. What is to be gained by doing it, and why does your baby need this essential first form of locomotion? There are several reasons. Your child’s eyes begin the work of learning to focus and converge together on near-point objects, a skill which is needed for everything from reading to depth perception. The tactile feedback given by the entire body moving against the friction of the floor teaches your child the location of the entire torso, arms and legs, and feet and hands. Proprioception, knowing where your body is in space, is based on these early messages of tactile input on the floor and feeling every movement through the feedback of this contact. The child is learning that they have two legs, two arms, two feet and two hands because they can feel these parts moving against the floor. Crawling engages virtually all of the muscles of the body, from the arches of your feet to your abdominal and neck muscles, all of which are used in the process of moving your body forward across the floor. Arm, chest and back muscles are utilized in pulling the arms forward and then pulling the body forward. Quads, hips and hamstrings are worked during the leg movement. This is a workout!

Learning coordinated movement starts here with crawling on the floor. Whether the child picks up the cross pattern movement on their own or they learn it through parent assistance, this is the beginning of that very fundamental movement of a right arm and left leg, left arm and right leg– the movement we use to walk and run, climb stairs and climb hills. When the child learns this by working on the belly crawl, they get all of that helpful tactile information through the limbs and through the torso, laying a strong foundation for more advanced forms of mobility. They also develop a very critical physical piece through crawling– muscle balance. The crawling movement is one of flexion and extension of the arms and legs, pushing and pulling using the flexor muscles, then the extensor muscles. One of the issues confronting many parents of children with Down Syndrome is that they are often advised that the child needs to begin developing trunk strength and tone through sitting because it is this lack of trunk strength and tone that creates the problem with crawling and walking. If sitting were the best thing for the development of the trunk, every adult would have strong backs and great abs. Sitting is not what develops the trunk; crawling and creeping is. The child should not sit independently until they can get themselves into that position independently, which is typically after they have learned to crawl on their tummy and creep on their hands and knees.

Another very significant aspect of crawling involves the integration of sensory input. Crawling provides the brain with what is quite possibly the best integrated sensory input that a child ever receives. This act of crawling sends simultaneous information to the brain from all of the tactile and proprioceptive receptors, the surface receptors, the deep receptors and the proprioceptive receptors in the joints. And not only is the brain receiving all of this input, it is receiving it through the simultaneous input from the movement of the right arm and left leg, and the left arm and right leg. This is very powerful sensory-integrating input. Many children, when they start to move forward on the belly, have to learn where their pieces are before they can really start coordinating their movement. Many start by just pulling with both arms together or both legs together. These children are learning where their arm and legs are. Then with a little time and help they begin to alternate arms or legs, and sometimes they get the arm and leg moving on one side of the body, or leave out one leg. As children go through these phases, they are getting more and more input, developing tactility, strength, tone, muscle balance, vestibular balance function, and proprioception. Furthermore the brain is learning to integrate all of this critical information. Given some time and some help, their brains and bodies can learn all of these critical developmental pieces and establish the foundation they need for all future physical and neurological function. It is also important to note that those children who find it the hardest to crawl need it the most, for they are the ones who really need to put all these pieces together properly.

Some children move through this stage very quickly and move on to creeping on hands and knees. Some children take longer to learn this stage and may need a great deal of extra input to locate their limbs in order to be able to control those movements. This may take longer than parents expect, but is time well spent. Children moving from a good cross belly crawl to a good cross pattern creep on hands and knees are in good shape to move on to developing proper walking. Children moving from rolling to scooting to sitting to walking have not had the opportunity to learn where they are in space and how to move their limbs in an organized fashion, nor have they developed the proper muscle balance or strength. They potentially have not even learned how to focus on close objects or to use their eyes together for depth perception.

Short cuts and quick fixes will lead to later repercussions. Don’t take the chance. Try to do it correctly the first time and avoid thousands of hours of time in the future in physical and occupational therapy trying to overcome the problems that are often created by skipping this critical developmental activity.

Reprinted by permission of The NACD Foundation, Volume 22 No. 12, 2009 ©NACD

The post Down Syndrome: The Importance of Crawling on the Stomach appeared first on NACD International | The National Association for Child Development.