Every parent’s goal is to have their child generalize the things they learn in therapy to their everyday lives, but that’s exactly the problem, the learning occurs in therapy and then we all go back to our everyday lives. All too often there is no crossover. Instead, there is the illusion that therapy needs to exist in structured settings with a clinician present, but teachable moments can be found throughout the day in so many simple daily living situations. From a clinical perspective, every moment has the opportunity to be a therapy moment. That’s where Therapy on the Run comes in. This article will help you have find those “perfect times” to work on SO many different skills, without having to set up a structured clinical hour that so many parents don’t have. Let’s take the example of mealtime:
For a child who is still having difficulty sitting, mealtime is the perfect opportunity to work on this. Motivation is high for food, use the opportunity! You can get the necessary tools from your OT, (sensory cushions, supported seating) and set small and achievable duration goals. As you meet each milestone, increase the expectation.
For a child who is having difficulty reading facial expressions and attuning, mealtime is one of the few times of the day we are all naturally sat at eye level, facing each other. You can use this time to increase your words, your affect and your actions, to harness your child’s attention naturally. Be silly, be playful, be animated, create opportunities for your child to truly connect.
For the child who is having difficulty with fine motor skills and manipulation, think of all the tools we naturally use at the table. You can try out different utensils, incorporate small containers onto the table and encourage your child to open them, use condiments in squeezy bottles and jars. Offer support with an expectation to fade it as the child becomes more able. Keep your support natural and remember “help means together!”
For a child who is having difficulty with organization and sequencing, you can use mealtime to work on setting the table. Determine your child’s current capacity and add small supports to help your child identify what to bring out, where to put it, how many plates, where does Mommy’s cup go, do we need spoons?
For a child who is having difficulty with reciprocal exchange and communication, mealtime is the perfect place to practice natural conversation. You can take turns asking questions to each other, (model language with an expectation for imitation). In addition to asking questions, you can observe and comment, helping to build many different opportunities for language participation.
And that’s just mealtime. The day is filled with these natural Therapy on the Run moments: loading the car, bath-time, bedtime, choosing movies, getting dressed, grocery stores, gardening, homework, laundry, even putting on Band-Aids. The challenge is recognizing the opportunity in the moment, with so many other contenders for our attention. One of the main goals in creating a functional treatment plan with families is minimizing the role of effort so that therapy feels like a “can do” in busy lives. So how do we formulate a plan? Here are some vital tips:
- The first thing we need to do is understand our child’s clinical program
All too often our end goal is the first goal, but this is like buying the dress before the gym membership. Whatever your end goals for your child are, sit down with your therapists and let them help you identify and map out the steps that are needed to meet those goals. Think of this process as a staircase and go up each step systematically. Some of the steps may seem irrelevant, you may want to rush, but each step is necessary to a staircase.
- Separate your goals, Speech versus OT versus Behavioral, versus Developmental, versus Physical Therapy versus Academics etc.
It’s much too hard to work on everything at once. A dinner table with a child working on their sensory system, while harnessing fine motor skills holding the fork, while sequencing with cutting the food, while practicing speech asking you to pass the salt, while addressing inhibitory behavior at the opportunity to just get some tactile input from that huge bowl of pasta, all while being social, taking turns with their sibling, and answering “wh” questions about their day… Its every parent’s nightmare, we become Jack of all trades and master of none. It is also often every child’s nightmare, and more often than not, we’re setting them up for failure when we do this.
Ask your entire clinical team to sum up two or three things they are currently targeting, in layman’s terms. In order to do Therapy on the Run, you will need to know what you’re working on. Write them out, make sure you understand them, make sure they complement each other. In order for it to be effective, the goals cannot contradict each other, this will just confuse you and your child.
Out of all the goals, pick the things that are most important to your child’s immediate development. This is a great time to sit down with your entire clinical team and come to a consensus.
A goal without a plan is a dream. Identify key times in your daily routine when you could work on your therapy goals, ask your clinical team to give you suggestions. Make a list and post them on the fridge so you have a quick reminder.
- Break it Down
If you decide you’re working on language today in the bath tub, then for how long? Are you working on circles of communication? Questions? Commenting? Nouns?…This may seem tedious but one of the best ways to achieve your goals is to make them achievable. Keep these goals small and manageable so that both you and your child have the chance to feel more successful than you do exhausted. Five minutes while in the bathtub can work wonders if both parties are truly connecting.
- Include the whole family
One of the biggest blocks to quality time is all the other things a parent has to do with the other children in the family. Find ways to include everyone. If your goal is engagement, get a balloon and a towel and play volleyball in the living room for 15 minutes with all the kids letting your children fall into their natural roles.
All too often parents get overwhelmed with the need to “teach.” Positive interaction is the key. Enjoyment and curiosity are the driving forces behind persistence. If you only have time to teach one or two things to your child today, be OK with teaching that.
- Turn chores into a teachable moment
What was previously a grocery store trip is now your chance to tick all the boxes your clinical team have set you for the week. You can work on processing, directions, tracking, sequencing, problem solving and team work. Pick one or two goals before you get out of the car and give them a go. Once you identify those goals, stick to them, don’t overwhelm yourself.
- Don’t try to do anything when you’re too busy
Acknowledge your own schedule and your own needs, they are important. In order to really support your child, you need to plan out these teachable moments in the community when you have the time to allow mistakes. Self-correction can only occur when the child has enough processing time. Processing time means we have to have time to spare.
After all this planning, take the time to notice your child’s responses and receptiveness. There is a significant difference between performance and true learning. It is potentially easy to get a child to perform, to imitate, to repeat. However, true learning, means the skill becomes integrated into the child’s natural patterns of responding, and for that we need to honor a child’s need for processing time and ownership. Without it, we find ourselves in the same scenarios over and over again, “re-teaching” our children. Realize the value of playful interactions — playing and learning are intricately woven in development, play is how children learn. Take time to incorporate play time. It is important to laugh, it is important that your child sees you laugh, it is important to laugh together.
Natalie Maddison is a Pediatric Developmental Clinician and Parent Trainer based out of Los Angeles. She has extensive clinical experience creating and tailoring interventions to treat children with neurodevelopmental diagnoses and the family units surrounding them. Natalie utilizes a strength-based model to help parents access their own skillsets to support their children. She received her B.Sc and M.S in Psychology from the University of East London and is currently completing an M.S/ Phd combined in Educational Psychology. In addition, Natalie is a certified Expert Training Leader with the Interdisciplinary Council on Development and Learning (ICDL), where she actively facilitates incremental practicum courses to students around the world at various levels of certification. She most recently joined the DIR® FloortimeTM Coalition of California- expanding awareness, access to, and use of developmental approaches through education, fundraising, research, networking, and policy advocacy.
This article was featured in Issue 37 – Making Educational Strides