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Featuring articles from our principal Occupational Therapist, Dr Nicole Grant, members of the therapy team, and guest posts from members of our community.  

Posts tagged attention
Low Muscle Tone and Poor Attention - A Case Study

A young boy, 4 years of age, was brought to me for assessment about 9 years ago. He had not been diagnosed with any particular disorder, but was easily distracted and found it difficult to pay attention to the task at hand. He had been seeing a Speech Therapist for some time due to a slight delay in his speech development and he dribbled.

The boy's mum was mostly concerned that he would not be able to concentrate in class when he started prep next year. She wondered what she could do to help him at home, in readiness for school.

I gave the child some activities to complete and observed that he fidgeted in his chair, and was easily distracted, and yes - had difficulty paying attention. One of the first things I noticed was that when needing to apply force or pressure, e.g to mould playdough, he would move to position himself over the table to use all his strength, rather than relying on his hand strength alone. When I asked him to throw a ring or ball, he needed to use two hands to get any sort of distance. Throughout the assessment I asked the boy to complete desk-based tasks that assessed things like posture, attention, and fine-motor skills, and more active tasks that assessed his balance, coordination and proprioception.

During the assessment, the 4-year-old managed to respond to multi-step directions, and complete age appropriate puzzles and games. I found that when he began to lose focus and become distracted, his posture also changed and he would recruit compensatory muscle groups to move or exert force on an object. I asked this child if he ever got tired in the neck, back, arms or legs when sitting for a long time. He thought for a second then answered "Yes. Sometimes my elbows hurt." His mum hadn't heard this before and wasn't sure what he meant by this.

By the end of the assessment, it had become apparent that the attention difficulties experienced by this boy were more likely due to low tone, than because of any cognitive or intellectual dysfunction.

Low tone or hypotonia is explained well in Wikipedia:

"Hypotonia is a disorder that causes low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength".

I recommended that the child engage in physical activities that promote muscle strength, balance and coordination, like climbing, running, and bike riding. He was already taking swimming lessons and going to structured gym classes, so he was already on his way.

With regards to desk-based work, I suggested that the boy be given a seat and chair that was appropriate for his size and that enabled him to sit with his feet flat on the floor and his back well supported. When performing desk-based tasks, it was probable that the child would become easily fatigued and possibly develop joint or muscle pain. He needed to be given the opportunity to stretch and change postures frequently.

With these strategies in place, and ongoing review of his progress and awareness of his needs, the 4-year-old boy should have no difficulty keeping up with his peers on commencing prep.

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10 ways to help your child to sit still

I often wish I could bottle the energy the children in my life seem to have in abundance. They don’t walk, they bounce. They don’t sit, they wriggle. Boundless energy, which is wonderful really. Except when you need them to stay still.

Most kids struggle to sit in one position. From the time they can first hold their little bodies’ upright, sitting still is hard work.

Being an active child is brilliant and should be encouraged, however sometimes sitting is necessary. Kids need to sit still at meal times, to get their hair cut, when at the dentist, in church, and one of the most challenging scenarios – at school.

It’s important for children to learn to sit still. Some activities are best undertaken in this position. It’s also good manners, and socially appropriate in many situations.

Here are a few tips and tricks to help your child to sit still:

1.    Give them a reason. Kids love to know why they need to do as they are asked. “Because I said so”, is not helpful. Instead, tell them the truth. “It’s good manners to sit at the table when our guests are still eating”, or “your handwriting will be neater if you keep still at your desk”.

2.    Set the rules. If sitting is expected at meal times, or when you have guests, include it in your family rules. Kids are visual learners. If these are written (or depicted as images for pre-readers), put them somewhere prominent to remind your little ones of what is expected.

3.    Model expected behaviour. Children imitate. If you are not sitting, why should they?

4.    Don’t expect too much. Kids generally can’t sit for as long as adults. Let them stand up to stretch their legs after 15 – 20 minutes. Let them shake their wriggles out before resuming the task at hand. It’s a skill that needs to be practiced.

5.    Make them comfortable. If your child can swing their legs, they will. If their feet can’t touch the floor, put a footrest (e.g. upturned box) under their feet to support them. Using a chair with a back support, rather than a stool is best.

6.    Make it fun. Kids struggle to sit still even more so when they are bored. Give them something to keep their hands and minds busy. If they’re not eating, then books, small (fidget) toys, or a game might hold their attention longer. If they are practicing handwriting or math’s tasks, can they use textured paper, or a coloured pen?

7.    Minimise distractions. Kids need to learn to work despite distractions, but too many can be a problem. Sit kids facing away from windows and other children. Limit (don’t eliminate) background noise, and avoid interruptions. Giving kids their own space for desk-based work is best, whether this be a corner of the kitchen bench or their own desk.

8.    Check their tone. Kids with low muscle tone can fatigue easily because they have to work harder to maintain one position. They can start to fidget and seek distractions after a while. Consider seeing an occupational therapist for an assessment if you think your child may have low tone.

9.    Consider extra support. Some children (particularly those with sensory processing issues) benefit from sensory feedback by way of a weighted lap pad or move n sit cushion. Always discuss these options with a qualified therapist first.

10. Don’t sit! Maybe sitting isn’t essential. Homework can be done with your child standing at the kitchen bench. Sometimes changing posture is actually stimulating. Does it matter if they are standing at the movie cinema? If their head is not blocking the line of vision of the viewers behind, does it really matter? Think creatively and be flexible.

Children with developmental delays, cognitive or physical impairment may continue to experience difficulty with sitting. Ongoing assistance from a therapist may be required to overcome some of these challenges.

If you have any concerns about your child’s seated posture, fine motor skills, or ability to concentrate or attend, further assessment by a paediatrician and/ or an occupational therapist should be considered.

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