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How to Make and Use a Visual Reward Board

reward board 3
Written By:  Elizabeth McMahon, MA, CCC-SLP
Speech-Language Pathologist

Visual boards are a great way to help children learn and complete targeted activities.  Sometimes, children may need to have a visual board as a reward system.  For example, in the picture above, the child has to earn 3 stars in order to play bubbles.  The way they earn the stars can vary and is up to the adult.  It could be completing specific activities, following directions, etc.   Here are some easy ways to make and use a visual reward board.

  1. Laminate a piece of construction paper or cardstock.  I like to use cardstock because it’s a little sturdier and doesn’t bend as easily.   You can find a basic laminator at any craft store.  I found one at Costco and it works really well.
  2. Place a line of Velcro on the laminated cardstock.   This is your visual board.
  3. Find pictures to use as the reinforcing object.  This is something that your child will work for.  What do they like?  What’s their favorite toy, food or activity?  You can find pictures online or take a picture of the object with your camera.  If your child is working with a speech pathologist, they may have the computer program called Boardmaker and can print some pictures for you.
  4. Laminate the pictures and add Velcro to the back.
  5. Introduce the visual reward board to your child.
    • Provide your child a few objects and find out which one is motivating to them.  Then, place that picture at the end of the board (e.g. bubbles).
    • Tell your child they have to earn 3 stars to get that object.
    • Tell your child how they can earn the stars (e.g.  “write your name on your paper, follow directions, put the puzzle piece on the puzzle, etc”).
    • After they complete the task, give them a star picture and have them place it on the visual board.  You may need to do hand-over-hand assistance the first few times to show your child where to place the star picture.
    • After your child adds the 3 stars, immediately give them the desired object and let them play with it for a few minutes.

The visual reward board can be used throughout the day at home, during therapy sessions and in the classroom.  You will need to change the desired object in order to have something motivating for your child.

Now It’s Your Turn:  Have you used a visual reward board with your child?  How did it go?

5 Tips for Playtime



As adults, we sometimes forget what it was like to be a kid.  It’s important to spend time playing with your child.  Some of us may need some guidance in how to “play.”  Here are 5 tips for playtime with your child:

1.  Be silly.  Don’t be afraid to make funny faces or act goofy.  Your child will love it and you’ll probably hear some laughs and giggles.

2.  Follow their lead.  Most children will make choices and show you what they want to play.  If they want to play cars, play cars.  If they want to play blocks, start building a tower.  Following their lead will show them that you care about them and their interests.

3.  Get down on their level.  If you are physically able to, sit on the floor with your child.  If you can’t get on the floor, then adapt your play to the table or couch. Children will play everywhere and anywhere, but it’s important to be able to be on their eye level and be truly engaged with them.

4.  Talk about what you and your child are doing.  While playing, there is a lot of language stimulation happening.  Don’t forget to talk and use language while playing.  Each toy and activity has its own vocabulary words.  For example, think about how many words are used while playing blocks.  Words like “on top, block, fall down, uh-oh, so big, big tower, big block, little block, etc.”  You are using a lot descriptive words and building your child’s language skills.

5.  Take turns.  It’s important for kids to play with others.  This builds social skills and peer interactions.  While playing, use words like “my turn, your turn” and “may I play?” to assist your child when they play with others.

Take some time to play with your child.  You both will benefit from playing together.  They will learn so much from you.  You will not only learn about what a cool kid you have, but you will be reinforcing and establishing a positive relationship with them – one they’ll remember well beyond their childhood years. Oh – and don’t forget to have fun!

Now It’s Your Turn:  What’s your favorite game or toy to play with your child?

Do’s and Don’ts for Protecting Your Child’s Joints


Written By:  Hannah Taylor, DPT
Brightsong, LLC Physical Therapist

Joint protection is important for children in order to prevent damage to their growing bones.  A joint is defined as the point where 2 bones are attached in order to permit body parts to move.  So, joints include the elbow, wrist, etc.   Here are some tips to protect your child’s joints.


  • Don’t pull on your child’s arms when assisting them from lying flat on their back to sitting.
  • Don’t swing your child by his or her arms, this can cause shoulder or elbow dislocation.
  • Do use proper hand placement to assist your child to sitting from lying flat or side lying (i.e. place hands behind head, back or on hips).
  • Do hold your child at their waist or trunk when lifting them up from surface or ground.


  • Don’t allow “W” sitting (i.e. when child sits on floor and knees are bent and out to either side of body).  “W” sitting places increased pressure and stretching on hips, knees and ankles.
  • Don’t pull on their legs, knees or ankles aggressively during dressing or play to prevent hip or knee dislocation.
  • Do provide good support of ankles and feet with proper shoe wear.
  • Do encourage proper sitting habits and posture.
  • Do monitor your child’s hips, knees and ankles in standing.  Are their knees hyperextended? Do their legs rotate in or out?
  • Do call your doctor if your child complains of pain in joints.


  • Don’t allow your child to participate in high impact sports activities or intense jumping without asking their doctor. This is especially true for children with Down syndrome – they are at risk for increased laxity in neck and vertebrae.
  • Do provide proper seating positions for your child. Make sure that chair is appropriate height for child; if needed place small stool or stack of books under child’s feet for proper support.

With proper care, we can help ensure that your child’s joints are protected in order to promote good growth and development. If your child complains about joint pain or if you have concerns about their posture, gait, balance or coordination – please talk to your child’s pediatrician.  They might need to see a physical therapist for an evaluation.

2012 Year In Review

The stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 4,600 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 8 years to get that many views.

Click here to see the complete report.

Why We Love Shape Sorters

The Shape Sorter is a classic toy that has been around for generations.  Many of us grew up with the toy in the picture – the cubed shape sorter.  Nothing fancy, just a box to put shaped blocks in.  But what this toy teaches your child is amazing!

1).  Problem Solving Skills – Children learn trial and error by attempting to match the shapes in the correct place. If the square doesn’t fit in the diamond shaped hole, you try another one – and another one. You keep trying until you get it right.

2).  Fine Motor Skills – Placing blocks in a container is a fundamental fine motor skill for children to learn.  The way in which a child picks up the block (raking it with their palm, using their fingers, etc) tells a lot about their fine motor development.  Some shape sorters require the shapes to match up exactly right – which uses a lot of fine motor manipulation and coordination.

3).  Language Learning – Shape sorters provide great language stimulation.  When your child plays with you and a shape sorter, they are hearing and learning about colors, shapes, sizes, etc.  These toys provide huge opportunities for vocabulary growth and development.

4).  Requesting and Naming – These toys typically come with several blocks. This is a great opportunity to have them request “more” by signing or vocalizing.  If you’re working on producing 2 word phrases, they can request “more please, more circle, more block, etc.”  As they get older, they can request “I want block” or “I want blue block, etc.”

5).  Cognitive Skills – Shape sorters come in many different styles, colors, shapes and sizes.  For younger children, they typically have only 3 or 4 shapes (circle, triangle, square, star, etc).  As they get older, the shapes become more advanced (hexagon, octagon, etc).  Children are learning early math and geometry skills when they understand the size and shape of objects.

As you can see, shape sorters are wonderful toys for children.  Take a few minutes to play with your child and you can see all these wonderful skills taking shape.


A Parent’s Guide to Pediatric Therapy: Putting the Pieces Together

Entering the world of pediatric therapy can be overwhelming for parents.  PT, OT, ST, DT, SC, IFSP, IEP, EI – what do all these mean?   Parents are thrown into this world at a time when they are still trying to understand their child’s diagnosis.  Although this can be a very emotional time for families, it is important to understand what exactly is going on and who are these people working with your child.

Early Intervention (EI)
In 1986, the U.S. Congress created the mandate for a range of services to be provided to infants and toddlers with disabilities, through what is referred to as “Early Intervention.”  This is Public Law 105-17, which established special services for the youngest members of our society. This was due to “an urgent and substantial need” both to “enhance the development of infants and toddlers with disabilities and to minimize their potential for developmental delay.”

Each state is provided grants from the federal government to provide comprehensive services to infants and toddlers with disabilities. A lead agency in each state administers the statewide program. Each state establishes criteria for eligibility within parameters set by the federal government. In Tennessee, the EI program is TEIS (Tennessee Early Intervention System).

TEIS is a “voluntary educational program for families with children ages birth through two years of age with disabilities or developmental delays.”  According to TEIS, the principles of EI are to “support families in promoting their child’s optimal development and to facilitate the child’s participation in family and community activities. The focus of EI is to encourage the active participation of families in the intervention by imbedding strategies into family routines. It is the parents who provide the real early intervention by creatively adapting their child care methods to facilitate the development of their child, while balancing the needs of the rest of the family.”

After the referral to the EI system, a service coordinator (SC) is assigned to each child and their family.  This SC will help guide families through the EI system and will network and assign other professionals to work with each child and family as needed.  These services may include: screening and assessment; family training, developmental therapy (DT),  speech therapy (ST), occupational therapy (OT), physical therapy (PT), audiology services, etc.  Depending on the state, these services are provided, with some exceptions, at no cost to the family.

Some children will be referred to their state’s EI system soon after birth.  For example, children born with a diagnosed condition (such as Down syndrome, cerebral palsy, spina bifida, cleft palate, etc) will be referred to their state’s Early Intervention (EI) system as soon as possible in order to start receiving services.   Other children may not show any signs of a developmental delay until they are older and their pediatrician, teacher or parent will refer them for services when concerns are noted.  In most states, any child can be referred to their state’s EI system for screening and evaluation if concerns are noted before their third birthday.

Individualized Family Service Plan (IFSP)
An IFSP is the plan written by the EI team.  Families are welcome to invite anyone to the IFSP meeting.  During this meeting, measurable goals will be developed for the child and family.  These goals will be targeted over the next few months.  During this meeting, the family, SC and other team members will talk about the child’s progress towards their goals.  If other supports and services are needed, those services will be discussed at this time.

Prior to the child’s third birthday, the transition process will begin.  Once children turn 3, they move from the EI system to the school system.   Part B of IDEA (Individuals with Disabilities Education Act) applies to children from 3 – 21 years of age. This program provides special education and related services (e.g. PT, OT, ST, etc).  These services are provided in the least restrictive environment and ensure local access for services.  Most of the time, these services are provided in your neighborhood school.  All children will not be eligible to enter into preschool special education programs. Each program has their own set of eligibility requirements.

During the transition planning meeting, parents and their child’s SC will meet with members from Part B to discuss the next steps, particularly, how to prepare your child for the transition out of EI.  An IEP (see below) meeting will be held to determine the services your child will receive after the transition.

Individualized Education Program (IEP)
The IEP is a written educational plan for each child with a disability that is developed, reviewed and revised during a meeting with the child’s parents, teachers, therapists and other school personnel.  A child must have an IEP in place before receiving services with the school system under Part B services.  During the IEP meeting, results from recent evaluations are reviewed and goals and outcomes are developed and addressed.  A parent may invite anyone to an IEP meeting.  If other supports and services are needed, they are discussed at this meeting.

Private Pediatric Therapy
For children who may not qualify for EI or Part B services, or for those who might need additional therapy, private therapy is an option.  Pediatric therapy covers the ages of birth to age 18 or in some clinics, up to 21 years of age.  These services are considered “private therapy” and are paid for by the child’s insurance plan or private pay by the child’s parents.   Therapy can be provided in the child’s home, school, clinic or other community setting.

Pediatric therapists work closely with the child’s parents, teachers and other professionals.  Many will implement a team approach to best meet the needs of the child and their family.  There are many different agencies and therapy approaches.  Each family should choose a therapist they are comfortable with and find the best therapy approach for their child.

Traits to Look For In a Therapist:
There is a shortage of pediatric therapists across the nation.  If you are looking for a private therapist, some traits to look for include:

  • Caring and Compassionate – Your child’s therapist should care about your child and family.   Many families will work with the same therapist for years and you want to have a good relationship with your child’s therapist.
  • Positive and Encouraging – In pediatric therapy, we do not yet know the extent of your child’s abilities.  Look for a therapist who will work with your child and encourage them to reach their goals in a positive manner.  All children should be encouraged to reach their full potential in all areas of their development.
  • Patient and Flexible – Working with children is a lesson in patience and flexibility.  Sometimes children get tired.  Sometimes they cry.  Sometimes they fall asleep.  Therapists must be able to make adjustments as needed and be creative enough to completely change their plan for the day based on the child’s needs at that time.
  • Empathic and Understanding – Having a child with special needs can be overwhelming.  Parents will have a lot of feelings to work through and a lot of questions about their child’s diagnosis and their progress in therapy.  Find a therapist who understands and listens to your concerns.  However, it is important to understand that parents are the only ones who can make decisions that directly impact the child.  Therapists can give recommendations (and if parents ask –opinions about certain situations), but parents are the ones to make the final decision.

Understanding the world of pediatric therapy can be overwhelming.  Understanding the process and finding a therapist you are comfortable with will help you through this process. For more information about finding a therapist in your area and to find out more information about EI and Transitioning to Part B services, please follow the links below:

American Speech-Language Hearing Association

American Occupational Therapy Association

American Physical Therapy Association

Early Intervention

School Age



Learning Through Play

Play is an important part of childhood. As Lawrence Frank once said, “through play, children learn what none can teach.” While playing, children are able to practice skills and roles needed for survival, learning and development. These skills include problem solving, sharing, taking turns, pretend play, etc. According to the American Academy of Pediatrics, play is one of the most important experiences of childhood and through it, children can develop physically, emotionally, socially and mentally.

Through play, a variety of developmental skills are addressed.  Playing with toys provides a foundation for learning.  Skills such as colors, shapes, numbers, letters, names of objects and people, etc. are all addressed during play activities. These skills are foundational skills which will help your child as they transition from early childhood programs to the elementary school setting.  Some children with developmental delays may have difficulty playing purposefully with their toys. During developmental therapy sessions, toys may be adapted to help children play.

Playing with others also encourages social skills.  Social skills are important in order to interact with and learn from others and the environment. Many children with developmental delays have difficulty with social interactions. This may result in limited eye contact, difficulty maintaining two-way conversations, difficulty playing with others, etc. Play opportunities address social interactions with others – including the child’s parents, siblings, teachers and peers.

Remember, you are your child’s best toy.  Taking time to play and talk with your child is the most beneficial thing you can do.

It’s Lunch Time!


A new school year is upon us and you may be wondering what your child will eat for lunch each day.  Whether your child buys their lunch at school, or you pack a lunch for them, there are ways to help ensure that they eat a balanced lunch.

If your child buys lunch at school, review the menu with them and help them understand which foods would be good choices and why.  Encourage them to drink milk and water and avoid sugary drinks like soda and juice.

If you pack a lunch for your child, spend some time brainstorming ideas with them. You might discover they have some great ideas and learn more about what types of food and snacks your child would like to eat.  Nutrition experts recommend that every child be exposed to a variety of tastes and textures. Each meal and snack should include at least 1 protein, 1 starch, 1 fruit or vegetable and a drink.  If you have a “picky” eater, be sure to include foods you know they will eat.  Some ideas for lunches might include:

  • Deli meat and cheese on bread, rolled in a tortilla or stuffed in a pita
  • Cheese and crackers
  • Trail mix, popcorn, baked chips or pretzels
  • Fruit (fresh or in natural juices), Fruit Leather
  • Yogurt, Jell-O or Pudding
  • Vegetables (celery, carrots, jicama, broccoli, snap peas, etc with veggie or Ranch dip)
  • Yogurt smoothies, water, milk or 100% juice box

When packing a lunch, make sure hot foods are kept hot and cold foods are cold.  Hot foods (soup, chili, etc) can be sent in a thermos.  Just remember, your child may not be able to heat up their food.   Always place a freezer pack in their lunch box when you pack meat, yogurt, cheese and mayo.

There are many different options when you pack your child’s lunch.  For more ideas, check out these links:

How to Pack a Healthy, Tasty Lunch for Kids

Healthy Sack Lunch Tips




Back to School

Summer vacation is coming to an end. School supplies will soon be purchased and lunches will be packed.  Children will start transitioning from long summer days to days full of learning.  Some children (and parents) may have difficulty transitioning to the new school routine. Here are some tips to help make the transition a little easier:

Meet the New Teacher and Tour the School:  If your child’s school has an open house, be sure to attend.  Children may be anxious about who they’ll meet and where to go.  If you can meet their teachers and take a tour of the school before the first day, this will help ease their jitters and help them feel more comfortable on the first day.

Transition to the New School Schedule:  Many families have a relaxed schedule during the summer.  To help your child get back into the school routine, slowly ease your child into their new bedtime and wake up time before the first day.

Discuss Their Concerns: If your child is feeling anxious or jittery about going back to school, talk about their concerns and role play how to handle different situations. For some children, implementing Social Stories (developed by Carol Gray) may help prepare them for a variety of situations which may arise.

Eat a Good Breakfast:  Children need to eat a healthy breakfast every day.  On the first day of school, you may want to have a special breakfast with their favorite foods to make the day fun.

Review the Rules: If you can get a copy of the school rules before the first day, it would be good to review them with your child. This is also a good time to review safety rules and rules about talking or going with strangers. If your child walks or rides a bike to and from school, review the route with them several times and reinforce the rules.

Get Organized:  Mark school events on your calendar and pack lunches the night before.  You and your child can pick out their clothes for the following day the night before too.  Have backpacks packed with the necessary supplies and by the door ready to go.  A little organization will help reduce your stress during the first few days of the new school year. Staying organized will also help your child get in a routine and schedule they can keep throughout the school year.

The start of a new school year can be a fun and exciting time.  For more helpful tips, visit the following links:

Back to School Transitions

Back to School – It’s Transition Time!

Back to School for Kids with Special Needs

Back to School Checklist for Parents of Children with Special Needs