Gateway Therapies
Brisbane occupational therapy, speech therapy, autism therapies and NDIS services for all ages

Get Help With Autism and NDIS Services Brisbane

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 occupational therapy
Task cards for assignment completion

A common challenge for older primary and high school age children is getting assignments submitted on time. Assignments can seem daunting for kids who struggle with time management and organisation skills. Often getting started is the hardest part. These Foldable Task Cards are a great strategy to help with planning assignments, and to help kids keep on track. Here’s how!

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SET UP

Step 1.

Fold a coloured piece of A4 card in half lengthways, and cut along the line.

Step 2.

Fold the long strip in half, and then each half into thirds. You should end up with 6 sections in total.

Step 3.

In the 1st section, write the heading - ‘Warm Up’. In the last section, write the heading ‘Reward’.

Step 4.

Draw a line across the entire bottom of the strip using a ruler.

Now it’s time to enter the details!

TASK PLANNING

The Warm Up

In the first section, we write a quick activity that is fun, but helps the child to get ready for desk work. Ideal warm up tasks will get hands ready for writing/ typing and brains ready for thinking. Students should have a say in their preference for warm up activities as this task needs to be very motivating. Ideas include:

  • Colouring mandalas

  • Crossword or word search

  • Advanced dot to dots

  • Type an email to a friend

  • Read a few pages of a book

The warm up task needs to be done at the desk or workspace and be quick to prepare and pack up.

The Reward

Everyone is motivated by something. The idea of the reward is to provide motivation for task completion and is an incentive to get the assignment started. Rewards can be longer, and can be completely unrelated to the project being completed. The Reward can be desk based, or outside, or can be a treat, food item, or game. Whatever is highly motivating for your child.

Timing

The bottom of the strip is used to set time limits for each stage of the task. It’s important that the student is realistic about how much time is required for each step. The time serves as as reminder to keep students on task and moving along. This is particularly helpful for kids who get stuck on one task.

TIP: If the assignment is a big one, tape two strips side by side so that there is 12 sections in total. This will give you 10 spaces for steps. Longer strips can still be folded.

Breaking Down and Writing the Steps

It is important that your child is involved in the process at all stages of making these task cards, however at this stage it is particularly crucial. This is where you read the project, homework or assignment requirements and decide a) what each step is, and b) how long each step will realistically take.

This process is also a learning opportunity as the student is required to work out the key pieces of information and what is actually required from them to be successful. Each section can have a few smaller steps, but the order of steps should make sense. Once again, it is important to be realistic about what can be achieved in the time you are allocating. Editing and checking work can be time consuming, but it is important to allow time for this.

Why this works

  • Coloured card is more eye catching, and creating a different shape to the usual A4 sized work sheets is visually different, and therefore a bit more interesting for the student.

  • Creating the task cards is a kinaesthetic activity, activating lots of different parts of the brain

  • The shape of the strip provides a prompt for the student to work systematically through each step towards the end point - the Reward

  • The strip is 3 dimensional when folded and provides a nice tactile experience for the student.

  • It can be folded in a number of different ways so that only 1 task is present at a time, which is important for those kids who get overwhelmed by too much information.

  • The cards are highly portable, and can be inserted into pockets on a wall calendar, or used as a bookmark.

Why don’t you try this for next term’s assignment tasks? If your child is struggling with getting work started or completed on time, an Occupational Therapist can assist.

Using visual aids to improve behaviour

Just like learning to eat solid foods, crawl, and hold a spoon, language and communication skills also take time to develop. For children with developmental delays and neurodevelopmental conditions such as autism, it can take even longer. A child’s poor ability to communicate and express wants and needs often goes hand in hand with tantrums and other challenging behaviours. It takes time to develop the full range of communication skills, and there are many!

Communication is a two-way exchange of information between two or more people. Good communication relies on all people involved having the ability to get a point across, receive and understand the message, interpret body language, and respond in a timely manner. Communication breaks down when there is an inability for either the communicator or the receiver to understand and/ or respond to what is being communicated.

For children with poor verbal communication skills, life can be frustrating. They can have lots of difficulty having their wants and needs met because they cannot find the words they need, or may have the words, but not the ability to produce the speech sounds. They might have an auditory delay which means they miss important information, or find it hard to keep up with conversation. They may lack the vocabulary to talk about the things they are interested in. They may not have the ability to understand directions, or interpret tone, or even pin point where auditory information is coming from. Body language and facial expressions can be confusing. Add to the mix a bit of distraction, classroom noise, and high anxiety, and communication becomes even more challenging.

It is very common to see challenging behaviours from kids who have poor communication skills. We can help to minimise the severity and frequency of these behaviours by making communication easier. By addressing the underlying cause of the behaviour, we are more likely to see the behaviour disappear.

Visual aids are one way we can help to improve behaviour by addressing the underlying issue, which is frustration caused by communication difficulties. Visual aids introduce an alternative, and sometimes easier, form of communication. Some kids with auditory delays find it easier to communicate using visual input, and are more motivated by images, pictures, and other graphics.

Visual aids can be things like schedules, checklists, images, pictures, PECS, and charts, as well as stories, cartoons and other graphics that show the child what is expected and/ or gives the child a choice of things from which to choose. Visual aids can show the order of events to eliminate anxiety caused by uncertainty. Visual aids can give kids the words they need to show you what they are thinking. Charts and graphs can provide a visual reminder of progress, which can be very motivating for some kids, especially those with autism.

The keys points on this topic are:

  • if you are having difficulty with a challenging behaviour, anger, aggression, or other concern, think about whether your child is having difficulty communicating something to you

  • Help your child to communicate by introducing visual aids

  • Talk to your speech therapist or occupational therapist to find out the best way to introduce visual aids

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Homework Organisation - Tips from an OT

At the beginning of a brand new school year, it’s a good idea to set aside some time to think about how homework will be tackled. Homework can be a source of anxiety for many of our kids. it can be perceived as boring and pointless. It can also cut into valuable free time after school, so no wonder the mere mention of homework can be a source of angst for both child and parent alike. Homework can be a POSITIVE EXPERIENCE however, with a bit of advance prep.

Here’s a few small ways you can prepare for a year of fuss free (or at least tolerable!) homework:

1. Set a realistic and age appropriate homework schedule. For young kids, aim for 10 minutes per day of good quality work rather than pushing for 30 minutes of laboured work. Kids have short attention spans in the early years. 

Also, pick your timing. Just before bed is unlikely to be the time your child will be at their best. 

2. Have the right tools for the job. Have a dedicated pencil case with everything you need so you are ready to go. This pencil case is for homework only and can be filled with the fun, sparkly stationery that is used only for special occasions, like homework.

3. Have a clear, dedicated workspace. This can be the table, a desk or kitchen bench. A space should be clear at all times, so that when it’s homework time there are no excuses for delaying getting started. 

4. Make sure your child can sit comfortably. Check your child can reach the floor or a footrest. Swinging feet are distracting and make for an ineffective seated posture. Your child’s ability to concentrate will increase if they are seated comfortably.

5. Be prepared to offer gentle praise and encouragement, not pressure. Any effort should be acknowledged. Bribing, threatening and demanding work be done will only fuel resentment. 

7. Delegate subject areas to parents depending on strengths. Maths not your strong point? Handover aspects of homework supervision to your other half if they have an aptitude for a subject area you're not great at. Forget about pride. Work out how each parent can best support their child's learning. It is both parents’ job to support their child’s educational development.

8. Have a dedicated in-tray for new work. Keep homework in a prominent place so that you are reminded to do a bit each day. Include homework in YOUR schedule and add it to your diary to give it significance. 

9. Be prepared to talk to the teacher. If you are concerned about the type or amount of homework your child is receiving, talk to their teacher. They might have some tips or make changes based on the collective feedback of the group. Also be prepared to say no to homework if your child’s homework load is simply too much for them.

If your child is resistant to homework ongoing, consider consulting with an occupational therapist. We can assist with determining the reason for homework refusal, such as biomechanical challenges (poor pencil grasp, poor posture), poor understanding of concepts, reduced attention/ concentration, fatigue, anxiety and more. Call us today on 3398 9367 to discuss further.


Meltdown vs Tantrum: How can you tell the difference?

What is the difference between a tantrum and a meltdown?

 Do you know the difference between a tantrum and a meltdown? You might be thinking – Of course I do! Only kids with autism have meltdowns. Every other child screaming in the shopping centre is just throwing a tantrum, right?

Wrong.

 Children with autism are certainly more prone to meltdowns, however every child (and adult for that matter) can experience a meltdown if the conditions are right (or wrong!).

 Whether your child has an autism diagnosis or not, it’s still important to know the difference between a tantrum and a meltdown, so you know how to respond accordingly.

 A meltdown is usually caused by a build up of sensory stimulus that becomes so overwhelming, it is hard to stay calm and in control. Children with autism and sensory processing disorders often become overwhelmed by sensory input (e.g. bright lights, loud noises, crowds etc.) and will experience a meltdown when they are no longer able to tolerate the amount or type of input they are receiving. A meltdown can also occur when emotions and feelings become overwhelming. This can happen to anyone, although it is more likely to occur if you have autism or other neurodevelopmental disorder. If your child experiences frequent meltdowns, without any apparent cause, it’s best to consult with your child’s general practitioner or paediatrician.

 A tantrum is usually caused by a child not getting what they want, being asked to do something they don’t want to do, or having something done to them that they are not happy about. Younger kids that struggle to find the words to express how they feel are more likely to have a tantrum. It’s a very effective (although undesirable) way to let others know something is not right in your world!

 An essential difference between a meltdown and a tantrum is that a meltdown is quite uncontrollable. There is little a person can do when in full meltdown mode, so the strategies to be used are generally around preventing them where possible, and providing a safe place to desensitise when the need arises.

 A tantrum however, is deliberate and somewhat controlled. A child will very rarely throw a tantrum if an audience is not present, whereas a meltdown will occur regardless of whether or not there are others around.

 How can a tantrum be stopped?

 A tantrum can be managed in a few different ways:

a)    By ignoring your child until they realise that you are not giving in,

b)    Giving them what they want (although not recommended!), or

c)    Redirecting/ distracting them.

 a) and c) are the better choices. It’s always important to let a child know that you have heard and understood them, but that a tantrum is not the way to express their wants and needs. As children learn to find the words they need, and self-manage their anger, frustration, and other challenging emotions, they should tantrum less. Parenting young children requires lots of patience!

 Detecting a meltdown

 It’s not always easy to anticipate a meltdown, but your child will have specific triggers and usually show signs when they are reaching their point of tolerance. Some children with autism will exhibit stimming (stimulatory) behaviours to try to over-ride or screen out the offending stimulus. This may look like rocking, flapping hands, humming or singing, covering ears, pinching or other self-harm, and other repetitive behaviours. These are not usually signs of an impending tantrum. Stimming does not always mean a meltdown is looming, so you will need to learn to read your child.

 How can I manage a meltdown?

 A child experiencing a meltdown will generally not benefit from the same behaviour management strategies that you use with tantrums. They instead need to be given time to recover from whatever sensory stimulus has affected them.

 If you have a child that is prone to meltdowns, try and work out their triggers. Over time you may learn to anticipate a meltdown and avoid it before it happens. Here are some things that may help your child to avoid a meltdown:

Bright lights and screen glare?

Try Sunglasses, Cap, Screen filters, Dim brightness on screens, monitors and devices, Retreat to a darkened room

 Too much noise?

Try listening to music through ear phones, ear plugs, pull down beanie over ears, wear a head band that covers the ears, retreat to a quiet place

 Too many people and lack of personal space?

Try having a tent or tepee nearby to hide in, spend time in a darkened room, wear Emotichew to let people know you’re not ready to talk, wear a hoodie to create a physical barrier

 Too much energy and excitement/ over stimulated?

Try jumping on a trampoline, heavy work activities like hanging off monkey bars or wall push-ups, chewy jewellery to chew on.

 If you have any concerns about your child’s behaviour, an Occupational Therapist can help. Call us today on 3398 9367 to discuss how the Gateway Therapies team can help.

(Article originally published in Families Mag)

The National Disability Insurance Scheme and Brisbane Families - What you need to know

The National Disability Insurance Scheme or NDIS is a federal government initiative that provides funding for adults and children with disabilities to access services and supports needed to achieve their life goals. It's a wonderful opportunity for people with disabilities to have the support they need to participate in education, vocational, leisure, community activities and more.  

In Brisbane, the NDIS rolls out in July 2018. If you are eligible and hoping to obtain funding, you need to apply NOW.  

You may be eligible for funding if you:

  1. Have a disability
  2. Are aged between 0 and 65
  3. Are an Australian resident

Your eligibility for funding is determined by a representative of the National Disability Insurance Agency (NDIA). Your application will be reviewed by either a Planner or Local Area Coordinator. The person assessing your application will ask you to state the applicant's goals. A goal may be to obtain a job in hospitality, make new friends who share similar interests, or learn how to independently access public transport.

Ready to apply? Here's what you need to do:

  1. Call the NDIS on 1800 800 110 and request an ACCESS REQUEST FORM.
  2. Decide what your primary and secondary goals will be.
  3. Decide what services you may like to access so you are clear on what to ask for in your plan. 
  4. Get together all your supporting documents. Gateway Therapies can provide you with a report outlining all your support needs and an overview of the applicant's needs to justify your funding request. We can also help you better understand the types of services you can access under the NDIS. Call us on 3398 9367 or use our booking form to request an NDIS planning Assessment.
  5. Once you've received your plan, it's time to choose a provider who can help you achieve your goals. Gateway Therapies is an approved provider of many NDIS approved services, however you can also find other service providers HERE.

 

For more information, you can download the NDIS Pathway fact sheet HERE


 

What's Best - Handwriting or Typing?

A few years ago, I conducted an Ergonomic Workstation Assessment for an adult who was employed in an administrative role. This particular employee had the task of completing a large number of forms by hand and she was experiencing symptoms that her GP thought might be early signs of Carpal Tunnel Syndrome. This recent assessment again got me thinking about writing.

Computers and other electronic devices are being used more frequently to communicate - either in real time or to convey a story or recount an experience. It appears as though typing has become the preferred method of communicating over writing and even at times over speaking. I wonder if this is the reason why there is an increasing number of both kids and adults who struggle with writing - either by writing poorly or by developing pain in their hands and wrists during this task?

It's important with any skill to practice often. Use it or you lose it - basically. My approach with working with kids is to firstly correct their pencil grasp, and then practice, practice, practice. Work on letter formation, letter height, width and word spacing. With adults who are reporting pain or other symptoms e.g tingling in the hands, I encourage them to continue writing, but to alternate written tasks with other activities. I encourage all clients, both young and old, to perform hand stretches before commencing writing tasks - just like a footy player would stretch his muscles before running onto the field.

I would love some feedback on this post. Which is more important - handwriting or keyboard skills? Do you experience hand or wrist pain if writing? What about your kids?

Please note, if you experience pain, numbness or tingling when writing or typing, and it does not go away, seek medical attention.

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The importance of building rapport in therapy

As the end of the school year draws to a close, I find that my school age clients get a little bit impatient, frustrated and less cooperative. I think it's a combination of fatigue, burn out, and anticipation of the holidays and Christmas.

One particular client, a boy with Cerebral Palsy, flatly refused to cooperate one day. Knowing that he was likely to be a little difficult, I had prepared activities that I thought would be fun. I only had a few things with me as I was seeing this boy in his home. When he showed no interest in any of the tasks I had on offer, I knew I had to try harder, as there was no alternative. In my therapy room I have a huge range of resources, but on home and school visits I am limited.

"I don't want you in my house", said the boy. "I'm the boss here" he added.

I told him that he wasn't and that we were there to work, that his father would be disappointed if we did nothing, and that it was to help him to use his arm better. "You need to practice using both your left and right hands to play the Wii!" His favourite thing to do.

"I don't want to", he said when I offered him different games. He had not even looked at them.

Complete resistence.

I needed him to understand that I wasn't going anywhere.

"I like you", I said. "I want to be here, and I would really like you to play this game with me".

Well those first three little words made the biggest different. The boy looked at the game I had in front of us, looked up in to my eyes and said "OK". For the rest of the session he was involved, he participated, and he worked hard. I was so proud of him and so thrilled that our therapy session was productive.

I think there are so many messages here in this story. It's important to show consideration and care for other people. It's nice to be told nice things, and it's nice to be nice. I meant what I said, and I think that's important too.

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How occupational therapy helps children with autism

Article originally posted as a Guest Post, Authored by Dr Nicole Grant at Baby Hits and Tips.

Occupational Therapists are highly underrated allied health professionals. Being one, I can say that with some authority. Seriously though, having just returned from a conference attended by about 750 of us, I can definitely say that they are an amazing bunch of people. The thing is, if you haven’t needed one, chances are you don’t know what an OT is, and how much you are missing out on!

OT’s are university qualified health professionals who are specifically interested in helping people to independently undertake those activities that matter to them most. For children, this quite often means helping them to play. We look at all of those things that can impact on a child’s ability to play – like physical injuries, intellectual impairment or developmental delay. We find out what kids love to do, need to do, and want to do, and help them to do it. This may include giving them special equipment or tools, modifying their environment to better support them, or engaging them in therapy aimed at improving their ability to play.

Children with autism can benefit from Occupational Therapy in many different ways. We can help to develop fine motor skills (handwriting, using cutlery, stacking blocks) as well as improve social skills (turn taking, joint attention, making friends). We can help establish alternate methods of communication where speech is limited (PECS, Makaton signing) or provide strategies to help overcome sensory dysfunction(such as hypersensitivity to noises and smells).  OT’s can also help with self-care skills such as toileting and dressing.

Many OT’s will undergo ongoing professional development or seek further education to become specialized in different fields. To work with children on the autism spectrum, you will usually find that your therapist has undergone specific training in interventions tailored towards helping children with autism.

If you are a parent of a child with autism, there are questions that you should always ask your therapist, before deciding if they are the right person for you. The following questions are adapted from the Early Intervention for Children With Autism Spectrum Disorders: “Guidelines for Good Practice”  (Roberts & Prior, 2012).

Questions to ask your OT

  • What are the specific aims of the program or service you offer?
  • Are there any medical or physical risks?
  • What assessments are carried out prior to the intervention?
  • What is the evidence base for this intervention? (i.e. what proof is there that this works?)
  • What evaluation methods have been used to assess the outcome of intervention? (i.e. how good are the studies that have tested this treatment option?)
  • Do you make money out of the intervention you are promoting?
  • What is known about the long-term effects of this treatment?
  •  How much does it cost?
  •  How much time will be involved?

At Gateway Therapies, we specialise in helping children with autism. Contact us now on 3398 9367 to make an appointment. 

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Should my child get a diagnosis?

A post from Director, Nicole.....

I often receive requests to assess for delays with development or dysfunction in the areas of sensory processing, fine and gross motor development, attention/ concentration and other areas of function. One of the questions I am frequently asked by parents, particularly when obvious issues become apparent, is - what do you think it is? Many parents are aware of neurodevelopmental disorders like those on the autism spectrum, and I often get asked about ADHD and sensory processing disorder.

I will always refer to a paediatrician for diagnosis, but can assist with the process by providing a report outlining my observations and recommendations.

Parents often feel reassured when they at least have a little more information as a result of an initial assessment, particularly as my focus is always on providing information and strategies to assist - regardless of whether or not a name is given to the challenges identified.

Once specific issues are identified, the treatment options or interventions used tend to be the same, regardless of what the diagnosis is, or will be. The problem here is that without a diagnosis, parents can have limited access to Occupational Therapy services. Government funding is available in Australia for children with special needs via such schemes as Helping Children with Autism and the Enhanced Primary Care Scheme. However, a diagnosis is required. Parents who wish to pursue intervention with a private allied health professional, and do not have a diagnosis, may be able to claim some of the expenses from their private health fund, or self-fund the fees.

Occupational Therapy services are available to the community via community services and more specifically to school age children through the Department of Education and Training. Waiting lists are often lengthy, which can affect access to early intervention services, however it's worth contacting your local department to check.

My concern with seeking a specific diagnosis or giving a name to the difficulties a child is experiencing, is that some children just do not meet all the criteria to be given a diagnosis. This doesn't mean they are any less in need of assistance. Many children can benefit from Occupational Therapy services, to develop skills to help them with their school work, social interaction, and self care. Click on the links or email me for more information.

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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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