Thursday, September 29, 2016

Challenging Behaviors Tool Kit

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Sometimes the difficulties of autism can lead to behaviors that are quite challenging for us to understand and address. Most individuals with autism will display challenging behaviors of some sort at some point in their lives. Autism Speaks has created this Challenging Behaviors Tool Kit to provide you with strategies and resources to address these behaviors, and to help support you and your loved one with autism during these difficult situations.
The guiding principle used in developing this kit is that each individual with autism and his family should feel safe and supported, and live a healthy life filled with purpose, dignity, choices, and happiness. With this in mind, positive approaches and suggestions are highlighted throughout the kit. The general framework and intervention principles included are relevant at any stage of life, and we have included basic background information, with links to further information and resources on a variety of topics. 

Click here to download the Challenging Behaviors Tool Kit.

The kit is broken into different sections. You may want to read the kit in its entirety or work through a section at a time:
We sat down with 2 experts to help answer your frequently asked questions: Gary S. Mayerson, Founding Attorney at Mayerson and Associates, and Nicole Weidenbaum, Executive Director of Nassau Suffolk Services for Autism. Check out the videos below to hear what they had to say!

Frequently Asked Questions

In the video below, Gary Mayerson provides information about crisis situations.
Gary also covered the following topics during our Q&;A session with him:
In the video below, Nicole Weidenbaum provides background information about challenging behaviors.
Nicole also covered the following topics during our Q&A session with her:
Do you have any questions or are you looking for resources to help your loved one with challenging behaviors? Call our Autism Response Team at 888-288-4762 or email us at familyservices@autismspeaks.org. We are always happy to help!

Wednesday, September 28, 2016

Safety for Your Child

Did you know that injuries are the greatest threat to the life and health of your child? Injuries are the leading cause of death of school-age children. Yet you can prevent most major injuries!
At age 5, your child is learning to do many things that can cause serious injury, such as riding a bicycle or crossing a street. Although children learn fast, they still cannot judge what is safe. You must protect your child. You can prevent common major injuries by taking a few simple steps.

Bike Safety

Your child should always wear a helmet when riding a bike. Buy the helmet when you buy the bike! Make sure your child wears a helmet every time he or she rides. A helmet helps prevent head injuries and can save your child's life.
Never let your child ride a bike in the street. Your child is too young to ride in the street safely.
Be sure that the bike your child rides is the right size. Your child must be able to place the balls of both feet on the ground when sitting on the seat with hands on the handlebars. Your child's first bicycle should have coaster brakes. Five-year-olds are often unable to use hand brakes correctly.

Street Safety

Your child is in danger of being hit by a car if he or she darts out into the street while playing. Take your child to the playground or park to play. Show your child the curb and teach him or her to always stop at the curb and never cross the street without a grown-up.

Water Safety

Now is the time to teach your child to swim. Even if your child knows how to swim, never let him or her swim alone.
Do not let your child play around any water (lake, stream, pool, or ocean) unless an adult is watching. NEVER let your child swim in canals or any fast-moving water.
Teach your child to never dive into water unless an adult has checked the depth of the water. And when on any boat, be sure your child is wearing a life jacket.

Fire Safety

Household fires are a threat to your child's life, as well as your own. Install smoke alarms in your house, and test the batteries every month to make sure they work. Change the batteries once a year.
Teach your child not to play with matches or lighters, and keep matches and lighters out of your child's reach. Also, do not smoke in your home. Most fires are caused by a lit cigarette that has not been put out completely.

Car Safety

Car crashes are the greatest danger to your child's life and health. The crushing forces to your child's brain and body in a collision or sudden stop, even at low speeds, can cause injuries or death. To prevent these injuries, correctly USE a car safety seat or booster seat and seat belt EVERY TIME your child is in the car. Your child should use a car safety seat or a booster seat until the lap belt can be worn low and flat on the hips and the shoulder belt can be worn across the shoulder rather than the face or neck (usually at about 80 pounds and 4 feet 9 inches tall). The safest place for all children to ride is the back seat. Set a good example. Make sure you and other adults buckle up, too!

Firearm Hazards

Children in homes where guns are present are in more danger of being shot by themselves, their friends, or family members than of being injured by an intruder. Handguns are especially dangerous. It is best to keep all guns out of the home. If you choose to keep a gun, it should be kept unloaded and in a locked place separate from the ammunition. Ask if the homes where your child visits or is cared for have guns and how they are stored.
Would you be able to help your child in case of an injury? Put emergency numbers by or on your phone today. Learn first aid and CPR. Be prepared...for your child's sake!
Last Updated
 
11/21/2015
Source
 
TIPP: The Injury Prevention Program (Copyright © 1994 American Academy of Pediatrics, Updated 9/2005)

Tuesday, September 27, 2016

Emotional Development in Preschoolers

Your three-year-old’s vivid fantasy life will help her explore and come to terms with a wide range of emotions, from love and dependency to anger, protest, and fear. She’ll not only take on various identities herself, but also she’ll often assign living qualities and emotions to inanimate objects, such as a tree, a clock, a truck, or the moon. Ask her why the moon comes out at night, for example, and she might reply, “To say hello to me.”
From time to time, expect your preschooler to introduce you to one of her imaginary friends. Some children have a single make-believe companion for as long as six months; some change pretend playmates every day, while still others never have one at all or prefer imaginary animals instead. Don’t be concerned that these phantom friends may signal loneliness or emotional upset; they’re actually a very creative way for your child to sample different activities, lines of conversation, behavior, and emotions.
You’ll also notice that, throughout the day, your preschooler will move back and forth freely between fantasy and reality. At times she may become so involved in her make-believe world that she can’t tell where it ends and reality begins. Her play experience may even spill over into real life. One night she’ll come to the dinner table convinced she’s Cinderella; another day she may come to you sobbing after hearing a ghost story that she believes is true.
While it’s important to reassure your child when she’s frightened or upset by an imaginary incident, be careful not to belittle or make fun of her. This stage in emotional development is normal and necessary and should not be discouraged. Above all, never joke with her about “locking her up if she doesn’t eat her dinner” or “leaving her behind if she doesn’t hurry up.” She’s liable to believe you and feel terrified the rest of the day—or longer.
From time to time, try to join your child in her fantasy play. By doing so, you can help her find new ways to express her emotions and even work through some problems. For example, you might suggest “sending her doll to school” to see how she feels about going to preschool. Don’t insist on participating in these fantasies, however. Part of the joy of fantasy for her is being able to control these imaginary dramas, so if you plant an idea for make- believe, stand back and let her make of it what she will. If she then asks you to play a part, keep your performance low- key. Let the world of pretend be the one place where she runs the show.
Back in real life; let your preschooler know that you’re proud of her new independence and creativity. Talk with her, listen to what she says, and show her that her opinions matter. Give her choices whenever possible—in the foods she eats, the clothes she wears, and the games you play together. Doing this will give her a sense of importance and help her learn to make decisions. Keep her options simple, however. When you go to a restaurant, for example, narrow her choices down to two or three items. Otherwise she may be overwhelmed and unable to decide. (A trip to an ice- cream store or frozen yogurt shop that sells several flavors can be agonizing if you don’t limit her choices.)
What’s the best approach? Despite what we’ve already said, one of the best ways to nurture her independence is to maintain fairly firm control over all parts of her life, while at the same time giving her some freedom. Let her know that you’re still in charge and that you don’t expect her to make the big decisions. When her friend is daring her to climb a tree, and she’s afraid, it will be comforting to have you say no, so that she doesn’t have to admit her fears. As she conquers many of her early anxieties and becomes more responsible in making her own decisions, you’ll naturally give her more control. In the meantime, it’s important that she feels safe and secure.
Just as it was when he was three, your four-year-old’s fantasy life will remain very active. However, he’s now learning to distinguish between reality and make-believe, and he’ll be able to move back and forth between the two without confusing them as much.
As games of pretend become more advanced, don’t be surprised if children experiment with make-believe games involving some form of violence. War games, dragon-slaying, and even games like tag all fall into this category. Some parents forbid their children to play with store-bought toy guns, only to find them cutting, pasting, and creating cardboard guns or simply pointing a finger and shouting “bang, bang.” Parents shouldn’t panic over these activities. This is no evidence that these children are “violent.” A child has no idea what it is to kill or die. For him, toy guns are an innocent and entertaining way to be competitive and boost his self-esteem.
If you want a gauge of your child’s developing self-confidence, listen to the way he talks to adults. Instead of hanging back, as he may have done at two or three, he now probably is friendly, talkative, and curious. He also is likely to be especially sensitive to the feelings of others—adults and children alike—and to enjoy making people happy. When he sees they’re hurt or sad, he’ll show sympathy and concern. This probably will come out as a desire to hug or “kiss the hurt,” because this is what he most wants when he’s in pain or unhappy.
At about the age of four and five, your preschooler also may begin to show an avid interest in basic sexuality, both his own and that of the opposite sex. He may ask where babies come from and about the organs involved in reproduction and elimination. He may want to know how boys’ and girls’ bodies are different. When confronted with these kinds of questions, answer in simple but correct terminology. A four-year-old, for example, doesn’t need to know the details about intercourse, but he should feel free to ask questions, knowing he’ll receive direct and accurate answers.
Along with this increased interest in sexuality, he’ll probably also play with his own genitals and may even demonstrate an interest in the genitals of other children. These are not adult sexual activities but signs of normal curiosity and don’t warrant scolding or punishment.
At what point should parents set limits on such exploration? This really is a family matter. It’s probably best not to overreact to it at this age, since its normal if done in moderation. However, children need to learn what’s socially appropriate and what’s not. So, for example, you may decide to tell your child:
  • Interest in genital organs is healthy and natural.
  • Nudity and sexual play in public are not acceptable.
  • No other person, including even close friends and relatives, may touch his “private parts.” The exceptions to this rule are doctors and nurses during physical examinations and his own parents when they are trying to find the cause of any pain or discomfort he’s feeling in the genital area.
At about this same time, your child also may become fascinated with the parent of the opposite sex. A four-year-old girl can be expected to compete with her mother for her father’s attention, just as a boy may be vying for his mother’s attention. This so-called oedipal behavior is a normal part of personality development at this age and will disappear in time by itself if the parents take it in stride. There’s no need to feel either threatened or jealous because of it.
Last Updated
 
11/21/2015
Source
 
Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

How The ACA is Helping Children with Special Needs and Their Families

The Affordable Care Act (ACA) has helped both children with disabilities and their parents.  Two reports from the Urban Institute (see Resources) highlight how two generations are benefiting from healthcare coverage under the ACA.


How Health Care Coverage is Maximized

The Urban Institute report cited a number of problems faced by families without insurance. “For instance, in September 2015 nearly 6 in 10 uninsured parents …reported that their family often or sometimes ran out of food in the previous 12 months… In addition, 45.0 percent of uninsured parents reported that they often or sometimes were unable to pay the rent, mortgage, or other housing costs; 69.3 percent had problems with unexpected bills, such as car repairs or home repairs; and 44.7 percent were unable to make the minimum payment on a credit card bill or loan.
Research shows that when parents have coverage, their children will too.*  One of the Urban Institute reports stated that “… just 1.7 percent of insured parents reported that their child is uninsured… In contrast, 25.2 percent of uninsured parents reported that their child is uninsured.”  Medicaid expansion data showed that uninsured parents were three times as likely as insured parents to have children who were eligible for Medicaid yet were uninsured.  Making sure parents have health insurance also helps retention for children’s coverage, resulting in continuity of care. 
Data presented at the NJ Hospital Association showed that uninsured children and adults were diagnosed on average two to four years after their peers who had insurance coverage.  This results in increased morbidity and mortality, since conditions are more severe and costly when there is a delay in diagnosis.  Uninsured children and adults are less likely to access preventive services as well, which are now provided at no cost for families under the ACA.  These services include but are not limited to:
  • developmental screening
  • depression screening
  • newborn hearing screening
  • vision screening
  • immunizations
  • lead screening for at risk children
  • obesity screening
  • special services for women regarding pregnancy, mammograms, cancer screenings, etc.


What Gains Have Been Made under The ACA for Families?

The Urban Institute reports indicate that there has been a decrease of 36% in uninsured parents since enactment of the ACA, and noted that “the share of parents with health insurance increased 6.4 percentage points and the share of children with coverage increased 1.7 percentage points – a historic high for families.” Notably there were “large declines [in uninsurance rates] among low-income and Hispanic parents and a narrowing of the difference in uninsurance rates between parents and children through early 2015.” 
Families with insurance reported better access to care than those without insurance, which means families didn’t go without care or struggle as much with medical expenses.  Parents were more satisfied with the newer health plans and thought they could get care when their child needed it, which is especially important for children with special health care needs.  One of the Urban Institute reports noted that these gains have been made even though “Children were not the primary target of the ACA’s coverage provisions given that they have had substantially lower uninsurance rates than parents and other adults.”


Remaining Barriers

Although there have been improvements in coverage for both children and their parents -- 96.4% of children and 89.6% of parents have health insurance – there are still many children and families who are eligible for health care coverage but remain uninsured.  The Urban Institute found that most common reason for this is concern about affordability.  Some families may not be aware of the subsidies available to help pay premiums.  Others have incomes too high for Medicaid but not high enough (100 percent of the federal poverty level) to get those subsidies (known as the “assistance gap”).  Other individuals are ineligible for premium subsidies or Medicaid due to immigration status.  And parents who are ineligible due to immigration status may not realize that their children may be eligible for Medicaid or premium subsidies.  Lastly, one third of uninsured families are in states that chose not to expand Medicaid.  Affordability could be addressed either by Medicaid expansion and/or increased financial assistance in the Marketplace.
In sum, there have been improvements in coverage for both children with special needs and their parents.  However, there are still obstacles to coverage for some families, such as affordability, ineligibility due to immigration status, and failure of states to expand Medicaid.  Additionally, there are some children and families that may not be aware that they are eligible so remain unenrolled.  Overall however, the latest data indicates that there has been increased enrollment and access to care including preventive care, which will most importantly result in better health outcomes for children with disabilities and their families.
Resources:
Urban Institute:
Georgetown University Health Policy Institute
HealthCare.gov

by Lauren Agoratus

Monday, September 26, 2016

15 Tips to Survive the Terrible 3’s


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By: Kathleen Berchelmann, M.D., FAAP
They call them the "terrible 2's," "trusting 3's" and "pleasing 4's," but in reality having a 3-year-old can be harder than the 2's.

Here are 15 tips to help you learn to love parenthood again (or at least make it through the day):

  • Yell less, love more: Yelling is a late defense mechanism, a technique we use when everything else fails. But yelling can hurt kids more than we realize– it might cause an immediate behavior change, but in the long run can cause real psychological harm. Rather than yelling and harsh punishment, children need positive parenting for healthy brain development. Dr. Joan Luby is a professor of child psychiatry and director of the Early Emotional Development Program at Washington University School of Medicine in St. Louis. Her research shows that positive parenting of toddlers in stressful situations, rather than scolding or corporal punishment, is actually associated with an increase in the size of certain areas of the brain. If you find yourself yelling at your kids too much, you need other options for discipline. Keep reading.
  • Label behavior: Instead of getting angry, label behavior. I got this from Sesame Street—there's one scene where Cookie Monster is accused of lying about stealing cookies. Frustrated and upset, Cookie Monster says, "Me glutton, not liar." If Sesame Street can use words like "gluttony" to label behavior, so can I. So now we use words like "gluttony," "patience," "kindness," and "diligence." It sounded weird at first, but now I love it when my 6-year-old tells her teasing brother, "That's not kindness!"
  • Be attuned to your children: The key to raising emotionally healthy children is attunement, or how well you recognize your child's needs at any given moment. Attunement, in short, is putting yourself in your child's shoes and then meeting their needs with the wisdom of a parent. Try to identify the root of your child'smisbehavior– why she won't put her shoes on or why she's throwing a tantrum– then tailor your consequence appropriately. In attunement parenting, we don't just give time-out as a rote response to misbehavior. Instead, attuned parents ask "why" a child is misbehaving. When we understand the root of a child's misbehavior, we can better meet their needs, love them, and get long-term healthy behaviors.
  • Give your child your full attention in frequent, small doses: If your 3-year-old is pulling your cell phone out of your hands, banging on your keyboard while you type, or knocking over all your piles of laundry, this one is for you. I know your 3-year-old wants your full attention all the time, but it's just not possible if you're trying do laundry, run errands, read your email, or otherwise have a life. So as soon as you realize your sweet thing is trying to get your attention, give her a few seconds of full attention. L ook her right in the eyes, ask her some questions, and listen to the answer. Use body language that shows attention, like putting your phone down. While you listen to her answers, think of how you are going to redirect her.
  • Redirect with creativity: Try to redirect early, and with a loving voice. Ask yourself, "Why is my child misbehaving? What do they really need?" Aggressive behaviors usually require physical redirection. For example, if a child is snatching toys or yelling, they might need to ride a bike outside for a while. If a child is lying on the floor and whining, they may need a little attention and some quiet activity– try reading them a book.
  • Touch your 3-year-old, many times per day: Most 3-year-olds need lots of hugs and snuggles, even when you're not ready. Be ready to put your work down and hug your child, multiple times per day. Don't forget to actually say, "I love you," especially when your 3-year-old is misbehaving.
  • Anticipate repeat offenders: Children, like adults, have patterns of misbehavior. They do the same wrong things again and again. Do you fight about clothes every morning, or struggle to get your 3-year-old strapped into her car seat? Know your repeat offenses, intervene early, and encourage your child to make good choices. I had a 3-year-old that liked to refuse to get strapped into her car seat, because she knew she could control the whole family– the car wouldn't move until she was strapped in. The more she refused, the angrier our other children became, and she felt powerful. So one day, on the way to the car, I said, "If everyone says, 'We love you!' three times, can I strap you into your car seat?" She said, "Ok, but you have to say it five times." We did and everyone was laughing. By giving her control of a little issue, I gained control of the whole situation.
  • Set clear expectations: Write a list of family rules. For 3-year-olds, make the list short and simple. For example, 1) Use loving voices, 2) Obey Mommy and Daddy, and 3) Don't hurt other people. Discuss the rules daily, and praise successes at dinner or bedtime.
  • Teach obedience: Kids aren't born obedient. We have to teach it. 3-year-olds are naturally seeking autonomy and will fight obedience. The trick is to teach kids that they want to be obedient, that they get lots of praise and positive reinforcement when they do what you say. To practice obedience, play "Simon Says," except change it to "Mommy Says," or "Daddy Says." Start with typical stuff like patting your head and clapping your hands, then transition to putting toys away.
  • Praise effort, not outcome: Try to give praise ten times as often as you correct, but praise in the right way. Praise effort, not outcome.  Too much praise can actually have an inverse effect on children's achievement—it can set the bar too high and lead them to fear failure. The New York Times magazine has an excellent summary of the powerful research behind this paradoxical effect.
  • Get a behavior sticker chart: Stickers will never again be as powerful than when your child is 3. Enjoy it. Get a sticker chart and start keeping track of days your 3-year-old stayed in bed, kept dry underwear on all day, etc.
  • Be consistent: Consistency does not mean harsh punishments or yelling, it means consistently addressing the same problem behaviors. If leaving your shoes on the floor is not OK on Monday, you can't pick them up for your child on Tuesday. That doesn't mean your 3-year-old needs a verbal lashing.
  • Get on the same page with other child care providers: What positive reward systems are in place in your child's preschool classroom? What about grandma's house?  If they are working outside home, try them at home, too. Rules at school and home need to be as similar as possible.
  • When all else fails, resort to time-out: Don't be angry, just ask your little defiant one to go to time-out, and pick him up if he doesn't go. Make sure you identify your time-out location beforehand and try to be consistent about this location. Give one minute time out for each year of life, or tell him he's staying in until he can stop crying and be sweet. As your child kicks and screams while you carry him to time-out, just gently tell him you love him. Resist the urge to debate to speak reason. He's 3. He won't be reasonable.
  • Take care of yourself: Ask for help. Talk through specific situations. Take a break. Remember that 4 is coming soon– let's hope you get a "trusting 4."

Additional Information on HealthyChildren.org:

Friday, September 23, 2016

Language Delays in Toddlers: Information for Parents

Your baby is able to communicate with you long before he or she speaks a single word! A baby's cry, smile, and responses to you help you to understand his or her needs. Learn how children communicate and what to do when there are concerns about delays in development.

Milestones during the first 2 years

Children develop at different rates, but they usually are able to do certain things at certain ages. Following are general developmental milestones. Keep in mind that they are only guidelines. If you have any questions about your baby's development, ask your child's doctor—the sooner the better. Even when there are delays, early intervention can make a significant difference.

By 1 year most babies will

  • Look for and be able to find where a sound is coming from.
  • Respond to their name most of the time when you call it.
  • Wave goodbye.
  • Look where you point when you say, "Look at the _________."
  • Babble with intonation (voice rises and falls as if they are speaking in sentences).
  • Take turns "talking" with you—listen and pay attention to you when you speak and then resume babbling when you stop.
  • Say "da-da" to dad and "ma-ma" to mom.
  • Say at least 1 word.
  • Point to items they want that are out of reach or make sounds while pointing.

Between 1 and 2 years most toddlers will

  • Follow simple commands, first when the adult speaks and gestures, and then later with words alone.
  • Get objects from another room when asked.
  • Point to a few body parts when asked.
  • Point to interesting objects or events to get you to look at them too.
  • Bring things to you to show you.
  • Point to objects so you will name them.
  • Name a few common objects and pictures when asked.
  • Enjoy pretending (for example, pretend cooking). They will use gestures and words with you or with a favorite stuffed animal or doll.
  • Learn about 1 new word per week between 11/2 and 2 years.

By 2 years of age most toddlers will

  • Point to many body parts and common objects.
  • Point to some pictures in books.
  • Follow 1-step commands without a gesture like "Put your cup on the table."
  • Be able to say about 50 to 100 words.
  • Say several 2-word phrases like "Daddy go," "Doll mine," and "All gone."
  • Perhaps say a few 3-word sentences like "I want juice" or "You go bye-bye."
  • Be understood by others (or by adults) about half of the time.

When milestones are delayed

If your child's development seems delayed or shows any of the behaviors in the following list, tell your child's doctor. Sometimes language delays occur along with these behaviors. Also, tell your child's doctor if your baby stops talking or doing things that he or she used to do.
  • Doesn't cuddle like other babies
  • Doesn't return a happy smile back to you
  • Doesn't seem to notice if you are in the room
  • Doesn't seem to notice certain noises (for example, seems to hear a car horn or a cat's meow but not when you call his or her name)
  • Acts as if he or she is in his or her own world
  • Prefers to play alone; seems to "tune others out"
  • Doesn't seem interested in or play with toys but likes to play with objects in the house
  • Has intense interest in objects young children are not usually interested in (for example, would rather carry around a flashlight or ballpoint pen than a stuffed animal or favorite blanket)
  • Can say the ABCs, numbers, or words to TV jingles but can't use words to ask for things he or she wants
  • Doesn't seem to be afraid of anything
  • Doesn't seem to feel pain in a typical fashion
  • Uses words or phrases that are unusual for the situation or repeats scripts from TV

Delays in language

Delays in language are the most common types of developmental delay. One out of 5 children will learn to talk or use words later than other children their age. Some children will also show behavioral problems because they are frustrated when they can't express what they need or want.
Simple speech delays are sometimes temporary. They may resolve on their own or with a little extra help from family. It's important to encourage your child to "talk" to you with gestures or sounds and for you to spend lots of time playing with, reading to, and talking with your infant or toddler. In some cases, your child will need more help from a trained professional, a speech and language therapist, to learn to communicate.
Sometimes delays may be a warning sign of a more serious problem that could includehearing loss, developmental delay in other areas, or even an autism spectrum disorder (ASD). Language delays in early childhood also could be a sign of a learning problem that may not be diagnosed until the school years. It's important to have your child evaluated if you are concerned about your child's language development.

What your child's doctor might do

Sometimes more information is needed about your child before your child's doctor can address your concerns. The doctor may
  • Ask you some questions or ask you to fill out a questionnaire.
  • Interact with your child in various ways to learn more about his or her development.
  • Order a hearing test and refer you to a speech and language therapist for testing. The therapist will evaluate your child's speech (expressive language) and ability to understand speech and gestures (receptive language).
  • Refer your child for evaluation through an early intervention program.

What to expect after the doctor's visit

  • If your child's doctor tells you not to worry (that your child will "catch up in time") but you are still concerned, it's OK to get a second opinion. You can ask your child's doctor for a referral to a developmental specialist or a speech and language therapist. You may also contact an early intervention program for an evaluation if your child is younger than 3 years, or your local school district if he or she is 3 or older.
  • If what your child says (expressive language) is the only delay, you may be given suggestions to help your child at home. Formal speech therapy may also be recommended.
  • If both what your child understands (receptive language) and what he or she says are delayed and a hearing test is normal, your child will need further evaluation. This will determine whether the delays are caused by a true communication disorder, generalized developmental delays, an ASD, or another developmental problem.
When an ASD is the reason for language delays, your child will also have difficulty interacting with other people and may show some or all of the concerning behaviors listed previously. If there is concern your child might have an ASD, your child will usually be referred to a specialist or a team of specialists for evaluation and treatment of an ASD or a related disorder. The specialist(s) may then recommend speech therapy and may suggest other ways to improve social skills, behavior, and the desire to communicate.

Programs that help children and families

If your child has delays or suspected delays, your child's doctor will probably refer you to an early intervention program in your area. The staff there might do additional evaluations and reassure you that your child's development is normal or tell you that your child would benefit from some type of intervention. Your child does not need to have a diagnosis of a developmental problem to receive services through this program.
If your child is younger than 3 years, the referral may be to an early intervention program in your area. Early intervention programs are sometimes called "Part C" or "Birth to Three" programs. Early intervention is a federal- and state-funded program that helps children and their families. You may also contact the early intervention program yourself (see Resources to find a contact in your state).
If your child qualifies for services, a team of specialists will work with you to develop an Individual Family Service Plan (IFSP). This plan becomes a guide for the services your child will receive until 3 years of age. It may include parent training and support, direct therapy, and special equipment. Other services may be offered if they benefit your child and family. If your child needs help after 3 years of age, the early intervention staff will transition your child to services through your local school district.
If your child is 3 years or older, the referral may be to your local public school. You may also contact the local public school directly. If your child is eligible, the school district staff will, with your input, develop an Individual Education Plan (IEP). This plan may provide some of the same services as the early intervention program but focus on school services for your child. The level of services also may be different. If your child continues to need special education and services, the IEP will be reviewed and revised from time to time.

Resources

Family Voiceswww.familyvoices.org
Learn the Signs. Act Early.www.cdc.gov/actearly
National Center for Medical Home Implementationwww.medicalhomeinfo.org/how/clinical_care/developmental_screening
National Early Childhood Technical Assistance Center (NECTAC)www.nectac.org (to find an early intervention program in your state)

Remember

As a parent, follow your instincts. If you continue to have concerns about your child's development, ask for a reevaluation or referral for additional formal testing.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned on this page. Web site addresses are as current as possible, but may change at any time.
Last Updated
 
11/21/2015
Source
 
Is Your Toddler Communicating With You? (Copyright © 2011 American Academy of Pediatrics)

Thursday, September 22, 2016

My child is sometimes very aggressive. What is the best way to prevent this type of behavior?

The best way to prevent aggressive behavior is to give your child a stable, secure home life with firm, loving discipline and full-time supervision during the toddler and preschool years. Everyone who cares for your child should be a good role model and agree on the rules he’s expected to observe as well as the response to use if he disobeys. Whenever he breaks an important rule, he should be reprimanded immediately so that he understands exactly what he’s done wrong.
Children don’t know the rules of the house until they’re taught them, so that is one of your important parenting responsibilities. Toddlers are normally interested in touching and exploring, so if there are valuables you don’t want them to handle, hide or remove them. Consider setting up a separate portion of your home where he can play with books and toys.
For discipline to be most effective, it should take place on an ongoing basis, not just when your child misbehaves. In fact, it begins with parents smiling at their smiling baby, and it continues with praise and genuine affection for all positive and appropriate behaviors. Over time, if your child feels encouraged and respected, rather than demeaned and embarrassed, he is more likely to listen, learn, and change when necessary. It is always more effective to positively reinforce desired behaviors and to teach children alternative behaviors rather than just say, “Stop it or else.”
While teaching him other ways to respond, there’s also nothing wrong with distracting him at times, or trying another approach. As long as you’re not “bribing” him to behave differently by offering him sweet snacks, for example, there’s nothing wrong with intentionally changing his focus.
Remember, your child has little natural self-control. He needs you to teach him not to kick, hit, or bite when he is angry, but instead to express his feelings through words. It’s important for him to learn the difference between real and imagined insults and between appropriately standing up for his rights and attacking out of anger. The best way to teach these lessons is to supervise your child carefully when he’s involved in disputes with his playmates. As long as a disagreement is minor, you can keep your distance and let the children solve it on their own. However, you must intervene when children get into a physical fight that continues even after they’re told to stop, or when one child seems to be in an uncontrollable rage and is assaulting or biting the other. Pull the children apart and keep them separate until they have calmed down. If the fight is extremely violent, you may have to end the play session. Make it clear that it doesn’t matter who “started it.” There is no excuse for trying to hurt each other.
To avoid or minimize “high-risk” situations, teach your child ways to deal with his anger without resorting to aggressive behavior. Teach him to say “no” in a firm tone of voice, to turn his back, or to find compromises instead of fighting with his body. Through example, teach him that settling differences with words is more effective—and more civilized—than with physical violence. Praise him on his appropriate behavior and help explain to him how “grown-up” he is acting whenever he uses these tactics instead of hitting, kicking, or biting. And always reinforce and praise his behavior when he is demonstrating kindness and gentleness.
There’s also nothing wrong with using a time-out when his behavior is inappropriate, and it can be used in children as young as one year old. These time-outs should be a last resort, however. Have him sit in a chair or go to a “boring” place where there are no distractions; in essence, you’re separating him from his misbehavior, and giving him time to cool off. Briefly explain to your child what you’re doing and why—but no long lectures. Initially, when children are young, time-out is over as soon as they have calmed down and are “quiet and still.” Ending time-out once they are quiet and still reinforces this behavior, so your child learns that time out means “quiet and still.” Once they have learned to calm themselves (to be quiet and still), a good rule of thumb is one minute of a timeout for each year in your child’s age—thus, a three-year-old should have a three-minute time-out. When the time-out is over, there needs to be a time-in, while giving him plenty of positive attention when doing the right thing.
Always watch your own behavior around your child. One of the best ways to teach him appropriate behavior is to control your own temper. If you express your anger in quiet, peaceful ways, he probably will follow your example. If you must discipline him, do not feel guilty about it and certainly don’t apologize. If he senses your mixed feelings, he may convince himself that he was in the right all along and you are the “bad” one. Although disciplining your child is never pleasant, it is a necessary part of parenthood, and there is no reason to feel guilty about it. Your child needs to understand when he is in the wrong so that he will take responsibility for his actions and be willing to accept the consequences.

When to Call the Pediatrician

If your child seems to be unusually aggressive for longer than a few weeks, and you cannot cope with his behavior on your own, consult your pediatrician. Other warning signs include:
  • Physical injury to himself or others (teeth marks, bruises, head injuries)
  • Attacks on you or other adults
  • Being sent home or barred from play by neighbors or school
  • Your own fear for the safety of those around him
The most important warning sign is the frequency of outbursts. Sometimes children with conduct disorders will go for several days or a week or two without incident, and may even act quite charming during this time, but few can go an entire month without getting into trouble at least once.
Your pediatrician can suggest ways to discipline your child and will help you determine if he has a true conduct disorder. If this is the problem, you probably will not be able to resolve it on your own, and your pediatrician will advise appropriate mental health intervention.
The pediatrician or other mental health specialist will interview both you and your child and may observe your child in different situations (home, preschool, with adults and other children). A behavior-management program will be outlined. Not all methods work on all children, so there will be a certain amount of trial and reassessment.
Once several effective ways are found to reward good behavior and discourage bad, they can be used in establishing an approach that works both at home and away. The progress may be slow, but such programs usually are successful if started when the disorder is just beginning to develop.
Last Updated
 
11/21/2015
Source
 
Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)