Author: btopousis

Why Handwriting Matters

Writing is a lifelong skill that starts long before kindergarteners sit down at their desks in school. Whether it’s within an early childhood educational group setting or in one-on-one occupational therapy sessions, we begin laying the groundwork for success in handwriting as early as two years old. But what’s the best way we can approach writing with our young children? The answer is: playfully. In this arena our number one job as parents and caregivers is to wire our child’s brain with positive associations and experiences with writing. Neuroscience research tells us that successful associations (through many, many “short and sweet” handwriting experiences, in this case) will ultimately support a child’s long-term curiosity, grit, and success with new skills.

[T]he physical processes involved with writing by hand improve our cognitive memory retainment, support understanding of sounds and language, develop future reading skills, refine our visual-motor skills (i.e. how our eyes and hands work together), and support the development of our executive functioning skills (e.g. working memory) throughout adolescence and into adulthood.

This is particularly important with writing, a skill that grows and changes with us and supports our interaction with the world around us in a myriad of ways. The art of writing recruits and engages our brains differently than tapping a touch screen or typing on a keyboard do. For example, the physical processes involved with writing by hand improve our cognitive memory retainment, support understanding of sounds and language, develop future reading skills, refine our visual-motor skills (i.e. how our eyes and hands work together), and support the development of our executive functioning skills (e.g. working memory) throughout adolescence and into adulthood.

Getting Started

What should we keep in mind when starting with our youngest writers? The answer boils down to a few key practices:

• Meet them where they’re at. Present children with developmentally-appropriate tasks. (See below.)
• Make it a win. Ensure children are successful while engaging in writing tasks like the ones listed below (and modify the activity so they are successful).
• Keep your eyes on the clock. Offer short writing tasks, and expect engagement for only two- to five-minute bursts of time.

Here are some reasonable, attainable, and developmentally-appropriate ways to target key skill areas with your young child:

• Build a strong understanding of simple size and shape concepts for the lines and curves that are necessary for forming capital letters and numbers — i.e. big lines and little lines, big curves and little curves.
• Practice imitating: Write something first; then ask your child to do what you just did. Try this with a vertical line, a horizontal line, a circle, and a cross.
• Use multi-sensory materials they can feel (read: they must be able to actually hold the materials in their hands) to practice building capital letters and numbers using lines and curved pieces. For example, use Play-Doh, sticks, bendable beeswax sticks, etc.; mold them into shapes; then form numbers and capital letters.
• Offer children short writing tools that will support the use of an age-appropriate grasp pattern. For example, offer thick crayons (less than three inches in length), pieces of chalk, short paint brushes, etc.
• Present children with a variety of different vertical surfaces to practice writing and drawing on. Vertical surfaces will support the development of their grasp and upper-body stability. Upright easels, chalkboards, washable shower doors/walls, or simple large pieces of paper taped onto walls are all great options.

Leave Lowercase for Later

In addition to learning what is helpful to do, it can be equally helpful to learn what you don’t need to do. So what shouldn’t you worry about? As an occupational therapist who addresses handwriting in children of all ages, this one is simple: with young children (ages two to five), there is no need to worry about practicing lowercase letters before they begin kindergarten. The primary reason behind this comes down to numbers. Here are the numbers that inform the developmental sequence in which we teach letters:

• All capital letters start at the top; lowercase letters can start in four different places.
• All capital letters are the same size/height; lowercase letters can be two different sizes.
• All capital letters occupy the same vertical space position; lowercase letters can occupy three different vertical positions (i.e. small, tall, descending).

From analyzing a simple comparison of key differences between capital and lowercase letters, you can see that capital letters are much simpler than lowercase, and young writers have fewer opportunities to make mistakes when they write capital letters — contributing to a child’s increased success and confidence with this new skill. Focusing on establishing a strong foundation in a young child’s understanding of line and shape forms, capital letters, and numbers is the most developmentally-appropriate path during this time and will bring a payoff later. When children learn and practice capital letters first, they tend to avoid confusion between capital and lowercase letters in the future, and they are also more likely to learn lowercase letters more easily when the time comes.

On the flip side, research tells us that children who are presented with unreasonable expectations (e.g. writing lowercase letters before they’re ready) are not only more likely to have difficulty with or struggle with writing later on, they are also more likely to avoid writing or exhibit low self-esteem and confidence around this skill.

Exposure Versus Expectation

You may be wondering, “Aren’t kids seeing lowercase letters all over anyway?” Yes, lowercase letters are everywhere in our world — at the grocery store, at the library, and in the books we read to our children at night. So let’s take a moment to clarify how this is different. Exposure to lowercase letters is a natural part of our world and is supportive for so many of our children’s skillsets, namely reading and writing. It is our job as parents and caregivers, however, to be cautious about what kind of expectations we set around these exposures with our children. Put another way, we can encourage exposure without setting expectations for forming lowercase letters before children are developmentally equipped to do so. The more we can set reasonable expectations for our child, the more engaged and intrinsically motivated they will likely become — and the more successful they will be.

A Little Goes a Long Way

Over the long run, working with your young child to develop the foundational skills supportive of handwriting will pay off in many ways, from the development of related motor capabilities to increased confidence and persistence when writing in a school setting for the very first time. As parents, it should be encouraging to know that a little bit of time spent each day can and will go a long way in building not only your child’s handwriting skills but also their self-confidence, grit, and willingness to engage with the world as a lifelong writer and learner.

by: Bridget Topousis, OTD, OTR/L

If you’ve ever wondered, “Is my child social enough?” – or even, “Is my child overly social?” – you’re not alone. As we watch our young children grow and develop alongside other children, these are natural questions to have as a parent. Although it’s within our nature as human beings to compare, it is also important to remember that children are developing socially at different times and at different rates, and our #1 job as parents is to meet them where they’re at and support their social skill development in ways that are meaningful and fulfilling for them as individuals.

Social-Seekers

Some kids are naturally inclined to seek out more social opportunities with others – whether it be with a friend at school, a teacher, or another child they just met at the park. These are our “social-seekers.” They have a greater threshold for social interaction, meaning it takes more interaction to fill up their cup and satiate their social needs, so to speak. Social-seekers will naturally look for and find more opportunities to connect with others in a social way – through conversation, humor, silliness, or other types of behavior.

Social-Savorers

On the flip side, some others need less social interaction to fill their cups – we call these children “social-savorers.” They have a lower (or limited) threshold for social interaction, meaning that is takes less interaction to fill their cups and meet their social needs. These kids often prefer to reserve their social interaction “quota” for more structured opportunities across their day – such as during classroom morning meeting time or lunchtime – and they look forward to alone time during other parts of the day.

What Creates a Seeker or Savorer?

What shapes these social differences in young children? Many factors – including learning styles, developmental differences (e.g., differences in speech and language skills), mental health conditions (e.g. anxiety), and individual differences (formed by our personalities, experiences, and backgrounds) – may influence a child’s social skills. These individual social differences are important to be aware of and to understand, since we are all wired differently as human beings and subsequently bring our own individual differences to our social environments – whether it be at home, in school, or in the community.

Why Be Social?

Being “social” (*to whatever degree is attainable and fulfilling for your child*) is important and meaningful for young children because it lays the foundation for the development of their social skills throughout life. Starting at birth, a child’s social skills will first grow through one-on-one connections and interactions with their caregivers. It isn’t until later that these social skills may expand to more people, such as within a small or large group (as we typically wouldn’t expect a child to demonstrate a specific skill within a group before they can use this skill with one other person). These skills are important because they support our ability to successfully interact in a variety of environments throughout life. And furthermore, it is essential to name that research confirms young children develop many of these lifelong social skills through PLAY!

Which specific social skills are we talking about? This table highlights the social skills that children have the opportunity to gain from 1:1 play, small group play, and large group play:

Benefits of 1:1 Play	Benefits of Small Group Play	Benefits of Large Group Play
– Focus on individualized play, reflecting the child’s specific interest areas– Sustained eye contact with play partner– Joint attention– Shared enjoyment– Reciprocal turn-taking– Reciprocal social conversation (the “back-and-forth”)– Practice reading non-verbal cues of only one other person– Practice making comments, requests, or asking questions– Practice social problem-solving as it relates to one conversation topic– Play scheme may shift more quickly than it would in a group	– Focus on either individualized play or rule-based play, depending on group size and dynamics– Turn-taking with several play partners– Creating and following group norms and rules– Practice reading non-verbal cues of group members (e.g. facial expressions, body language)– Practice making comments and/or asking questions of others– Practice taking others’ perspectives– Shifting between leading and following the group’s plan– Cause-and-effect social reasoning– Social pragmatics (i.e. the social use of language and how people interact with others)	– Focus on rule-based play reflecting the group’s interest areas– Group collaboration– Identifying and shifting between individual roles within the group– Mental flexibility– Social pragmatics– Reading non-verbal cues of group members and appropriately applying cues to group plan– “Code Switching,” or changing language for the listener or situation– Developing skills of sharing with other group members with delayed gratification– Social negotiation skills– Building grit while persisting toward long-term group goals– Developing Theory of Mind skills (i.e. the ability to think about mental states – including emotions – of your own and those of others)– Learning values of teamwork, compromise, cooperation, and morality

Disclaimer: The social skills presented in the table are being included with the type of play (i.e., 1:1, small group play, large group play) that they are most often associated with. However, these skills may be observed across several different types of play and do not necessarily belong to the one type of play listed above.

Hesitancies and Fears

It is also common for children to have hesitancies or fears related to being social or joining social situations. Reasons behind these fears can vary from child to child, as well as situation to situation. Fears could be rooted in previous social experiences (e.g., being left out of a game, causing them to fear rejection; bullying/not being accepted by their peers; etc.), anxiety or excessive worrying, or simply a preference for solitude or more “alone time.” Research tells us that children who consistently withdraw socially are at a higher risk for a range of negative outcomes, including socio-emotional difficulties (e.g., anxiety, low self-esteem, depressive symptoms, and internalizing problems), peer difficulties (e.g., rejection, victimization, and poor friendship quality), and school difficulties (e.g., poor-quality teacher-child relationships, academic difficulties, and school avoidance) (Annual Review of Psychology, Rubin et al., 2009). Fortunately, there are ways parents can respond to counteract these risks.

What Parents Can Do

Research has shown that parents who do the following things can actually help their children become less socially-inhibited and more socially-skilled during early childhood:

• Maintain sensitivity to their socially-inhibited children’s needs.
• Encourage independence.
• Provide and support opportunities for peer interaction (e.g., arranging play dates and offering structured social opportunities, such as meeting the child’s classmate at the park).

(Rubin 2002; Rubin et al. 2001, 2002).

Key Strategies

Here are a few key strategies to keep in mind as you stay sensitive to your child’s social needs and support their social development throughout childhood:

• Acknowledge, then model. Acknowledge where your child is showing you they’re at by using clear, natural feedback. Then, if they’re ready, model (using your own words/actions/body language) a possible next step for them to try.
  • For example, you could say to your social-seeking child, “I see how disappointing it feels for you when the activity is over or when friends are all-done playing. It’s hard to feel disappointed, isn’t it? You can give them some time and space, and then check back in with them in 10 minutes.”
  • You could say to your social-savorer child, “I see that you’re feeling like you want to be done with the group. That’s ok. Why don’t you let the group know you’re feeling ‘all done’ and are going to take your last turn before doing something else for awhile? You can always check back in with them later if you’d like.”
• Ask questions, and make suggestions. To encourage social communication with your child, ask questions or make suggestions to help them use language in different ways (American Speech-Language-Hearing Association, 2021). Here are some specific examples:
  • If you are trying to get your child to make a comment, try making an open-ended comment such as “Tell me about…,” or ask them the question “What did you do?”
  • If you are trying to get your child to state a request, try asking “What do you want?” or suggesting “Tell your friend you want to….”
  • If you are trying to get your child to ask a question, try suggesting “Ask me…”
• Practice, practice, practice. If you notice that your child needs more help or support during social situations throughout the day, practice using everyday situations can be a helpful way to model new or developing social skills. Here are some examples:
  • Give your child the opportunity to practice asking questions by asking other family members what they would like to do on Saturday.
  • Encourage discussions with your child about other people’s thoughts, wants, and feelings and the reasons why they act the way they do.
  • Practice staying on topic while talking about a book, movie, or school event.
  • Allow your child to ask for what they need to make a recipe or complete a craft (ASHA, 2021).
• Show how non-verbal cues are important. For example, look at pictures of familiar people in the child’s life and focus in on their non-verbal cues (e.g., their faces or body language may indicate how the person might feel). See how many “clues” they can find that tell them how the person in the picture is feeling. For older children, you can also talk about what it means when a person’s face doesn’t match what they say (e.g., sarcasm, humor, etc.).
• Keep the balance. Depending on your child’s needs and thresholds, set aside time during the day for “alone time” as well as “together time.” This makes social situations more predictable and manageable for both the social-seeking and the social-savoring child.
• …PLAY! Engaging in rich imaginary play experiences enhances a child’s ability to relate to others, develop creativity, and benefit from naturally-occurring social problem-solving with others.
• Read about it together. Reading a book with your child can serve as another way to send a powerful message related to social-skill concepts you’re already talking about with them. Moreover, hearing and talking about stories (particularly those involving surprises, secrets, tricks, and mistakes) encourage children to see things from different perspectives!
  • Here are some recommendations for books related to making and keeping friends for children:

• Here are some recommendations for books related to anxiety in children:

Book List

Here are some recommendations for books related to making and keeping friends for children:

How to Be a Friend: A Guide to Making Friends and Keeping Them by Laurene Krasny Brown

Join In and Play (Learning to Get Along) by Cheri J. Meiners

Making Friends by Fred Rogers

Forever Friends Club by Gaurav Bhatnagar

Teach Your Dragon to Make Friends by Steve Herman

Growing Friendships: A Kids’ Guide to Making and Keeping Friends by Dr. Eileen Kennedy-Moore and Christine McLaughlin

Social Skills Activities for Kids: 50 Fun Exercises for Making Friends, Talking and Listening, and Understanding Social Rules by Natasha Daniels

Here are some recommendations for books related to anxiety in children:

Wemberly Worried by Kevin Henkes

Wilma Jean – the Worry Machines by Julia Cook

What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner

by: Bridget Topousis, OTD, OTR/L

by: Bridget Topousis, OTD, OTR/L

While We’re Asleep

While it’s one of our most basic needs, what sleep does for our bodies is quite complicated. It may come as a surprise to know our brains are actually just as active when we are asleep as when we’re awake. When we sleep, our brains are busy multi-tasking. They’re making decisions, putting together creative connections, forming and recycling memories, processing information, clearing out toxins that build up throughout the day, and learning and remembering how to do physical tasks (e.g., shooting a free throw or playing the guitar). Our brains also release growth hormones while we sleep, enabling us to promote muscle growth and cell repair within our bodies after a busy day. As it turns out, there is plenty of truth in telling a young child, “We sleep so the muscles in our bodies can grow!”

In fact, young children specifically need more sleep than older children and adults for many reasons. One of the most significant reasons is that young children’s brains are establishing and refining more neuronal connections (and at a faster rate!) for new skills and experiences (e.g. learning how to walk, engage in new routines, eat with a fork, develop expressive language, etc.) than we tend to establish and refine later in life.

Overall, a good night’s sleep plays a vital role in priming, protecting, and restoring our bodies and brains, enabling us to feel our best and make the most of our skills and abilities.

In the long term, getting too little sleep as a young child contributes to poor sleep patterns, which puts children at an increased risk of developing more serious health conditions later in life – including ADHD, high blood pressure, obesity, diabetes, stroke, heart failure, and depression.

Quality and Quantity

In children, sleep can be affected by several factors – e.g., if a child’s basic needs are being met; if they have a regular routine; if a child feels safe and secure, stressed or anxious; and if a child is able to self-regulate. When children get enough quality sleep, they are more likely to exhibit positive outcomes related to improved attention and memory, behavior, learning, emotional regulation, quality of life, and overall mental and physical health.

Healthy sleep patterns are all about balance. If children are getting too little sleep, they may experience impacted attention skills (i.e., difficulty thinking/focusing and poor memory), behavioral or mental health issues, learning problems, and an increased risk for accidents and injuries. In the long term, getting too little sleep as a young child contributes to poor sleep patterns, which put these children at an increased risk of developing more serious health conditions later in life – including ADHD, high blood pressure, obesity, diabetes, stroke, heart failure, and depression.

If children are regularly sleeping too much, it may be an indicator that they are not sleeping for an appropriate or adequate amount of time on a regular basis during nighttime hours. (For example, they might be experiencing frequent wakeups.) They are also at a higher risk for developing diabetes, obesity, and other mental health conditions.

Here are some signs and symptoms that could indicate your child is either getting too much or too little sleep:

When a child isn’t getting enough sleep, they might exhibit…

• Excessive excitement or hyper-like behavior prior to bedtime (e.g., running around).
• Difficulty attending or focusing in school (i.e., symptoms mirroring Attention Deficit Hyperactive Disorder, aka ADHD).
• Increased emotional reactivity or “moodiness” related to things that wouldn’t otherwise warrant as intense a reaction.
• Out-of-the-norm symptoms of clumsiness or appearing accident-prone.

When a child is getting too much sleep, they might exhibit…

• Drowsiness or low energy during the day.
• Increased feelings of anxiousness.
• Increased sleepiness or fatigue that is not resolved by daytime naps.
• Depression or other mental health issues.

(American Academy of Pediatrics, 2016)

The American Academy of Pediatrics (AAP) reports that about 25% of children under the age of 5 aren’t currently getting enough sleep. How do we know if our kids are getting enough sleep? The AAP supports the following guidelines set by the American Academy of Sleep Medicine (AASM), outlining recommended sleep duration for children from infants to teens (Journal of Clinical Sleep Medicine, 2016):

Child’s Age	Recommended Sleep Duration*
Infants 4 months – 12 months	12-16 hours
Children 1-2 years	11-14 hours
Children 3-5 years	10-13 hours
Children 6-12 years	9-12 hours
Teenagers 13-18 years	8-10 hours

*per 24 hour period (including naps for infants through age 5) on a regular basis and without disturbances to promote optimal health

(Journal of Clinical Sleep Medicine, 2016)

Setting the Stage for Success

How do we set our children up for the ‘just-right’ amount of quality sleep? Research tells us that there are things we can offer our children during the day to support their sleep quality. These include physical exercise, sunlight, and plenty of outdoor time. Scaffolding your child’s daily schedule around these targets may provide a payoff in their nighttime sleep quality and duration – and yours, too.

At night, sleep routines are a wonderful and healthy way to support your child in getting the right amount (and quality) of sleep by offering a consistent sequence of activities to do each night. The repetitive nature of these routines will add predictability, give your child an increased sense of security, and ultimately support their own sleep independence. Here are some key pieces to consider as you establish, manage, or modify the sleep routine of your growing child:

• Power off the screens. Turn off screens (e.g. TV’s, tablets, videogames) at least two hours before bedtime. Light from screens actually suppresses melatonin (the hormone responsible for controlling our sleep-wake cycle) in our bodies, which impacts our ability to fall asleep and stay asleep and delays our REM (Rapid Eye Movement) sleep – the stage of sleep in which our brains are most active. Screens also act as an alert to our brains to stay engaged, making it harder to fall asleep (American Sleep Association, 2021).
• Start earlier. Begin your child’s bedtime routine 30-60 minutes before you expect them to fall asleep. This sends an important message to your child’s brain that sleep is coming, and they will naturally begin to anticipate sleep-related routines and environmental cues during this time. Most importantly, this type of anticipation is comforting, regulating, and calming.
• Stick to the sequence. As much as possible, keep the sequence of bedtime tasks within your child’s bedtime routine the same. Again, this repetitive sequence helps your child anticipate sleep-related routines and environmental cues and is comforting and calming. For example, a 3-year-old child’s sleep routine sequence may be to put on pajamas/a nighttime diaper, brush their teeth, read three books (it’s ok to set a firm and predictable boundary here), hug and kiss goodnight, and turn off the lights.
• Reconnect together. Engaging in quiet and simple conversation with a parent or caregiver before bedtime can provide your child with a warm connection that is calming and reassuring. Here are some age-specific examples of calming conversations that are developmentally appropriate:
  • With a 2-year-old, recount their day: “Today you woke up, ate cereal for breakfast, went to school, painted a purple pumpkin, and then came home and spent time with Mom and Dad. Tomorrow we will go visit Grandpa. First night-night, then Grandpa.”
  • With an 8-year-old, offer simple, reflective questions that are encouraging and comforting: “How was your Tuesday? I noticed how you helped your brother get off the bus this afternoon; that was very kind and helpful. I appreciate you. What is something good that happened to you today?”
• Have an exit strategy. Give your child a tender yet brief hug and/or kiss, say goodnight, turn off the lights, and leave the room while they’re still awake. This will help them learn to have more independence with falling asleep on their own (a lifelong skill), improved self-regulation, and an increased sense of internal security. Lingering for an excessive amount of time can be confusing and cause a child to have additional worries or feelings of anxiousness.
• Wrap it up. A full bedtime routine for young children (<5 years old) should be about 30 minutes in duration – and slightly longer if a bath is included.

Most of all, though, investing your time and thoughtfulness into consistently offering your child a loving, nurturing, and regular sleep routine can support your child’s health and sleep skills for years to come.

Adapting

One of the most important pieces of info to keep in mind as you establish, navigate, and problem-solve a sleep routine is to remember how normal it is for these routines to “ebb and flow” as your child grows. Expect to adapt your child’s sleep routine as they grow and mature. Offering a visual, such as a picture chart (consisting of simple images that reflect each task of the sleep routine, such as a toothbrush for the task of brushing teeth), can be a good reminder and an easy way to modify the sequence of your routine as needed. Adding modifications to your child’s sleep environment can serve as good ‘signals’ to our brains that sleep is coming. These include white-noise machines, blackout curtains, and a screen-free bedroom. Most of all, though, investing your time and thoughtfulness into consistently offering your child a loving, nurturing, and regular sleep routine can support your child’s health and sleep skills for years to come.