The Importance of Sensory Awareness

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The processing of sensory information is something we all do. Sensory processing is the means by which we receive, interpret, organize and use the stimulation that activates our eight senses – hearing, sense of position/movement (vestibular), sense of body part position/movement (proprioception & kinesthesia), feelings of what’s going on within our bodies (interoception) touch/tactile, vision, taste, and smell.

Each one of us is processing sensory information continuously, consciously and subconsciously.

When sensory processing is effective we respond to life’s sensory events (both those related to ourselves and those within our surroundings) adaptively. When sensory processing is a problem, it may be related to the function of a specific sensory organ or sensory system, or it may be related to a neurologically-based condition known as sensory processing disorder, whereby sensory function is less than reliable to varied degrees. Stimulation may be poorly adjusted to, misinterpreted, missed, tuned into with heightened sensitivity, sensed as uncomfortable or adverse, avoided, craved, or inadequately filtered. Most frequently, with a sensory processing disorder more than one sensory system is involved and there is variability among the systems involved. Those with disordered sensory processing either must work harder to respond adaptively, or they experience problems that could manifest in many different ways because the processing of sensory stimulation is at the foundation when it comes to how we function.

Awareness of sensory stimulation and individuals’ patterns of responses to basic sensory information is not only helpful, it’s essential in understanding and changing behavior and performance.

Here’re a dozen reasons why sensory awareness is important –

1. Sensory stimulation affects our physiology, psychology, emotionality, motor function, language, thinking, learning, interaction and development through our lifespan.
2. Reliable and sufficient sensory input is necessary for adaptive appropriate output.
3. Everyone tunes into sensory information his/her own ways.
4. How a person takes in sensory information naturally varies from day to day, and within the 24 hours of a day.
5. Different types of sensory information may be processed and affect behavior in different ways
6. Sensory stimulation (aka our experiences) can affect brain change when provided with at critical intensity and frequency over a span of time, for better or worse. With brain change, sensory processing can change.
7. The chicken or the egg? Dysfunctional sensory processing can lead to other problems such as inadequate sleep, attentional limitations, anxiety, emotional reactivity and motor skill deficits, and in turn, problems such as these can affect how sensory information is received.
8. Stress can interfere with sensory processing.
9. Oftentimes if someone is feeling the need to protect him/herself from a certain type of stimulation that isn’t comfortable or tolerable, discrimination of the qualities of the stimulation ultimately suffers.
10. Sensory processing affects the value of repetition. Repetition, which is a valuable tool for learning, is not true repetition if the stimulation taken in and responded to is processed differently from day to day.
11. Sensory processing can affect our awareness of and thoughts about ourselves, as well as our awareness and interaction with others and our surroundings.
12. Sensory processing dysfunction can exist without a known cause, yet it can also alongside other conditions, such as autism, ADHD, ADD, prematurity, it often subjectively appears to be genetically related, and can also be related to trauma.

Each occupational therapist at Pediatric Therapeutics is trained and experienced in the evaluation, treatment and management of sensory processing disorder. Interested in learning more about sensory processing disorder and other sensory based problems? Give us a call, or email and we’ll be in touch to answer your questions and direct you to resources.

–Sheila Allen, MA, OT

A Note from Griffen…


Earlier this month Griffen’s parents were checking his work for school (explain and relate to an assigned precept) and what they found sent them “over the moon”… It did the same for us, and we can only imagine what his teachers felt when they received it.  Sometimes the teacher isn’t giving the bonus points when assignments are completed, he/she gets them…the honest, trusting sharing of an appreciative student, not to mention an endearing and engaging fulfillment of an assignment.  Thanks to Griffen and his parents for allowing us to share this inspiring, heartfelt, unedited message he simply referred to as “homework”. 


“This precept means to me that you should never doubt yourself, like when you feel you can’t do something, but you actually can do it. I think you chose this precept because it can mean a lot to a child in a way that it feels like you feel it inside you. This precept can relate to my life because, honestly, I normally doubt myself in ways, like thinking I can’t do sports, but I can. It feels like a very honest thing to me, and I realize that I CAN BE GOOD ENOUGH and never give up.

I hope you understand everything I’ve told to you thus far, and I will try everything I can. I feel happier now that I told that to you, just got it off my chest. I feel…actually cheerful for once.

I love being your student, Mr. ____. Thank you SO much for doing teaching so well in ways even a kindergartner would understand (in a nice way, because your teaching are easy to understand and happy to work with), and I hope you continue this even when I’m in middle school. High school. COLLEGE. Thank you. Innovation is abound when you and Mrs. ___ teaches, and also Ms. _____ as well.

: D : D : D : D..wait, I’m going off topic, aren’t I?.. Sorry, I just answered all the questions and I’m not sure how to continue at this point, OK?

Thanks for teaching me so far. I feel happy. Sorry for doing this later than expected. When I wanted to do it on Thursday, my internet went down due to cleaners getting the Wi-Fi router wet. Had to wait until yesterday to get on the Internet. It was excruciating. At least my family went to Arturo’s (the pizza shop, Griffen recommends) the night before I got back on.

I hope you like this!

You’re a very nice teacher! (out of things to say at this point) (ONE MORE THING) It’s awesome that you teach. Is this too many lines for one answer now? Not sure.

I hope you’re having a nice day. Sorry about the situation you’re in, and that you can’t get much done. I hope you never give up, despite the situation.”

–Griffen, Age 10

Getting Back into the Swing of Things with School-Year Resolutions

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The morning air is crisp. Pencils are sharpened. Folders and papers are smooth and organized. And just like new shoes have a little room to grow, so do our lives in this back-to-school season. It’s time for a fresh start, and it’s the perfect time to set some school-year resolutions!
Resolutions made in January often come from reflection on a previous calendar year, and for many, might come from a source of unhappiness or stress, coming off a hectic holiday season. Individuals often want to make more drastic changes (e.g. “I’m going to lose 20 pounds, so I’m never eating sweets again!”). Those individual/personal resolutions might be somewhat easier to implement, but since families are already in the routine of the school year (with all their individual moving parts and schedules), it can be more challenging to make changes as a family unit. The summer season likely slows us all down a bit, giving us the ability to think more clearly, forecast and dream up our ideals for how we might want our lives to run when school starts again. And that time is here again, now.

The idea of school year resolutions isn’t a new one. In her book Happier at Home, Gretchen Rubin describes “September as the other January”, as she created her own “happiness project” that spanned only the months of school year. She stated, “September, for many people, marks a fresh start and a new beginning, so it’s good to think about changes to make with this clean slate.” To read more, go to, or to hear more, listen to her Happier podcast, Episode 129 with September is the Other January in the the title, at

A September 24, 2016 Wall Street Journal article by Anne Marie Chaker also speaks to school year resolutions in its title alone: September is the Real New Year: More than just back-to-school; people improve routines, consider career moves and join the gym.

And in 2015, Pearson and NBC teamed up to coordinate the School Year Resolution Program, which consisted of resolutions from thousands of parents, students, educators, grandparents, celebrities and public figures. Examples of such resolutions included

• “to help my children deal with their emotions”;

• “to get all my homework done before I watch YouTube, etc., and stop procrastinating so much.”

To read more examples and view video clips, click here!

As a pediatric occupational therapist, I am constantly thinking about the changes that are taking place in my clients’ schedules and lives and how I can best support them and their families during this transition to a new school year. Occupational therapists consider a person’s occupational profile, which consists of a “client’s history and experiences, patterns of daily living, interests, values and needs” to guide their practice (AOTA, 2014). Part of this profile includes analyzing performance patterns of engagement – routines, roles, habits and rituals – and how they change over time (like how they are changing now!), while also considering the environment, context and client/family’s goals. 
Take this opportunity to think about your family’s patterns in daily life, how they are shifting, and where opportunities for change come into play. As a parent of two school-age children, thoughts ranging from establishing ease in morning and bedtime routines, to the amount and variety of afterschool and weekend activities, to the nights we can be home to have dinner as a family, etc. replay each day in my mind. 

To set a resolution, think of an ideal or goal, and behind each a goal, think about the intention for that resolution to give further meaning to “why” you have set this goal. Consider individual roles, habits and rituals and how they influence each other.

Are your resolutions personal? Professional? Related to specific family members or your family as a whole?

Furthermore, are your resolutions measurable? e.g. Are you going to do this “new something” every day, or just on school/work days, or just on the days the kids have activities?

Two of my personal resolutions include:

• I will do some sort of fun, easy and helpful brain-based movement activity (such as a BrainGym activity) with my child(ren) before the school day at least 3 days a week.

• I will leave my phone in my purse when I arrive home until after all bags have been gone through and emptied, mail has been sorted and I have thoroughly checked in with everyone about their day. 
(intention- being present with my family, relationship building, organization and peace at home).

Some additional Pediatric Therapeutics therapists goals include:

One said,
“Mine – for myself and my kids is to have outfits picked out and lunch made the night before, for the next day.” The intention behind this resolution is “peaceful mornings and peace of mind- as well as a more restful sleep because it’s done.”

Another therapist said,
“I definitely think the beginning of the school year is a natural time for resolutions.  My “school year” resolutions for this fall – 1.) healthy, delicious dinners on the table by 7:15 at least 4:7 days 2.) no screentime after 9:30, with bedtime by 10:30 (my new year’s resolution; I did well for keeping it up for several months, but it slid in the spring…thanks to the beginning of the school year, I’m consciously back on it).”

Whatever YOUR school year resolutions might be, we hope they bring you and your families joy, peace and the fresh-start you are looking for. Please share them in the comments! We are here to support you and help you achieve them

–Liz Duffy, OT

The IEP Process Must Involve Parents!!!

The Individuals with Disabilities Education Improvement Act (IDEIA 2004) mandates that every child identified as having a disability and in need of special education services be provided an Individualized Education Program or IEP. Parents must be in included in the process of developing these plans and are considered members of the IEP team along with school personnel. Seven steps are involved in the IEP Process. These and the parents’ role and rights in each step are outlined below.

1. Pre-referral
This entails parents and school personnel working collaboratively to determine if general education teachers can appropriately address any educational or behavioral difficulties in the general or regular education classroom. Teachers may try different techniques and strategies, alter instructional delivery, and make accommodations tailored for the students. If concerns persist, a referral for a special education evaluation should occur.

2. Referral
A referral for evaluation may be generated through the process detailed above. Parents may also make a written request for an evaluation. In New Jersey the Child Study Team (CST) receives this written request. The CST is comprised of a Learning Disabilities Teacher-Consultant (LDT-C), a School Psychologist, and a School Social Worker.

Next, an Initial Evaluation Meeting to determine whether an evaluation is warranted is conducted within 20 calendar days of the receipt of the written request. At least one parent, the CST, and the student’s regular education teacher are required participants in this meeting. If this team determines that an evaluation is warranted, they will then plan the nature and scope of the evaluation. Parents must give written consent in order for the evaluation to proceed. If it is determined that an evaluation is not warranted, the team must delineate other appropriate actions to address the presenting concerns. Other participants may include a Speech and Language Pathologist, Occupational Therapist, Physical Therapist, and Behaviorist as these professionals may also be needed to evaluate areas of concern. Parents may invite other individuals to attend the meeting.

3. Evaluation
The CST and possibly some or all of the other professionals listed above will review records including existing evaluation data, attempted interventions, work samples, classroom-based assessments, teacher observations, and information provided by parents. The Initial Evaluation will consist of a multi-disciplinary assessment in all areas of suspected disability. At least two assessments must be performed by at least two CST members. A CST member, usually the School Social Worker, will conduct an interview with the student’s parents. A minimum of one structured observation by one CST member must also be performed. This can be in the general education classroom, or for a student of preschool age, an environment appropriate for that age.

The main purposes of the Initial Evaluation are:

• To determine whether the student has a disability under the New Jersey Special Education Code

• The present levels of academic and functional achievement and educational needs

• Whether the student needs special education and possibly additional therapy

• Provide a baseline of performance that informs the development of the IEP if the child is found eligible for special education

• Evaluation results will be used later to assess the efficacy of the IEP that was implemented

Parents must be provided with reports of the evaluations no more than 80 days after signing initial consent to perform them. A meeting to determine eligibility for special education must be convened no more than 90 days following initial consent.

4. Eligibility
If the evaluation process has identified that a student has a disability and the IEP team classifies that disability, an eligibility meeting is conducted. This meeting occurs following the discussion of the evaluation results. At this point the parents may sign that they either agree or disagree with the determination made from the evaluation process. If the parents agree, the participants immediately shift to an IEP Development meeting. If the parents do not wish to make a decision immediately they have the right to consider eligibility for 15 days and no IEP can be developed at that time. In this case a meeting would be rescheduled for approximately 15 days later.

Preschool children ages 3-5 may be eligible for special education if they meet New Jersey Code specific criteria: A 33% delay in one developmental area or a 25% delay in two or more developmental areas listed below.

• Physical, including gross motor, fine motor and sensory (vision and hearing)

• Intellectual

• Communication

• Social or Emotional

• Adaptive

A preschool child may also be eligible if they have an identified disabling condition, including vision and hearing, that adversely affects learning or development and that requires special education.

Within three years of the previous classification, reevaluation for eligibility for special education services is conducted. It can be conducted sooner if the student’s parent or teacher requests it. Parents also have the right to withhold consent for a reevaluation.

5. Development of the IEP
As mentioned above, the evaluations that were performed provide a baseline of performance that informs the development of the IEP.
Again, parents must be in included in the process of developing the IEP and are considered members of the IEP team along with school personnel. Parents meet with the school-based IEP team, and the child if appropriate, to develop measurable goals and short-term objectives or benchmarks which are driven by the child’s needs. The school-based team must include one general education teacher, one special education teacher, a representative of the school district, and someone to interpret the instructional implications of the assessment results. The interpretation of the instructional implications of the assessment results is usually done by the LDT-C. These implications are typically specified in the educational report that the parents have received prior to the meeting.

The team also determines what constellation of program or services are necessary to meet these needs. When developing the IEP the team must consider the strengths of the student as well as the concerns of the parents for enhancing the education of their child.

It is important to recognize that IEPs are binding legal documents. Five key principles must be adhered to:

I. The student’s needs must be met.

II. Whether services are available or not is not a determining factor as to whether or not they are contained in the IEP.

III. All IEP specified services must be provided.

IV. It is self-evident that INDIVIDUAL Education Programs, as specified in Federal and State Code, are intended to be individually formulated. No two students, even with the same disability category, have precisely the same needs or patterns of strengths and weaknesses. Cookie cutter templates or one size fits all constructs constitute a disservice to all stakeholders.

V. The contents of the IEP should be communicated to all school personnel who interact with the students. This includes the principal and other administrators, teachers, aides, specialists, school nurse, substitute teachers, and other relevant personnel.

It was my practice in the public schools to meet individually with all personnel to discuss each student, have them read the IEPS, and field any questions they might have. They were required to sign that they had read the IEPS and maintain a copy in a safe place for reference. Substitutes were also required to familiarize themselves with the IEPS and know of its’ location in the classroom. Particular attention was paid to the modifications and accommodations specified in the IEP for each student.

6. Implementation of the IEP

This is when service delivery commences. This should begin immediately upon the parents’ consent for implementation being obtained. IEPS may be amended or altered during the course of a school year prior to the annual review due to a variety of reasons. Most amendments do not require any additional meetings, just a parent’s signature. However, if it is proposed that any of the goals or objectives are to be amended, a meeting must be convened to discuss the change(s) before they can be instituted.

7. Annual Review
The student’s progress toward meeting the IEP goals and objectives is reviewed at a yearly meeting known as the Annual Review. Any goals and objectives that have been achieved should either be eliminated or revised with more demanding criteria substituted. Sometimes specific goals and objectives are no longer relevant as the student’s needs and/or program have changed. Thus deletion of these goals or objectives or a tweaking of them is necessary. Parental feedback is important in this process.

I have frequently observed that students’ performance in school can be much different than at home when doing homework. Not only academic performance, but also behaviors often vary considerably across these settings. Thus discussion of how to maximize outcomes across settings and fine tune communication between parents and school personnel is usually another important component of the annual review.

An additional key feature of the annual review is that a new program is developed. As students progress and grow the previous year’s decisions regarding placement and supportive services may not be optimal for the ensuing year. Sometimes more intensive special services may be necessary. In other instances it may be appropriate to diminish the degree of support due to documented progress and increased student independence. Another scenario is when a student has made great academic strides, has often become a strong self-advocate, and is functioning on or above grade level with little or no extra support from school personnel. These students are no longer in need of special education services. When this occurs it has been a source of deep satisfaction and pride for parents as well as for me as a professional.

–Scott Bagish, M.Ed., LDT-C

Anticipation & Anticipatory Behavior


Let’s face it: even though our presence in the moment seems to be encouraged nowadays more than ever, “the brain is all about anticipation and prediction”, as neuroscientist Josef Rauschecker, PhD has reminded us. (Rauschecker, 2009) From infancy we’ve been learning about relationships between sensory stimulation and our behavior, relationships rooted in pattern seeking and recognition that help us think ahead to events, prepare ourselves, and act in relation to those events which we expect to happen.

We may have thoughts about the upcoming solar eclipse, a summer get-away, special events on the calendar, what’s in store for the day, tonight’s dinner, tomorrow’s meeting, a new school year approaching, a pending responsibility, taking a shower, flushing a toilet, stepping onto a sidewalk, walking into a room, looking at that person, saying something to someone, a new video game, and so forth. The list of events we might ultimately anticipate is seemingly endless, ranging from something like a rare astronomical phenomenon such as the Great American Eclipse, also predicted to be an extraordinary visual experience for its viewers, to a mundane task such as putting on a shoe or climbing a flight of stairs. When we take action, prepared with and by our thoughts related to life events (aka sensory events), rather than the actual events themselves, we are engaging in “anticipatory behavior”. Whether in response to special circumstances or everyday life events, simple or complex, anticipatory behaviors can be adaptive (enabling the individual to meet environmental, situational, personal or interpersonal demands), or maladaptive (interfering with participation).

Prediction-> Expectation -> Anticipation
Synonymous with expectation, prediction, excitement or suspense in the English language, anticipation, in neuroscientific language and in the study of mind and cognition, is viewed a bit more distinctly. Giovanni Pezzulo, PhD, a researcher of cognitive processing, and his colleagues help us understand the distinction, and progression in time, between prediction, expectation and anticipation –

Prediction – a representation of a particular future event that the mind thinks will happen
Expectation – the mind thinks something will happen and somehow becomes prepared for it
Anticipation – a future –oriented action, decision or behavior based on a prediction; anticipatory behavior is directed toward events that are expected to happen, not toward events that are immediately present

“Neural clairvoyance”
Dr. Rauschecker refers to the brain activity when someone anticipates an act or sensory input that has yet to occur as “neural clairvoyance”. Studies conducted by him and his colleagues, have found prefrontal cortex and premotor cortex, basal ganglia and cerebellum to be involved in anticipation, acknowledging that anticipation involves strong activity in areas of brain responsible for preparing the body to move. The hippocampus, part of the limbic system involved with memory and spatial navigation, has also been found to be involved with anticipation (Fleisher, 2007).

Considering that anticipation and anticipatory behaviors are related to sensory input that has yet to occur, it is important to recognize ways in which disordered sensory processing could affect not only anticipation, but the prediction and expectation that are part of the progression. Here are three:

Studies on pain patients have identified greater likelihood of attention to and inferred threat from seemingly tolerable stimuli in patients with heightened anticipation of pain. (Lyoyd, 2016) This seems much like what is seen in the anticipation shown by individuals with sensitivities to sound, touch, movement, positions, taste and smells who demonstrate fear, increased protective instinct and reduced discriminative abilities. Their anticipation of an expectedly adverse stimulus, rather than the stimulus itself, has shaped their responses to the actual input.

If a prediction happens to be based on insufficient or unreliable sensory input and related memories, preparations and actions are likely to align with a fundamental misrepresentation of the given future event. Consider, for example, a child who is uncomfortable entering birthday parties due to his difficulty with novel, complex multi-sensory environments. This child’s anticipation of the birthday party will likely be related to his thought of going to a place that makes him uncomfortable rather than relating to a thought of a pleasurable event.

Lastly, if the anticipatory behavior ultimately interferes with successful participation, then the experiential or sensory basis for future adaptive anticipation would likely be further compromised. The individual stays “stuck”, or stereotypic, in his maladaptive response because that action, and the stimulus it provides, is what he has come to associate with the event. An example of this would be a child who regularly gets up and jumps during circle time as his turn approaches, rather than doing what is expected during a turn. His jumping with turn taking may have begun because it either helped him stay at the circle, it could have felt good at a time when he wasn’t sure of himself, or perhaps it began because he was excited about circle and his turn. While there is likely to be a self-regulatory basis to the jumping, what has naturally evolved is an inclination to jump during circle rather than engage in the given circle task.

The sensory-cognitive nature of anticipatory behaviors and the prediction and expectation involved with anticipation is worthy of our consideration when planning intervention. Steps taken to promote adaptive responses to life’s events assist not only with participation in an event that is actually taking place, they serve to shape the prediction, expectation and anticipation of future events. Why cast a shadow on someone’s shine unless it’s part of a glorious rhythm and alignment?

Sheila Allen, MA, OT

Fleischer, JG (2007) Neural correlates of anticipation in cerebellum, basal ganglia and hippocampus. In Butz MV, Siguard O, Baldassarre G, Pezzulo G (Eds.), Anticipatory Behavior in Adaptive Learning Systems: From Brains to Individual and Social Behavior. Lecture Notes in Artificial Intelligence, vol. 4520, 19-34.
Leaver AM, Van Lare J, Zielinski B, Halpern AR, Rauschecker, JP (2009) Brain activation during anticipation of sound sequences. Journal of Neuroscience 29, 2477-2485.
Lloyd D, Helbig T, Findlay G, Roberts N, Nurmikko T (2016) Brain areas involved in anticipation of clinically relevant pain in low back pain populations with high levels of pain behavior. Journal of Pain 17, 577-587.
Pezzulo G, Butz, MV, Castelfranchi C, Falcone R (2008) The challenge of anticipation: A unifying framework for the analysis and design of artificial cognitive systems as cited in

What We’re Reading: Summertime, Any Time


Pleasure, professional and current events reading, and the books our own children are reading – Pediatric Therapeutics readers do it all; everybody who works at Pediatric Therapeutics reads books, professional journals, and articles related to selected interests. Almost everybody reads magazines too. A few of us read poetry and there’s one short story reader among us.

With summertime reading often considered “leisure time” reading, we’ve compiled a Pediatric Therapeutics’ “picks” list for you, based on practitioner/staff recommendations, in case you’re searching for another good book or two.

The Letter, Kathryn Hughes
Almost Sisters, Joshilyn Jackson
Sometimes a Great Notion, Ken Kesey
A Natural Woman, Carole King
Animal, Vegetable, Miracle, Barbara Kingsolver
Twilight, Stephenie Meyer
The Way of the Peaceful Warrior, Dan Millman
The Gene, Siddhartha Mukherjee
Four Elements, John O’Donohue
You are a Badass: How to Stop Doubting Your Greatness and Start Living an Awesome Life, Jan Sincero
Girl Waits With Gun, Amy Stewart
A Gentleman of Moscow, Armor Towles


While most of us at Pediatric Therapeutics prefer our books and magazines in print, many of us routinely rely on digital media to help us stay informed and to inspire us in areas of self awareness and care. This trio of online resources, based on what some of us read ourselves, may include something that aligns with you and just may fit into your full schedule. – a subscription only online resource, with a 30 day limited free subscription, that delivers daily tips to optimize yourself, offers ideas from optimal living books distilled into pdfs & practical lessons and book suggestions, and provides “How to Live” classes – an online resource available by way of free subscription that covers breaking research and top science stories, covering a wide variety or topics and interests including health, medicine, neuroscience and more – available in print or online, by subscription, and covers news, current events, special interest stories, people, entertainment and more


Regardless of our professional reading responsibilities, interests and needs, reading for pleasure is a lifestyle choice. Oprah Winfrey has referred to books as her “pass to personal freedom”. Now, who wouldn’t take that pass if it was offered, or find a way to get one of those passes? That’s something to think about! You know that 15-20 minutes of reading most students are required to do daily? Maybe a “daily reading requirement” is, like “summer reading” is something that’s just the ticket for all of us at any age!

–Sheila Allen, MA, OT

How do I know if my preschooler is on target with his/her speech and language development?

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This is a frequently asked question and one that has many different answers. The range of “typical” is expansive but in general, there are developmental milestones and benchmarks SLPs look for and may include some of the following for 2, 3 and early 4 year olds:


• by 2 years, children begin to use more words than gestures and have a vocabulary of at least 50 words

• they begin to put 2 words together spontaneously

• they can demonstrate understanding of more than 300 words

• they can identify body parts when named and follow novel one step directions

• they can respond to yes/no questions with head shakes and nods

• speech intelligibility is quite variable, but 2 year olds typically can clearly articulate p, b, m, h and w


• by 3 years, a child may consistently use 3 word phrases when speaking

• they can begin to use pronouns and some direction words (on, in)

• 3 year olds follow 2 step directions (“pick up your coat and bring it to me”) and can identify action words and some basic concepts such as the functional use of objects (“what do you wear on your feet?”)

• many 3 year old are consistently understood by their caregivers and typically have a vocabulary of 200-500 words that are intelligible

• 3 year olds now add n, t, d, k, g, and sometimes f to their clearly articulated sounds


• by 4 years, children are beginning to follow more complex 3 step directions and demonstrate knowledge of primary colors

• they understand prepositions and enjoy listening to stories and may be able to begin to answer some who, what or where questions

• 4 year olds tend to combine words to form sentences of 5 words or even more and begin to ask many questions

• they may use more pronouns and possessives in their speech

• generally by the end of the 4th year children have added f and v consistently to their speech along with y, ing, l, some consonant blends, sh, ch and possibly r, s and z.

Often SLPs look for PATTERNS when assessing articulation or pronunciation abilities. These patterns are instrumental in determining when to intervene with targeting specific sounds and when to wait.

For any questions regarding speech and language development, we encourage conversations with pediatricians, developmentalists and speech-language pathologists.

–Anne Toolajian, MA, CCC-SLP

Our SLPs Share 4 Of Their Favorite Treatment Activities

At Pediatric Therapeutics, our Speech-Language Pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children. We work very closely with family members and frequently collaborate with physicians, school personnel and other health professionals to provide a unified approach to treatment. In asking our SLPs to share one of their favorite treatment activities, the responses are all varied and interesting with one common thread. Can you guess each therapist’s choice?

1. This therapist says one of her favorites is the Curious George Beach Discovery Game! All the kids enjoy it. She loves the versatility—she uses it to assist with multiple skills including articulation activities, memory skills, vocabulary building, turn taking, sequencing, direction-following and answering questions.


2. This therapist enjoys using her iPad with communication therapy apps. Among her favorites are those which allow the child to create something unique such as a story which they can then illustrate. There are apps with animation, sounds and visual input to assist with sound production skills and social stories which assist with social communication skills. She loves that her clients are empowered by the use of technology while staying focused on the goals of the session.


3. This therapist says Balloon Lagoon is one of her many favorites! The four stations allow for practice of a variety of skills including turn taking, vocabulary, matching, sorting, phonemic awareness, articulation, and much, much more. She and her friends can focus on any one or a combination of many skills. Kids love it because it’s just plain FUN!

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4. This therapist prefers toys where the emphasis is on eye contact, attention, interaction and reciprocity. Blocks are a favorite for their myriad uses in building skills and practice for every treatment goal. Whether improving vocabulary, listening skills, counting, articulation or verbal elaboration, building all kinds of structures requires a combination of skill and interaction. Versatility and FUN remain a common thread among us all!!


1. Karen Betheil
2. Maureen Harper
3. Terri Jones
4. Anne Toolajian

–Anne Toolajian, MA, CCC-SLP

Why are swings used in therapy?


Why are swings used in therapy?

When a person enters therapy it’s usually because something needs to change. Something is not occurring in response to the stimulation of everyday life and environments are as it should be; there’s a desired change that is in need of specialized help. A therapist helps create and hold the space for change, and orchestrates the specialized intervention that is needed to stimulate the desired change over a course of time.

Since movement is an essential part of life, it’s an essential consideration of therapy in one way or another. While the use of suspension equipment/swings in pediatric therapy was initially unique to sensory integration therapy, we now know enough about sensory integration and the value of movement to recognize that swings are useful in most types of pediatric therapy. Intentionally provided movement experiences can contribute to sensory, physical, emotional, cognitive, language and social changes that lead to improved function.

Swings are a primary way of providing intentional movement, or movement that is being provided with an express purpose. We sense our bodies moving whether we’re being moved passively, we’re moving ourselves, we’re moving movable objects, or we’re actually moving to move objects that move us. And we’re able to sense stillness. Sensation of movement or lack thereof, can come to our conscious awareness or can be processed subconsciously. The versatility of swings, and of certain swings in particular, is priceless when it comes to treatment planning, as most swings can be used in many ways in order to offer the desired type of movement. In fact, when each of the Pediatric Therapeutics OTs were asked about their “Big Room Favorite” (favorite piece of equipment in our sensory gym), each named a swing and mentioned versatility as a reason for their choice. Missy and Carrie both mentioned the many positions possible when swinging on the glider swing, even when weakness or lack of confidence may be an issue. Liz mentioned the endless possibilities for using the hammock (“superman”) swing for varied activities, from calming to intensively stimulating, working on weightbearing, strengthening, visual motor skills, directionality, and fine motor skills, while engaged in linear or rotational movement. Anne mentioned various aspects of postural control that can be addressed with the long cylindrical shape of the bolster or “horse” swing.

Our movement and position in space, and in relation to the pull of gravity is received by a part of the ear called the vestibular system, but the vestibular system is not the only system that gives us information about where we are, how we’re positioned and how/where we’re moving. Information from our muscles, joints, eyes, hearing part of the ears, skin, and nose also contribute to our awareness of our bodies in space. When we’re using swings we are able to easily and creatively incorporate other types of sensory input to increase awareness and discrimination related. The movement and positional information offered by swings can support our abilities to regulate our physical and emotional selves and to do what we need/want to do.

10 reasons we use swings:
1. Swings provide an opportunity for shared steady beat/rhythm that helps therapist and child, or one child and others, sync up with one another.
2. Swings are a way of enhancing positional and movement stimulation.
3. Swings can be easily adapted to meet sensory processing patterns and needs.
4. Swing movement can help activate muscles and muscle groups.
5. The rhythms of swing movement can be used to affect internal rhythms.
6. Swings can be used to work on timing.
7. Swings can be used to support the working relationships of midline, and the right and left sides of the body
8. Swing choice/use can be graded for working on balance.
9. Swings lend themselves to imaginative play and creative processes.
10.Movement stimulates vocalizing/speech and language.

Swinging can be fun! Ask to try out a swing in our Big Room…you’ll see why we use them all the time!

–Sheila Allen, MA, OT

It’s Time For a Pet. What Now?


We’ve decided it’s time to get a pet. What can you tell me about assistance dogs?

You’ve made the decision to get a pet! As if it’s not hard enough to decide upon what kind of animal would be the best pet for your child and your family, whether you want a specific breed or mix, and whether you want to establish a relationship with a breeder or go the rescue route, you also have the consideration of the specific role the pet will play in your child’s and family’s life and how official you’d like that role to be.

Most pet owners would agree that most pets have a therapeutic effect them and their loved ones. They would agree that their pets support & enrich their lives immeasurably. Yet most pets are not officially designated as “assistance”, “service” “companion”, “emotional support” or “therapy” pets. And to add to the mix (no pun intended!), there’s a distinct difference between registering and training these working animals. An assistance pet is one who provides some sort of assistance (i.e. service, companionship/emotional support) and a therapy pet or “pet therapist” is is an animal used in animal-assisted therapy or other activities to help a person work toward therapeutic goals. Animal training, if available, is strongly encouraged and often absolutely required.

To help you get started with your exploration of assistance pets, we have provided you with some resources. As you will see, as you begin your exploration, there is a good deal of information to review. Assistance Dogs International,, has been involved with setting standards for assistance dogs since 1987. This website provides a thorough review related to access and other laws. Certapet,, provides a nice review of laws related to emotional support animals, a group of assistance animals for which regulations seem less clear and training is generally not required.

When it comes to assistance pets, the organization we know best and regularly recommend is Canine Companions for Independence. Founded in 1975, Canine Companions for Independence® is a non-profit organization that enhances the lives of people with disabilities by providing highly trained assistance dogs free of charge and offering ongoing support to ensure quality partnerships. Learn more about Canine Companions and the four types of assistance dogs they raise, train and partner – service, hearing, facility and skilled companion dogs, at

Canine Partners for Life (CPL) is a another non-profit 501©(3) organization dedicated to training service dogs, home companion dogs, and residential companion dogs to assist individuals who have a wide range of physical and cognitive disabilities. In operation for over twenty years, Canine Partners for Life (CPL) envisions that the lives of those they serve will be forever changed through the opportunities and independence afforded by a steadfast relationship with a service or companion dog. They also provide seizure alert, diabetes alert and cardiac alert dogs. A suggested donation, on a sliding scale, is requested as part of partnership arrangements. Visit to find out more.

The Seeing Eye,, is a philanthropic organization whose mission is to enhance the independence, dignity, and self-confidence of blind people through the use of Seeing Eye®dogs. While the Seeing Eye is specific in its service to the blind, this organization may be of interest to you because of their adoption program for their puppies who do not go on to actually becoming full fledged Seeing Eye dogs.

Pet therapy is a desirable alternative for those whose families cannot have pets but would like to have their children develop a relationship with an animal that is loving and therapeutic in nature. Therapy Dogs International,, is a volunteer organization dedicated to regulating, testing and registration of therapy dogs and their volunteer handlers for the purpose of visiting those in need. Home visits can be arranged through TDI. Creature Comfort Pet Therapy, is a similar organization that provides facility-based visits. In addition to dogs, CCPT also works with other animals including cats and rabbits for animal assisted activities; a mini-horse has also been a part of their group.

While most of us are not likely to be able to have a horse at home as a pet, hippotherapy and equine assisted activities can meet a host of therapy objectives while also offering the opportunity to relate and care for a horse. Health and Recreation Through Horses, is a useful resource for equine organizations/stables/facilities. Rocking Horse Rehab,, is a pediatric rehabilitation and family wellness center located within an equestrian center. It specializes in equine assisted therapies along with alternative and traditional therapeutic programs. Over the years many children who receive Occupational, physical or speech/language therapy at Pediatric Therapeutics have been successfully involved in riding and other activities at Rocking Horse Rehab.

How many times have you heard somebody say that his/her pet makes him/her a better person? Given how often this is said, it’s a comment worthy of our attention, particularly when we’re looking for positive changes in one way or another! Your decision to get a pet and/or to explore various options that suit the needs of your child/family may very well be one of the best decisions you’ll ever make.

–Sheila Allen, MA, OT