Why don't you just belt up!

SIMPLY IMPOSSIBLE.  ( the complications of a seemingly simple task for those with dyspraxia/DCD)


In this blog I will unpick the seemingly 'simple' task of sitting in a car and doing up a seat belt.
For those of you who have been following this little series of blogs you will know the following but for those who haven't I need to point out that dyspraxia/DCD affects a great deal more than motor function. Motor difficulties along with a compromised perceptual profile can make the most simple of tasks very complicated indeed.


Motor skills are a function, which involve the precise movement of muscles with the intent to perform a specific act. Most purposeful movement requires the ability to "feel" or sense what one's muscles are doing as they perform the act.

Perception = the way you take in information through your five senses and make that information meaningful to you. Your Perceptual Style acts as a filter between sensation and understanding. It is at the core of who you are and it impacts greatly on how you function.

When we consider successfully doing up a seat belt we add a further skill into the mix and that is the ability to 'cross the midline'.

What is “crossing the midline”?

By the age of 3 or 4 years old, a child should be able to use both sides of the body together. This is the ability to move one hand, foot, or eye into the space of the other hand, foot or eye. We cross midline when we scratch an elbow, cross our ankles, and read left to right. Crossing the midline of your body helps build pathways in the brain and is an important prerequisite skill required for the appropriate development of various motor and cognitive skills. Children who have difficulty crossing the body’s midline often have trouble with skills such as reading, writing, completing self care skills and participating in sports & physical activities. These skills require a type of coordination that comes from experience with “cross-lateral motion,” which is movement involving the left arm and right leg, or the right arm and left leg at the same time. 

Children with dyspraxia/DCD are often(but not always) late to develop this skill Laterality may not be established until late in primary school. I once watched a child actually swap hands in the middle of a page , the left hand writing on the left side and the right hand the right.

The guardian.

They do not recognise that their bodies are made up of two different sides, they lack that awareness and neural pathways are late to establish.

Apply this knowledge to the task in hand and you begin to understand the difficulties.

To successfully do up a seat belt you need to :-

• Pull a taught strip of material across the midline of your body.
• Place a small fiddly rectangular metal object into a hole that it only just fits.
• Press down until you hear an audible click against tension pulling n the opposite directon.
• Manage all the above with very few  visual cues and so much of it is done by 'feel'.

Perceptual and fine motor skills of the highest order required. The very things that are often compromised.

I introduced the idea of backward chaining in my last blog (breaking down a task and working through it in reverse). It is useful in may scenarios. Here it is worth the child learning simply to click the seat belt into place whilst facing it just by sitting on the car seat and looking.

Practice the various components and then one by one bring them together and allow your child to be successful and therefore motivated to do more. If they get stuck go back a step .  It took my son two years to conquer this particular task.

The movement required to cross the midline can be practiced. Some examples of how to help can be found here https://www.growinghandsonkids.com/crossing-midline-exercises-for-kids.html

If you work with an Occupational therapist ask for their help.

By now you should be able to apply this to almost every new skill that a child is asked to learn.....

• Getting dressed
• Doing up shoe laces (and over rated skill in my opinion).
• Walking across a busy dinner hall with a plate of food.
• Putting coins into a slot machine.
• Learning to swim.
• Brushing teeth.
• Wiping one's bottom.
• The list is endless.

All of these things that are difficult can be improved so don't despair.

A great idea is to video your child attempting these new skills. It takes time and practice and patience and empathy for them to be successful. I used to video three tasks each year (getting dressed, using cutlery, riding a bike) and on those days when my boy and I felt that we were getting nowhere we would watch the video from the year before and celebrate how far we had come!!!!!

Please note that this blog focuses on children but bear in mind that dyspraxia/DCD is a life long condition and new tasks later in life can be difficult to master. Ask a young man with dyspraxia who is learning to shave!!!!!
When one begins to understand how extremely difficult these every day tasks are it is really easy to recognise how remarkable people with dyspraxia are. The tenacity and forgiveness they exhibit is often heroic. They get up and try again even in the knowledge that they may well not be successful. We must recognise the effort rather than the achievement, celebrate the improvements and one day look back and realise that he/she CAN do it!!!!! 

For further info and general advice re dyspraxia/DCD www.dyspraxiafoundation.org.uk

Put a sock in it.

SIMPLY IMPOSSIBLE.  ( the complications of a seemingly simple task for those with dyspraxia/DCD)

Following on from my blog re toilet troubles I thought I would look at the skills required to successfully put on a pair of socks. One of those 'simple' tasks that other children seem to simply just do. Initially I was going to write about getting dressed as a whole but on closer examination of the subject I realised that each item of clothing is testing and so I have chosen just one.

Socks come in sizes (as we know) so that they fit a foot snuggly and comfortably. For someone with compromised motor and perceptual skills that means that one needs to get a seemingly big item (a foot) into a rather small floppy one (a sock). Before the task is even begun the child with dyspraxia may visualise their failure at it.

The task requires good body awareness, an awareness of one's position in space, stability, flexibility, and very good fine motor control. All things that a person with dyspraxia has difficulty with.

Just to remind you:- 

Motor skills are a function, which involve the precise movement of muscles with the intent to perform a specific act. Most purposeful movement requires the ability to "feel" or sense what one's muscles are doing as they perform the act.

Perception = the way you take in information through your five senses and make that information meaningful to you. Your Perceptual Style acts as a filter between sensation and understanding. It is at the core of who you are and it impacts greatly on how you function.

If we simply leave the child to the task, the end result will at best probably be odd socks put on poorly with the heel uppermost and a huge number of creases which will cause sensory issues when the foot is put into a shoe.A worse the child will become so frustrated they may experience a 'melt down' and the whole family is left feeling wretched.

How we can help.

Buy socks that have a good visual reference. Coloured toes and heels for example.

Try and buy really stretchy socks with plenty of 'give'.

Factor in some extra time to allow your child reasonable opportunity for success. I you are in a rush put the socks on for the child if that saves tempers and frustrations (if you are going to have to 'give in' eventually then give in  quickly)..

Backward chain the activity. SO......

Consider the process in its entirety and break it down thus...

• Place the sock on the foot and over the heel initially and ask the child to pull it up the leg. Allow them to be successful at this several times.

• Place the sock over the foot and stop before the heel. Allow the child to pull it over the heel and up the leg. Again opportunity for  practice makes perfect.

• Place the sock over the toes and ask the child to complete the task. Lots of repetition of this stage will increase confidence and foster a 'can do' attitude.

• Let the child have a go at the whole process.

JOB DONE!!!

Chaining is a technique used in to teach individuals with developmental disabilities complex tasks by breaking them down into discrete responses or individual behaviors. With a backward chaining procedure, all of the behaviors in a single task are completed by the trainer except the last step.

I appreciate that by doing this for every task the parent/supporter may get exasperated and/or exhausted but by breaking down tasks into manageable steps we enable the child to succeed and in doing so they will approach the next task with greater motivation. 

This works well for adults too who may experience a sense of panic when facing a new task socially or at work. A reasonable adjustment would be for someone to break down the tasks expected of them and allow the individual to practice them in a non threatening and relaxed situation until they has been mastered. A little time and patience to start with will pay dividends.

Toilet Troubles. Dyspraxia/DCD.

SIMPLY IMPOSSIBLE.  ( the complications of a seemingly simple task for those with dyspraxia/DCD)

Task 1. Toilet troubles.

Dyspraxia/DCD is a common, lifelong condition which affects some  6% of the population to a significant degree. It affects, fine and gross motor coordination, organisation, perception and thought and sometimes speech and language.

Having lived with a son with a severe degree of the condition for the last 30 years it is fair to say that I have watched him really struggle to manage the most simple of tasks. I have often absolutely ached to do something for him as I observe him desperately trying  to plan and organise himself to make a meaningful movement towards an end goal.  All the things that other people just 'do' have taken a painstaking amount of preparation, execution and practice until the task is mastered. Even then it is extremely difficult for him to transfer that learning into a new set of circumstances and/or environment. When faced with something new, the panic shows, even now. Exhausting for him and exasperating for those offering support. 
I thought I might write a few blogs which explore these seemingly simple tasks so that those supporting/affecting the child can be mindful of the difficulties that dyspraxia imposes upon them.

One of those seemingly simple task is using a toilet successfully. This requires excellent motor and perceptual skills. 

Motor skills are a function, which involve the precise movement of muscles with the intent to perform a specific act. Most purposeful movement requires the ability to "feel" or sense what one's muscles are doing as they perform the act.

Children with dyspraxia often have a compromised perceptual profile.

Perception = the way you take in information through your five senses and make that information meaningful to you. Your Perceptual Style acts as a filter between sensation and understanding. It is at the core of who you are and it impacts greatly on how you function.

Children with dyspraxia require a broad base for balance and so this may require the removal of all the lower clothing in order to sit on a toilet with legs wide apart (remembering that putting those clothes back on is another very difficult process). The child is asked to sit on a large gaping hole (most of us do not have the privilege of a child size toilet) and this can result in an unstable child teetering over that very a large hole, feet swinging in the air and clinging onto the sides of the bowl for dear life.

Motor and perceptual differences  have far reaching repercussions. Poor depth perception for example means that the child has no idea how the deep the hole is that he/she is balancing above (how would you like to wee over a well????!!!) .

We now have a child sitting on something that may be like a bottomless pit, legs dangling affording no base for balance or proprioceptive feedback, and we ask them to 'just quickly use the toilet'.  If they manage that, we then ask them to wipe an area that they are unable to see, meaning they have to let go of the thing they are hanging onto for security,  because of their  co ordination and balance difficulties. We are almost asking for the impossible. No amount of promises, star charts, bribes or encouragement will help. The child does not have the skills in place to conquer the task in hand.

Such a 'simple' every day task becomes a daily trauma, and can lead to children refusing to go to the toilet (chronic constipation) and/or developing real phobias around defecation. 

We MUST be mindful of what we are asking and break the task down in our heads into it's component parts and try to visualise the task through the eyes of the child who views the world differently and live in an unstable and unpredictable environment.

What might we do to help?

Try some bottom wiping movements. For us it was passing things to each other through our legs, replicating the wiping motions of a hand . Goodness knows what an observant window cleaner would have thought as I passed tins of beans from cupboards to children between my legs!

Choose clothes that are easy to remove, like jogging bottoms and something with a logo on the front to make dressing easier. School trousers might have flies replaced with a velcro strip or a strip down one side seam for ease of removal. Choose velcro or slip on shoes and socks with coloured toes and heels for good visual reference.

 

Adapt the toilet to give the child somewhere to plant their feet (flat) and has handles to hold for support and security . If your child is lucky enough to work with an occupational therapist ask his or her advice. 

Use some moist toilet tissue for cleansing and let the child master one thing at a time.  Removing clothes quickly and easily could be a good first step and then perhaps sitting still and securely could be  the next.........until the whole process is mastered. This will take time and patience and positive reinforcement.

Have a good routine, perhaps 'train' a bowel action in the evening at home with a good high fibre tea, and then the child can go straight into the shower afterwards. This also saves the problems faced with using an often busy (and stressful) toilet block at school. 

Don't force the issue. Because others say it is time that your child should be doing something doesn't make them right. Remember your child is an expert and being him/her and children with dyspraxia tend to take longer to master things and may be older than their peers when they do so. That is just fine. Life is not a race. 

Info re bowel training https://www.aboutconstipation.org/bowel-retraining.html

Proprioception = Proprioception (or kinesthesia) is the sense though which we perceive the position and movement of our body, including our sense of equilibrium and balance