Small Steps - Setting the Stage

We begin Season 2 with a discussion on how small, intentional changes to can lead to progress when raising a child with a disability.

Transcript:

Bethany Darragh 0:20

Welcome to the Theralinq podcast, where we explore practical strategies and real-life solutions to help families thrive. I'm Bethany Darragh, a pediatric occupational therapist, and I'm excited to bring you this special series called small steps. Join me and my co-host, Brennan Barber in this three-part series, we'll focus on how small, intentional changes can lead to meaningful progress for families, especially for those navigating life with children who have disabilities or therapy goals, whether it's creating a consistent routine, working toward therapy milestones, or simply finding more balance in your daily life. We'll guide you through practical and manageable steps that build toward big transformations over time. If you've ever felt overwhelmed by where to start or how to keep moving forward, this series is for you. Every big transformation begins with a small step, and we're here to take those steps with you.

Brennan Barber 1:21

All right. Bethany, so as we kick off this new season, we're doing a little bit of a new format. Do you want to explain a little bit about what we're doing and what this new three-part series is?

Bethany 1:31

Yes, we're going to do three episodes about setting up your household and your family for goal setting. So, the first episode today will be setting the stage, and then we'll talk about the first step and then sustaining momentum in the last episode. And the reason why I wanted to do this is because, as a pediatric occupational therapist, I have a lot of families that come to me, and they just aren't quite ready for change. They come to occupational therapy, they come to that first session, and it's a lot of work to get there, and they've, they've made it, but they're not quite ready to implement a bunch of exercises or a bunch of new structures in their life. And so, this is kind of that precursor of what really could help you before you go to therapy or before you start implementing goals and exercises at your house. These are just some basic things that need to be in place before you're going to see progress.

Brennan 2:26

Great. So, we should probably jump in then talk a little bit about routines and consistency. So what do you think? How can having a consistent routine influence a child's emotional and cognitive development.

Bethany 2:43

Yes, the first thing we're going to talk about today is a consistent routine. What we need to remember with our kids is that they can very easily snap into a fight or flight mode if they don't feel like things are safe and predictable. And our kids with developmental disabilities are going to be even quicker to jump into that fight or flight mode because something in their own body feels a little out of control, and so they are going to need a lot more control and consistency in their life to be able to make these changes. So even if you feel like you have a very consistent routine, your kid may not realize it because they can't see it, or it's not repetitive enough, or whatever it may be.

Brennan 3:25

So what's the difference? What do kids need? How do you do that?

Bethany 3:28

Okay, they need something visual, so it doesn't have to be fancy at all. So even as simple as I will take a piece of paper and draw out little stick figures for my kids, if something is off schedule. We have visuals in our house of what's expected of them every day that I've just made on Word or Google Drive and dropped pictures from the internet on but if there's something that I need them to understand today, we're doing something different. I won't go through the trouble of making a document. I will just get a Sharpie and a piece of paper and draw stick figures and say, first we're doing this, or second, we're doing this. And I do that with the kids at school as well. If I'm coming to work with a kid who hasn't met me, or we're doing something different, I will draw out exactly what we're going to do before we start. Just even a stick picture of a kid sitting in a chair, a stick picture of a kid standing next to his desk, a stick picture of a kid saying goodbye. I mean, just as basic, basic, they need to see what's going to happen once you have these things set in place.

Instead of saying, okay, we just ate breakfast. And then next, we go brush our teeth. Okay, you brush your teeth. Okay. Now go brush your hair, instead of telling them that schedule over and over again. If we have a visual, I'm gonna prompt instead. So okay, we just finished breakfast. Now what? And the kid says, I don't know. And say, how could you find out? And they can say, go look at the schedule. Or you can prompt them to go look at the schedule. So that way they're starting to learn to use their tool to predict what's next without you.

Brennan 4:57

So, then what are some ways that, just talking about communication, parents might like, unknowingly fail to communicate some of these routines or effectively show these visuals to their children.

Bethany 5:09

We just have a very mental dialog of what's going on in our life all the time, and we just assume kids are just gonna trust and follow, which and a lot of times they do just trust and follow, but they also can't quite see exactly what's going on. So, we just have to talk it out. Every time we do something, talk it out. Talk it out. And even with the very routine things, talk it out or show it. Show it with those visuals. And even if it's something that the kid's not quite independent with yet, I'm still gonna point to the visual again and again and again. So going back to the example in school, when I'm working with a kid and they are resistant or they don't want the challenge, I'll show them again. We're gonna do one thing, two things, three things reward, one thing's two things, three things reward. And then we'll do one thing, I'll present the second thing, and I'll remind again. This is the second thing we already did, one thing, we've got one more thing, and then reward. And it seems like silly to repeat this much, but this is really what need. What kids need. They need a lot of repetition to feel comfortable with the routine. And I want to remind you that when you're doing these routines, you're going to realize that this is way harder than just doing everything yourself. So, you may have realized, you know, you were just grabbing your kid's toothbrush and putting toothpaste on it and handing it to them, and that was the way you prompted them to brush their teeth. And so now having to remind them to look at the schedule and figure out what's next and get the thing next, it can take a lot more time and be a lot more frustrating. So, this might be a time that you need to assess how complicated is your routine. Is there something you could simplify so that they can be more active, and the more active they are in the routine, the more they're going to understand what comes next and be more comfortable. This is extremely this is important for all of our kids with goals, our motor goals, but this is extremely important for kids with behavior goals, because when you are trying to change a kid's behavior and they're snapping into fight or flight mode, you're going to see those tantrums happening a lot more often. When we can keep them nice and calm, we can make more growth with giving them demands that they would normally have resistance to. They're going to be able to take those demands with a little bit more success.

Brennan 7:33

Back to visuals again, really quick. So, you mentioned some creative things you've done with stick figure visuals. What creative or unique ways. Have you seen families use visuals to structure their days?

Bethany 7:45

Yes. So, some people take pictures and print them out and put them in order. Some people use Velcro in each individual picture so they can move them around and be flexible every day. Some people use an object schedule so they will take different toys or miniatures and actually use the object for the kid to see what's coming up. So, you know, breakfast may be a little, tiny spoon and then a little, tiny toothbrush, and it would actually be the objects themselves that the kids have. And then sometimes it helps for there to be a tactile and kind of motor component with the process. So, you might have a place where the components of the schedule live, and they have to go be placed in the place where you would do the activity. So, for example, you might have a schedule with um, pictures of, you know, breakfast and then tooth brushing, and then hair brushing, and then shoes and um, they were all say they're all velcroed onto a strip in a central location. The kid may have a location in the kitchen where they can velcro their breakfast so they would go to the schedule, they would take off the breakfast picture, and then go take it to the kitchen and Velcro it and the kitchen. And then after breakfast, it would be like, what's next? The kid could go back to the schedule, get the brushing picture, and then there's a place in the bathroom where you Velcro that picture into the bathroom, and that just helps for kids who get a little bit lost in the transitions where on the way to the bathroom, they their eye catches a screen or a toy and they get distracted. But if they have that picture in their hand, they're more likely to go put it in the place where it's supposed to be and actually do the task.

Brennan 9:39

So, there's some really cool, low-tech solutions. Some follow up questions. There. One being, you know, for families that you know may have tight schedules, not able to create something like that. You know, what would you recommend? And I guess are there? Are there more? You know, what we'll call high-tech solutions out there that you would recommend families could look into where children would use, or you've seen effective with children using?

Bethany 10:08

Yeah, so if you don't have enough time to do all these things, I still recommend having some sort of visual. Maybe it's just posted on the fridge, and again, you are just talking through all the points while you're doing them. So instead of just saying, okay, after breakfast, go brush your teeth, you're gonna point to the visual and say, we're eating breakfast. Now next is and just a conversation that doesn't really shouldn't take too much more time. Technology, I always recommend people using reminders, alarms and timers. I don't expect anyone to be so rigid that they do a certain task at the exact same time every day, but I do think kids can follow along a lot better when there are visual timers involved. And I have an app that is just a visual timer. When I say visual, I mean not a timer that just has numbers. It's called Countdown, and it has a circle and it's a picture is covered up, and as the timer goes down, more of the picture is revealed, so the kid can see that change, because numbers don't really mean a whole lot to a lot of our kids, so they need to see the visual getting closer and closer, and those that's really helpful. So especially with things like screen time or preferred tasks, you're gonna play outside for 30 minutes, and then you're gonna have screen time for an hour, or whatever it is, giving them those timers to transition from one thing to the next, or okay, we're gonna put shoes on, and then we're gonna get in the car. You've got two minutes to put your shoes on. Those timers can help a kid stay focused and get the things done so they can be more participant, more of a participant, in the process, but also not make it take four hours to get out of the door in the morning. Reminders also, I, I know that a lot of kids have the screens we have. Were resistant for a long time in this household, but now all my kids all have screens, and so I am using their calendar app, and I'm using reminders and for chores. And so, they can check at any time their own screen, their own app, know what's expected of them any given day, and check off their to do list or their reminders to get their own chores done. So, I recommend using all those things if, if they're convenient, more convenient.

Brennan 12:31

What do you think are some potential downsides of relying on technology for routines? And how can parents balance this?

Bethany 12:38

What I found when I'm recommending technology to kids, especially in the school setting, I just see kids have a lot more access to distractions. So it can be when I even bring in a device to use one of these strategies. You know, I'm handing them like the whole world of roadblocks and expecting them to, like, not look at that at all. So that can be a downside. It's just adding more distractions. But other than that, technology does provide an opportunity for more accessibility and more options, as far as like, how you interact with the visual schedule so, or the visuals that you're providing So, and for a child that isn't going to be tactile, grabbing and moving,the technology just gives more options for how they can interact.

Brennan 13:36

Great. Okay, so that's routine. What comes next in the process?

Bethany 13:40

Yes, so the next thing you need to do in your household is to start a habit of praise. So how often are you giving your kids affirmation or praising them during the day? Are you finding it hard to find something to praise them for? So, the for the work here is for the parents, not for the kids. It's time for a perspective shift. So sometimes, especially if you are on your way to therapy, your mind is focused on what your child is lacking and what needs to be improved, and you've got to get your head on straight and see what you already have and what you can praise your child for. Right now, there absolutely is something you this is kind of a soul-searching time for you to find what that is and get into the habit of those affirmations daily, so being really intentional. So, this is the point where the parent needs to put that reminder on their calendar, on their you know, phone, to affirm their child. And it seems, you know, silly that you would have to, like, remind yourself to do that. But I think the point is, if you're doing it, that's great. Do it more. Remind yourself to do it more and more and more, because it is scientifically proven that you can see.

More change with positive reinforcement than negative reinforcement. So, if we're waiting for our kids to mess up and then we're commenting, oh, you should have done this, we're going to be stepping backwards rather than stepping forwards, instead of every little thing we see that they do well already, just talking about it.

So, take a close look at your parenting. Are you doing more, you know, teaching? Are you doing more nagging, which we're all guilty of, but just try to catch yourself if you say, find yourself always nagging about the same thing for me, here's an example. It's shoes by the door. We have a shoe shelf where the shoes go, and the shoes are never on the shelf, like literally never on the shelf. And I only talk about shoes when I say, why are your shoes next to the front door? Why aren't they on the shelf? And so when I've heard myself say that three or four times, I need to change the system. And so I'm gonna now switch it up to where if I happen to catch somebody's shoes on the shelf, they're gonna get, you know, a quarter sticker, like whatever system kind of works for your kid, or just say, oh my gosh, I can't believe these shoes are on the shelf. This is fantastic. You know, run around the house praising that child about the shoes that little change.

You know, may mean that for a while, I've got to put shoes on the shelf more often, but that little change is going to make a huge difference in the kid's ability to take on that that behavior, change it and make it last.

Brennan 16:32

So, all of us who are parents, I think, can relate on some level, that there are just times where you struggle to find things to praise. And what would your advice be for parents who are kind of struggling to find those things to praise their child about, and how can they can shift their mindset to create a habit of positive reinforcement?

Bethany 16:52

Yes, this is something that everyone at some time has some difficulty finding that thing that they can praise their kid when they're so focused on all the change that needs to happen, it can be hard to find that positive point to focus on. So, what you should do is look for what your kid is doing at all, like whatever they're doing. What are they doing? If it's not something that's ideal, it's a behavior you're trying to get away from, but still just study what they're actually doing consistently. So, for example, if your child is having a really hard time moving away from video games, and every time you have to move them away from a video game, you're getting a full-blown meltdown, you know, tantrum, pre tantrum. Look at the skills that they are doing in that video game where they are in their zone and they're happy and they're focused and they're engaged. And what skills can you find in that activity that are praiseworthy? Are they? Are they handling setbacks Well, if they lose the game, are they able to step back and do it again? Are they showing attention and focus? Which a lot of my kids, a lot of my family's had, that have trouble. Oh, they can't focus on anything and, but they can focus on video games for a really long time. So that's something that they're able to focus on. And are they able to problem solve? Is there a challenge in the game that they can figure out and kind of get around. So, I challenge you in that behavior that you are trying to avoid, there still is some skill that your kid is showing in that behavior, and that might be a good starting point for how to start praising them before it's time to transition before the tantrum. Notice those things. Wow, I saw how you lost that level, but you just tried it again, and you weren't frustrated, and you just gave it another try. That's perseverance. I see that you have perseverance in that game. So even if it's the if, even if we're starting with kind of the behavior that we're trying to get away from, we can still find something there. And also, just our kids personality, like, are they super silly? Are they super energetic? Are they strong? Are they fast? You know, whatever it is those things about their personality, you can, you can find something that you can find a moment where that, that attribute is, is, you know, good and right? So maybe they're bouncing off the walls, and they have very high arousal, and they're, you know, jumping off the couch and a little too wild and rough and tumble, you know, when it's time to be outside. Um, praise the junk out of that. Like, look how Look how high you can jump, look how far you can run, look how fast you are, look how much energy you have.

Brennan 19:40

So that kind of leads into my next question, then around shifting perspectives. So, you know, obviously talking about affirmation for things that a child is doing well, but how do you do all that without losing sight of areas of improvement?

Bethany 19:53

For the purposes of this conversation, I think we need to handle these one thing at a time, and I think I, for all these things we're talking about today, you know, a routine, a habit of praise, and the other things we're going to talk about, these need to come first, and then, then after you have this in place, then you talk about goal setting and moving forward. And I think as adults, we can handle a lot of these things in our head all at once. And but for kids, they really need to take one tiny bite at a time before they can accomplish the next task. So, for adults, we can silently hold those things in our head for the future, but we are going to let them sit on the back burner, and we're not going to talk about them with our kid until we feel like they are safe and confident with the routine and they feel praised, and they feel confident and they're ready to take on a challenge until they're ready to take on a challenge. Those are problems that we will hold and we will not share with them.

Brennan 20:52

So, kind of blending the conversation, then of visuals and affirmation, what role do tools like a family affirmation poster or gratitude, garden play and fostering positive home environments?  

Bethany 21:06

Yes. So, as you start to work on goals in the future, you're definitely going to need a system of praise and reinforcement. So now it's kind of the time to start figuring out what works for your family. So, I see, I know some families that before they go to school or on their way to school, they have just like family affirmations that they say every single day, those are very personal to that family or to that child, or what that kid's good at, or what the parents are good at, and they just say them on their way to school every day. There could also be a shout out board where people are giving compliments to other people in the family, and you just kind of post them somewhere, even if it's just sticking them up on a window or the refrigerator. And then another thing I've, I've seen and I've tried, is a gratitude garden where you can, you know, write things that you're thankful for, whether they are, you know, people or actions or events on little garden sticks. And kind of stick them out in in your yard, or in your in your pots that have, you know, flowers growing in them. And it kind of have a place where they are shown. These are going to kind of be the practices that you know, are the baseline. And then as we start to add goals and add rewards on top of that, they'll kind of build from here. But this kind of helps, you know, like the location where does something like this live in our house, where we see it all the time and we look at it all the time, or would we like something on a screen? Or do we like something on paper? Or do we like something tangible that we can hold, like a rock or a marble. You know, different, different kind of strategies that work for everybody. And, you know, I'll say my family, it's always worked well for us to have something, you know, tangible that we could hold and drop in here. You know, we would put marbles into a glass jar or something like that, to let us kind of note positive behaviors, or, you know, compliments or things like that that work for our family. So again, it all comes back to being really visual. And this is to, you know, kids are all kids are very multi-sensory, and they need to, like, touch, feel, hear all the things going on. And a lot of our kids who have therapy needs. They're even extra multi-sensory. So, you know, this is just letting us remember that verbal praise is one piece of the puzzle. But then give them something visual, something they can hold, something they can touch. Maybe there's a high five that goes along with it. It does not have to be complicated. It doesn't have to be something that you buy at Target. It can be something that is at home, just make it multi-sensory. Can they hear it? Can they feel it? Can they touch it? So that's what needs to happen as part of the praise routine.

And then, talking about technology, I have an app that I love that does this, and it's called Thumbsters. And all it is, it's on my watch and on my phone, and every time I want to praise my kids, I can just press a button on the app and it shows them a thumbs up. So that helps me. When I was - we had this system of marbles in the jar at home, but then we would be out in public, and they would say they needed that reinforcement right away. Kids need to get that praise attached to the to the behavior within 90 seconds of the behavior. So, you need some sort of recognition that something positive has happened. And so I was doing, I started using, when we're out and about, using the app where I would press the app show them and it, you know, gives you a little monster giving a thumbs up and makes a sound, and it's a whole thing. So that's in that that for them was enough, that it worked in those other times, I have some families who literally carry around, like a bag of pom poms or marbles. And just like, keep doing the tactile thing out in in public too.

Brennan 24:53

That's great. And then, you know, just kind of taking a step back from, you know, all the work that we're doing and the ways in which we're trying to support and help our children grow, how do we simplify some things like, what do we do to kind of take a step back and enjoy some of that downtime?

Bethany 25:14

Yes, I would say almost everyone needs to, you know, evaluate what can go in their life before they add some change. So, I encourage everyone to take an inventory of your of your weekly downtime, like sleep, hobbies, rest. How much do you have? Do you have enough to add another challenge into your life, like therapy and therapy goals, evaluate which one of the things that you have going on in a week are life giving and which ones are wearing you down. And can can you get rid of some of the things that are wearing you down?

You know, obviously we can't give up, like the dishes or taking the garbage out, but are there some things that you're doing every week that you realize had become more of an obligation than something that is life giving. And then pick one thing to start and let it go.

Maybe it's that you have this dream that your kid's gonna play soccer, but they really don't like soccer, and you're going everyone's going to soccer. Little grumpy every week. Just get rid of soccer, you know, like one thing in your life is that you can let go, and maybe you take an inventory, and you realize you have a lot of downtime, but it's just become kind of, you know, screen time, or kind of lost time. So, see how you can create some boundaries to, like, get some of that time back.

Brennan 26:44

Great. And I think along those lines too, you know, maybe talk a little bit about why it's so crucial for parents to really give themselves some, you know, kind of forgiveness during the week. You know, so many of us, especially those of us with children who are receiving multiple therapies have very busy schedules, balancing caregiving, plus full-time roles plus family life. Why would you say it's important to just, you know, cut yourself some slack every now and then?

Bethany 27:17

Change is not linear. You're always going to have setbacks, so just mentally being aware of that before you get started is helpful. You just have to give yourself a lot of grace when there are weeks where you know you are yelling about the shoes instead of praising about the shoes, you know it's it's that happens, and so you're just going to reassess. What could you change slightly to shift it the other way? And usually, these things are adult, personal things that we need to shift in ourselves and not expect from our kids. I mean, if our kids are needing to go into therapy for whatever reason, we need to hold the weight of these things on ourselves and help set the stage for them with just a really, you know, clean and simple routine. And yes, we just have to be aware that there's going to be some bad weeks, and we're just going to take a little bit of extra rest that week. We're going to reassess, and we're going to try again in this stage right here, this step of the process, the routine, the praise and simplifying are the three things that you're going to come back to over and over and over again when you're in the middle of making a lot of progress, and then things just kind of go stagnant for a little while. This is where you need to come back and make some changes to see if you can't re-up that progress that you had.

Brennan 28:37

Great those were really impactful insights. And I think, you know, both for me as a parent, and I'm sure other parents listening, you know, number of takeaways. And I think that's really, you know, kind of what we're getting after with this new three-part series to kick off season two of the podcast. So, let's talk a little bit about what's coming up next month.

Bethany 28:57

Okay, so we're going to start talking about goal setting and how to actually make some progress. These tips will have relevance to motor goals or cognitive goals or behavior goals, speech goals, any goals, therapy goals that you have, and even just like family goals, like, you know, less screen time or, you know, more compliance with adult directions, you know, things like that. Any goals that you have, we're going to talk about how to set those up and how to start making progress.

Theralinq app is coming soon. We're working on a tool to support your therapy journey by reminding you to do your therapy exercises, providing simple videos to guide your home practice while tracking your progress. So don't forget to visit our website at WWW dot Thera link, T, H, E, R, A, L, I, N, Q.com, to sign up to receive updates about the app, ask questions, share your personal success stories, or connect with us.  We’d love to hear from you.