A Look at ADHD
Jason Clopton, O.D., F.C.O.V.D., A.B.O. & Heidi Clopton, OTR/L
Center of Vision Comprehensive Vision Care and Therapies
Center of Development Pediatric Therapies
1445 East 10th St. Cookeville, TN 38501
931-372-2020 http://www.drclopton.com
http://www.covd.biz & http://www.developmentaldelay.net

 

“ADHD Does Not Exist” – Wow, now that’s a book title that will get your attention!

Dr. Richard Saul released this book a month ago and has been on many media circuits explaining his title. He is no newbie to the world of ADHD. Dr. Saul was a pioneer in the diagnosis and treatments of ADHD way back in the 1970’s. He explains this provocative title in the intro to the book. Dr. Saul states, “Attention related symptoms are all too real, with negative consequences for children, adults, and broader society; those affected face challenges in academic, professional, and social settings, often with lifelong repercussions.

But the medical establishment’s reliance on the ADHD diagnosis- and the medical community’s embrace of it- has also had several negative consequences: the failure to diagnose underlying conditions that explain attention symptoms in whole or part; the omission of much-needed treatment for those primary diagnosis; the health related, economic, and emotional costs of undiagnosed and hence untreated conditions.”

Diagnosis- The diagnosis for ADHD is a very subjective diagnosis, often a checklist of symptoms. The Diagnostic and Statistical Manual of Mental Disorders 5th edition was released in 2013 and lowered the number of symptoms needed and raised the age to 12 yrs from 7yrs which will result in more children qualifying for the diagnosis now. Dr. Saul raises the question to the medical, psychological, and educational community, “What if the symptoms of ADHD can be explained fully by other conditions? Once I treated what I saw as the primary diagnosis (the non-ADHD diagnosis) the ADHD symptoms usually disappeared…”.

Research is showing many co-morbid conditions that go along with ADHD that are often not the “focus” as the primary treatment due to 2/3rds of those with ADHD use medications as their only treatment. With 20% of high school aged boys and 7% of the total population with this diagnosis it is vital to find what could be an underlying condition that is mimicking ADHD symptoms. Are the short and long term side effects of stimulant medications worth it when the child may have another issue causing them to look inattentive, hyperactive, and/or impulsive?

Top Underlying Causes of Inattention, Hyperactivity, and Impulsiveness:

1. Vision Problems- “Eyestrain can make classroom attention impossible” reads the subtitle of an online article published by the Children’s Vision Information Network. 20% of school children suffer vision problems that make it difficult for them to sustain focus on academic tasks or near focus tasks. Eye-teaming, meaning how the eyes coordinate with each other, is often not checked in routine vision exams. Children with Convergence Insufficiency (CI) have been researched to show the same symptoms as ADHD.

60% of students identified as “problem learners” have CI. 5-12% of the population have CI. Tennessee only requires a vision “screening” once they entire school yearly, but vision screenings reportedly only catch about 20% of visual issues. The other 80% of students are left feeling like they passed their vision test…when they actually desperately need a comprehensive vision exam from an eye doctor to determine their visual acuity, convergence, eye muscle control, visual perceptual skills, and many more visual skills needed to focus all day in a classroom or even an adult focusing on a computer screen!

The good news is that these conditions are easily treated and backed by research through a comprehensive vision exam, lenses and/or neuro-visual therapies.

2. Sleep Disorders- “Sleep Deprivation Creating a Nation of Walking Zombies” this ABC news article will get your attention too! We are not quite The Walking Dead yet…but if we continue our addictions to gaming, electronics, caffeine, lack of exercise, poor diets, and keep neglecting our basic need for good sleep it is quite scary to think of what a sleep deprived nation would look like! The National Institutes of Health notes: “Sleep deprivation can cause daytime hyperactivity and decreased focused attention. This can be mistaken for ADHD or other behavior disorders in children”. The Mayo Clinic states the following as the right amount of sleep for age groups: Infants 14-15 hrs, Toddlers 12-14 hrs, Schoolchildren 10-11 hrs, and Adults 7-9 hrs.

3. Hearing Problems- “It’s like hearing underwater!” This is a common explanation for how children with sinus issues, allergies, and ear infections hear their environment. No wonder it is so easy for them to “tune out” and not pay attention to the teacher! Hearing and auditory processing are vital parts of our social and educational lives. Over 80% of what a child does in a school day will rely on listening to verbal directions. Hearing problems can result from underdeveloped or damaged inner ear or auditory nerve, prevention of sound waves reaching the inner ear, and as simple as built up wax or multiple ear infections. Central Auditory Processing Disorder is also a newer diagnosis that is the cause of symptoms that look like ADHD.

4. Learning Disabilities- 5-15% of children suffer from a learning disability. Many of the issues that children with ADHD have are often a learning disability that has not been diagnosed. The DSM-V requires one of the following symptoms to be present for 6 months or more to diagnose a learning disability: inaccurate or slow reading, difficulty understanding the meaning of written text, spelling issues, difficulty with written expression, significant challenges with number sense, and/or problems with math reasoning. Getting a proper psychological evaluation that includes IQ testing and visual perceptual skills is vital if your child has symptoms of ADHD.

5. Sensory Processing Disorder- SPD can be diagnosed when an individual has symptoms in multiple areas that involve challenges integrating sensory information and responding to it appropriately. This can be either over or under responsiveness to sensory stimuli, craving of excessive movement, difficulty filtering out background sensory stimuli, or in-coordination that results in avoidance behaviors of writing or fine motor tasks. The potential to confuse SPD as ADHD is so great that a 2007 Time magazine article about SPD was titled, “The Next ADHD?” Sensory processing trained occupational therapists in medical based outpatient clinics are the primary evaluation and treatment source for SPD.

6. Other Conditions- Dr. Saul lists many other conditions in depth in his book that can mimic ADHD. These include but are not limited to: Seizures, Substance Abuse, Mood Disorders, Giftedness or high IQ, OCD, Tourette’s Syndrome, Asperger Syndrome (now included under Autism diagnosis), Neuro-chemical issues, Fetal Alcohol Syndrome, and biomedical issues. Food sensitivities, nutrient and vitamin deficiencies can often cause ADHD like symptoms.

Something as simple as low iron can cause symptoms of ADHD. A 2004 study in France found that 84% of children with ADHD had low serum iron. When given an iron supplement and vitamin C to help absorb the iron their symptoms improved drastically.

A Dutch study in 2011 used food elimination diets to research the effects of special diets for ADHD. This study showed decreased ADHD symptoms for 64% of the children to the point that they would no longer qualify for the ADHD label.

Several research studies have shown improved word reading, spelling, and attention benefits from DHA supplements. Since our American diet is lacking in enough clean and healthy fish, proteins, veggies and fruits it is no wonder that the rise in ADHD could be mistaken for a decline in the American diet.

Too much electronic time and not enough exercise, free play and movement time have also been shown in research to cause ADHD like symptoms.

The take away from this provocative book is that Dr. Saul wants our doctors, therapists, educators, psychologists, and most importantly our families in America to not conform to the “fast paced” diagnosis of ADHD. He urges us to take the time to listen to all of your child’s needs, explore all the possible underlying issues, and do not be hasty in giving out a diagnosis and treatment that may have long term effects on your child. Finding the appropriate diagnosis and treatment for ADHD like symptoms will be a much more accurate treatment plan with a lifetime benefit…and no side effects!

cute picture of hands with paintSensory Issues…when to worry, when to intervene, and when to relax.

We all have them… those little “quirks” that make you feel “wigged out” or “stressed out”. It may be the way your skin crawls at the sight of a centipede, walking barefoot in the grass, or wearing wool. You may need to cut out those irritating tags in your shirts. Maybe you get overwhelmed with all the kids talking (or screaming) in the car and can’t wait for the peace and quiet. You may crave a massage, neck or back rub to calm down. Your children have sensory preferences too. Some like to swing fast, some like to rock and be held, and some love to jump on a trampoline to feel calm and organized.

But when does a “sensory preference” become “Sensory Processing Disorder”?
Children and adults can suffer from sensory issues that affect their daily life skills and their social interactions. These issues are far more interfering than that pesky shirt tag. When a sensory issue has crossed the line into interfering with daily life with how an individual acts or reacts to their environment, then it is considered a “disorder” not a “quirk”.

This is the child that cannot tolerate playing with other children at a party due to being overly sensitive to sounds, touch, or movement. Or it may be the infant that cannot be consoled by typical rocking, massage, or being held. It’s the child who doesn’t sit still, fidgets and squirms, and craves wrestling, jumping, running, and climbing in excess. Many adults suffer from sensory issues that affect their daily life and limit them in the ability to socialize or even connect in personal relationships. When you are fighting daily over what your child needs to wear, eat, or their ability to tolerate normal grooming then it’s time to get some help.

Newest Research on SPD
Sensory Processing Disorder or “SPD” is a term used in the therapy community to describe a group of symptoms in which an individual’s nervous system over or under reacts or misinterprets sensations of touch, taste, smell, sounds, vision, movement, and muscles/joints. SPD is more prevalent in children than autism and as common as attention deficit hyperactivity disorder, yet the condition receives far less attention partly because it’s never been recognized as a distinct disease. In a groundbreaking new study from UC San Francisco, researchers have found that children affected with SPD have quantifiable differences in brain structure, for the first time showing a biological basis for the disease that sets it apart from other neurodevelopmental disorders. One of the reasons SPD has been overlooked until now is that it often occurs in children who also have ADHD or autism, and the disorder has not been listed in the Diagnostic and Statistical Manual used by psychiatrists and psychologists.
“Until now, SPD hasn’t had a known biological underpinning,” said senior author Pratik Mukherjee, MD, PhD, a professor of radiology and biomedical imaging and bioengineering at UCSF. “Our findings point the way to establishing a biological basis for the disease that can be easily measured and used as a diagnostic tool,” Mukherjee said.
Therapy is available with sensory integration trained occupational therapists to help individual’s sensory systems get “organized” and learn how to make accommodations in their daily routines to help calm their sensory nerves. Many insurance companies cover these services if they are affecting daily life skills or causing developmental delays.

The following are some “red flags” for when a sensory processing therapy evaluation may be needed:
“Sensory Avoider” Reacts with fear, flight, or aggression to any typical sensations such as: unexpected touch, loud noises, textures or certain clothing on skin, screams at haircuts or hair brushing, upset by typical movement experiences such as swinging or climbing, avoids touching foods or gags at sight of new foods, cries excessively over a small bump or cut, or gets carsick easily.
“Sensory Craver” Craves excessive amounts of movement, loud voice volume, “on the go” constantly, difficulty with attention, uses too much force in touch, takes too many risks on the playground, or spins excessively. These children are constantly “on the go”!
“Clumsy” Sensory motor issues can show up as gross or fine motor skill delays such as being very accident prone, poor balance skills, low muscle tone, difficulty learning to ride a bike, catch a ball, hop on one foot, or fine motor skill delays learning to write, cut, or do fasteners.

Most children and adults with SPD are a mixture of both under and over sensitive, which explains why inconsistent behavior is a hallmark of the disorder” states Lindsey Biel, co-author of Raising a Sensory Smart Child. “It’s not an obvious diagnosis. The behavior of a child with SPD can be confused with that of a kid who may have overlapping behaviors and a different diagnosis, such as ADHD. A child who doesn’t get enough proprioception will seek ways to stimulate his muscles and joints-continuously moving, or chewing. What’s more roughly 40% of the time kids have both SPD and ADHD.” states Dr. Lucy Miller founder of the STAR Center, a SPD therapy and research center in Colorado.

Finding the right help to understand sensory issues and a therapist that knows therapeutic procedures and activities that re-wire the sensory nervous system can be the beginning of understanding your child, yourself, and helping both of you get through the sensory filled world calm and collected.
To learn more please visit: http://www.spdfoundation.net or http://www.developmentaldelay.net.

Heidi Clopton, Pediatric Occupational Therapist
Center of Development Pediatric Therapies

Jan 09 022

Educators often hear from therapists, “When in doubt, crawl, crawl, crawl!” It seems from the onset, crawling is an amazing develop-mental activity that translates into all kinds of academic success.

The importance of a long crawling and creeping period in development is often overlooked by Pediatricians and parents. Many just don’t know the vital importance of this developmental milestone and impact later on in life.

As Occupational Therapists, we see children daily that have poor reading skills, difficulty tracking visually left to right, poor hand dominance or crossing of midline, decreased trunk strength (may look fidgety or ADHD), poor handwriting, immature grasp patterns and difficulty with fine motor skills all due to short or missed belly time!

Infants should spend as much time as possible on their bellies from the time they can turn their head at a few weeks when playing. Babies should not spend their “floor time” in supported sitting, car seats, entertainers, walkers, or johnny jumpers! Floor time should be a priority every day, getting down in the floor on belly learning to control their bodies, gain core strength, learn what their hands can do while their vision is engaged, and making millions of neural connections for later skills. Getting on their bellies sooner will prevent a myriad of developmental and learning delays later in development!

If an infant does not like belly time or is not crawling by 7 months or creeping by 9 months, then there could be issues that need to be evaluated by a pediatric PT and OT. Some children who have food sensitivities to cow’s milk and heavy sinus pressure avoid this position due to the pressure on their ear canals. A child with touch sensory defensiveness will avoid being on belly and hands, a sure sign that pediatric sensory based OT is needed asap! Infants with clinically low muscle tone will need therapy to help get them in this position and help this important stage develop. All red flags need a pediatric OT or PT eval, this is not something to wait and see about.

Please don’t “wait and see”…the time is NOW for therapy evaluation if a child is 9 months and is not crawling and beginning to creep, or avoids belly time all together. Most infants start creeping within a few therapy sessions!

Crawling is when you are on your belly “like an army man or snake”.
Creeping is when you are on your hands and knees like a “cat creeping up on a mouse”

Doing this activity even through older ages helps in all areas of development:
• Calms by activating heavy work receptors in the muscles and joints
• Continues to calm by building muscles that help breathing
• Helps children sit in chairs by building back and stomach muscles
• Coordinates two body sides so hand specialization is more likely to occur
• Improves handwriting by developing shoulder, arm, and wrist stability
• Helps develop fine-motor coordination as it builds the arches of the hand
• Decreases touch sensitivities by deep input and rubbing the floor
• Integrates many of the primitive reflexes, integration of these reflexes is vital to gaining higher motor skills
• Strengthens trunk, shoulder and arm strength which is needed to sit and attend
• Sets up the communication in the brain across the midline of the brain which is needed for reading skills to occur
• Increases muscle tone, muscle strength, and coordination throughout the body

The benefits of a good long crawling and creeping stage are too many to just “wait and see” about. An early walker is not always a sign of good development. Many of the children we see later in 1st-4th grade with reading, writing, and handwriting issues were early walkers. Please don’t hesitate to get an evaluation and necessary treatment for your precious one!
Center of Development Pediatric Therapies Cookeville TN
http://www.developmentaldelay.net 931-372-2567 Heidi@covd.biz

this is creeping position, not crawling

this is creeping position, not crawling

Everyone knows that Early Intervention is the key to treating children with developmental delay.
But, did you know that orthopedic and fascial conditions can also affect development as they grow?

Babies with torticollis, weakness, scoliosis, or stiffness in their muscles or fascial system can have difficulty properly developing their vision, vestibular, and balance systems.

They may also have symptoms similar to ADHD, ADD, sensory processing disorder, or autism by the time they are toddlers or preschoolers.

Babies can have fascial restrictions from birth that lead to these problems and continue to get worse as the child grows, causing pelvic obliquity, limb length discrepancy, torticollis, even progressing to scoliosis, adult arthritic conditions, and spine pain over time.

Children with pelvic obliquity and leg length discrepancy as little as 1/8” or even mild torticollis can develop scoliosis, be delayed in development of quadruped creeping, balancing, and ambulation skills.

Children with even minor torticollis or scoliosis can develop delays in vision and sensory processing that cause them to have difficulty with bilateral coordination.

Sheri Brimm, PT is now available to treat children at Center of Development. She has developed a comprehensive evaluation and treatment system which utilizes manual therapy techniques such as myofascial release and soft tissue and joint mobilization techniques, as well as traditional strengthening and sensory integration techniques to treat the whole child in a 3 dimensional manner. She has noted improvements in pelvic obliquity and movement that result in the child improving their developmental skills and balance dramatically.

Sheri is specializing in John Barnes Myofascial Release techniques and the Total Motion Release Program (by Tom Dalonzo-Baker) that work well for children and are easy to follow as a home program for parents. These techniques work!!

Early Intervention is the key to better outcomes!
The earlier we can evaluate and intervene for children 3 and under, the more improved functioning we can see by Kindergarten. Medically necessary therapies are very different than educational therapies through TEIS or school systems. Most children need both to make huge gains in development! Families rely solely on their pediatrician’s referral for medically based therapies.
Here are some “red flags” to know when to refer for medically based pediatric therapies.
Gross Motor
Any known medical diagnosis can be considered a “red flag”: Down’s syndrome, cerebral palsy, congenital heart condition, frequent ear infections, sensory avoiders, low muscle tone or high tone…
Newborn to 3 months old:
• Unable to turn head both ways fully or postures with sidebend of neck and trunk ( Possible torticollis or fascial restrictions causing pelvic obliquity and tightness of neck muscles)
•Breathing erratically, has excessive belly breathing, caving in at chest, appears restless, has excessive tongue thrusting (could be sign of fascial restrictions or high muscle tone)
•Constipated or having difficulty with reflux (could be sign of fascial restrictions in abdomen, pelvis, or chest area)
•Not moving arms and legs equally on both sides, not bringing hands to midline, not making eye contact, maintains arms/legs fully flexed or fully extended position (signs of muscle tone abnormalities)
Six to Nine Months:
• Not rolling by 6 months of age from supine to prone both R and L sides
• Not pushing up on straight arms, lifting his head and shoulders, by 7 months of age
• Not sitting upright in a child-sized chair by 9 months of age
• Not sitting independently by 7 months of age and falls over easily
• Not crawling (”commando” crawling–moving across the floor on his belly) by 9-10 months of age or inability to move legs or arms equally

Ten to Fourteen months:
• Not creeping (on all fours, what is typically called “crawling”) by 11 months of age or any abnormal creeping patterns like bottom shuffling or scooting.
• Not pulling to stand by 10 months of age
• Not standing alone by 12 months of age
• Not walking by 14 months of age

Age 2 years and above:
• Not jumping, kicking, catching or throwing a ball by 28 months of age
• Not independent on stairs (up and down) by 30 months of age
• “walking” their hands up their bodies to achieve a standing position
• walking on their toes, not the soles of their feet
• frequently falling/tripping, for no apparent reason
• still “toeing in” at two years of age

For referral information and insurance coverage questions, please call 931-372-2020. Centers of Development.

 

Pouty FaceCall 931-372-2567             FAX Orders 931-372-2572

Early Intervention is the key to better outcomes!

The earlier we can evaluate and intervene for children 3 and under, the more improved functioning we can see by Kindergarten.  Medically necessary therapies are very different than educational therapies through TEIS or school systems.  Most children need both to make huge gains in development!  Families rely solely on their pediatrician’s referral for medically based therapies.  Using the Bayley Scales of Infant Development and other standardized assessments, we can evaluate to see if a child is greater than 25% delayed and may need therapy.  The sooner we can evaluate, the sooner the family will know if therapy is going to benefit their child. 

Here are some “red flags” to know when to refer for medically based pediatric therapies.

Gross Motor

If a child is…

  Not rolling by 6 months of age

  Not pushing up on straight arms, lifting his head and shoulders, by 7 months of age

  Not sitting independently by 7 months of age

  Not crawling (”commando” crawling–moving across the floor on his belly) by 9-10 months of age

  Not creeping (on all fours, what is typically called “crawling”) by 11 months of age  or any abnormal creeping patterns like bottom shuffling or scooting.

  Not sitting upright in a child-sized chair by 9 months of age

  Not pulling to stand by 10 months of age

  Not standing alone by 12 months of age

  Not walking by 14 months of age

  Not jumping by 28 months of age

  Not independent on stairs (up and down) by 30 months of age

  “walking” their hands up their bodies to achieve a standing position

  only walking on their toes, not the soles of their feet

  frequently falling/tripping, for no apparent reason

  still “toeing in” at two years of age

  unusual creeping patterns

  any known medical diagnosis can be considered a “red flag”: Down’s syndrome, cerebral palsy, congenital heart condition, frequent ear infections, sensory avoiders, low muscle tone or high tone, etc. 

Fine Motor

 
If a child is…

  Frequently in a fisted position with both hands after 6 months of age

  Not bringing both hands to midline (center of body) by 10 months of age

  Not banging objects together by 10 months of age

  Not clapping their hands by 12 months of age

  Not deliberately and immediately releasing objects by 12 months of age

  Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age

  Still using a fisted grasp to hold a crayon at 18 months of age

  Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age

  Not imitating a drawing of a vertical line by 24 months of age

  Not able to snip with scissors by 30 months

  Using only one hand to complete tasks

  Not being able to move/open one hand/arm

  Drooling during small tasks that require intense concentration

  Displaying uncoordinated or jerky movements when doing activities

  Crayon strokes are either too heavy or too light to see

  Any know medical diagnosis can be considered a “red flag”: Down’s Syndrome, cerebral palsy, low or high tone, other developmental delays.   

 

Cognition/Problem Solving

 
If a child is…

  Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby)

  Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another)

  Not able to imitate a model from memory by 27 months (ie, show me how you brush your teeth)

  Not able to match two sets of objects by color by 31 months of age

  Having difficulty problem solving during activities in comparison to his/her peers

  Unaware of changes in his/her environment and routine

 

Sensory

 
If a child is…

  Very busy, always on the go, and has a very short attention to task

  Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)

  A picky eater

  Not aware of when they get hurt (no crying, startle, or reaction to injury)

  Afraid of swinging/movement activities; does not like to be picked up or be upside down

  Showing difficulty learning new activities (motor planning)

  Having a hard time calming themselves down appropriately

  Appearing to be constantly moving around, even while sitting

  Showing poor or no eye contact

  Frequently jumping and/or purposely falling to the floor/crashing into things

  Seeking opportunities to fall without regard to his/her safety or that of others

  Constantly touching everything they see, including other children

  Hypotonic (floppy muscles, weak grasp, poor trunk tone, usually poor motor coordination)

  Having a difficult time with transitions between activity or location

  Overly upset with change in routine

  Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.

  Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.

Sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.

Possible visual problems may exist if the child…

 Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes.  Any eye turns in or out separate from another. 

  Does not reach for an object close by

 Avoids doing near work,  poor at puzzles, and avoids eye contact

Self-Care

If a child is…

  Having difficulty biting or chewing food during mealtime

  Needing a prolonged period of time to chew and/or swallow

  Coughing/choking during or after eating on a regular basis

  Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)

  Having significant difficulty transitioning between different food stages

  Not feeding him/herself finger foods by 14 months of age

  Not attempting to use a spoon by 15 months of age

  Not picking up and drinking from a regular open cup by 15 months of age

  Not able to pull off hat, socks or mittens on request by 15 months of age

  Not attempting to wash own hands or face by 19 months

  Not assisting with dressing tasks (excluding clothes fasteners) by 22 months

  Not able to deliberately undo large buttons, snaps and shoelaces by 34 months

Social/Emotional/Play Skills

If a child is…

  Not smiling by 4 months

  Not making eye contact during activities and interacting with peers and/or adults

  Not performing for social attention by 12 months “in their own world”

  Not imitating actions and movements by the age of 24 months

  Not engaging in pretend play by the age of 24 months

  Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers)

  Fixating on objects that spin or turn (i.e. See ‘n Say, toy cars, etc.); also children who are trying to spin things that are not normally spun

  Having significant difficulty attending to tasks

  Getting overly upset with change or transitions from activity to activity

Water play fun!

Water play fun!

 

Communication:

·        Difficulty making and maintaining eye contact with an adult by 6 months

·        No big smiles or other warm, joyful expressions during interaction with another person by 6 months

·        No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months

·        No babbling by 12 months

·        No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

·        No consistent responding to their names by 12 months

·        No words by 16 months

·        No following simple and familiar directions by 18 months

·        No two-word meaningful phrases without imitating or repeating & says at least 50 words by 24 months 

·        No back-and-forth conversational turn-taking by 30 months

·        Any loss of speech or babbling or social skills (like eye contact) at any age

 

Most babies who are doing well with development exceed these milestones by leaps and bounds.  These are very, very low thresholds for all the skills listed.  If your child or patient is not meeting these basic guidelines, please don’t dismiss your feelings.   Seek professional help from your pediatrician and ask for a medical based therapy evaluation. The earlier we can evaluate, the earlier we can see improved development!   

 

Gluten (Wheat)-Casein (Dairy)- Soy- preservative free shopping guide.

 

This is a small list of things that all my kids eat, we eat for snacks, and simple substitutes for cheeses or butter…obvious meal choices like fresh fruit, veggies, meats, etc are not listed because they are easy to find GFCFSF…These are ALL GLUTEN, CASEIN, and SOY FREE and LOCAL snack foods or breakfast foods:

 

Krogers:

Snapea Crisps Plain (baked snapeas) are a great snack for kids and were the first finger food for my kiddos!  They hanging in the produce section at Krogers. 1.99 You can buy 12 bags for $17 on Amazon.com grocery if you can wait and stock up.

Organic apples and fresh fruit and veggies best at Krogers. 

Organic/Health section:  Almond, Rice, and Coconut Milks (choc or vanilla taste best on cereals or drinking.  Plain for baking) Coconut Milk is the healthiest choice. 

Coconut Milk CREAMER for coffee and  use the plain cream for baking with creams. 

Earth Balance butters are dairy & soy free and taste better.  Walmart has cheaper.

Coconut Milk yogurts usually on sale one time a month for .99 bottom right of yogurt area.

Frozen gluten free waffles and French toast sticks in freezer in organic section.

Frozen gluten free breads here as well if you must have breads, learning to eat just lunch meat with GF crackers is healthier option though. 

Coconut Milk ice creams are the yummiest, but expensive.  Use as special treat. 

Nut  & Rice crackers across from here and gluten free dairy free snacks. 

Canned soups also in this section are healthiest.  Some kids will eat veggies if in a soup base and soft rather than alone. 

Knudsen’s Mega Greens Juice- very healthy way to get in greens in a sweet juice.  I hide natural calm liquid vitamin in this for our son.  They go on sale for 2 for 5 usually. 

Rice cereals on next aisle.  Rice Bars, Oat cereals, etc.  Watch for sales.  Watch ingredients, often have hidden wheat or casein. 

Rice Works Chips (plain salted are GFCFSF) cheaper at Walmart if you are going there though. 

KIND Bars  are awesome!  Oatmeal cookies…lots of snacks in this section! 

Veggie STIX (bottom of shelf and they run out often…kids LOVE THEM) check for wheat…some have wheat.  Look for veggie chips without wheat. 

Terra Chips (watch labels on flavors…all I had at home to check was the plain, but I think several are GFCFSF) Plain Root chips GREAT FOR YOU and YUMMY! also at walmart cheaper!

Orville Red. naturals simply salted microwave popcorn (the best microwave popcorn I have ever had!)

Organic Blues Corn Chips and salsa…yummy snack! Garden of Eatin’ chips are very yummy too. 

Fruit sorbets by Private Selection in the regular freezer ice cream section (we love them all but really like the black cherry)  Great alternative to ice cream!

Nitrate free Sausage patties are in the long freezers in the very back wall. 

  

 

 

 

Walmart

Vanilla Rice Milk and Plain Rice Milk for cooking or Plain almond milk for cooking (none of us like to drink the plain flavors but keep some in the pantry for cooking or baking) in the dry section and cold section in back of store near special chip & snack section near the bathrooms. 

We like the chocolate milks for drinking and vanilla for baking…rarely use the plain. 

Terra and Rice Chips at the end of the chip aisle on the end closer to the cold section. 

Rice CRACKERS  in brown box on very bottom of shelf below rice chips.

Orvilles Naturals Salted Popcorn

Lots of flavored almonds and nuts in this section sweetened with STEVIA and chocolate almonds are one of our favs! 

Canned Evaporated Goat Milk to subtitute for any Sweetened Condensed Milks, or condensed milks for baking. 

Coconut Milk in a can cheapest here for Thai cooking or sauces or as a thickener in soups or sauces. 

Coconut Milk Water in the Spanish food section is a great nutritional drink.

Goat milk based carmels  2 different flavors in the Hispanic food section top shelf.

Earth Balance Butters cheapest at Walmart…with other butters near eggs.

Nitrate, MSG, and gluten free Hormel Naturals lunch meats and salami! Brown cardboard and red writing boxes…ham, turkey, salami choices! 

Nitrate free natural hot dogs, Angus meat

Nitrate free BACON

Gluten free rice pastas at Walmart in gluten free section are great, watch directions you cook differently than reg noodles! 

Frozen fruits for making smoothies with coconut milk in place of milkshakes, you can make them really thick for a homemade ice cream too!  

 

SAMS

Cheapest “log” of goat cheese in Cookeville, we go through about 4 logs a month…we eat it like cream cheese on crackers, dollop in chili for subbing sour cream, make cheesecakes, use as riccotta cheese, etc.  About $6 for 1lb! 

Peccorino Romano Argintoni Brand Triangle and Shredded Cheese for anything Italian or to mix with bread crumbs for breading…it is Sheep’s Milk not cow…make sure you get the one that is Sheep not Cow’s, it is clearly labeled.  This tastes like parmesan cheese. 

They also carry 2 block cheeses that can be used as sliced cheese that tastes like mozzarella cheese or a white chedder.  In the speciality cheeses…they are made from sheep, goat, and other animal milks that don’t have the hard to digest casein protein. They are getting new cheeses without dairy often, check labels and ask! 

Fruit gummies- on the back wall when in a pinch for needing a sweet snack on the go they have all natural fruit juice gummies in pouches that don’t have artificial colors added.

Gluten Free crackers in a large box comes with 2 bags of great crunchy crackers!

Eggs with added Omega 3 in 24 box cheapest at Sam’s

Organic Carrots, spinach (hide it in your smoothies, juicing, & lasagna) cheapest at Sam’s

Blueberries, grapes, blackberries, etc cheapest at Sam’s 

 

Good Shepard Health Foods- great for a face to face advice on supplements and special diet options. Healthy foods, local honey, etc. They can also hook you up with local farmers & raw milks.  If you want a natural solution for a problem…start here! 

All experts agree with the following taken daily:  Probiotics (milk free raspberry chewables at Good Shepard are great for kids), Cod Liver Oil, DHA fish oil based, & multivitamin with magnesium & Vitamin D for most children and adults!  Our American diet just doesn’t have what we need for our brain, body, emotions, behaviors, etc. 

 

AMAZON.COM

I love to shop LOCAL as often as possible…but when you can find it for half the price then sometimes our budget calls for online shopping. 

Kid Calm multivitamin liquid by Natural Vitality only $20 and has all the multivitamins, minerals, DHA, probiotics, D3, and naturally calming magnesium for all kids needs.  This is very essential as a basic multivitamin for ANY child. 

We put it in orange or green juice or with fresh made juice daily.

Enviro-Kids rice bars several flavors, Snapea Crisps, oatmeal cookies in small bags, and organic lolli-pops!  Put in gluten free on Amazon and explore your options.  Delivered to your door, no tax, free shipping over $25 order! 

Lots of gummy vitamins too.

 

 Where to eat:  Thai, Japanese, Chinese, Indian, hamburgers with no bread, grilled chicken…etc all offer gluten & casein free options.  32 degrees Yogurt has milk free yogurt options and Only 8 brand which are gluten & casein free!  You can buy quarts to take home too!  Baskin Robbins always carries at least one dairy free ice cream.  Smoothie King for smoothies.  The Turn Around restaurant off the square is excellent for juicing, smoothies, salads, soups, and all around healthy eating with many gfcfsf options.

What to do about PIZZA!  We make rice crust at home and make at home.  If taken with probiotics we can eat on occasion the Take and Bake De Lite pizzas and just ask them to make it without cheese.  We put our own Sam’s cheeses on at home when we bake it.  We try to limit the amount of gluten to one time weekly…and take our probiotics with it! 

More info:

Center of Development  www.developmentaldelay.net

Facebook pages:  Center of Development,  Casein Free in Middle TN

Word Press Blog:  Pediatric Therapist, Heidi Clopton, OTR/L

Email:  Heidi@covd.biz  I lecture nationally on special diets, supplements, whole foods, and how this effects development.  If you are interested in my lecture notes I can email them to you!  Just let me know!

Changing your diet and your child’s diet will have the GREATEST effect on attention, behavior, development, and their BRAIN!  Research shows that diet changes has the greatest effect over medications & therapies!

Make the change, we are here to help!

 

Clopton home typical meals weekly example menus:

 

Breakfast- nitrate free sausage or bacon, eggs, boiled eggs, fruit smoothies, protein shakes made with coconut milks, fruits cut up in small pieces for kids, fruit salad fresh made, oatmeal, oatmeal muffins (healthy oatmeal cookies made with gluten free rice or nut flour and honey instead of sugar in ingredients baked in cupcake liners for easy grab and go breakfast), rice cereals, granola cereals with oats, cereal with coconut milks, gluten free waffle or pancakes, rice bars, apples and goat carmel, gluten free bread and all natural jellies.

 

I try to pre-bake oatmeal squares and gluten free snacks that are easy to eat in the mornings and pack in lunches on the weekend enough for the whole week. 

 

Lunches- nitrate free lunch meat with raw carrots and chips, nitrate free hot dogs with snapea crisps, soft goat cheese on rice or almond crackers, chips & salsa and we pack a lot of the amazon.com snacks into their lunches.  When home we may make hamburgers we just don’t eat the bread, we just cut up the hamburger meat and eat like steak.  Canned soups when home also are great. 

 

Dinners-  we eat baked chicken many different ways with veggie as a side and rice.  Cooking veggies to a softer texture makes them easier to eat for most texture sensitive kiddos.  Using a lot of the Earth Balance butter and salt helps too!

 

Potato crusted fish with veggie side or sweet potato fries. 

 

Whole chicken from Sam’s with baked carrots (add a little honey to the carrots to make them sweeter) and broccoli casserole made with goat cheese and sheep parmesan cheese shredded on top.

 

Chicken soup- I take the left over chicken carcass and boil it up to make a chicken soup broth and add a can of chicken from Sam’s, carrots, tiny pieces of broccoli cut up, and celery in the chicken soup.  You can add the rice pasta macaroni noodles from Walmart also for a noodle soup.

 

Lasagna made with rice noodles from Walmart and goat cheese in place of the ricotta with sautéed spinach in the goat cheese, layer with a little of the sheep parmesan on each layer then shred the parmesan on top really thick!  Spaghetti or macaroni rice noodles (Walmart) with the organic tomato sauce from Sam’s.   You can bake this with the shredded sheep cheese on top too for a pizza bake.

 

Mac and cheese- use rice mac noodles from walmart, melt earth balance butter and goat cheese together in the microwave and pour on the noodles when done!  Sometimes we like to add some sautéed fresh spinach to this as well. 

 

Veggie soups and beef broth soups with soft veggies…basically you can take any recipe and make a substation with a gfcfsf idea!  Heidi@covd.biz

ImageLove is the foundation to a secure child who grows into a giving, loving adult.”  This is a statement on the first page of the book, The Five Love Languages of Children by Gary Chapman, PhD. and Ross Campbell, M.D.  What could we desire more as parents than to raise a loving, kind, giving, and secure child? 

Dr. Chapman’s psychology theories and recommendations are simple, yet work!  Relationships are very complicated, but improved emotional bonding may be as simple as the love language you speak, understand, and perceive as “love”.  

Relationships are very complicated…but also very simple when you think about love as a language.  If a wife speaks Chinese and the hubby speaks English…there might be some communication issues right?  The same happens when the wife’s love language is acts of service and the husbands is physical touch…guess what, they can’t feel connected, they have trouble communicating, and they just can’t feel loved like they did when they were dating.  The wife will have to learn how to speak his love language of physical touch more often…while he has to learn that painting the bedroom a new color is speaking love to her. 

The same happens with the rebellious teenager.  The parents speak the love language of giving gifts and supply all her needs and WANTS…car to drive, the coolest clothes, and fun money.  But this teen is still unhappy and slams the door screaming “You don’t love me!  I hate you!” .  Her parents are perplexed wondering how in the world she can’t see how much they love her.  Her love language may be quality time, she may simply need more time one on one time with her parents.  All she sees is how much they work, and she is alone way to often feeling sorry for herself. 

 Everyone has a primary way in which they perceive love, but speaking all 5 love languages is vital in any relationship. Asking your loved one what is most important to them can help you understand how they perceive love…and it may change daily!  The simple question, “what can I do for you today” can be very insightful into their need for love. 

Little ones perceive love through are caring touch, being there to make them feel safe and secure, meeting their needs for comfort and food, and play time.  My girls are now 9 and 8, and they still need some quality time right before bed to “feel my love”.  This always amazes me that they still crave that bedtime routine, but I have to remember that it “speaks” to them that I love them and how important this one on one time is for them.

 Teenagers often change their primary love language often, thus why parents go crazy trying to understand their teens!   When our children are younger they may perceive love as playing in the floor together, wrestling, putting them to bed, reading books, or small gifts for no reason.  As the teenage years approach and they are establishing a greater independence in who they are, this love language may change…even daily in their needs.  We may even have to ask the “would you rather” question to understand what is more important to them.  Teaching the teenager that they need to show selfless acts of love back to others is very important as well!  Doing volunteer work together in the teen years such as local volunteer groups and mission trips can be life changing and remind them that the world does not revolve around their needs. 

Spouses often run into the problem of poor communication.  It is more of a need than just spending time together talking.  It is how we are perceiving love.   If the wife’s love language is acts of service and quality time, and the husband has been consumed with work outside the home then she is going to feel like she isn’t important to him, and will not want to “speak” to him.  She has to remind herself that his act of working is an act of service, just as vital to their relationship as helping with the laundry.  Men often need to be told what to do in a relationship.  They understand to put on the romance when they are courting you…but that all changes when you have been married for years.  They forget that we still need those acts of love 10 years later.  Ask and you shall recieve…make your needs vocal in a sweet and loving manner by letting your man know what is important to you. 

Men most often perceive love through physical touch and quality time.  This is very hard when the wife has little ones wanting her to hold them all day and she is busy keeping the home and work in balance.  But remember that just like you want your husband to help out more with the kids and home…he wants you to sit next to him while he watches a sports show you have no interest in just to feel your presence and touch.  Men need to feel loved as much as women, they need to feel our loving touch and know that we want to be with them…even if we don’t “feel like it”. 

The hardest part of a relationship is being selfless…showing love with no expection of getting love in return.  But the beautiful thing about love is that the more you show…the more you do get!  Unconditional love is simple to understand…show love with no conditions…but harder to act on! 

Here are the 5 love languages in which everyone perceives love…

  1.  Physical Touch – the importance of touch has been scientifically proven to be a very powerful tool to affect an individual’s mood, emotions, brain chemistry, learning, behavior, and overall health!  Parents instinctively show love through touch with babies by holding, rocking, cuddling, and even “baby wearing” our little ones for the first 12 months.  Then all of a sudden when they become “mobile” we expect them to not need as much calming touch.  Many children crave more touch then what they are receiving.  My little boy needs to wrestle in the floor with Daddy every night to get his “love tank” filled.  My girls still request a back rub every night before bedtime.  Using pressure touch (big bear hugs, shoulder massage) as a powerful calming tool may help a child with ADHD.  As a pediatric occupational therapist we are trained extensively in the neurologic aspects of the touch system and how it can be used to calm or alert.   Deep pressure touch on major muscle regions (back, arms, legs) such as massages, squeezes, rough housing, bear hugs, or sitting in a parents lap to read a book can be very calming.   

  

2.      Words of Affirmation– This individual needs to hear how well they are doing often.  Their face lights up when you tell them your love and appreciation.  They thrive on hearing how hard they studied or played a sport.   It is vital to be aware of their need for positive affirmation daily.  Remember the tongue is a very powerful tool that can be used to uplift or tear down.  A child reaps the benefits of affirming words for a lifetime. 

 

3.       Quality Time– This may be the hardest love language to express for a busy family, but it is essential to MAKE quality time with your child a priority.  I was amazed at Leah, my middle daughter’s answer to the question, “Would you rather Mommy buy you a new toy or play a board game with you?”.  She emphatically stated, “Play a game with me Mommy!”.  The simplest act of eating breakfast and riding to school alone with Daddy at 7 am fills her love tank daily.  Quality time doesn’t have to be a special event.  It can be as simple as doing chores together or playing a board game as a family.  During your quality time it is essential to leave the phone and facebook behind…even if you are just watching a movie together, give your full attention to that person. 

 

4.      Gifts– For this love language to truly be received as unconditional love, then the gift must come with no conditions.  The English word gift comes from the Greek word charis, meaning “grace, or an undeserved gift”.  Gifts used as a love language are given “just because I love you”.  These types of gifts often cost very little, but have a lifetime of meaning.  Children often express this love language by drawing pictures for loved ones, picking wildflowers for Mommy, or giving away toys to all their friends on play dates.  Remember for gift giving to be a valid love language, it is truly, “The thought that counts!” and not a payment or reward. 

 

5.      Acts of Service– This requires our time and altruistic effort and can be the most demanding love language of all.  As parents we are constantly showing our love through acts of service to keep our homes in order.  Parents often feel overwhelmed and under-appreciated for the acts of service we do at home, work, and kid-taxi services we keep running. We have to remind ourselves that we are showing our love by providing for our family.   For children, love shown through acts of service may be something totally unrelated to daily chores or bringing home the bacon.  Acts of service should be activities that they cannot do for themselves.  Fixing their bike, putting together a difficult toy set, going camping with them, making special crafts together, volunteering, or helping them with homework are all examples.  

 

To learn more about the 5 love languages and how they affect all of our relationships read Dr. Chapman’s extensive library of resources at www.fivelovelanguages.com