Category Archives: Neurodiversity

Do the ASQ Screening for Your Child

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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.

Note: if you had a paper version of the questionnaire, results look like this:

tally

The white zone is “on schedule”, the gray zone is “monitor” and the black zone is “not on schedule.”

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.

Child-Directed Play: Floortime

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floortime

Child-directed play is an intentional practice where you sit and play with a child, allowing them to guide the play, as  you follow along. The Greenspan Floortime approach describes this as:

  • Follow your child’s lead, i.e. enter the child’s world and join in their emotional flow;
  • Challenge her to be creative and spontaneous; and
  • Expand the action and interaction to include all or most of her senses and motor skills as well as different emotions

Floortime was created by Dr. Stanley Greenspan for children on the autism spectrum and those with developmental delays. It can also be used with typically developing children. It is helpful for any parent or caregiver who wants new ways to interact and have fun with a child, wants to feel more engaged with and connected to a child, and wants to know how best to interact with a child to foster communication skills, social-emotional development and cognitive learning.

How Floortime works:

Set the Stage

  • Find a time when you can focus on play, when you and your child are both well-rested and fed.
  • Be present – set aside your mobile devices and other distractions, relax, and stay focused on the interaction.
  • Gather items that interest your child and have them available, but not so many that it’s overwhelming.
  • Your position is important. Be in front of them – that’s better for connecting than it is to be side by side or for you to be behind them. Get down to their level – typically on the floor. Your physical nearness, affectionate touch, and eye contact help them to stay engaged.

Follow their Lead

  • Let them choose the activity. Offer toys that they love. It doesn’t matter what you play, it matters how you play.
  • Join in their play. Match their level of play – if they’re low key, you are too. If they’re very energetic, match that (without escalating up to wild.)
  • Don’t feel like you have to teach them. Just let them explore and discover. Copy the way that they play. If they signal that they want your help doing something, then help them, but don’t just jump in and do things they haven’t asked for.
  • Measuring intent. Watch their gaze, expressions and body language. Where is their attention? Let them know it’s OK to take initiative and start an activity.
  • If they are motivated, don’t change the activity. It’s OK to do the same thing over and over again.
  • Be playful! Find joy in your interaction. Their current interest may not be inherently interesting to you. But tune into how it gives them joy.
  • Look for the gleam in their eye. That’s a great sign that it’s working.

If it’s not working: Are you trying to control the play too much – do you need to step back? Are you being too passive and aimlessly following them around – how can you join them in interactive play? (Learn more about following their lead.)

Here is a video sample of child-directed play:

Narration

If you feel tempted to ask a lot of questions, or do a lot of teaching, or you’re just over-talking, try observing silently, or responding to their play with simple reactions “uh oh!”, “what’s that?”, “hurray”.

If you want to talk, try narrating what they are doing. “You’re putting the toys in the basket. You noticed there’s only one toy left on the floor. Whoa, you dumped all the toys back on the floor so you can do it again!”

This narration tells them that you’re paying attention and that what they’re doing is important to you. You’re also building their language skills by giving them words to describe the things they do.

Use Emotional Expression and Responses to Engage

  • Expression – Use your eyes, facial expression, tone of voice and body language to connect and communicate. Your emotions (especially anticipation, surprise, and delight) help to attract their attention and keep them engaged. When you pair your words with emotional expression, it gives your child a better understanding of both the words and the emotions.
  • Observation and Response – Can you read their emotional cues? Do your expressions engage them more? If so, keep it up. If they’re seeming overwhelmed by you, back down a little – you’re following their lead.

Circles of communication

When Floortime is working well, it’s like a game of volleyball or ping pong. You know your child’s interests, so you “serve” by offering a toy. They “bounce back” to you by taking the toy. You talk to them about the toy. This back and forth interaction is where all the magic learning takes place. A young toddler, or a child with autism or delays, may only be able to go back and forth a few times before disconnecting. The older they are and the more play experience they have, the better they’ll get at this. The goal of Floortime is to build persistence – more of these circles of connection.

Once it’s working well, you settle into a flow of play – Floortime calls this “getting it cooking.”

If it’s not working: Are you waiting long enough for them to respond? Are they overwhelmed – are you talking too much or moving too fast? Are you following their interests and joining them where they are? (Watch for any expression, sound, or gesture that might invite you into their play.)

Stretch the Play

Once you’re “cooking” – you’re connected and have a nice back-and-forth pattern established, then you can work to take their play up a level.

Expand the play by adding in some new toy or new aspect of play, or offering some choices. For example, if they’ve been using blocks to make a stable for their toy horses, you can put a “roof” on one of the “stalls.” If they’ve served you the toy pizza over and over, ask for a drink to go with it. If you were playing peek a boo, drop the scarf and pretend to have a hard time finding it.

Expand just enough, but not too much. Your goal is sustained engagement – we want to keep out back-and-forth exchange going as long as we can. So, if your new extension keeps them engaged, and you’ve got that gleam, keep it up. If you lose their attention, back up a little.

If it’s not working: Some parents try to intervene too much. Some are too passive and don’t help child stretch.  Try to find the balance between following their lead and challenging them to interact, communicate, and think.

Tailoring to the Individual Child

Some children have sensory preferences – they really respond to sounds or to touch or to movement. Some children are easily overwhelmed by certain kinds of stimulation – sound or touch or smell might be too intense for them. Children may also prefer different speed of interaction – some like things to move slowly, some like fast moving play. This worksheet may be helpful if you feel like there are sensory or timing issues involved.

Benefits of Floortime

Some parents wonder – if I’m just playing the same simple game over and over, is my child actually learning anything? According to Autism Speaks, the back and forth play of Floortime “builds the foundation for shared attention, engagement and problem solving. Parents and therapists help the child maintain focus to sharpen interactions and abstract, logical thinking.” They also note these key aims: self-regulation, engagement in relationships, communication skills, and emotional learning.

Learn more

Learn more about tips for Floortime sessions, and see videos of parents and caregivers demonstrating these skills:

Self Discipline and Impulse Control

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temptationOur goal for discipline, in the long-run, is to make ourselves obsolete. Our children need to learn to discipline themselves… We don’t want a child who only behaves well because we praise him for it. Or one who only avoids misbehavior if she thinks she might get caught and punished. Or one who has no real sense of what is good and what is bad unless we’re standing there interpreting the situation.

We want to raise adults who are capable of controlling their impulsive behavior, capable of working hard for a delayed reward (or even no reward other than their satisfaction with a job well done), and who have such a strong internal sense of right and wrong that it guides their every action, and who do what’s right simply because they can’t imagine behaving differently.

Impulse Control and Simple Ways to Teach It

To succeed in school and life, kids need to be capable of: sitting still when they want to move, being quiet when they feel like talking, not letting other kid’s misbehavior lead them astray, and so on.

Lots of childhood games and parenting methods are all about teaching this. Try these:

  • Sing the “Clean Up Song”. Stopping playing and cleaning up takes a lot of self-control.
  • Sing songs like “You shake and you shake and you stop.” Play stop-moving-while-playing games like “Red Light, Green Light” or “Musical Chairs” or “Freeze Tag”.
  • “Simon Says.” It’s hard to hold still when someone says “touch your nose” and touches theirs!
  • Play imagination games like “pretend you’re a castle guard – how long can you stand still?”
  • Use “Emotion Coaching” to help acknowledge that although it’s always OK to have feelings, it’s not always OK to act on them. Help them learn ways to manage their feelings.

Delayed Gratification and Simple Ways to Teach It

Some day your child will be an adult who needs to do her job every day, even when she doesn’t feel like it, so that at the end of the month she gets a paycheck and can pay her bills and then purchase some treat she wants. How will she do that well? If you start teaching delayed gratification now.

  • Make them wait. When they ask for something, don’t get it immediately. Acknowledge the request, and tell them when you will do it. “When I’m done washing this dish, I’ll get the toy.”
  • Encourage children to take turns, wait in line, and share. Toddlers struggle with these things, but we start laying the foundation early so they get it as they get older.
  • Let them get bored. Don’t feel like you have to entertain your child continuously. Sometimes their greatest learning happens when they have to get creative to ward off boredom.
  • Teaching manners also helps. When they drop something on the floor, and scream for it, say “Ask me nicely, and I will pick that up for you.” And then mosey your way over to do that.
  • Offer rewards they need to work for. “If you put away your toys, I’ll read 2 books at naptime.”
  • Be a consistent and reliable parent. If your child can trust that you fulfill your promises, they will be much more willing to wait. Check out this post on the “marshmallow experiment” to learn more.

Right vs. Wrong and How We Teach It

As our children go out in the world, they will continuously encounter new situations, with new ethical dilemmas. We won’t be there to interpret all of these situations for them, so we want them to have their own sense of right and wrong. How do we teach that?

  • We continuously model how we would like them to act. (When we do things we don’t want them to do – yell, swear, etc. – we may apologize for our bad behavior. Don’t just hope they don’t notice, because they do. I      won’t tell you what swear words my 3 year old knows!)
  • We talk about our values. When we read books, or watch TV, or see people out in public, we make observations about the behavior we like. (It’s tempting to criticize bad behavior, but it is more effective to tell      them what TO DO, rather than what not to do.)
  • We praise them when they “do the right thing”, especially in situations where that’s hard. (Like sharing a favorite toy, or apologizing for upsetting someone.)

To Get Involved or Not

One question parents often face is how much to intervene. If children are battling over toys, or pushing to see who gets the next turn on the slide, or threatening to hit, when do we step in? The answer varies a lot by culture. Christine Gross-Loh, in Parenting without Borders, tells about her experience watching kids on the playground in Japan. What she was used to, from American playgrounds, was that parents would quickly step in and referee conflicts between children. In Japan, parents did not intervene. They let the children work it out. They viewed playground battles, the crying that results, and making up as normal and natural ways for children to learn how to get along with others. What impact does that have as children get older? One researcher looked at Japanese and American 10 year olds. When asked why they should not hit others of be mean to them, American children said it was because you don’t want to get in trouble with a teacher or parent. Japanese children said you shouldn’t hurt others because it’s wrong and would hurt their feelings.

Wait for It – The Developmental Timeline of Self-Regulation

This self-discipline is a long time in coming. Our toddlers have a very hard time controlling their impulses, and rely on us almost completely for guidance. Pre-schoolers are better at self-control. And elementary aged kids are even better.

But, to be honest, we need to expect even our 17 and 18 year olds to still have regular lapses in judgment and moments of rash action. That’s because the part of their brain that is responsible for planning, impulse control, and making complex judgments (the prefrontal cortex) is still developing. They often make decisions in the moment based on their limbic system (the part of the brain which processes emotion). Anger, fear, excitement, peer pressure and sexual attraction can inspire adolescents (especially boys) to do things faster than the prefrontal cortex can slam on the brakes.

When they make their inevitable poor decisions, you’ll be glad you’ve got 17 or 18 years’ worth of practice at positive discipline and that you have already built a strong relationship based on trust and respect, but in which you’re still the “boss” of them.

Scaffolding

We can’t expect our toddlers to have self-discipline. We hope our teenagers will. How do they get there? Through “scaffolding” – a process where in their early years we intervene a lot and give lots of clear explicit guidance, but the older they get, the more we hang back, the more we wait for them to find their own solutions, the more we help them reflect on their responses and what they could have done differently. As we fade back, they take on more responsibility for their actions, and live more with the consequences that result.

Learn More:

Self-Regulation: www.parentingcounts.org/professionals/parenting-handouts/information-for-parents-self-regulation.pdf

Video that does a nice overview of benefits of self-control, and gives parents tips for how to help their child learn: www.king5.com/news/learning-for-life/Parent-to-Parent–196937571.html

Photo credit: http://www.freeimages.com/photo/734909

 

Here is a printable handout on Self discipline. Find more handouts on my Resources for Parent Educators page.