You’ve probably met Isaiah before. In his child care classroom, his teacher struggles to keep him at the table long enough to complete the finger painting activity or to finish his meal. He’s constantly on the move, climbing and pulling toys off the shelf. At home, his parents find it challenging to play with him because he won’t sit still. He throws toys after the first few seconds, gets frustrated easily, and prefers climbing on the couch whenever he can.
You will be the primary provider to support Isaiah’s family and child care teacher. Where do you start?
What Might Be Affecting Isaiah’s Behavior?
Toddlers like Isaiah are challenging to engage – for families, child care teachers and for early interventionists because they are constantly on the move and often have such difficulty sustaining attention. There are several questions to consider when you meet a child like Isaiah.
What’s the daily environment/routine like – chaotic or structured? Is the child’s behavior different in different environments? A chaotic day with little 1:1 interaction makes it very hard for many children to regulate themselves. Isaiah behaves similarly in both environments, but other children not because they’re reacting to the environment which important to know when planning intervention. If the environment is chaotic, you might be able to reflect on the impact of the environment on Isaiah with the caregiver and help him/her come up with alternatives. This is often a sensitive topic so tread lightly.
Are there sensory differences that impact Isaiah’s ability to slow down and attend? If yes, bringing in a team member with expertise in sensory processing (if that’s not you) as a consultant could be very helpful.
Is Isaiah on any medication? Have there been any recent dosage changes? Sometimes side effects can affect a child’s ability to be calm and attend.
Does Isaiah have motor-planning difficulties? If he’s struggling with how to plan out his fine motor movements, this will really impact his ability to play with toys and do activities that require more refined movements (like feeding himself).
Answering these questions might not give you all of the answers, but they’re a good place to start when planning intervention with the family.
Intervention Strategies for Isaiah
It’s also so important to find out about the family’s priorities for Isaiah. If they relate to his challenges with attention and behavior, these strategies might be useful for intervention:
Partner with his caregivers – Observe interactions, talk about what captures his attention and what ideas they have for expanding it. Find out what activities they’ve already tried to encourage more focused interaction and play and what they would like for Isaiah to be able to do. Ask what they enjoy doing with him now and what they’d like to be able to do together. Build intervention on these activities.
Capture Isaiah’s attention by joining him in what he likes to do – Coaching his caregivers to engage him in his favorite activities. Try to increase engagement by playing turn-taking games using gross motor movements such as a high energy game of peek-a-boo over the top of the couch. Once he’s engaged, introduce a lower intensity activity like coloring on a magnadoodle.
Expand attention by increasing expectations – Teach Isaiah’s caregivers ways they can help him complete one more step before he is allowed to end the game or move away. They might need to use (and fade out) hand-over-hand guidance with a verbal cue like “last time!” to help him complete the task, such as making a mark on the magnadoodle. Once he’s done it, they can praise him and let him have a break to move around, then bring him back to the activity and play some more. Expect two marks next time and make it fun!
Play in places where Isaiah is less active – Plan together for how to play in the high chair, in the bath tub, in a ball pit, in the caregiver’s lap, by lying on your bellies, etc. This might make being still and concentrating less challenging for him.
The idea here is finding ways to make slowing down and sustaining attention less difficult for Isaiah. Attention is a “must-have” for learning and this really applies to all children, even toddlers. It’s also important to have appropriate expectations since a toddler’s attention is naturally fleeting. It is when that short attention span interferes with the child’s ability to learn and interact with others that we want to provide support.
If you were supporting Isaiah and his family, what else would you ask?
What strategies do you use for helping toddlers attend to play activities and interact with others?
What are your thoughts on ADHD and toddlers – can we tell this early?
Share you ideas in the comments below!