Aggression, Tantrums and Refusal—Annoying and Frustrating but Treatable

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Dr. Scherbarth works with a child and his parent to help them understand and relate to each other better by building reasonable and enforceable limits.

The trifecta of terrible problem behavior in children is physical or verbal aggression, with tantrums and refusal to follow instructions. These symptoms are often consistent with the diagnosis of Oppositional Defiant Disorder (ODD). It is very annoying and frustrating for parents and peers—to say the least. Parents often try their best to manage it—including seeking out anger management for their child—but nothing they try seems to work. That said, ODD is entirely treatable by a clinician skilled in one of several Behavioral Parent Training programs.

ODD is a pattern of behavior for over six months that has three parts: a child or teen being argumentative in general or defiant when given instructions; the child being very angry and irritable most of the time; and at times the child may be vindictive and deliberately trying to make others angry. It can seem from the outside that the child is totally fine one minute and blows up the next minute. This appearance has led many people down the wrong path to think it’s bipolar disorder—especially when the tantrums last 45-90 minutes or when they are very destructive at home or school. However, bipolar disorder is a very different diagnosis.

ODD not only causes frustration in the moment for the parent and child, it also spreads throughout the family’s entire social life at all levels.

Parents of kids with ODD often do not want to go to stores or restaurants anymore for fear that something will set their child off. Parents may hear that other parents don’t want to set up play dates anymore. Schools may send these children home early because of the disruption they cause, or they may totally refuse to enroll these kids altogether. Kids with ODD often have little or no friends, and the friendships they do develop may be very conflicted. Clearly, it takes a serious toll on everyone and this toll creates resentment in the family towards the child and from the child back towards the family.

ODD typically emerges in younger childhood (before age 5). Without treatment, up to 2
5 percent of kids may lose ODD traits on their own; however it persists for many years in half of all kids, whereas the other 25 percent have behavior that starts to become downright cruel or even criminal in nature. With a total of 75 percent of kids with ODD having years of difficult or even criminal behavior ahead of them, it’s clearly to everyone’s advantage to seek treatment by a qualified therapist who goes beyond individual anger management counseling to also include some form of behavioral parent training.

There are a number of risk factors related to development of ODD (Barkley, 2013). Individual factors from the child include having ADHD, a mood/anxiety disorder or just an irritable temperament from birth. Parent factors include if they have ADHD themselves, irritable temperament, high stress due to a number of reasons and/or being young parents. Family social environmental factors include living in an area with a high crime rate, being influenced by delinquent peers, or having conflicted marriages or a conflictual extended family. How parents raise their children is one of the most important factors. Inconsistent parenting, highly negative parenting (or by contrast, low negative but also low discipline parenting), inappropriate expectations, as well as lack of monitoring of the child, and/or low positivity in parenting are all  risk factors.

At least one parent and the child engage in the Coercive Family Cycle (Patterson, 1982). A parent gives an instruction (possibly a harsh instruction or nearly impossible instruction), then the child reacts with negativity and both continue with negativity (yelling, harsh tone, possibly escalation to destruction) until one or the other gives up. It’s not healthy for the child, even if it “works” in the moment. Worst case scenario, the child gets away without having to do what they’re told and the negative behavior reinforced. In the “best case scenario,” the adult is able to force compliance BUT then the child learns the social lesson that to be respected in the family and society, that is that a child has to be big, loud, angry and bad. That’s not a very good outcome.

By contrast, Behavioral Parent Training (BPT) aims to make an impact by changing the parenting factors. It’s NOT about finding better ways to punish children more harshly. Rather, it has two aims—to improve warmth between parents and kids, as well as to build reasonable and enforceable limits. Warmth can be provided by making sure that there’s always positive interaction time and that when the child follows the instructions, good things happen—like acknowledgement and normal daily privileges. Limits include expectations that school work must be completed school work, children are expected to clean up after themselves to whatever extent that they can in relation to their age, destructiveness leads to consequences and rude or obnoxious behavior doesn’t pay off. The consequences for destruction shouldn’t be harsh, just consistent and providing for everyone’s safety.

Of course, BPT has limits. It only addresses the parenting factors. At times, the child’s individual factors (irritability, impulsivity) have to be addressed as well, possibly in conjunction with Cognitive Behavioral Therapy or anger management. However, anger management alone is insufficient. A course of treatment may take 3-6 months or even longer, depending on how longstanding the issues are and other factors. Therapy may require a lot of effort and be difficult at times, but it can’t be any more difficult than having these behaviors affecting the family for years or decades.

Behavioral Parent Training can allow the parents to enjoy their kids again, and kids to enjoy their parents. Contact Keystone Behavioral Pediatrics to learn more about how BPT can help.

Resources for Parents/Caregivers:

Centers for Disease Control

Mayo Institute

Child Development Institute

National Institute of Mental Health—DMDD

National Institute of Mental Health—Treatment of children with mental health issues in general

 

Macy’s Makes a Special Wish Come True at Thanksgiving for a Special Young Person

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Katie Falwell, CEO, hugs Sam LaManna, 14. She and other Keystone therapists have worked with Sam since he was six years old.

Sam LaManna is 14 years old and a student at Mainspring Academy a school for students with special needs. When he celebrated his birthday this past January, he had just one wish – to get an autograph from Macy’s Thanksgiving Day Parade Executive Producer, Amy Kule. Sam first saw Amy cut the ribbon at the parade a few years ago and she has been his hero ever since!

Sam’s mother had placenta previa, which caused birth trauma and low heart rate and oxygen levels for Sam. Five days after his birth, the doctors discovered that he had two intraventricular brain hemorrhages. Sam survived but now lives with hydrocephalus, the buildup of fluid in the cavities deep within the brain. The excess fluid increases the size of the cavities and puts pressure on the brain, which damages brain tissues and causes a large spectrum of impairments in brain function.

Macy’s has invited Sam and His Family to be Special Guests at the 90th Anniversary of its Thanksgiving Parade

Last year, with the help of his teacher, Sam made a video message asking Amy for her autograph. The video went viral, eventually Amy saw the video, and she was honored to make his wish come true. Not only did Amy send Sam an autograph, she made a video herself inviting his family, Sam and his former teacher to be her special guests at the 90th annual Macy’s Thanksgiving Day Parade! Amy and Al Roker, weather anchor on NBC’s Today and Sam’s other favorite person, have a special Thanksgiving Day planned for Sam.

Sam still attends Mainspring Academy, a private, nonprofit school located in Jacksonville’s Southside. The school opened in 2010 to serve children with a broad range of special needs from elementary through high school.

Sam also receives a number of therapies provided by Keystone Behavioral Pediatrics, which offers integrated healthcare for developmental, behavioral, emotional and learning issues. Using a collaborative team approach, more than 120 therapists are available to help children.

Sam’s lead therapist is Angela Chionchio. Keystone has worked with Sam since he was six years old. When his mother first brought Sam to Keystone in 2008, she described him as happy and affectionate, noting that he loved to read, learned quickly and had excellent memory. Yet, she was concerned that he was stubborn, easily distracted and developmentally delayed. He didn’t sit up until he was 13 months old and didn’t walk until he was 27 months old. Socially, Sam struggled to make friends and seemed disinterested and withdrawn around others.

According to Sam’s lead therapist, Angela Chionchio. “Sam has trouble with ‘first time listening,’ meaning he can be noncompliant when he impulsively sees an object that he wants play with but should not be available at the moment. In the classroom, his teacher and I prompt him to raise his hand to ask permission to do these things and offer him alternatives.”

Sam also has a problem with schedule change. “We help by preparing him for upcoming changes and praising him when he accepts change appropriately,” Angela says.

“Sam is doing great this year,” she says. His new classmates offer him opportunities to grow socially and behaviorally.

“When I asked Sam why he loved the parade so much, he said that it was because he loves when the producer cuts the ribbon at the start of the parade,” she laughs. “He said he also is very excited to see Santa Claus at the grand finale  and meet the host of the Today Show.”

“Sam is a wonderfully unique little guy,” his mom says. “I knew great things were inside him, but I needed Keystone’s help for Sam to bring out all that he has to offer the world.”

Sam’s trip to New York City is made even more special by the fact that his parents and he tried to visit the city last year, but had to cancel at the last minute because Sam needed emergency surgery. The IV shunt that was implanted in Sam’s brain unexpectedly quit working, so Sam had to endure hours of major surgery.

An implanted shunt diverts cerebrospinal fluid from the chambers within the brain to another body region where it will be absorbed. This creates an alternative route for removal of cerebrospinal fluid which is constantly produced within the brain and usually restores physiological balance.

Sam has blossomed under the therapy he receives at Keystone and in his classes at Mainspring Academy. All of us at Keystone and Mainspring are so excited for Sam that he has been able to achieve and even exceed his dream of getting autographs from Amy Kule and Al Roker.

“Sam is a wonderfully unique little guy,” his mom says. “I knew great things were inside him, but I needed Keystone’s help for Sam to bring out all that he has to offer the world.”

Sam’s trip to New York City is made even more special by the fact that his parents and he tried to visit the city last year, but had to cancel at the last minute because Sam needed emergency surgery. The IV shunt that was implanted in Sam’s brain unexpectedly quit working, so Sam had to endure hours of major surgery.

An implanted shunt diverts cerebrospinal fluid from the chambers within the brain to another body region where it will be absorbed. This creates an alternative route for removal of cerebrospinal fluid which is constantly produced within the brain and usually restores physiological balance.

Sam has blossomed under the therapy he receives at Keystone and in his classes at Mainspring Academy. All of us at Keystone and Mainspring are so excited for Sam that he has been able to achieve and even exceed his dream of getting autographs from Amy Kule and Al Roker.

Military Transitions Clinic Helps Children Cope

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Brian Ludden, director of the Military Transitions Clinic, is a licensed mental health counselor, national certified counselor and certified clinical mental health counselor.

Under the direction of Brian Ludden, MS, LMHC, NCC, CCMHC, Keystone’s Military Transitions Clinic focuses on those issues that are unique to service members and their families. Our experience with military families allows us to provide the support these families need through a variety of military-life transitions; for example, preparations for permanent changes of station, deployment readiness, deployment separation, reintegration, separation from the Armed Forces, and even death and loss.

Keystone’s proximity to Mayport Naval Station and Naval Air Station Jax (NAS Jax), as well as NAS Jax’s designation as an EFMP (Exceptional Family Member Program) provider makes us ideally situated to meet the mental health and behavioral health needs of Northeast Florida’s very mobile military service members and their families. The clinic uses evidence-based therapeutic practices to treat military-transition related concerns. Some of these therapies include Cognitive-Behavior Therapy, Rogerian Therapy, Family-Systems Therapy, and more. Keystone’s compassionate and caring clinicians acknowledge and va

Our highly trained, experienced and compassionate staff is eager to support and assist families through any and all transitions, struggles and successes they may experience, military related or not.

Common diagnoses include:

  • Separation Anxiety: The experience of inappropriately extreme or excessive fear or distress when separating from parents/caregivers or other major attachment figures or items in the child’s life. It can cause a reluctance to leave home or significant individuals, as well as causing nightmare, sleep disturbances and physical symptoms including headaches and stomachaches.
  • Generalized Anxiety Disorder: Uncontrollable worry about multiple situations, performance, social, academic and health; “what if” concerns that span far into the future, physical symptoms including headaches and stomachaches, inability to unwind, low risk-taking and needing constant reassurance
  • Major Depressive Disorder: A significant depressed mood, loss of interest in pleasure and activities, or both, nearly every day. It can impact appetite, sleep, concentration and cognitive function, and reflexes.
  • Adjustment Disorder: Emotional or behavioral issues in relation to an identifiable stressor. Stressors can include changing schools, moving, parental separation, loss of friendships, and more and can be accompanied by depression, anxiety and conduct issues.
  • Posttraumatic Stress Disorder (PTSD): For children of military service members, learning that their parent/sibling/loved-one has been involved in a traumatic event can be enough for them to experience PTSD symptoms. It is characterized by intrusive thoughts of the event; hypervigilance; extreme avoidance of distressing thoughts, memories, or feelings about the event; frightening dreams; problems with concentration; sleep disturbances; irritability, and more.

Before joining Keystone, Brian spent three years working as a mental health counselor in Clay County School in northeast Florida as the county’s Military Connected Student Support Specialist, where he provided counseling support for military families and children coping with transitions, deployments, separations and grief.  Brian’s primary experience has been in supporting and assisting children with anxiety disorders through art therapy and guided visualization, as well as intensive cognitive behavior therapy and exposure and response prevention. 

Brian is a licensed mental health counselor, national certified counselor and certified clinical mental health counselor with a Master of Science degree in clinical mental health counseling from the University of North Florida.  He is currently a doctoral candidate in educational leadership at UNF and will be defending his dissertation later this year, with a focus on the availability of adolescent mental health services in urban public school settings. 

In addition to serving as director of Keystone’s Military Transitions Clinic, Brian serves as the director of the Anxiety and OCD Clinic and provides mental health counseling and support to children and their families.  Additionally, he provides supervision to master’s level mental health interns seeking to gain experience in the field of counseling.

Resources for Parents/Caregivers:

Military Child Education Coalition (MCEC)

Tutor.com for U.S. Military Families – Free Academic Tutoring for Dependents of Active Duty Service Members

Military Connect – “Connect with Kids Like You”

Keystone CEO Recognized for Integrated Healthcare

Keystone CEO Katherine Falwell, Ph.D. and clinical psychologist, was recognized in a recent issue of the Ponte Vedra Recorder for her efforts to help children with integrated healthcare that focuses on all areas of behavioral, developmental, socio-emotional and learning services provided by Keystone Behavioral Pediatrics, which Dr. Falwell founded in 2008.

The article chronicled the path that led Dr. Falwell to open Keystone, starting with her postdoctoral residency at the University of Florida, where Dr. Falwell became part of the faculty at University of Florida in the Department of Behavior Analysis. She became aware that Northeast Florida needed more comprehensive pediatric services than it had available at the time to meet the growing numbers of children with unique needs and took the opportunity to open Keystone Behavioral Pediatrics in 2008 to further her idea of collaborative, integrated healthcare.

Keystone provides Integrated Healthcare that Focuses on All Areas of Behavioral, Developmental, Socio-Emotional and Learning Services

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Katie Falwell (far right), in addition to her passion for helping children become successful, is also devoted to her family and northeast Florida beaches community.

Next, Dr. Falwell opened Keystone Child Development Center in 2013, because she believes passionately in research that supports the importance of providing individualized instruction and support as early as possible in a young child’s life. She designed KCDC to focus on all aspects of a child – mind, body and soul – to offer children the best opportunity for success in elementary school and throughout life.

In response to the paper’s question about her focus on early intervention, Dr. Falwell notes, “All children learn and grow at different rates. These first five years of a child’s life are filled with major developmental milestones that prepare them for lifelong learning.” She refers to research which shows that 90 percent of a child’s brain is developed by age 5.

Research also confirms that getting help early can lead to the best outcomes for kids. Developmental, learning, behavioral and social-emotional issues are estimated to affect one in every six children. Because these issues are often very subtle in young children, only 20 to 30 percent are identified as needing help before kindergarten.

The article described Keystone’s new Right from the Start Clinic designed to help parents know whether their baby would benefit from early intervention to solve or alleviate any issues before they become problematic. The Right from the Start clinic is a free screening clinic for children between the ages of one month and 5-1/2 years old. Parents can complete a free questionnaire online by clicking on the ASQ logo on our website. The questionnaire gives Keystone therapists an idea of areas of a child’s development that are of concern to the child’s parents. A client care coordinator contacts the parents after the clinic receives their completed survey and invites them to visit Keystone for a free multidisciplinary screening evaluation to assess their child’s developmental progress. Parents will meet with clinicians from Keystone’s psychology, occupational therapy and speech language departments, as well as a pediatrician. At the end of the visit, they will receive information on how their child is doing developmentally, with suggestions to target any areas of need that have been identified.

Keystone Behavioral Pediatrics, located in Jacksonville, Duval County, northeast Florida, offers integrated healthcare by a collaborative, interdisciplinary team of 130 child psychologists, mental health counselors, social workers, behavior analysts and technicians, speech and language pathologists, occupational therapists, teachers, and pediatrician working in 17 specialized clinics. The focus is on early intervention regarding health and wellness, the whole child and all issues that affect a child’s potential for success including physical, developmental, learning, behavioral and social-emotional issues.

Keystone works with children from one month old to 22 years old on all types of behavioral, developmental, socio-emotional, physical and learning issues in four types of clinics: assessment clinics (Neuropsychological, Attention Deficit Hyperactivity Disorder (ADHD), Health and Wellness and Educational and Learning), developmental clinics (Autism and Developmental, Right from the Start, Early Intervention and Day Treatment); Rehabilitative Clinics (Feeding, Occupational Therapy and Speech and Language); and Treatment Clinics (Parent-Child Interaction Therapy, Anxiety and Obsessive Compulsive Disorders (OCD), Disruptive Behavior and Mood).

Keystone Child Development Center offers safe, nurturing and stimulating preschool and early intervention services from infancy through kindergarten. We have a minimum of two teachers in each classroom and a child development team that works with the teachers to focus on intellectual, social and behavioral success for each child. With maximum class sizes of 12, KCDC is able to create individualized learning plans.

Behavior Therapy Education for Police Reduces Misunderstandings

By Matthew J. Delaney, MSW, BCBA

Director of Applied Behavior Analysis

If you have tuned into the news recently, you are well aware of the behavior therapist in Miami who was shot by law enforcement as he was trying to bring his client who has autism back to the group home from which he had wandered. The video footage going viral on social media shows a behavior therapist with his hands up pleading with the man with autism to remain still and to lie down on the ground for fear that the police will shoot if he does not comply. The 23 year-old man with autism holding a toy truck continues to rock back and forth not adhering to the therapist’s request.

The fact that the individual did not comply with the demands of his therapist, and likely the demands of law enforcement, placed him at significant risk for harm. While many details will come out in the next few days regarding this unfortunate event, I think it is a great opportunity to spark discussion about the need for greater collaboration’ between behavior analysts and our law enforcement community in an effort to prevent events like this from reoccurring.

The Substance Abuse and Mental Health Services Administration funded a global initiative called Mental Health First Aid. The premise behind this initiative is that if an individual had a heart attack in a public venue, it is likely a witness in the community could come and provide CPR. However, if an individual was contemplating suicide or having a panic attack, the odds are less likely that a bystander would know how to adequately respond. These trainings are open to anyone, but are particularly marketed toward law enforcement and our first responders.

While this initiative is meeting a huge need within the mental health community, it does not address information and techniques specific to individuals with autism and related disorders. Similar to this initiative, there is an urgent need for behavior analysts to partner with first responders to provide training on the many presentations of autism symptoms and train law enforcement agencies on ways to interact with individuals who may have autism or related disorders that protects them from further escalation or harm.

Keystone Behavioral Pediatrics is eager to partner with law enforcement and other first responders in the Jacksonville community. We will provide educational training sessions as a community service to help empower these professionals with the tools and knowledge necessary to work with individuals with autism and related disorders.

We take seriously our role as advocates for the children and young adults we serve, and, in that role, we hope to build lasting partnerships with Jacksonville’s first responders and be a community resource for education and training on working with individuals with autism and related disorders.

You may contact Matt Delaney, 904.619.6071, delaney@keystonebehavioral.com, to discuss a potential educational training session or other ways that we may be helpful.

Free developmental screenings target birth to five years

Keystone Behavioral Pediatrics will open a new Right from the Start Clinic beginning Aug. 2. The clinic is offering community infants and toddlers from birth to age 5 free comprehensive screenings to help parents identify as early as possible any physical or developmental issues that children may have. Study after study has shown that the earlier a delay is recognized and intervention is begun, the better chance a child has to substantially improve. Developmental screening is one of the best things you can do to ensure a child’s success in school and life.

Parents are invited to contact Keystone for a login code to complete a FREE online screening tool, part of the Ages and Stages Assessment and Toolkit. The screening involves answering a series of simple questions regarding their kid’s abilities (for example, “Does your child climb on an object such as a chair to reach something he wants?” or “When your child wants something does she tell you by pointing to it?”).

Keystone Behavioral Pediatrics' Right from the Start Clinic identifies early developmental and behavioral delays.
Keystone founder and CEO Katie Falwell, Ph.D., works with young children to identify developmental delays and issues as early as possible to correct them before children start school.

Parents’ answers to the screening go directly to Keystone for therapists to identify any possible concerns. Then, parents are scheduled to bring their child in for a 1-hour session that includes free screenings by a licensed child psychologist, pediatric occupational therapist, pediatric speech/language therapist and pediatrician trained in developmental growth. Each of these four disciplines will give parents a “report card” with green, yellow or red light results. A green light means that the child is on track with peers, yellow means that there are slight indications of a developmental or behavioral delay compared to peers that parents will be advised to watch closely, and red means that a definite delay has been identified and should be addressed by professional therapy immediately so that the child is prepared for elementary school.

For children who receive a green light, the screening reassures their parents. Parents of a child who receives a red light report will be given recommendations of next steps that they may want to take on how to get the intervention services they need. All parents who participate will have access to a number of free resources about developmental stages to anticipate and ways to help their child.

To further encourage parents to get their infant a developmental check-up as early as possible, Keystone is offering FREE on-site first birthday screenings (by appointment on Tuesdays beginning Aug. 2, 2016). These screenings look for physical, developmental and behavioral delays, beyond what pediatricians typically monitor at a child’s 1-year well visit. Local pediatric health providers and daycare providers may contact 904.619.6071 or info@keystonebehavioral.com to request free Happy First Birthday postcards to give to their parents with 1-year-old children.

Parents of children from birth to age 5 should call Keystone Behavioral Pediatrics, 904.619.6071, to receive a log-in code to complete the Ages & Stages Questionnaire, which will be accessed on Keystone’s website, www.keystonebehavioral.com.

Background

Keystone Behavioral Pediatrics offers integrated healthcare by a team of highly educated child psychologists, behavior therapists, occupational therapists, speech/language therapists, feeding therapists and a medical director who lead the 120-person staff in collaborating to bring the best resources for addressing behavioral, developmental and physical issues in children. It offers one stop services to parents plus collaboration is the most effective way to address interactive issues that children often have. The organization is led by Katie Falwell, Ph.D. and a Florida licensed psychologist who specializes in child development. 

The American Academy of Pediatrics (AAP) recommends that all infants and young children be screened for delays as a regular part of their ongoing health care. Research shows that addressing these issues in children before they start elementary school can produce significant gains in language and mental abilities, improve their social communication and correct any physical delays or impairments before they become disabling. Because these issues are subtle in young children, most children who would benefit from early intervention are not identified until after they start school. 

As the National Academy of Sciences stated in From Neurons to Neighborhoods, “Compensating for missed opportunities, such as the failure to detect early difficulties or the lack of exposure to environments rich in language, often requires extensive intervention, if not heroic efforts, later in life.” 

Developmental delays, learning disorders and behavioral and social-emotional problems are estimated to affect 1 in every 6 children, yet only 20-30 percent of these children are identified as needing help before school begins. Identifying these issues prior to children starting kindergarten has huge academic, social and economic benefits. Studies have proven that children who receive early treatment for developmental delays are more likely to graduate from high school, hold jobs, live independently and avoid teen pregnancy, delinquency and violent crime which results in saving to society of about $30,000 to $100,000 per child. Plus, getting help with these issues as early in a child’s life as possible improves quality of life and reduces stress for the whole family.

Keystone discusses child behavior disorders in Jacksonville publication

Child behavior disorders such as oppositional defiant disorder (ODD) and childhood apraxia of speech (CAS) were the topics discussed in Jax4Kids.com‘s November 2015 issue by Dr. Andrew Scherbarth, clinical child psychologist, and Kaitlyn Kludjian Shrum, a licensed speech pathologist, part of Keystone Behavioral Pediatric’s integrative team in Jacksonville, Florida.

In his article, Andrew acknowledges that ODD symptoms such as aggression, tantrums and refusal are annoying and frustrating for parents and peers. But, he also reassures parents that ODD “is entirely treatable by a clinician skilled in one of several Behavioral Parent Training programs.” BPT is effective in changing the parental factors in the Coercive Family Cycle that develops in families with a child experiencing ODD. The cycle consists of a parent who gives an instruction to which the child reacts negatively, and then both the parents and child proceed with increased negativity until one or the other gives up.

Kaitlyn discusses the struggle that children with childhood apraxia of speech face of knowing what they want to say but not being able to get the words to come out right. She points out that the first step in determining if a child has apraxia of speech is to rule out normal, but delayed, development through an evaluation by an ASHA certified speech language pathologist (SLP). If a differential diagnosis is made, the SLP will determine the best course of treatment.

Read the articles at http://bit.ly/1RLPTIw to learn more.

Aggression storyApraxia story

Grant funds new sensory garden

Keystone Behavioral Services has broken ground on a new sensory garden, with a grant it was awarded March 2015 from the HEAL Foundation. The garden is the vision of Sam Bean, MOTR/L, assistant director of Keystone’s Occupational Therapy Department, and Dawn Berg, BCaBA, director of the Feeding Disorders Department, who wanted an outdoor space for the children and community that would enhance learning and therapy.

Staff has been busy clearing the land and building retaining walls for the new Keystone Sensory Garden.
Staff has been busy clearing the land and building retaining walls for the new Keystone Sensory Garden.

Staff volunteers have begun clearing land and building retaining walls. Next the staff will prepare the soil and choose plants that will appeal to all five senses. The goal is to have Keystone Sensory Garden planted and growing sometime this summer to offer a richer and more therapeutic experience to children with special needs.

“A sensory garden offers the children we serve many benefits,” Berg. “The children take pride in their work and gain a sense of responsibility, plus working in the garden helps reduce stress, anxiety and frustration. It’s a natural learning environment,” she said.

The garden enhances math, science, health, writing/language arts and social studies concepts taught in Keystone Child Development Center and Keystone Academy students.

It also offers therapeutic value for all children served by Keystone Behavioral Services, many of whom face behavioral challenges such as ADHD, autism, cerebral palsy, speech/language disorders, Down Syndrome, feeding disorders, or brain injury, for example.

“The children have been very curious about the garden,” Bean said. “Their education has been inside and in a relatively sterile environment, so we’re all very excited that they will be able to interact with nature and learn outside.”

“In addition to improving fine and gross motor skills, working in the garden encourages communication and increases social skills. One student even went out of his way to thank the volunteers for helping in the garden,” Bean said.

Four types of plants will be included in the Keystone Sensory Garden: tactile plants such as Touch Me Not with leaves that fold inward and droop when touched or shaken and Lamb’s Ear with a silvery grey foliage that is soft and fuzzy; olfactory plants such as rosemary and cilantro; visual plants such as hibiscus and coleus; and gustatory plants such as lemons and peppers. Staff hopes to add special features such as wind chimes, a birdhouse, hummingbird feeder and a water feature.

The concept of a sensory garden is based on clinical research. One article, “Gardening as therapy for children with behavioral disorders” written by Marilyn McGinnis, BSN, RN, and published in the Vol. 2, Issue 3, pages 87-91, September 1989 issue of Journal of Child and Adolescent Psychiatric Nursing, reports that in addition to the physical benefits the children received from the garden, they also were able to discuss “feelings of fear, sadness, abandonment and pride, as well as family issues” (91).