Cobb Pediatric Therapy Services » Tips for School Psychologists
At Cobb Pediatric Therapy Services, school therapy is all that we do. Founded by June Whitehead in 1989, our mission has always been connecting talented speech therapists, occupational therapists, physical therapists and school psychologists with public, private and charter schools.
Attention Deficit Hyperactive Disorder, also known as ADHD, appears to be as prevalent as chickenpox. Every child seems to have it and every parent/teacher complains about it. As soon as a child demonstrates a difficulty with sitting quietly still or appears distracted, even slightly, everyone points to ADHD. It’s become the excuse for bad behavior, a lack of understanding, and poor child management. Of course, I’m not saying every child diagnosed with ADHD has been falsely identified. What I am saying is that we all need to be more aware of what it actually is vs what is expected from a child of certain ages. We all think we know what ADHD looks like but do we truly understand the disorder? If you are adamant that you understand ADHD, still please review this info to see if you are correct.
Remember: Age is another important factor to consider and a normal activity level for a 5 year old is very different than a normal activity level of a 15 year old.
Instances of Normal Child Activity
Instances of actual Hyperactivity
Having a high-energy level at times but is not always prevalent in certain settings
Becoming fidgety or wiggly after having to sit for several minutes but can be easily redirected. (Especially if he/she is not used to just sitting)
Becoming fidgety or “playing” with items on occasions
Enjoys climbing on playground equipment. Typically, won’t try to climb on non-playground equipment after he/she has been told not to do so.
Shifting and small movements while remaining seated during carpet time. (As seen typically in kindergarten and sometimes 1st grade classroom).
Chooses to leave parts of projects unfinished for a set amount of time.
Generally, sits through meals, but may get up occasionally.
Constantly having a high-energy level regardless of setting
Constantly in motion (shaking his/her leg, etc) and exhibits extreme difficulty staying seated. Very difficult to redirect
Constantly fidgety or “playing” with items in his/her desk or tapping.
Appears to be compelled to climb inappropriately in/on both items and settings, such as in stores, railings, furniture, etc. This will occur even after he/she has been told not to do this.
Major movement while sitting on the carpet such as rolling around. This student appears to require twice as much space as his/her peers.
Gets sidetracked during projects and forgets to come back and finish.
Gets up from the dinner table several times and has difficulty remaining in his seat while he eats. Again, in a constant state of motion.
Instances of Typical Child Inattention
Instances of Significant Inattention
Zoning out in activities that are not of interest to the child
Not paying attention to topics that are above this student’s level
Forgetting to complete a low interest assignment on occasions
Occasionally losing important items
Being messy and unorganized but can become more organized, within reason, when provided a structure and adult support.
Makes careless mistakes sometimes
Gets distracted when there is a lot of noise or an extreme change in the external stimuli. Such as someone suddenly turns on the bright lights.
Child procrastinates to complete tasks. He/she will respond to the adult request with reluctance.
Constantly zoning out in activities of high interest to the child (sports activities or favorite subjects)
Not paying attention, regardless of the topic or level.
Regularly forgetting to complete any assignment regardless of interest level.
Often losing any item
Appears to be constantly battling with messes in all areas, even when given organizational structure and adult support.
Constantly makes careless mistakes and is oblivious to these careless mistakes
Gets distracted easily with any noise. Cannot filter past external stimuli of any kind.
Child needs to be reminded several times to complete each step of any task including the bedtime routine, despite doing this same routine constantly. He/she will typically respond positively to the adult redirect without the reluctance.
Instances of Typical Child Impulsivity
Instances of Significant Impulsivity
Getting excited and occasionally shouting out an answer.
Says things without thinking on occasions.
Has trouble waiting his/her turn
Occasionally speaks out of turn when he/she has something important to say.
Occasionally makes choices that lack good judgment or that are considered “poor choices”.
Constantly forgetting to raise his hand and will blurt out answers loudly.
Constantly blurts out thoughts without thinking it through
Has extreme trouble waiting his/her turn in almost all settings.
Frequently interrupts others who are on the phone or are engaged in conversations.
What is cyberbullying? Cyberbullying is the same as traditional bullying, but it occurs primarily online and in social media. The reason cyberbullying is such a hot topic right now is for the mere fact that it never stops. Traditional bullying typically only occurs throughout the school day and stops at the end of the school day. However, with cyberbullying, there is no escape from it. Many students in this current day have access to the internet and social media in a variety of ways. From computers to smartphones, many students have the easy of accessibility to either torment and harass or to be tormented or harassed via the internet. Cyberbully is also far more serious an issue because the bully can hide behind the anonymity of the internet. It’s far easier to say terrible mean things to another person when you don’t have to look them in the eye, face to face.
Here are some ways to prevent cyberbullying:
Educate yourself to what cyberbully actually is and looks like.
Be aware of what your students are looking at and experiencing, if you are an educator. If you are a student, be aware of your friends.
Protect your passwords and never share private information with others. Try not to save passwords on public computers.
Remember, whatever you place on the internet, will forever be on the internet. Only post or send “PG” pictures of yourself. Before sending or posting something, try to imagine what your grandmother would say if she saw this picture or read this post.
Do not post anything that may compromise your reputation. People will judge you based on how you appear to them online. They will also give or deny you opportunities (jobs, scholarships, internships) based on this.
Never open an email or read a message from someone whom you already know to be a bully. Sometimes things are better left unread. Delete them.
Don’t be a cyberbully yourself! Treat others how you would want to be treated. This includes responding to social media, etc. Just because you cannot see the other person, doesn’t mean your words are not hurtful.
What To Do When Cyberbullying Happens:
Keep an eye out for warning signs, it doesn’t matter if you are a parent, teacher, or a student. It’s up to all of us to stop cyberbullying and to support each other properly. Remember, cyberbullying is still a form of bullying, and adults should take the same approach to address it:
Support the student being bullied.
Address the bullying behavior of a the bully.
Show everyone that cyberbullying is taken seriously and not tolerated.
However, because cyberbullying happens online, responding to it requires a some additional approaches.
Keep a record of what is happening and where. Be diligent with this and take screenshots of harmful posts or content, if possible.
Most social media platforms and schools have clear policies and reporting processes. If you are a student and a classmate is cyberbullying, report it to a teacher or school staff. You can also contact app or social media platforms to report offensive content and have it removed. If a student has received physical threats, or if a potential crime or illegal behavior is occurring, report it to the police.
If everyone strives to support each other and focuses on the positive, then there will be no place for bullying of any kind. But, it will take all of us, children and adults to stop bullying. Because bullying is not only contained to schools or to those under the age of 18, many adults also face bullies and cyberbullies. Be aware of each other and look out for each other, no matter your age. Good Luck out there!
Let me begin this blog saying that bullying is an unacceptable behavior that adults and students have a responsibility to stop. It’s incredibly important that schools must have clear and comprehensive prevention practices/policies that address all forms of bullying and/or harassment. I know October was Bullying Prevention Month, but I wanted to speak upon this topic more than just within the confines of one month.
Bullying is so detrimental because it can negatively impact the learning environment as well as threaten a students’ physical and emotional safety at school. Truthfully, the best way to address bullying is to stop it before it starts. I know the bullies can be sneaky in their bullying, but school staff have the capacity to deter this negative behavior.
Training school staff and students to prevent and address bullying can help sustain bullying prevention efforts over time, as noted from the StopBullying.gov website. By helping staff and students be aware of the potential dangers of bullying, it should decrease the incidents of this happening. Truthfully, some children don’t realize their words or actions can be classified as bullying. At the end of the day, they key is to:
Make sure all students feel safe at school and in their learning environment.
Make sure students understand the difference between teasing vs bullying as well as tattling vs reporting. You want students to clearly understand what bullying is and why it’s a form of abuse.
Help students realize that if they are being bullied, they are not alone and they are not powerless to stop it.
Allow students to help take ownership for the well-being of themselves as well as others. Empathy and positive support for each other is a great means to preventing bullying.
Although formal programs, such as PBIS, are great way to implement a school wide program, it’s not always necessary. Individual classrooms can incorporate anti-bullying lessons into their formal lessons fairly easily. Examples of such activities could include:
Creative writing pieces incorporating bullying and its prevention.
Poems or other artistic works.
Research, such as looking up types of bullying, how to prevent it, and how kids should respond. This could be a library activity or an internet research activity.
Presentations on how to stop bullying.
Discussions about topics like how to stop bullying or how to handle a bully.
Classroom meetings to talk about peer relations, social interactions, etc.
So, now you know each student’s sensory preferences and aversions. What do I do with this knowledge? Help your students make a list of the items and strategies that will help them. I recommend making a sensory kit for the classroom. You can set this up as one large classroom kit or small individual kits per student. Choice is yours. Try to not refer these items as “toys”, consider instead referring to the items in the kit as “tools” to help support learning. It’s imperative that you, as the teacher, firmly distinguish between using these sensory tools and “playtime”. These tools are not for playing but to better engage with the information and learning presented.
Some possible tools for the kit could include but are not limited to:
Fidget toys (spinners, squishy ball, any small item the student can twirl, roll, rub, etc)
CD/music with “movement break” songs
Headphones for music OR to drown out noise
A quiet space in the room
Pillows of differing textures and firmness
Sensory bottles (plastic bottles filled with items such as beans, rice, googly eyes, water, colored water, beads, etc.)
Photos of different stretches/movements
A weighted blanket
Scented lotion or essential oils
The fun part is your students can help create and assemble their own tools and sensory materials. This will help create ownership and responsibility on their part if they have a hand in making their personal items. Besides, this project can be a lot of hands on fun for your students.
Remember, you as the teacher must set the precedence for these sensory materials. Set firm ground rules on when and how to use these items. Try role-play of “what to do” and “what not to do” with your students so there will not be any room for confusion later. I would also recommend creating a Sensory Tool Contract where the student needs to check an item out and he/she promises to use the tool appropriately.
So here we are. A new school year has started. Everyone has begun settling into the routine of school and your classroom management except for that one student who just can’t seem to sit still or appears to be “too sensitive to everything”. This is the student that is constantly out of his/her seat, fidgeting for no reason, reminding you that the lights are too bright, that he/she cannot concentrate because someone is mowing their lawn somewhere in a 20 mile radius, etc.
What do you do as a teacher? How do you appropriately handle this precious child while ensuring not only he/she is learning but everyone else in the class is too, despite these distractions? Is it a disability? Or could it simply be stimulation in the environment. Before we jump onto the ADHD or Autism bandwagon, let’s consider Sensory Processing.
It is advantageous for us to review what Sensory Processing is exactly. Very simply, it is the way the brain receives and responds to information that comes in through the senses. It is processing sensory input. We all do it constantly and without knowing it. We can hear the hum from the projector, we can see the sunlight bouncing off the glass of water on the teacher’s desk, we can feel the way our clothing is touching our skin, we can smell the scent of freshly sharped pencils. Most of the time, we learn how to sift through all these inputs and focus on only what is necessary for that moment. Some of us seem to have “heighten senses” where we are constantly observant to every little input while some of us are a bit more oblivious to the world around us. It is only when the sensory input awareness falls into the extremes, where day to day functioning is hindered, that it’s considered to be a sensory processing disorder.
We all have our own unique sensory preferences. Do you feel like you can concentrate better when studying if there is music playing? Does the smell of lavender seem to calm you when you are upset? There’s a reason for this and our students are no different. Sensory input is very important component to address within the classroom for all students but especially for the “rowdy” ones. So, as a teacher, help your students explore their sensory preferences. Reassure your students that their sensory preferences and aversions, as long as it doesn’t interfere with day to day functioning, is absolutely normal and it’s what makes each of us special. Talk to them about what sensory experiences they enjoy and what do they dislike. Also, help your students research ways they can encompass these experiences to helping them stay calm and attentive in school. This would be a fun project for the whole class without the students realizing you are actually targeting on that one “disruptive” student.
Many children today have demonstrated a difficulty with not only the fundamentals of reading but the overall reading achievement itself. If this sounds like your child, I’m sure you have faced a considerable amount of time and frustration trying to help, teach, and motivate your child to read. Like most parents, you may have experienced that most of your efforts end in tears whether it be yours, your child’s, or both. So what do you do?
Do you have a dog or another furry friend at home?
If so, there may lie your answer. Numerous studies have been completed regarding the use of dogs, primarily, to help increase reading achievement. The idea behind this method is simple, take out the stressors.
Most students desperately want to please their parents and teachers along with avoiding embarrassment, especially in front of their peers. This can be observed even at the kindergarten level. Therefore, when reading is difficult and the teacher has to spend extra time with the child, he or she can feel bad and embarrassed by this. The stress of the other children watching, the desire to do it right the first time, and the overall frustration can easily lead to the child shutting down or having a melt down. These stressors and behaviors are comparable within the home environment as well.
How do you cope with stressors?
Simple, by utilizing the family pet. Typically, a pet will lay beside your child just appreciative for the attention. Fido won’t laugh at a mispronounced word or complain that “it’s taking too long.” This allows your child to make mistakes without the threat of disappointment and creates an ability to practice reading in its purest form, thus building confidence.
Moreover, studies have found that petting a dog or a cat will physiologically reduce stress within the body. This means your child will naturally pat the family pet, especially in more difficult reading sections, thus calming the sense of anxiety or stress. This, in turn, allows for greater endurance in tackling more difficult reading selections.
Does this mean as a parent you no longer have to help your child read? You can simply hand your child a book and say, “go read to the dog.” Not at all! Utilizing the family pet is just another tool for you to use. I recommend working with your child for 10-20 minutes on reading via sight word practice, paired reading, etc. Then allow your child to excuse themselves to a designated reading place, with their furry friend, for some quiet reading time. You know your child and when pet reading will work best. Try it out. You should see your child’s confidence and reading achievement grow. Good luck and happy reading!
School-based therapy is one of many settings in which children with disabilities may receive therapeutic intervention. As one piece in the child’s rehabilitation puzzle, you may be asking yourself where do I fit in the overall picture and how does each piece connect to the next?
Two pieces occur prior to school-based intervention and serve as a foundation for future intervention.
NICU is an intensive care unit for infants born prematurely and/or with medical complications. Therapeutic intervention focuses on positioning, tone/contracture management, feeding, and sensory input regulation. The service team consists of the family, doctors, nurses, and therapist. The entire team coordinates care until discharge. Children are usually referred to outpatient or early intervention services for follow up.
Early intervention is therapy and medical services in the natural environment for children ages 0-3. Goals and intervention are based on family concerns and outlined in the IFSP (individual family service plan). A service coordinator helps acquire and schedule evaluations and services. Family training is desired over frequent direct intervention and/or multiple specialties. Early intervention provides a transitional meeting for children to assess their need for service continuation via the school system at age three.
The next three pieces can be used together or separately at any point in time. Realizing that you may not be the only therapist involved in a child’s care is essential to finding your fit.
School system intervention is provided to children ages 3-21 with disabilities that affect their ability to participate in and benefit from the educational system. The service team, consisting of the child, family, therapists, teachers and others, is involved in making the IEP. Goals, frequency, and duration are specific to needs within the education setting.
Outpatient therapy services are clinic based. The service team can consist of multiple therapy disciplines, and a physician order is usually required. Frequency and duration are determined by the evaluating therapist to attain the patient or family goals. Some families may attend outpatient therapy services in conjunction with school-based intervention to address goals outside of education needs.
Inpatient rehabilitation/PICU are hospital based therapy interventions that can occur at any age following an illness, surgery, or injury. Therapy interventions are focused on the child being able to function upon return home following discharge. Children can be discharged with the need for continuing services and equipment. A working knowledge of therapy services can assist upon the child’s return to school, such as a change in equipment and physician issued restrictions.
Completing a puzzle can take time and effort, such as understanding how one setting transitions to another, or discussing equipment needs with all of the child’s therapists, or focusing on tasks that are not being addressed by other settings. By better understanding how other therapists are shaped by their specific role, you can discover how to become the child’s perfect fit.
Reactive attachment disorder (RAD) is a rare but serious condition in which a child fails to establish healthy attachments to parents or other caregivers. It is caused by chronic maltreatment, neglect or abuse early in life. For instance, children born to drug or alcohol addicted parents learn very early on that things do not feel good and are not safe for them. In severe cases, where children have been abuse or violence victims, they learn that adults are hurtful and cannot be trusted.
The good news is that with proper treatment, children who suffer from RAD may develop stable and healthy relationships with adults. Treatment options include positive child/caregiver interactions; a stable, nurturing environment; psychological counseling, and parent and caregiver education.
Symptoms of RAD
How can you spot reactive attachment disorder in a child? Look for these symptoms:
Withdrawal, fear, sadness or irritability that is not readily explained.
A constantly sad, listless appearance.
Failure to seek comfort or show response when comfort is offered.
Failure to smile.
Failure to ask for support or assistance.
Failure to reach out when picked up.
Lack of interest in playing interactive games, such as peekaboo.
A child with RAD may try to completely control their world, as they feel they would otherwise be in danger – because they have not developed the normal attachments to other human beings that allow them to trust, accept discipline, or develop cause and effect thinking, self-control or responsibility.
A child with RAD may:
Initially be very charming, making you wonder why they have been reported otherwise. Then, after some time, they will suddenly become openly defiant, moody, angry and difficult to handle.
Be highly unpredictable from one day to the next.
Be unable to make or keep friends and not function well in groups.
Not perform well in school, despite having above-average intelligence. This is due to a lack of problem solving and analytical skills.
Test poorly, because they have not learned cause-effect thinking.
Self-inflict injuries or seek attention for minuscule or non-existent injuries – yet avoid adults when they have real injuries or genuine pain. They have not learned to seek and accept comfort because their earliest experiences have taught them that adults don’t care.
Be in a constant battle for control of their environment. If they are in control, they feel safe. If they are protected by an adult, they are convinced they will be hurt.
What You Can Do
Work closely with the parents of children with RAD. Talk with them about what you see at school. Parents who are in counseling and therapy with their children will eventually open up to you – and then you can help your RAD students to get healthy.
Make it perfectly clear to children with RAD that you will take care of them. Remind them – unemotionally but firmly – that you make the rules. Stay as neutral as you can, using structure and control without threat. Constantly acknowledge good decisions and behavior.
It’s a long road to effectively treating RAD, but when you do, remember what a vital role you’ve played in providing hope, encouragement and the chance at a normal life for a child most in need of it.
As a school-based therapist, part of your responsibility is accurately identifying students who show signs of depression – as well as making their loved ones aware and helping to steer them in the proper treatment direction. Accurately diagnosed, depression can be successfully managed. But left unattended, its consequences can be devastating or even fatal.
Signs of Depression
Children with symptoms of depression show behaviors that cause them severe distress and can manifest as problems in social relationships and difficulties at school. Watch for:
Intense sadness, irritability, anger or grouchiness. Sadness may be expressed through frequent bouts of crying or tearfulness.
Loss of interest in friends or daily activities that they formerly enjoyed. Difficulty with relationships may intensify into extreme emotions or hostility.
Hopelessness, persistent boredom, guilt, or low self-esteem or energy.
Extreme sensitivity to rejection or failure.
Frequent complaints of feeling ill, especially with a stomach or head ache. High absenteeism.
Unusually poor concentration or academic performance.
Talk of running away from home or resorting to suicide or other self-destructive behavior.
What You Can Do
When compared to their peers, students suffering from depression are not only more prone to being self-destructive, but they also are more likely to have unprotected sex or become substance abusers.
All children are naturally sad sometimes, but when their symptoms last for an unusually long time and interfere with their normal functioning, it’s time to step in and take action. Learn to identify their cries for help – and when they need immediate attention from you and/or other mental health specialists.
Actively observe the behavior of students whom you suspect may have depression. Consider how they behave alone and with peers, inside the classroom and on the playground.
Provide resources. Work with teachers, parents and other adults significant in the lives of your students. As you guide them down a treatment path, you can utilize and offer resources such as ChildrensMentalHealthMatters.org, the American Academy of Child & Adolescent Psychiatry at www.aacap.org, the National Association of School Psychologists at www.nasponline,org, and the National Institute of Mental Health at www.nimh.nih.gov.
For additional resources to add to your school-based therapy toolkit, or to take your career to the next level as you plan ahead for the future, contact the Cobb Pediatric Therapy Services team. We’re therapists ourselves – and we can assist as you realize your ongoing career goals.
Mood disorders in children and teens have been recognized for decades – though they can sometimes be difficult to pinpoint. This is especially true in young children or others who may have difficulty describing how they feel.
Generally caused by chemical imbalances in the brain, mood disorders also may be triggered by environmental factors, as in the case of seasonal affective disorder. Students with mood disorders often are either depressed, manic, or alternating between the two.
A Tough Diagnosis
Often, mood disorders go undiagnosed because their symptoms can mimic the normal emotional and behavior patterns associated with growing up. This is particularly true in adolescence, when hormonal changes, peer pressure and rapid physical and cognitive development occur. But left untreated, mood disorders can lead to serious academic and lifestyle problems including school failure, extreme irritability, substance abuse, risky or self-injurious behavior, or even suicide.
Recognize the Signs
It’s normal for everyone – including children and teens – to occasionally feel sad or depressed as the result of upsetting events. With the right love and support, these feelings generally resolve themselves. Symptoms of mood disorders occur or reoccur over an extended period of time and interfere with normal activities and relationships.
Look for these symptoms:
In preschoolers: A somber, almost ill appearance; frequent complaints of physical ailments for which no medical basis can be found; lack of enthusiasm or tearfulness for no justifiable reason; spontaneous and unexplained irritability; frequent negative self-statements; self-destructive behavior, or anhedonia.
In elementary, middle and high school students: Disruptive behavior; academic difficulty or declining school performance; frequent peer problems; increased irritability or aggression; suicidal threats; anhedonia; statements that they hate themselves and everything around them; excessive sleep; rapid, unpredictable emotional swings; racing thoughts; increased interest in problematic activities such as overspending or drug use; grandiosity and inflated self-esteem; greatly increased or decreased sex drive, or uncharacteristically poor judgment.
Mood Disorders are Treatable
The good news is: Mood disorders are treatable. You can help your affected students by knowing the signs of mood disorders and where and how to get appropriate care.
Schools that provide prevention and early intervention-focused services are better equipped to help students with mood disorders. This should include educational programs for students, parents and staff, as well as collaboration with community agencies for referral and follow-up purposes.
Specific treatment should be recommended, after thorough evaluation by child mental health specialists. This treatment should be based on:
A student’s age, overall health and medical history.
The extent and severity of the condition.
The specific type of disorder.
The students’ and parents’ tolerance for specific medications, procedures and therapists.
The prognosis or expectation for the course of the condition.
The opinions and preferences of parents and students, in collaboration with mental health professionals.
Treatment for mood disorders may include medications, psychotherapy or family therapy. Regardless of the specific treatment plan, communication between home and school is critical. Counseling, community referral information and collaborative support must be ongoing. Working together, an involved team of adults can help ensure the ongoing mental health and well-being of every student.