Kids Making Strides
News From TLC's Pediatric Outpatient Services
What's New
Happy New Year from TLC’s Outpatient Occupational Therapy, Speech-Language Pathology, and Testing, Tutoring, and Counseling Departments. While 2020 challenged us in many ways, we not only survived, but thrived with exciting new virtual services across all departments! These virtual services continue in this new year along with our in-person sessions for therapies and evaluations. The PPE and social distancing will be with us a while longer, but will not prevent us from providing quality programs. With Spring around the corner, we will again offer free Occupational Therapy and Speech-Language screenings to families because early detection is the key to each child’s success. Stay tuned for exciting information on what Summer at TLC will include!

Brigid Baker
Director of TLC's Clinical Programs
Occupational Therapy Department
Indoor Family Fun: Active and Chill Edition
While the recent verdict from Punxsutawney Phil was six more weeks of winter, now is not the time to be idle! Cold weather and shorter daylight hours may cause us to be less energetic and motivated, but it is important for your family to stay active during the winter months! Even if that means inside. Or, bundle up for some outdoor adventures. The key is to emphasize and encourage physical activity in order to boost mental alertness, expend energy, and improve physical fitness.
Some ideas for indoor fun include:
  • A family push up, sit up, or plank contest, with prizes for the winner
  • A hula hoop contest
  • Shoot baskets with rolled socks and a laundry basket or empty box
  • Bowling game with empty water bottles or plastic cups
  • Create obstacle courses with household items (couch cushions, pillows)
  • Create a fun play list and have a dance party

More sedentary (but still fun) activities can include:
  • Bring snow inside. Fill a large bin or container with clean snow. Break out the sand toys to make snow castles or scoop snow with shovels into buckets. Fill spray bottles with colored water and spray to make “rainbow snow.” Use Mr. or Mrs. Potato Head pieces to make silly snowman heads
  • Make a snow volcano
Speech-Language Pathology Department
Book Recommendations
Books are an excellent way to build language skills with your child. These are some great books to curl up with on a blustery winter day. Many of these are books that TLC’s speech-language pathologists have used in therapy and are always a hit with our clients. Many are also available as read-alouds on YouTube for free. And don’t forget the hot chocolate! Hot chocolate bombs are delicious and fun to make with your child. Here is an easy Hot Chocolate Bomb recipe to make at home.
The First Day of Winter by Denise Fleming
In the Snow by Huy Voun Lee 
When This World Was New by DH Figueredo
  • The Mitten by Jan Brett
  • Snowy Day by Ezra Jack Keats
  • Lemonade in Winter by Emily Jenkins and G. Brian Karas
  • Bears Snores On by Karma Wilson
  • Good Morning Snow Plow by Deborah Bruss
  • Red Sled by Lita Judge
Feeding Therapy Department
What is Feeding Therapy?
At TLC, our goal is to make mealtimes an enjoyable experience for families.
Therapists work with children and their families to determine the cause of feeding challenges and to develop personalized plans to promote healthy eating habits.
Red Flags
  • Challenging mealtimes
  • Eats a limited range of foods, “picky eater”
  • Refuses entire foods groups
  • Takes longer than 30 minutes to eat
  • Has difficulty chewing foods

Why TLC Feeding Therapy?
  • SOS-trained therapists
  • Certified lactation consultant (CLC)
  • Evaluations/therapy for children infancy through school age
  • Parent education and training
  • Individual and group treatment
  • Spanish evaluations/therapy 

Common Contributing Factors to Feeding Problems:
  • Metabolic disorder
  • Constipation
  • Gastrointestinal or stomach pain
  • Gastroesophageal reflux
  • Cardiac Condition
  • Renal conditions
  • Absorption disorder

For more information including Tips for Picky Eaters, visit the TLC
Testing, Tutoring, and Counseling Department
5 Hidden Signs of ADHD
As a society, we have grown significantly in our knowledge and understanding of Attention-Deficit/Hyperactivity Disorder (ADHD). Most of us realize that ADHD involves attention difficulties and hyperactive behavior. But there are several other behaviors that are highly prevalent in children with ADHD that often go unnoticed or appear to be “bad behavior.” Understanding some of these ‘hidden’ signs can help parents understand their child’s behavior in a new context. 
A. Slow getting started on tasks
Children with ADHD often have difficulty initiating tasks and getting started on assignments. You might find them staring at a computer screen or a worksheet, unable to get started. While this may look like lapses in attention, children with ADHD often don’t know what their first step is. They may be thinking of all the steps together and feel overwhelmed. At home, this can also affect their ability to get started on chores or homework. Helping a child get started on the first step, will often lead to quicker completion times overall.
B. Difficulty with sequencing multi-step assignments
For a child with these difficulties, when asked to build a small city on poster board, they may see the first step as bringing down their Hot Wheel cars for the city. Children with difficulties related to ADHD often have trouble understanding how to properly sequence steps in the correct order. As a result, they may start in the middle of a task (e.g., building the city) and miss important first steps (e.g., writing down the steps, making a plan, listing needed materials.) These children will need explicit help with the sequential steps needed for activities for school or home.
C. Hyper-focus
A common question is how can individuals with ADHD be so focused on things of interest to them (e.g. video games) but lack focus for classwork or less engaging topics. The truth is, it’s easier for all of us to pay attention to our favorite TV show or movie, compared to an informational lecture on a topic we don’t care about. But for individuals with ADHD they can develop a hyper focus, in which they can focus exclusively on one activity and tune out all other activities. During this time, they are not easily distracted, don’t lose focus, and appear highly attentive. You will also notice they may struggle to transition away from that task and have emotional outbursts when required to transition away. These children need time to reduce their hyper-focus, to have a more successful transition away. 
D. Spending way too much time on a task, then getting frustrated that the task takes too long
Children with ADHD can be inefficient problems solvers. In addition, they may end up completing tasks in a novel, less efficient way. This process can make the task more interesting to them and keep their focus. However, these strategies often result in the task taking longer than needed. Children who are struggling with ADHD can become overly frustrated with the length of these tasks, even though teachers and parents realize it didn’t have to take them that long. When children do this, they aren’t trying to be difficult. They are often trying to make it more interesting, in order to keep hold their attention, or they simply don’t know the most effective approach. Helping a child be more efficient in their approach can reduce frustration. Children also may need a break when they become frustrated, before returning with more guidance around an efficient process.
E. Becoming quickly frustrated and upset about seemingly minor events
We often think of impulse control problems as someone blurting out answers without raising their hand. But impulse control skills also stop our emotional responses before they become overwhelming. If you’ve ever become way too upset about forgetting to bring your coffee on your drive to work, you know what it’s like to let your emotions run wild. Individuals with ADHD have a hard time reigning in hurt feelings or disappointment before it becomes overwhelming. It may seem overly dramatic to us, or intentional, but anger management is an executive functioning skill. It will be important to rule out more clinical implications of these behaviors (e.g., anxiety or depression) before making a determination that executive functioning skills are impaired. However, understanding the link between executive control and emotional control will go a long way in helping us support our children.

The classic hyperactive and inattentive symptoms of ADHD are incomplete without a more holistic understanding of the way children can experience executive dysfunction. These are just some of the associated behaviors, but they are often overlooked when thinking about ADHD. Understanding how these behaviors are related, and not simply indicative of “acting out” or “misbehaving,” can help us create strong strategies when working with our children. This allows us to use our executive functioning, to plan the best approaches and help our children be successful in school and in life. 
Led by an Occupational Therapist and
Speech-Language Pathologist
For children ages 4-10, we will offer both in-person and virtual program options. Camp will target gross motor, sensory processing, communication and social interaction skills in a fun and age-appropriate manner!

Stay tuned for updates about registration and other details by visiting TLC's social media pages and website.