Treatment Approaches

1
Treatment Approaches

• The Irritable Child

2
Techniques for the irritable child

• Rule out medical problems reflux, ear
  infections, allergies
• Address sensory hypersensitivities that
  contribute to irritability clothing, auditory
  and tactile overstimulation
• Avoid overstimulating child during attempts to
  console, through too many activities

3
Techniques for irritability

• Soothe both parent and child create breaks for
  both calming den for child
• Help child to learn how to self-calm on own, to
  recognize precursors of irritability
• Help child learn how to transition on own thru
  transitional objects, picture boards to predict
  sequences

4
Techniques for irritability

• Provide clear limits and boundaries when child
  acts out but redirect once calm to productive,
  organizing activity
• Help child become more self-reliant- to do things
  for self, play alone
• Develop tolerance for frustration and distress

5
Techniques for irritability

• Support parents in feelings of isolation and
  provide respite
• Address parents anxieties about why child
  behaves this way
• Help parent differentiate what crying or
  irritability means when it is distress,
  manipulative, etc. Learn to read cues.

6
Techniques for sleep and separation problems

• Develop appropriate sleep-wake schedule
• Address sensory problems associated with high
  arousal
• Evaluate if milk intolerance affects sleep
• Put child in bed awake rather than drowsy or
  asleep
• Use security object at bedtime

7
Techniques for sleep and separation problems

• Ferber method may work after child is 6-7 months
  go into bedroom after 5 minutes of crying,
  reassure and reorganize briefly but dont play,
  feed, or pick up child. Leave. Increments of
  waiting increase each night.
• Address parents fears of abandoning child at
  night, how to cope with crying, how to get sleep
  for self

8
Techniques for Sleep and Separation problems

• Discourage middle of night feeding or falling
  asleep with bottle
• If child vomits in bed (when not sick), throw
  towel over. Avoid lifting child out of crib but
  can sit in room to help child if extremely upset.
• Spray out monsters with water bottle.

9
Techniques for sleep and separation problems

• Assure bedroom environment supports sleep-
  oscillating fan, white noise, stuffed toy that
  smells of parent, lullabies, body pillows
• Water mattress, crib cradle may help for children
  who need movement or cant move easily in bed

10
Techniques for sleep and separation problems

• Address separation issues during daytime games
  like hide and seek peek-a-boo
• Watch parents face for signs of anxiety upon
  reunion
• Provide opportunities to play about sleep in CCA-
  nesting pillows or cubbies
• Encourage parents to get enough rest

11
Techniques for sleep and separation problems

• Keep sleep log noting activities done in daytime.
• High vestibular activities in afternoon often
  help child sleep at night
• Keep TV off before bed, do soothing routine
• Use sedatives like Benadryl, melatonin with
  physician guidance

12
Techniques for separation issues

• Play disappearing games with objects easier than
  favorite person leaving
• Practice hiding games self and objects
• Make good-bye book with pictures of mom, dad, and
  child leaving
• Formalize good-byes (dont slip out)
• Use transitional objects and rituals to help

13
Treatment of Feeding Disorders

• Address tactile hyper sensitivities in mouth
  electric toothbrush, terry clothe towel on checks
  and in mouth
• Begin with firm food textures expand food
  repertoire beginning with smooth, soft textures
  before uneven textures.
• Address motor needs in holding utensils

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Treatment of Feeding Disorders

• Drop cloth under high chair shirtless, dipping
  bowl for hand wipe issue, dab face rather than
  wipe
• Engage in ritual of hand wash, set table, candles
  on table for atmosphere, and clean-up afterwards
• Label hunger and fullness states

15
Treatment of Feeding Disorders

• Work with pediatrician around monitoring weight
  and dietary needs
• Rule out reflux with physician position to
  promote digestion
• Set up mealtime schedule with schedule snacks.
  Avoid middle of night bottles.
• Provide rationale for mealtimes (appetite drive)

16
Treatment of feeding disorders

• Establish food rules during mealtime (no throwing
  food, no standing in chair)
• Put on plate only what is reasonable to eat
• Practice oral-motor piece at other times
• Food should not be used as reward for other
  behaviors
• Provide opportunities for child to play about
  nurturing, feeding, control, etc.

17
Treatment of feeding disorders

• Support parents in feelings of rejection and
  depression in not being able to nurture and feed
  child. Nurture child in other ways.
• Explore meaning of food and eating for parents
  (past history of anorexia)
• Socialize mealtime experience (no TV on)

18
Treatment of feeding disorders

• Everyone should eat at mealtime to model eating
  (Parents need to be careful about dieting)
• Go to fun places like McDonalds where child can
  see others eating and having fun.
• Acknowledge and respect cultural issues related
  to feeding and mealtimes

19
Treatment of Attentional Problems

• Provide structure in environment by reducing
  number of toys and other distractors
• Introduce spatial barriers in environment,
  particularly small enclosed areas
• Inhibit hyperarousal through deep-pressure/proprio
  ceptive and high intensity vestibular activities

20
Treatment of attentional problems

• Provide structure in day with periods of novel
  activity coupled with periods of calm, quiet or
  routine activity
• Through CCA, focus on letting child self-initiate
  attentional cycle
• Allow child to leave and return to toys as
  attention span dictates, however, help parent to
  elaborate on what child is doing with toys

21
Treatment of attentional problems

• If child is finished playing before 15-20 minutes
  of CCA, help parent to stay with child and wait
  until child organizes something.
• Work on pace and timing of parents interactions
  with child, decreasing overstimulation and need
  to entertain or organize child.
• Discover childs processing time during play,
  learning style (visual/auditory) and provide
  timing and activities to foster.