Author Archives: Janelle Durham

About Janelle Durham

I teach Family Inventors' Lab, a STE(A)M enrichment class in Bellevue, Washington. I am also a parent educator for Bellevue College, a childbirth educator for Parent Trust for Washington Children, the former program designer for PEPS - the Program for Early Parent Support, a social worker, and mother of 3 kids - age 25, 21, and 7.)

Gift Guide: Toys to Build Toddler Brains

photo showing toys like Duplo train, Quadro climber

Parents often ask me for recommendations for “the best toys for toddlers”. It’s a little tricky for me, given that I often advocate for owning fewer toys. But, if you’d like a few special items for a child to unwrap for their birthday, Christmas, or another holiday, here are some thoughts on how to choose the best toys. I’m going to sort them into categories based on ways to build a variety of skills and multiple intelligences. (I also recommend you check out my handout on activities and free items which also help to build their brains.)

Word Play (Linguistic / Verbal Intelligence)

We go to the library a lot! And when my son was a toddler, we went to story-time at the library every week. This means we get to “try out” hundreds of books a year for free! We only buy copies of the very best. Here are my favorites for books that toddlers love, preschool level books about inventors and makers, and books that sing. (For your adult reading enjoyment, here’s my recommendations for recommended parenting books and resources for teaching STEM to kids.)

It’s also helpful to play a lot with letters: I like magnetic letters for the refrigerator (which you can use all over the house) and duplo letters.

I also recommend a Kindle Fire tablet with Kindle FreeTime installed, which includes lots of ABC games and literacy building apps. (Here are thoughts on making screen time work for your family.)

Doing the Numbers (Logical – Mathematical Intelligence)

Everything you have more than one of is a math toy! You can count how many blocks you have, figure out whether you have more trains than balls, and so on. A few helpful specialty math tools are: a set of Duplo numbers, which you can use for counting, number recognition, while mixing them into your building tools, Unifix Cubes, and a great app called Bedtime Math. Every night at bedtime, we read a story problem and solve some math puzzles related to that story.

Putting the Pieces Together (Spatial Intelligence)

I like wooden puzzles for younger children and jigsaw puzzles for older kids. Melissa and Doug is generally a reliable brand. Babies 6 – 18 months like stacking toys and shape sorters. Toddlers love wooden train tracksto assemble and a big collection of wooden trains.

There’s tons of great building toys for older kids (I list many here in my STEM Gift Guide) but my all-time favorite is building toy to give is a basic Duplo set. For a 5 – 6 year old, choose basic Legos.

Moving & Grooving (Bodily – Kinesthetic Intelligence)

I would recommend several balls of varying sizes and textures, a Nerf style baseball bat, a Strider bike, and plenty of time to run and play indoors and out.

Rather than buying a pre-made climber that can never change configurations, I recommend a climber built of Quadro (Quadro is a fabulous combination of building toy and playground equipment! We’ve had ours for 20 years now, in near constant use.)

Playing Well With Others (Interpersonal Intelligence)

Imaginary play and telling stories with characters is one way to build interpersonal intelligence. Choose a few stuffed animals or puppets,  a collection of finger puppets to tell stories with, a toy picnic basket with fake food.

Learning about Myself and How I Feel (Intrapersonal Intelligence)

This category of intelligence isn’t about tangible stuff. It’s more about interaction and emotion coaching, and also making sure your child has time for quiet contemplation and down time.

Song and Dance Routines (Musical Intelligence)music

We have a box of miscellaneous musical instruments he can pull out anytime he wants. A few were purchased for him, but most are just items that have entered our lives over the years, like the plastic Yamaha recorder I had as a child, and the plastic Yamaha recorder I had to buy for my daughter’s class when I couldn’t find my old one… We also have a very old electric piano that’s in his room and he spends part of many “nap times” exploring the piano.

We listen to a lot of music together (one older sibling loves Broadway show tunes, one loves vintage jazz, Abuela loves classical and Spanish music) and sing songs A LOT, and enjoy circle-time songs at BC classes and library story times and hymns at church.

Fun with Flora and Fauna (Naturalistic Intelligence)

As you can guess if you’ve read other posts on my blog, we spend a lot of time outdoors. Camping, hikes, zoo trips, farmer’s markets, walks to the library and the pool. The only “tools” we use outdoors are a bucket and a shovel. (But, when we forget them, a stick and a rock can fill in as digging tools, and an empty Starbucks cup from the car makes a fine bucket.) Some day we’ll find our binoculars again, and pick up a new magnifying glass.

Expanding Horizons (Magic / Imagination / Religion / Cultures)

We have a big box of miscellaneous dress up – old Halloween costumes from his siblings, sunglasses, silly hats, etc. In all of our books and the videos we watch together, we aim for showing lots of diverse cultures and experiences, and we go to a church that talks a lot about diverse beliefs and appreciation of the sacred in all forms.

All the Pretty Colors (Artistic Skills and Appreciation)

This is the one area we have an abundance of STUFF.

One cabinet in the kitchen is over-flowing with art supplies: Model Magic clay, no-spill watercolors, pom poms, pipe cleaners, paint, paper, glitter glue, stickers, markers, crayons, beads, scissors, and so on. When he and I are in a relaxed, mellow mood, we pull these out and get to work.

I try not to do much art when I’m in a cranky mood, or when I won’t have time to deal with any mess that arises. I have to confess that I can have a hard time when he’s being really messy or “wasting” art supplies, or “messing up” art supplies – like when he dips the red-paint-covered paintbrush into the yellow paint. Because I know that about myself, I make sure that he has plenty of opportunity to do art in spaces that are designed for kids’ art and where it’s OK to make a mess. So, this year, he’s enrolled in Creative Development Lab, which is all about exploring and experimenting with art.

Child-Directed Play

In addition to buying stuff for your kid to play with, also make sure they have some time to play with you that is child-directed – where they get to decide what they want to play. Learn more about child-directed play.

If you have an older child, check out my Gift Guide to STEM Toys for Ages 3 – 6.

(Note: this post includes Amazon affiliate links. If you click through and purchase anything, I get a small referral fee. I spend any income from that on doing outreach to encourage more parents and educators to come check out what I offer here on this blog.)

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Autism Acceptance Month

AAM-logo

April is Autism Acceptance Month.

Autism Speaks is a major national non-profit which says April is Autism Awareness Month. This is a major fundraising effort for them. They talk about “lighting it up blue” to raise awareness of autism, but you’ll note that their website about the event is focused on raising funds for them. [It’s worth noting how they spend that money: 16% of their budget goes to fundraising, their executive pay is >500K per year (source), 22% of their budget goes to research.] Many autistics voice concerns that Autism Speaks has used ableist, pathology-based descriptions of autism, invoking pity as a fundraising strategy and that their research has a focus on preventing or “curing” autism. (source)

What’s the problem with pushing for a cure to autism?

“Many autistic people don’t actually want a cure

It is true that a lot of autistic people suffer. But what they suffer from is not so much being autistic as living in a society that is not friendly to autistic people.

A society that frowns upon people wearing sunglasses and earplugs indoors despite their sensory differencesA society where someone flapping their hands will be stared at and pitied, or told “quiet hands!” rather than be seen for the joy they’re exhibiting… The people who enforce these beliefs are not only telling autistic people that their very existence is wrong, but they are participating in oppression.

Moreover, the idea of curing autism isn’t as simple as it seems from the outside… Autism is a neurological difference that inherently shapes an autistic person’s identity, perspectives, dreams, and desires. As my sister put it: ‘Whenever you tell an autistic person they should be cured, you’re telling them that they shouldn’t be them.’ ” (Source)

So, instead of “lighting it up blue”, let’s instead talk about this as Autism Acceptance Month. Here’s how the Autism Self-Advocacy Network describes that.

“During Autism Acceptance Month, we focus on sharing positive, respectful, and accurate information about autism and autistic people.

Autism Acceptance Month promotes acceptance and celebration of autistic people as family members, friends, classmates, co-workers, and community members making valuable contributions to our world. Autism is a natural variation of the human experience, and we can all create a world which values, includes, and celebrates all kinds of minds.

In a nutshell, Autism Acceptance Month is about treating autistic people with respect, listening to what we have to say about ourselves, and making us welcome in the world.”

Autism acceptance shouldn’t imply that being autistic is easy, or that we celebrate the very real challenges. However, it does imply we should see the strengths of autism as well, and see how simple accommodations could make a huge difference.

“I do not celebrate my inability to consistently feed myself. But I do celebrate my unusual capacity for focusing on small details – a trait which makes me a good musician, a good student, and a good gift-giver. I do not celebrate my self-injurious stims. But I do celebrate my innocuous ones – I like making the pterodactyl screech, even though people stare. I do not celebrate the fact that I can’t make eye contact well enough to succeed in a job interview. But I do celebrate the fact that I can make conversation without needing to stare at someone’s eyeballs. I do not celebrate the fact that I was viciously bullied throughout elementary, middle, and high school. But I do celebrate the fact that I’m infinitely more gentle, compassionate, and interesting than any of my bullies will ever be. I do not celebrate my deficits in auditory processing that make taking notes in class nearly impossible. But I do celebrate that my experiences as a special needs student motivate me to teach special needs kids today the self-advocacy skills that I so sorely lacked when I was their age.

Try, for a minute, to look at autism through the lens of the social model of disability. Consider that, perhaps, it’s not our style of communication and interaction that disables us, but it’s the society in which our way of being is perceived as abhorrent. Perhaps what we need is a more accessible society, one in which autistic people – including those who require high levels of support for daily living – are accepted and accommodated.” (Source)

Learn from Autistics

A common slogan of autistic advocates is “Nothing About Us Without Us“. Often autism awareness activities are designed by people who are not autistic. They may staff panels with professionals in the field or parents of autistic people, but not include a single autistic person. “While it has become standard practice to have conversations about autism and Autistic people without Autistic people, this is a practice that must change.” (From Lydia X. Z. Brown) (Also learn more about including autistic people in research into the experiences of autistics.)

For this post, I tried to primarily read the voices of #ActuallyAutistic authors. I will quote  from autistic authors, because it is important that their voices be heard as speaking their own experience. (Check out the #actuallyautistic hashtag on Twitter, this list of Actually Autistic Blogs, GoodReads’ list of Books by Actually Autistic Authors)

Identity-First Language

I refer to autistics or autistic people, not people with autism. I say someone is autistic, rather than has autism. This is because many autistic advocates request this “identity-first language” vs. “person first language.”

“Person first language is often used to describe something negative — a deficit or disease (for example, person with cancer).
For Autistic people, autism is seen as just like any other identity marker—similar to gender, race, ethnicity, hair color, or any number of other value-neutral characteristics. We are not “people with tallness,” “people with maleness,” “people with Jewishness,” “people with gayness,” or “people with autism.”
We are Autistic people.”  – Autistic Self-Advocacy Network

“The theory behind person-first language is that it puts the person before the disability or the condition, and emphasizes the value and worth of the individual by recognizing them as a person instead of a condition. But let’s think about what we are doing… When we say ‘person with autism’, we say that it is unfortunate… we affirm that the person has value … [and that] autism is detrimental to that value…

When we say ‘Autistic person’, we recognize, affirm and validate… the value and worth of that individual as as Autistic person.” – Lydia X. Z. Brown

I speak of neurodiversity when speaking of the benefits that autistic perspectives can bring to a conversation. Neurodiverse can also be used to incorporate people with other differences in learning styles, such as ADHD.

I may refer to people without autism as neurotypical or as allistic. Allistic is a new word to me, but it was coined by Zefram in 2003, who says:

Allism is the condition of not being autistic. They are alternative brain structures, both valid, with a continuum of intermediate possibilities, just like heterosexuality and homosexuality… [there are] no connotations of normality or abnormality; they should be treated as descriptive terms on a par with “male” and “female”.

The advantage to allistic is that it’s completely value neutral. Neurotypical could be seen as meaning “normal” which would mean that neurodiverse people are “abnormal.” It is “othering” language. But I know autistics who take pride in being neurodiverse vs. “those [boring] neurotypicals”, so for now, I’ll continue using that term as well as allistic.

The Spectrum

Autism is short for the official diagnosis: autism spectrum disorder. (Note: “many autistic people feel that the term “disorder” unnecessarily pathologizes our neurology” – source)

People often ask about an autistic person “where on the spectrum are they?” as if some sort of quantitative ranking would sum up what they need to know. In trying to describe an individual’s capabilities or challenges, in the past, you may have heard them labelled as high-functioning and low-functioning. “Be aware that many autistic people may be uncomfortable with functioning labels … The short reason is that [they are] often used to deny those deemed high-functioning from necessary services and accommodations and used to strip those deemed low-functioning of their rights.” (Source)

This comic by Rebecca Burgess offers a helpful perspective on the spectrum. She says people often think the spectrum looks like this:

a line showing a spectrum from not autistic to very autistic

But Burgess describes how this doesn’t really describe the actual experience of autism. And it can also lead to misunderstandings of a person’s skills and accommodation needs. If someone is verbal and able to conform to most of the demands of a school or work setting, they get labeled as “not that autistic”, but then if they have too many demands thrown at them and have a meltdown, then suddenly they decide you’re on the high end of the spectrum and must not be capable of anything at all.

She thinks this would be a better way to illustrate a spectrum for a particular individual.

An illustration of a circle where the "pie pieces" are labeled language, executive function, etc. and dots indicate where the person might have more strengths vs. more difficulties

This spectrum illustration better shows where that person’s strengths lie and what things might be more challenging for them.

Someone who is skilled in most of these areas, but has some challenges may be able to “pass” as neurotypical – able to blend successfully into a school or academic setting – though they may be perceived as “odd ducks.” In the past, they may have been called high-functioning, or diagnosed with Asperger’s Syndrome. Some people have limited skills in most of these areas, and have very high support needs, such as needing help with toileting  or engaging in self-harming behaviors. They were once described as low-functioning. And some people have very low skills in some areas and VERY high skills in others. They were called savants or “rain man”. They are all autistic people. With different spectrum plots, and different support needs.

When we talk about autism acceptance, we can’t just focus on one “end” of the spectrum and ignore the challenges faced by people on the other “end” of the spectrum and by their caregivers. It is essential that all people with autism and their caregivers get the supports they need based on their own individual situations.

But all autistic people, regardless of their “level of functioning” will benefit from respectful treatment which sees their strengths rather than pathologizing them as inherently flawed due to an autism diagnosis.

Co-Morbidities

Read this passage from an allistic mother of an autistic son:

I have a real beef with the notion of celebrating autism when 22% of children with autism develop epilepsy and 70% experience gastrointestinal problems. In a recent study in the Lancet, two-thirds of adults with Asperger Syndrome, now part of the autism spectrum, reported considering suicide. 35% had made specific plans or an attempt. Another study showed children with autism were three times more likely than their typically developing siblings to be bullied. Children with developmental disabilities have a substantially increased risk of becoming victims of sexual abuse.

The issues she is describing here are co-morbidities and social issues, not autism itself.

Co-morbidities are physical and mental illnesses that are much more common in autistic people than they are in the general population. Yes, these include epilepsy, gastrointestinal problems, ADHD, anxiety, bipolar disorder, schizophrenia. These are all illnesses that need medical attention, and having both autism and one of these conditions can make it more challenging to treat these, but these illnesses are not autism.

The fact that people with autism are more likely to be abused, more likely to be bullied, less likely to be successful in school, less likely and (perhaps as a direct result of these challenges) more likely to be suicidal are social issues. They are not due to autism, but to societal attitudes about autism.

“While it’s certainly not fun to be hated, discriminated against, and abused, as too many autistic kids and adults are, I hardly think it’s fair to blame autistics’ neurology for the ableism, ignorance, and lack of compassion showed by the neurotypicals who surround them.

…Autism doesn’t cause suicidal thoughts. Mass abuse of autistic people, on the other hand, just might. That’s why, instead of fearmongering about autism, instead of amplifying the already loud voices out there that talk about how hard it is to be autistic, and how hard it is to have an autistic child, I choose to advocate for a world in which we treat autistic people better, in which accessibility and acceptance, not compliance training and abusive ‘cures’, are the priority.” (source)

“Cures” vs. Acceptance and Accommodations

In my writing, I will not describe the increased prevalence of autism diagnoses as an “epidemic” or a “crisis”. I will not talk about “curing” autism or about a “person afflicted with autism” or “person suffering from autism.”

I will not talk about vaccines causing autism. They don’t. But, even if they did, I worry about the societal messages that lead parents to choose not to vaccinate because of their terror of having a child with autism. As one autistic, Sarah Kurchak, put it:

Someone who refuses to vaccinate their children because they’re afraid of autism has made the decision that people like me are the worst possible thing that can happen to their family, and they’re putting everyone at risk because of it.

It’s time to accept that autism is a common variation on the human experience. By current definitions, 1 in 63 people are autistic. It’s time to start thinking about how we accept this and how we help create accommodations that support autistic people with meeting their own goals.

Some autistic people may choose therapies that help them learn to look and act more like an allistic person. But not all will choose that.

“Many autism interventions focus on making autistic people look more like non-autistic people. Common therapy goals include increasing eye contact and reducing unusual movements. These aren’t priorities typically selected by autistic people ourselves. More common priorities include reducing the impact of some of the downsides associated with autism, such as anxiety and sensory hypersensitivity; learning skills needed to succeed in education and find employment; and accessing supports and accommodations to assist with daily living. There may be intolerable costs associated with a focus on achieving an appearance of normality. Eye contact may feel painfully intense and intrusive, or it may be impossible to simultaneously make eye contact with someone and understand their spoken words. Staying still may require a vast amount of attention, leaving little left for learning. Hand-flapping may be an expression of joy, or a way to regain a sense of where one’s body is in space. Those of us who have either made ourselves look more normal or achieved some of our goals are often told we have “overcome” autism. This is misleading. We have often had to confront and overcome prejudices, or put much more work into learning a skill that comes more easily to others.” (source)

So, can we relax a little bit about whether or not someone makes eye contact when they talk? Can we not worry about whether someone feels more comfortable wearing headphones in loud environments? Can we chill a little about stimming behaviors such as rocking and hand-flapping? Can we understand that “restricted interests” isn’t evil in and of itself? (Read “The Obsessive Joy of Autism” for insights into the experience of autism.)

Now, I’m not saying it’s not helpful for autistic kids to learn how to use neurotypical social skills. This will make their lives easier as it will help them to fit in better to school and work environments that are primarily geared for neurotypical people. But we describe it that way… we don’t describe it as teaching them how to be normal so they’re not such a problem at school and work.

And all the work shouldn’t be on autistic people. Allistic people should also think about meeting them halfway. What are things we can do to make those school and work environments more flexible and more accommodating for all people, both allistic and autistic?

Symbols

A puzzle piece is often used as a symbol for autism.

Back in 1963, the National Autistic Society chose a puzzle piece as a logo because autism was “puzzling.” Many people (often allistic people) still think this symbol makes sense, because autism is often puzzling to them. Some autistic people think it’s fine because neurotypical people puzzle them. Some (often allistic parents of autistic children) feel the puzzle piece is a good symbol because finding all the right supports and accommodations to help an autistic thrive is like putting together a puzzle.

But the full logo in 1963 was a puzzle piece with a crying child on it. That implied that only children have autism, and that it is a condition that they will suffer from. A lone puzzle piece can also seem isolated.

Some autistics are also troubled by the puzzle piece symbol because “The jigsaw piece also signifies that something is missing. That autistic people are not whole.” (source) “It implied that we are something to be solved or fixed… We don’t need to be fixed, or solved  there’s nothing wrong with us, and most attempts to fix us… are actively harmful.” (source)

“Some autistics dislike the symbol of a colorful puzzle piece because it appears childish. The bright primary colors and image of a “toy” most commonly associate with children identify autism as a childhood disorder.” (Source)

Here are some alternatives:

In 1999, the Autism Society adopted the puzzle piece ribbon for autism awareness.

It’s definitely an improvement – it includes many colors of puzzle pieces, interconnected with others.


logo for autistic self-advocacy networkThe Autism Self-Advocacy Network has chosen a spiraling rainbow heptagon as their symbol.

Their symbol for autism acceptance month seen at the top of this post is a seven pointed star woven from all the colors of the rainbow.


Many autism rights advocates recommend the rainbow infinity symbol, which can also be used to represent neurodiversity, to include all the colors on the spectrum. This has been called the “autistic pride” symbol.a rainbow infinity sign, used to symbolize neurodiversity

(Read more thoughts on symbols from autistic writers:  Autistic and Unapologetic, Learn from Autistics, OllibeanAutistic Alex, and Art of Autism – which is written by an allistic person, but quotes autistics)

Blue or Red?

Autism Speaks’ logo is a blue puzzle piece, and they encourage people to “light it up blue”.

“It’s a nice symbol of solidarity, really, it is, but here’s the thing: it’s blue because they operate on the outdated assumption that it’s mostly boys who are autistic. On the one hand, let’s overlook the old science, and the gender stereotype of “blue is for boys,” because the large majority of people and organizations lighting it up blue are simply trying to be supportive of the autism community.” (source)

Many autistics advocate for #redinstead in April.

Learning More about Autism Acceptance

ASAN has a website for Autism Acceptance Month with great resources for autistic people, parents, educators, employers, and allies.

Thinking Person’s Guide to Autism has a great page which includes: criteria for evaluating whether autism articles and efforts benefit, rather than harm, autistic people, where to look for good information, where to donate money if you want to support autistic people, recommended books to buy or give, and how to help boost autism acceptance materials.

This Wikihow article on How to Observe Autism Acceptance in April includes ideas like: research an organization before participating in their events, notice the way that organization talks about autistic people, share articles written by autistic people, share information about respecting autistic people, donate to autistic run organizations (here’s how to evaluate campaigns), and support autistic run businesses.

Disability in Kid Lit publishes articles / reviews on the portrayal of disability in middle grade and young adult books. They have recommendations for books featuring autism.

 

Picky Eaters

photo of child who doesn't want plate of vegetables

When I teach about nutrition for toddlers and preschoolers, I include a few tips about introducing new foods. Then parents  say “But I’ve got a really picky eater.” About 30 – 50% of parents of preschoolers describe their child as a picky eater!

So, this post will talk about how that may be just a normal toddler phase, plus lots of steps we can take to work on those challenges.

Start with Empathy

Parents will say “Will they ever not be so picky?” I turn this around on the parent, and ask them: “Are there foods that you know that other people may love, but that you just don’t like to eat? If you were out to lunch with a friend, and they kept insisting ‘no really, it’s good! Just try it!!’, how would that feel for you? Or if there’s a ‘weird food’ you’re not willing to try, would you want anyone to pressure you to eat it?”

I don’t think anyone necessarily outgrows being a picky eater. You could eat lots and lots of meals with me and never notice the ways in which I’m a picky eater. We could sit at many breakfasts and I would happily drink my tea or cran-apple juice, and happily eat pancakes, waffles, eggs. You might never notice that I NEVER drink coffee or orange juice and I virtually never eat bacon or sausage. And I never eat the really weird foods – my husband will try anything in any foreign country, but not me! We all have our preferences. But because I manage my own food choices, my friends don’t need to know or care about my preferences. But for our kids, since we’re making all their food choices for them, and we feel responsible for their diet, we keep hitting the wall with their preferences. It can be frustrating, but it’s also important to acknowledge that we may not be able to change them quickly.

But I do think everyone can learn to be more flexible, more adventurous, and can learn accommodations. But let’s start from this place of empathy and figure out how we can offer and encourage without pressuring or forcing the issue.

Relax a Little

Although we all benefit in the long run from a diet featuring a wide variety of foods, if your child goes through a picky stretch where they only want a limited selection, it will be OK.

Toddlers are figuring out independence and control, and are ripe for power struggles. If you turn food into a battle ground, no one wins! If you force a child to eat, they will eat less.

Know how much they need to eat

Babies grow so fast in the first year that they have very high caloric requirements. But then that growth slows down, so your toddler’s appetite will decrease. It is helpful to know how much they need to take in per day – often parents are worried, then discover their child is actually eating plenty.

A child age 1 to 3 needs about 40 calories per inch tall. (source) Another way to think about it is to think of serving sizes as one tablespoon per year of age. (source) At at one meal, a 3 year old might get 3 tablespoons each of peas, noodles, and chicken.

If your child is gaining weight well and has plenty of energy, that’s a good sign that they’re getting enough food.

How much variety do they need

Well, all of us would benefit from a widely varied diet of healthy foods. But, young children may naturally have a more limited range than adults. As long as they’re eating some protein, some calcium sources, and some good sources of fiber and healthy fats, they should be fine.

I had a nutritionist tell me informally that if a kid eats more than five types of food, she’s not too worried. If you’re concerned, ask your child’s doctor.

Get them Involved

Take your child grocery shopping with you, or to a farmer’s market. Let them choose the things they want to try. Let your child help you to prepare the food (scrub vegetables, stir the fruit salad) or set the table for a meal. If there’s a meal where you want them to try something new, let them choose their favorite familiar foods to accompany that new option. Offer choices – not “do you want a vegetable at this meal?” but “do you want broccoli or carrots at this meal?”

Role Model / Communal Meal

Make meal times relaxed and social. Serve the same food to everyone as much as possible. Eat your own food and talk about what you like about your food. If there’s something you are OK with eating, but don’t love, you can say that “I don’t love this, but I know it’s good for me, so I’ll eat some of it, then I’ll eat the other things that I like better.” Don’t talk to your child a lot about foods you don’t like or model picky eating.

Introducing the New Food

Give them a very small taster serving – like a single pea, or a shred of cheese. Allow them to touch it, sniff it, lick it – do whatever they need to do to feel comfortable trying it out. Respond positively to any attempts they make, but don’t pressure them into eating it all. If they choose not to eat it, say “OK, we’ll try again at another meal.” Wait several days before trying again. Plan to offer a new food several times before it’s fully embraced. The first few times, offer just one bite. Over time you can give them a full serving.

Use food bridges – think of something they already like – what new food is like that? Try that one before you try something that’s unlike any of their favorite foods. Think about textures, colors, and tastes. If they like mushy foods, they’ll prefer mashed potatoes to french fries. If they like crisp things, try kale chips and apple slices. If they don’t like green food, try carrots, cauliflower, sweet potato, jicama.

Many parents go for the technique of “hiding” vegetables – blending lots of veggies into spaghetti sauce or dip, or mixing grated carrots into other things. Some nutritionists recommend this, some say it’s better to teach them to like the whole food. If you have a super-picky eater, I wouldn’t recommend this – if your child doesn’t “trust” foods, this will just reinforce that.

It may help to try new foods at snack time when they’re hungry, and not at a mealtime when you’re hoping for the whole family to have a relaxing time together.

Make New Foods Fun

Make trying new foods a fun activity by documenting what faces your child makes when they try a new food. Try adding a dip – many kids will eat anything they can dip. Do taste tests, crunch tests, cut food into fun shapes, go on a food field tip to learn where it’s grown. (ideas here)

Stick to the Familiar in Unfamiliar Environments

When your child is on vacation, or otherwise outside of their normal routine, they may need familiar foods to calm and reassure them. When my daughter was in a picky phase, we took a vacation where she carried a small container of Kraft parmesan cheese to every meal, and if nothing else on the menu seemed OK to her, we’d just order noodles with butter and she’d sprinkle on her cheese, and everyone was happy. When we got back home, we worked on broadening her diet.

Sometimes Foods

If you make any food a “forbidden fruit” that only increases its appeal. Go ahead and have fast food, or ice cream, or candy, or whatever. But do it in moderation, and explain that it’s a ‘sometimes food.’ (We don’t keep ice cream in the house, where it would be tempting to have it more often, but we do go out to ice cream as a special family treat.) A friend of mine has the ‘strong food’ policy – if you’ve eaten some of the food that keeps you strong and healthy, then you can have treat foods. (But don’t sell the treat as the reward for eating the healthy food – that could imply the healthy food is the icky stuff you have to slog through to get to the good stuff.)

But do remember that snack foods are scientifically designed to push kids’ pleasure buttons with salty, sweet, fatty goodness. It’s hard for healthy foods to be as appealing. So, realize that it can be hard to go back from junk food to healthy food. (And I say this as a parent whose kid is addicted to Cheez-Its!)

Keep Trying

Kids tend to be pickier about new foods from age 2 to 5, an age when they may cling to familiar routines. As they get older, they make get more flexible. So once your child starts elementary school, try re-introducing some things they may have rejected in their toddler years. They may be more flexible now. As they move toward their tweens and teens, they may try anything their friends eat!

Beyond Picky

So, my first child ate everything easily. Of course he went through periods of having preferences, and he didn’t always love vegetables, but he was always pretty flexible. My second child was a typical “picky eater” kid and we used all the tips included here to get her to eat. She was especially picky about protein sources, so we had to be especially creative there. As she got older, she was able to articulate that lots of proteins upset her stomach, so now at 22, she’s a soy free vegan and eating an otherwise very diverse diet.

My third child… well, he’s a whole different level of picky eater. I’d been a parent for 17 years when he was born, and I was a parent educator, so I knew all this stuff about picky eaters and how to work with them, and believe me, I tried all these tips. And his diet is still very limited. So, if you’ve tried all these ideas and are feeling like you’re at the end of your rope, check out my other post on super tricky eaters.

Sources for more info:

 

 

 

The Super Picky Eater

photo of a child disgusted with food

If you have a “typical” kid, just check out my basic overview of toddler nutrition. If you’re one of the 30 – 50% of parents of toddlers/preschoolers who would describe your child as a “picky eater” then check out and try my tips for picky eaters. But, if your kid is a whole other level of picky eater – where you’ve tried all those tips, and your kid still eats a very limited set of foods, then this post is for you.

And I’m here in solidarity with you! I could easily make a list for you of all the foods my 8 year old is willing to eat. And they’re specific – I can’t say he eats yogurt. I can say he eats yoplait brand only and only these flavors: strawberry, strawberry-banana, and blueberry. When I say he eats chicken mcnuggets, I don’t mean any kind of breaded chicken product, I mean ONLY the ones from McDonald’s (or Wendy’s in a pinch).

And if you’re judging me for feeding my kid McNuggets, then here’s the thing – it’s the only meat he has ever put in his mouth in pretty much his entire life. And if you’re judging me for that, well, then you’ve never lived with a super picky eater, and this is not the post for you.

Why are some kids super picky?

There can be a wide variety of reasons. A child with an extremely strong sense of smell may be overloaded while eating – a child with a very limited sense of smell may not enjoy food. A child who had a traumatic experience with choking may be very hesitant to eat after that. Children who have food sensitivities may not be able to articulate them or understand them – they just know that sometimes they feel icky after they eat so they just eat less.

Many extreme picky eaters are either autistic, or have anxiety, or have sensory issues. Or like my son, they may have all three of these challenges.

This blog post, written by an autistic nine year old has given me the best insight into “The Reasons [They] Don’t Like to Eat.

“Sometimes I eat something and it tastes nice; it is the right color and it feels nice and soft in my mouth. But then some days I eat what you tell me is the same and it isn’t the same… I get upset. You ruined it. … You damage it if it has sauce or potatoes on it. Then it is not nugget skins, but some weird thing my brain does not know. So, all nuggets are dangerous. And I get scared again.”

I totally see this with my son. He will love blueberries for a long time – but then he gets one bad blueberry – an under-ripe overly tart one, or an over-ripe squishy icky one. Then for weeks he has a hard time trusting blueberries again. He prefers processed packaged food to real whole foods, because Cheez-Its taste the exact same and have the exact same texture every time. He can trust them. Bananas are a risky proposition.

If you’re having a hard time understanding this, just think about one of your preferences. Maybe you like Coke but Pepsi is really not the same and you’re disappointed if you have to drink it. Or you really like your coffee with half-and-half and Splenda. And if you’re on a trip and they only have skim milk and sugar, it’s just not the same, and it throws your morning off a little. Now, put yourself in the shoes of an anxious child, who doesn’t have the perspective and flexibility you’ve gained from experience, and perhaps you can understand the upset?

If your child is old enough (maybe 5 or older?) try asking them open-ended questions to learn about what they like, what they don’t like, and what worries them about food. Understanding this can guide you in the next steps to take.

Can you force them to try foods?

I have to be honest that I have never tried to force my child to eat. With my older kids, I could do a little wheedling and nagging, and they’d give it a try. With my youngest, the nagging doesn’t work, and I’ve always had the sense that if I tried to force it, it would be bad.

There are plenty of examples of super picky eaters who will gag or vomit if you try to force them to eat something. Then later on, they’ll gag or vomit if that food is even in the same room with them, even if they’re not being pushed to eat it. And their food repertoire becomes even more restricted.

I don’t know if that would be the case with my son. I do think he would have big meltdowns, and I do think it would damage the trust he has in me, and I think it might make eating new foods even more stressful for him.

Encouraging Them to Try to Broaden their Eating

Be sure to check out the tips in my picky eaters post, plus:

Steps to Eating

When introducing a new food, tips will often say “offer just a few bites… expect your child to have to try something 7 or more times before they accept it.” For a super picky eater, we need to take even smaller baby steps. This Steps to Eating chart is helpful in describing those steps… can the child tolerate being in the same room as the food? Can that food be at the same table? On their plate, but not touching any of their other food? Are they willing to try smelling the food? Touching it with one finger? Licking it? Each step closer to eating it is progress!

Food Chaining

Another helpful tool is food chaining. Think of a food your child likes. Level 1 is to give them very similar foods – same taste and texture – for example, with my son, we’ve introduced Tyson chicken nuggets (yes, not the most healthy option, but very similar to McNuggets, but something we can have in the freezer at home). Level 2 is to vary the taste, but keep the texture – maybe dip the nugget in sauce? Level 3 is to maintain the taste but change the texture – so chicken strips made with whole chicken breast rather than the ground / reconstituted chicken in a nugget. Level 4 is to vary the taste and texture – breaded fish patty?

Slow and Steady Changes – Texture and Color

Some young children are very picky about texture. At some food clinics, they will puree all the child’s food, and they gradually move toward chunky purees, then eventually solid foods. Some kids will eat only crunchy foods – so parents try lots of the veggie chips, kale chips and so on. Eventually hopefully moving to carrots and apples for crunch.

Some children are picky about color. If a child preferred white food, they could start with 90% mashed potatoes and 10% sweet potatoes, and gradually increase the orange.

Many picky eaters like very bland foods (white noodles, white bread). But a few are sensory seekers and want very intense flavors – you may need to spice everything up.

Record Progress

Take notes on what they tried, and whether they liked it, and how much they tried. Comment on how much you appreciate their flexibility and willingness to try.

Have them rank things on a scale from 1 to 10. If it’s 5 or higher, encourage them to try it again a few times in the next week. If it’s lower than 5, don’t offer it again for quite a while till you’ve had successes with other foods. A reward system might increase their motivation.

Limit Sensory Input at Mealtimes

If a child is easily over-stimulated, eating is a LOT of sensory input. Try eating in a quiet, calm place without a lot of other stimuli. Don’t talk too much about the food – just put it there and allow them to explore it.

Familiar Food in Unfamiliar Environments

I only ask my child to try new things when he’s having a good day – we’re relaxed, hanging out at home, all is going well. But when we’re in a challenging situation, I make food as easy as I can. To understand why, read this quote from the blog post cited above:

“Sometimes people even want me to change rooms to eat… School does that. You want me to move to some place, sit down, and eat what you have made… No one told me I would smell different things, hear different voices and touch different stuff, and now you even want me to taste things? It is too much, so I just freeze.”

When my son is having challenges at school, I want to make sure his lunchbox is filled with all of his familiar favorite comfort foods and that it always meets his expectations. There are always 5 items – there’s always a yogurt tube, always cheesy crackers, always two fruits and always either a peanut butter sandwich or apple slices with peanut butter. And if we’ve run out of any of those things, I tell him when I pack his lunch, and I explain the substitution I’ve made. I want to be sure that lunch at school is something that re-grounds him, not upsets him. We can try for more food variety in all the other meals in his week. And when we go on vacations or to family camp, we pack protein drinks, protein bars, and peanut butter crackers. I know we can always find fruits and grains he will eat, but these are the ways I ensure he gets protein.

When should you seek help?

If your child is a super picky eater, you should already be talking to their doctor about it for advice and to monitor their weight gain and development.

Also, watch for physical signs of food intolerances or allergies. Many “picky eaters” are later found to have food sensitivities. So, if you see rashes or eczema, or your child has frequent diarrhea or constipation, or frequently complains of a sore tummy, talk with your doctor to see whether any kind of allergy testing or food elimination would be warranted.

If a child often gags or chokes or has problems swallowing, they might benefit from a “swallow study” or work with an OT or speech-language pathologist to build their eating skills and muscle coordination.

But here are some red flags that they may need additional support:

  • It’s getting worse – their list of accepted foods is getting smaller and smaller. Maybe it used to be 20 foods, and now it’s 10.
  • You believe your child would starve or be hospitalized before they’d eat foods they don’t like.
  • They will only eat if someone else feeds them. (In a child who should be old enough to feed themselves)
  • If their pickiness is limiting their life – for example, they can’t go on play-dates or sleepovers or eat out at a restaurant due to food limitations.

If this is the case, talk to your child’s doctors about your next steps.

More ideas

Words Matter

We recently did an exercise in a parenting class that I teach, where I talked with parents about discipline and ways to speak with our kids to increase the chance that they will do what they are supposed to do. How you talk to your kids and what you say effect the chances that they’ll listen.

Here are some ineffective communications techniques and ways to turn them around to make them more effective:

Vague Commands

What you may be saying: Be good. Behave better. Be nice. You better behave well at the restaurant.

Why this may not be working for you: Saying “be good” implies they are bad. And, these vague commands require them to guess what it is that you want them to do. (What does “be good” look like?)

Alternative approaches that may be more effective: Set clear expectations in advance about what good behavior is in that context. “At lunch, you’ll need to sit in your chair or my lap and use a quiet voice.” If issues arise, give very clear, concrete instructions for what they should do. “Please sit on your chair now or you can sit in my lap.”

Try re-writing these sentences:  “Be good at the movie.” “Be nice to her.”

Broken Record

What you may be saying: We’re late, let’s go. Come on, we’re late. Can you just put your shoes on? We’re late, we need to go. Come on!

Why this may not be working for you: If you feel like you’re saying the same thing over and over, you should ask yourself: can they hear you? Do they understand what you want them to do? Do they have the skill to do that? What’s stopping them from doing it?

Alternative approaches that may be more effective: Connect to Correct. Make sure you have their attention first, then tell them what the behavior issue is. Go near them, get down to their level, establish eye contact, and use a calm voice. Once you have their attention, then offer clear guidance – say it once – loud and clear!

Try re-writing this sentence: “Stop jumping on the couch. Cut it out. No jumping. You know you’re not supposed to jump on the couch. Stop it.”

Only telling them what NOT to do

What you may be doing: Don’t throw that / spill that / hit the dog / slam the door

Why this may not be working: If you just say what not to do, they have to first stop their impulse, then figure out what they can do instead. Both are hard for young kids to do!

Alternative approaches: Tell them what to do: “Carefully hand that to me. Move your milk so it doesn’t spill. Pet the dog softly. Close the door gently.”

Try re-writing: “Don’t throw your Legos.”  “I hate it when you slam the door.”

Dismissing their Feelings

What you may be doing: I don’t care if you’re mad – we don’t break things…. You know we need to leave the park now – crying won’t change that… I know you’re excited, but you need to sit down.

Why this may not be working: Dismisses their feelings as unimportant. Until the emotion is acknowledged, it may be hard to move past it. Saying “I know you have this feeling, BUT…” doesn’t count as validating, because that “but” implies you don’t care about their feelings.

Alternative approaches: Validate emotions first, then address the behavior or re-state limits. “I know you’re mad. It’s not OK to break things.” “I can see that makes you sad. I get that – I’m sad too. And… it’s still time to leave the park.” “I know you’re excited and it’s hard to stay still. It’s important to sit down so other people can see.”

Try re-writing: “Don’t cry. You know I won’t give you more candy.” “I know you’re mad that he took your toy, but you can’t hit him.”

Over-using If / Then Threats

What you may be doing: If you don’t brush your teeth right now, then no bedtime story.

Why this may not be working: Could imply you expect they’ll do the bad thing. (Kids are good at living up to expectations!) Could imply you’re looking forward to punishing.

Alternative approaches: When / then – When you do [this good thing], then we get to do [something mutually enjoyable] together. “When you’re done brushing your teeth, we get to read a bedtime story. If you’re fast enough we get to read two!”

Try re-writing: “If you don’t help me clean, then you don’t get to go to the park.”

Note: there is a place for using if/then threats as consequences, but start with when/then.

Asking Questions when you mean to give Commands

What you may do: Would you please stop yelling? Are you ready to sit in your car seat?

Why this may not be working: If you ask it as a question, that implies they can say no, or opt out of what you’re asking them to do.

Alternative approaches: If you’re really offering a choice, make sure they know they can choose either option. If you don’t mean to offer a choice, then give a command not a question. “Use a quiet voice.” “You need to sit in your car seat now.”

Try re-writing: “Do you want to put on your boots now?”

Do Try This At Home

Sometime in the next week, test this out! When you find an opportunity to change your communication from your normal style to trying out a new communication strategy from above, then seize the moment and test this out.

Then reflect on these questions

  • What happened as a result of using this new communication strategy?
  • What did you notice about how it felt?
  • What happened with your child?
  • How might this support a relationship with your child?

Share your experience in the comments!

Here’s a free printable version of this exercise on Effective Communication Techniques to Improve Discipline.

Do the ASQ Screening for Your Child

stick

Why do a developmental screening?

Developmental screenings are a helpful tool for making sure your child is on track with their development. They are a “snapshot” of how your child is doing at this moment. They’re helpful even if you’re pretty sure your child is on track, because they help you get ideas of where to focus your attention in the short-term to make sure they’re well rounded. They’re especially helpful if you have any concerns about your child’s development – a screening tool can either reassure you that they actually are on track, or can verify that they have some challenges that you should seek support for early on.

Developmental delays, learning disorders, and behavioral and social-emotional problems are estimated to affect 1 in every 6 children. Only 20% to 30% of these children are identified as needing help before school begins.(Source)

The ASQ

There are several great screening tools and resources for understanding child development. Today, I’ll walk you through the ASQ – the Ages & Stages Questionnaire, a free online tool, using a method that’s been proven through research with tens of thousands of parents. (Learn more about the ASQ.)

It looks at how your child is doing in five areas: communication, large motor, fine motor, social-emotional, and problem-solving. Learn more about these developmental milestones.

Doing the questionnaire likely takes 15 – 20 minutes. It’s easier to do on a laptop or desktop than on a mobile device. It’s best to do it when your child is around so you can check their skills if there is any answer you’re not sure about. And it’s best if they’re rested, fed, and relaxed so they can show you their best skills. That said, it can also be helpful if another adult is around to help you with distracting the child while you’re filling out questions and can help you figure out answers to questions you’re not sure about.

Note: Some parents choose to download the questionnaire and print it to fill in off and on over the next week, then return to the website to enter their results online so that it will do the scoring for them.

Completing the Online ASQ

Go to https://osp.uoregon.edu/home/checkDevelopment. Click on “Let’s Get Started”

On next page click continue – on next page click to agree to terms and continue, then enter date of birth. Then you’ll get a screen saying something like “For ages 25 months through 28 months – 27 month ASQ” – this is making sure you’re using the right checklist for your child’s current age.

Continue to online questionnaire. (Or download it to fill out by hand and then return to the website later.)

There will be a page where they ask about demographics – ethnicity, education and so on – they ask this because the people who are offering this survey are doing research on who uses the tool, and this is helpful to their research process. They do not do anything with this data which would violate your privacy, and you won’t get any emails from them except the results of this screening.

The next screen will be instructions – they’ll tell you that you need to try every activity with your child before marking an answer – that would be ideal, but you don’t have to… if you know your child can do something easily, it’s OK to just mark it yes. On things you’re not sure about, do have your child try it.

On the questionnaire, you’ll be asked 30 questions – 6 questions per category in 5 areas of child development. You’ll mark “yes” if this is something your child is definitely capable of and has done successfully multiple times. If they have done it a few times or they can sometimes do it but not always, mark “sometimes”. If they’ve never done it, mark “not yet”. The way the survey is designed, we might expect a not yet or a couple sometimes in any given category, so don’t worry if you’re seeing some.

Mark answers as accurately as you can – this screening is not about “making your child look good” – it’s about getting an accurate assessment of where they’re at.

Then there will be a few general questions, like does your child hear well, do they have vision problems. It’s OK to fill those out or to skip them.

Then it will say something like: “For ages 21 through 26 months (24 month ASQ:SE). The ASQ:SE-2 asks simple questions about your child’s behaviors. Before continuing, please read instructions…”

This second questionnaire, the ASQ-SE ,is optional. I would say: if you feel like your child has more behavioral challenges than the average child, or more big meltdowns / tantrums, or doesn’t connect to you and others like you see other children do, or there are other things that make you worry that your child may not respond like other kids do, then do this questionnaire. If not, you can choose to skip it. This questionnaire takes 5 – 10 minutes.

Enter your email address to receive results by email. (If you’d prefer not to give your email, then click to skip this step, and it will take you on to a page where you can “download your ASQ Results letter”)

Understanding Your ASQ Results

Your results will look something like this:

Results for your child BXD born on November 23, 2016
Your child’s development appears to be on schedule at this time.
On schedule Communication, Gross Motor, Fine Motor, Problem Solving, Personal-Social
Monitor None
Not on schedule None

or

Results for your child BXD born on November 23, 2016.
ASQSE Social-emotional development is in a monitor area at this time.
Overall Section You noted a concern in this section. See below for follow-up ideas.

If your child shows as being “on schedule” that’s good news. This test rarely has any “false positives.” If a developmental screening shows that a child is on track developmentally, we can be pretty reassured that all is well. You can just keep doing what you’re doing with them. Or, if there’s one developmental area where you had more “sometimes” or “not yets” then you may choose to do more activities in that area to ensure they stay well-rounded. For example, if you didn’t mark “yes” on all the large motor questions, then spend a little more time at the playground, pool, or gymnastics or dance classes so they can run, jump, kick, throw…

If your child has some things marked as “monitor” – I think of those as “grey areas”. This test can have “false negatives” where the test shows a possible problem, and it turns out that all is well.

If I see “monitor” in one area, that makes me go “hmmmm…. I wonder why.” Here are the questions I ask myself

  • Can they do similar things? The first thing I do is look back at the questions in that section and how you answered them. (The questionnaire with your answers marked will be attached to your email, or you can find it by clicking on “download your completed ASQ”.) Sometimes there were just super specific questions, for example, there’s a fine motor question of “does your child flip switches on and off” or “can your child string beads on a string” and you said no just because they happen to have not ever done this… but think, are you confident that they have enough fine motor skills that they could do something like that? If so, then there’s no reason to worry about it.
  • Is there something about that question that doesn’t apply to their experience? All standardized questionnaires have some biases or assumptions. For example, there are questions about climbing stairs, and there are children who grow up in a town with no stairs. There are questions about forks and some families tend to only eat finger foods or they use chopsticks so may not use forks at home. When the mother of one of my students was doing this questionnaire, and she showed her daughter the incomplete stick figure drawing in the illustration at the top of this post, her daughter said it showed a teacher. This may not make sense to you, but if you’d met me, it would make sense! (I have one leg and this child knew me well as her first teacher.) If the question doesn’t directly apply to your child, again ask yourself “do they know similar things?”
  • Is there a reason they might be behind in this particular area of development at this particular time? For example, if you are a bilingual or trilingual household, your child might test as “behind” in language in ONE of those languages. But if you think they have solid language skills in BOTH languages, I wouldn’t worry. If you tend to solve problems for your child whenever they get frustrated, they might be “behind” in a problem solving skill, like getting themselves dressed. Or sometimes kids are behind in large motor skills in the winter time just because we haven’t been playing outside where there’s room to run.
  • Is there a reason why they might be behind overall right now? If you’ve had any big stressors in your family recently like a move, a new baby, a death in the family, a divorce – these are all things that might have distracted your child’s learning temporarily.

If you find answers to these questions that satisfy you, it’s likely that all is well and there’s no reason to worry. It wouldn’t hurt to put some extra effort into building your child’s skills over the next two months, and then do another screening just to be sure.

If you’ve taken all of these questions into consideration, and your child still seems to be missing some skills, then definitely work on building those skills (see below) and do another screening in a few months, or seek more information now.

If your child is marked as “not on schedule” in one or more areas, you definitely want to explore it more. Ask yourself the questions above to get a clear understanding of the results, then consult with your child’s doctor, teacher, or another professional to learn more. It is possible that when you investigate more, it will turn out all is well, or there is only a very temporary delay. But it’s important to check to be sure, because if a child does have any developmental challenges, the sooner they get extra support, the better.

Resources if you’re concerned about your child’s development:

Resources to build all kids’ skills

Whether your child is on schedule, not on schedule, or in that gray area of “monitor” they will benefit from diverse learning experiences. I have lots of articles on Play and Fun Activities on this blog. Or check out:

 

Note: Easter Seals also offers the ASQ online for free: www.easterseals.com/mtffc/asq/. Theirs works just fine as an alternate, I just prefer the uoregon site listed above because Easter Seals asks for more of your private information (name, address, phone number) and will add you to their mailings.

Ages & Stages Questionnaire

How ASQ works

The Ages & Stages Questionnaire, or ASQ, is simply one of the best tools available for developmental screenings of children from birth to age 5. It has been in development for about 40 years and tested by tens of thousands of participants.

You can purchase questionnaires, or it is now available as a free* online screening tool at https://osp.uoregon.edu/home/checkDevelopment.  A parent may complete it by themselves, or it can be done with a professional. (Parent educator, social worker, child care worker, physician…)

Completing the questionnaire

First, you choose the correct questionnaire for the child’s age: they’re in two month increments for the first two years (2 months, 4 months…. 24 months), then every 3 months (27, 30, 33, 36), then every 6 months (42, 48, 54, 60).

The parent fills out the questionnaire. It asks six questions in each of five realms of child development: communication (what child understands and what they can say), gross motor (running, climbing, throwing), fine motor (hand and finger coordination), problem solving, personal-social (self-help skills and interactions with others).

The form asks simple questions, like “If you point to a picture of a ball (kitty, cup, hat, etc.) and ask your child, ‘What is this?’ does your child correctly name at least one picture?” The parent answers the questions yes, sometimes, or not yet. They are encouraged to try things out with their child as they go through the questionnaire, so they can see what their child’s abilities are for sure.

There is an additional optional questionnaire called ASQ:SE which assesses social-emotional development, such as autonomy, compliance (ability to follow directions), adaptive functioning (sleeping, eating, toileting), self-regulation, emotional affect, interaction (ability or willingness to respond to others), social communication.

Results (and how they’re calculated)

With the online questionnaire, the parent receives a report which lists which categories their child is “on schedule” with, where they should “monitor” and if there are any categories where the child is “not on schedule.”

To give professionals a little more insight into the calculations that lead to these categorizations: The results are scored 10 points for every yes, 5 for sometimes, 0 for not yet, so a maximum of 60 points per category. On the written test, you would then tally it on a table similar to this:

tally

If the child scored as we would expect for a child of this age (on the example above, this would be a score of 40 or higher on problem-solving, shown in the white/un-shaded area of that row), then the child’s development appears to be on schedule. If they scored close to the cut-off (in the gray area, shown as 35 or 40 points on the personal-social row), that would be something to monitor. If they score below the cut-off (a unique number for each category of each questionnaire), then further assessment by a professional is recommended.

This is a screening tool, not a diagnostic tool. If all looks well for the child (all scores are in the white area or the online tool says “on schedule”) then we can be assured that they are likely well on track. If they’re in the gray area / “monitor”, then we ask more questions to figure out why. If there’s a good explanation, then the score probably is not a cause for worry, but you could recommend adding activities to build the child’s skills in those areas and re-screening in a few months. If they’re in the black area / “not on schedule” consider referrals to more resources. The Oregon website offers this helpful ASQ Review Guide to help you determine next steps.

These videos for providers offer more information about how to use the ASQ with parents.

Follow-Up

It’s most effective when this tool is used as the beginning of a conversation with parents. After completing the tool, what do they see as their child’s strengths? Do they have any concerns about their child’s development? Did the screening reduce those concerns (they discovered the child is actually on track) or increase them (child is shown as monitor or not on schedule)? What are some next steps they can do to help their child’s development?

On my post for parents about how to complete the ASQ, you can see how I talk with parents about interpreting their results – whether to worry, how to seek help, etc.

If they completed the online questionnaire, their emailed test results will include links to age appropriate learning activities and play activities.

* The screening is free for parents. Since I know the ASQ is a product that is sold, and is fairly pricey, I wanted to be sure I wasn’t violating copyright by promoting use of the online tool. The website is for the Oregon Screening project, so  I have looked for legal terms on the site to see whether they limit its use to Oregon residents or in any other way, and all I have found is “This site is open to all parents of children ages 1 month up to 72 months.”

The screening is also available free at Easter Seals: www.easterseals.com/mtffc/asq/. I prefer the Oregon screening project, because Easter Seals asks for all of the family’s contact information and will add them to their mailing list.