nuture shock

Relational Aggression

We want our children to have friends. We also want them to have pleasant interactions even with kids who aren’t necessarily their friends. We also don’t want our children to be bullied or to bully others.

There has been a lot of talk about bullying lately and although I work with children every day, even I am become weary of the subject. However, I recently read a book that put a slightly different spin on bullying. Nurture Shock: New Thinking About Children by Po Bronson and Ashley Merryman discusses many aspects of child development based on new research presented in a very accessible manner. The chapter titled, “Plays Well With Others” was particularly poignant. The authors discuss 3 types of child-on-child aggression that is prevalent among young children in our society. Physical and verbal aggression are familiar to all of us. The third type of aggression is relational aggression. In pre-school age children, relational aggression involves saying things like, “You can’t play with us” or ignoring children who want to play. Did you ever think of that as aggression? I hadn’t but it makes sense. Children with social cognition challenges want to play
and talk with peers. Being ignored or left out of play can have long-lasting effects.

We posed the following question to our 5 and 6 year old kids in the Social Adventures group.  “What do you do if you ask someone if you can play with them and they say, ‘No’ “? The answers included:

– “Say, ‘Please, please, please, PLEASE’ ”
– “Run away”
– “Say, ‘You can’t make me leave!’ ”

As we role played alternative responses we found the children we were coaching to say “No” didn’t know how to say no in a kind way. So, we worked on that as well.

The beautiful thing is that you could practically see their self-esteem meters rising as we worked on how to say ”No” and how to respond to “No”. The kids learned to tell each other to come back later and the ones who were gently rejected in this way, went on to play with others. Happily, this little exercise transferred to the playground time and we witnessed kids being more relaxed about the freedom to say “No” without worrying about being mean. Kindness begets kindness. We witnessed little relational aggression that day. Hopefully, the kids went home with another tool in their box to help them experience more positive social interactions.

submitted by:  Jill Perry, MHA, MS, OTR/L

sensational kids

Helping Kids Through Tantrums


Helping Children Through Tantrums In the Moment

Parents often ask what can be done when their sensitive child is having a full-blown tantrum.  I have worked with many wonderful families who implement sensory diets, use visual schedules, and write social stories to try to cover all bases.  Yet…life happens, unexpected events abound, and kids tantrum.

Dr. Lucy Jane Miller has provided a wealth of information about sensory processing disorders through relentless research and advocacy.  She is committed to educating parents so they can practice clinical reasoning in their own unique situations.  In her book, Sensational Kids, Dr. Miller offers these respectful words:  “One of the desires nearly all parents voice for therapy is for strategies to improve daily life with their sensational kids.  A toolbox of techniques for specific priorities is indispensable, but parents also need broader strategies to help them address sensory and behavioral issues that can be variable, contradictory, and baffling.”

Dr. Miller created the acronym, A SECRET, to provide parents a way to remember and implement the fundamentals of clinical reasoning in their everyday lives.  Families need a flexible way of considering their child’s personality, temperament, needs, and context in order to find effective ways to manage melt downs.

A SECRET includes seven elements.  The first three elements are individual characteristics that influence the child internally.  The last four elements are contextual and influence the child externally.  This is an elastic strategy that can be used with children of any age.  When your child tantrums, ask yourself the following questions:



Attention Is there a way I can draw my child’s attention away from his anxiety?
Sensation Is there a sensation that is alarming my child right now?  If so, what is it and can it be modified?  Can I use another sensation to override the alarming one?
Emotion What emotion is my child experiencing and what techniques do I know that work best when he feels this way?
Culture What part of the culture of this activity can be changed to avoid situations like this in the future?
Relationship Is there something in my child’s relationship with me or someone else right now that is causing him to act a certain way?  What can I do about it?
Environment What in the environment is setting my child off?  How can I change it?
Task What is troubling my child about the task at hand?  How can the task be modified so that it is not so problematic for my child?


If your child is currently treated by an occupational therapist, discussions with that clinician will help you better understand and use A SECRET in your everyday lives.


Jill Perry MHA MS, OTR/L


Miller, Lucy Jane. 2006. Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD). G.P. Putnam’s Sons. New York, New York.


Sensory Processing Disorder Foundation:

kids journal

Kid’s Journal Brings Therapy Home!

When I talk with parents after therapy, I focus on goal areas, skill building, and home activity suggestions.  While that is a good thing, parents don’t hear much about the specific activities that were done in therapy.   My young clients often lack the memory, language capability or sequencing skills sufficient to tell their parents what they did and how they felt during therapy.  The Kid’s Journal app is a great way to wrap up sessions with young clients and a useful tool for communicating specifics about the session with parents and caregivers. 

My favorite features:

Kids record feelings.  Only 5 different expressions are provided but I find this is OK for kids who are under 6 years of age.  I use this as a reflective tool to discuss how angry the child may have been when she struggled with an activity but how happy she was when she accomplished it.  It’s important for kids to realize that frustration and anger may be experienced when they are learning a new skill but they must still push through to find the joy of success.

One picture or image can be imported onto the page.  We take the picture during the session or find a picture from my photo library that fits the day.  The visual image is helpful and appealing, especially when kids can’t read or write.

There is a very small space (6 lines) for recording “What did I do today?”  I see many kids who are hesitant to write and intimidated by large spaces.  These small, simple lines actually pull kids in to type a little.  If they dictate and I type, they need to think about the session and be clear and concise.

The entry can be exported to ibooks and then e-mailed directly to parents.  This has been a nice feature that encourages kids to talk with parents about their session when they get home.

The journals are saved and a calendar button allows you to go back and review previous entries.

This app is so simple and easy to use!

My not-so-favorite feature:  There are only 3 environments from which to choose – “home”, “school”, and “away”.  I wish there was another option so OT, PT or speech-language sessions could be differentiated from school or home.  A palm tree is the icon that represents the “away” button.  (I don’t think many kids think of OT as a vacation!).  

In conclusion, as an OT who looks for simplicity in apps and opportunities to help kids reflect, the Kid’s Journal app works great!

by Jill Perry, MHA, MS, OTR/L


Speaking of Apraxia

Title: Speaking of Apraxia: A Parents’ Guide to Childhood Apraxia of Speech

I feel fortunate to be able to review this book. Leslie A. Lindsay, R.N, B.S.N., the author of this book, and mother of a child with Childhood Apraxia of Speech (CAS) reached out to us to potentially read and review her book. I’m so glad that she did. I have found a wonderful resource that I will be recommending to parents and other professionals for years to come.

Leslie’s book combines parent perspectives (her own and others’ with children with CAS), the latest academic and medical research, as well as CAS professionals such as SLP’s perspectives. I love her clear writing style, and the way she organized the book. Each chapter has highlighted parent questions/”real life” stories,  the “nuts and bolts” of each chapter, a chapter summary, and extensive “Read on!” Recommended Resources, where she offers additional supports such as books, videos, websites, and even individual professionals with expertise. As a professional, I have found this extremely helpful and thorough.

One section I particularly love, and will be referring many parents to (both with and without a diagnosis of CAS), is the section she labels “Doctors and Specialists” (pg 37-41). Here she offers clear descriptions of the many professionals that can be involved in a child’s care. I find that these “titles” can be overwhelming and confusing to parents (and professionals alike). She lists the professionals  (i.e. Pediatrician M.D, Pediatric Neurologist, Development Pediatrician, Pediatric Physiatrist, Child Psychologist, etc.) and offers clear descriptions of their individual roles, which would help parents who are seeking a diagnosis or support for their child. There is also an extensive list of school professionals (pg 230-232) and descriptions (i.e. Special education Coordinator, Occupational Therapist, Social Worker, etc). Additionally, in this chapter she helps parents through the Individualized Education Plan (IEP), and how best to support your child in the classroom.

Leslie also offers supports for parents who want to help at home. She titles a chapter “What you can do at Home” Tapping into Your Inner Speech Pathologist. In this section, she offers specific suggestions for parents for activities they can do to help their child “make progress in a fun and nurturing speech-rich environment at home and on the go.” I found this section to be wonderful to refer parents to. Parents ALWAYS want suggestions for home, and this is a great chapter on ideas. Again, these suggestions would be wonderful for any parent who is looking for ways to create a language rich environment for their child. She offers activities, books, arts and crafts, and toy recommendations. As a therapist, she offered some great ideas for me too.

The resources in this book are endless. I have only touched the surface of all that Leslie offers. She breaks down this complex disorder into understandable, manageable sections.  I have found myself referring to it constantly for ideas, supports for parents, and overall perspective. Her writing style is easy to read, informative, realistic, and organized. She provides a wealth of knowledge for parents and professionals. I am thrilled to share this resource though our all4mychild network, and at the clinic. I wish I had found this sooner. Thank you Leslie for this opportunity, and for your extensive knowledge on this important and at times misunderstood disorder.

  • Leslie is a parent blogger (and former nurse) on top of being a writer and parent of a child with CAS who offers great resources on her blog. Read it here
  • For more information. Check out this review of the book and more through discussion of CAS from @SpeechLadyJen Jennifer Hattfield, SLP)  at Therapy and Learning Services, Inc. Blog Radio Post

Submitted by Meghan G. Graham M.S. CCC-SLP

Please support books4all and order this book from

let know

The Power of Social Catch Phrases

I have been coordinating the Social Adventures Group Program at Children’s Therapy Associates in Natick, MA for nearly 15 years.  As coordinator, I have spoken with hundreds of families looking for support for their children with social challenges.  While some of these children have ASD diagnoses, others have been diagnosed with ADHD, NLD, or social anxiety.  Most of the children we serve struggle socially in spite of relatively intact receptive and expressive language abilities.  These kids (ages 3-10) learn best by doing. When asked, they can usually tell you what they are supposed to do in a given situation, but they aren’t accessing that knowledge “in the moment.” In response, we have developed a strategy that we have found to be incredibly effective:  Social Catch Phrases.

Over the years, as I have talked to parents, several common areas of challenge have surfaced.  The areas that they feel are most disruptive to their child’s social success revolve around:

  • Poor initiation skills
  • Reduced reciprocity
  • Being inflexible / bossy
  • Difficulty managing change/ frustration
  • Not tuning into nonverbal cues
  • Poor body space awareness
  • Being too literal/ misinterpreting feedback from friends

For each of these areas of difficulty, we have developed Social Catch Phrases along with activities to introduce and practice them.   One of the catch phrases that we use in each and every group is Let Them Know.  We have found that many, many, many of the kids we see tend to only respond to peers if the topic somehow relates to them (and even that is iffy).  They either respond with “I … “ or they simply stare blankly (or are completely distracted by something else entirely).  As social interaction is built on reciprocity, we spend quite a bit of group time reinforcing the importance of letting friends know we are listening.  We role play what it looks like when kids don’t respond and when they do; we play games which give kids a chance to practice a variety of responses from a simple nod to an enthusiastic, “wow!” to asking a probing question; and then, we use the catch phrase as a prompt “in the moment” during less-structured activities to support generalization.  For our 9 most popular phrases, we have developed adorable cartoons, like this one:

Not only are these catch phrases and cartoons helpful within the context of group, but parents have consistently told us how helpful they are at home and in the community. They also tell us that they use them to facilitate a consistent approach among school staff and others in the child’s life.

As we, and the parents we work with, have found this approach to be so meaningful, we wanted to make the Catch Phrases  (as well as the activities we have found most successful for teaching them) available to other therapists, teachers and parents.  We have begun to do so with our Social Adventures app.  We chose to provide this information in the form of an app so that we could continually add new information to it.  The app currently includes more than 44 activities for improving social skills, many of which have accompanying Catch Phrases, as well as a Sample 8-week Program and easy access to our 9 cute cartoons.   For those of you who like to introduce new concepts through literature, we have also written short poetic stories to introduce each of the 9 cartoons.  You can read a sample here.

by Karen S Head, MS, CCC-SLP

If you like these ideas, be sure to check out the nearly 80 activity ideas for promoting social cognition in our Social Adventures Apps.


Words of Praise

I’ve thought a lot about positive reinforcement. Praising children seems to be a no-brainer. But I’ve had some questions:

● What makes the new learning stick and have meaning?
● What can I say or do to help kids retain what they’ve learned?
● What makes MY new learning stick?

The key is finding intrinsic meaning in the task at hand. The new information needs to relate to something real and meaningful. Making associations or learning with a friend is one way to create meaning and is fun. It also helps if the task is experiential.

As a parent, my husband and I wanted our kids to feel good about themselves for being who they are; not in response to how others judged them. We thought that if our kids could reflect on and recognize their personal growth and worth they would be lifelong learners and ultimately feel better about themselves. (I think it’s working but the parenting is not over yet!)

So many kids come to our Social Adventures Groups with poor self-esteem; the world is telling them they don’t measure up. Our goal is to build competence leading to confidence. They learn how to be a friend; not because we tell them they are good friends but because they are actually acting friendly and are rewarded by kids saying, “You’re my best friend” or “Can you come to my house to play?” The kids don’t need us telling them, “Good job” or “Those words made Johnny feel so much better.” The friendly feedback and all around good feelings create the intrinsic motivation to learn more, try harder, remember, and grow. Reinforcement is good but the ultimate goal is always to create a safe place for children to learn, make mistakes, recover, reflect and bloom. As Spring approaches, I wish you all many opportunities to plant and water seeds of learning in your children and watch them feel proud in all their splendid glory!

Submit: Jill Perry M.S. OTR/L

image by: crimsong19