The Hidden Foundations For Fine Motor Skills

Fine motor skills can be defined as the skilled coordination and movement of the small muscles of the hands, fingers, tongue and mouth. Oftentimes parents and teachers can identify difficulties with functional outcomes such as handwriting or self feeding with a spoon. An occupational therapist can help a parent understand and identify the hidden foundational skill areas that are impacting the child’s growth.

 The first hidden foundation is called postural control. Similar to how tree roots provide stability to the tree trunk and its branches, adequate abdominal strength is needed before fine motor skills can be refined. If a child is unable to sit at the table on their own, parents can help provide stability by properly positioning their body. Children with poor postural control would benefit from a small chair with back and side supports, both feet touching the ground, and a 90 degree bend in the knees and hips. Some activities that build postural control are:

-Encourage children to try different positions during play, work, or group time such as lying on their stomach while resting on elbows or side lying

-Have a child sit on a therapy ball or exercise ball rather than a chair (with support from parents as needed).

 Next comes the trunk of the tree called proximal shoulder and wrist stability.

Many children’s emerging fine motor skills begin with using big movements at the shoulder and wrist for pre-handwriting, feeding themselves, self care, and play skills. They learn how to refine to movements by adjusting how much of their muscle strength is needed during each daily activity. For example, the amount of muscle work needed for a child to dig in thick, muddy beach sand versus the amount of muscle work used to slowly tilt an open cup to drink without spilling. Some activities that build proximal stability are:

-Painting on a vertical surface (i.e. easel or large paper on the wall).

-Animal walking (crab, bear, etc.).

-Use a spray bottle to water plants or wash away chalk designs.

Another hidden foundation is called touch perception. Imagine playing as a young child and reaching into a large beach bag to find your toy without being able to see what’s inside. Touch perception gives your hands the ability to perceive the shape of an object without looking. If a child has difficulty with this area, it would be similar for them to be wearing a large over-sized gardening glove while trying to find and grasp their toy. They can appear clumsy and will frequently drop small items. This can make self care activities such as feeding, zippering, and buttoning challenging. Some activities that build touch perception are:

-Help the child find hidden beads in playdoh.

-Wash or hide small animals or cars in shaving cream.

The last hidden foundation for fine motor skills is bilateral coordination. Bilateral coordination is a developmental sequence for the use of both hands and legs to perform in the same or different actions. Initially children will learn to use both hands to do the same action such as pulling a shirt over their head. Reciprocal bilateral coordination occurs when they are able to do a different action for each side of the body, such as holding the zipper with the one hand while hooking and pulling a jacket zipper up with the other hand. Bilateral coordination also contributes to developing a hand of preference around the age 2-4 years old and hand dominance around 6 years old. Some activities that build bilateral coordination are:

-Yoga poses.

-Hide treasures inside zip-lock bags and have children open and close the bags.

-Flatten playdoh to make a pizza or hot dog, then cut it using playdoh scissors

The following is a list of fine motor skills acquired by age:

18 months:
Builds a three block tower
Scribbles spontaneously
Independent with spoon
Independent with open cup

24 months:
Takes off hat, socks, shoes
Zips and unzips without engaging the zipper
Vertical and horizontal lines
Can snip with scissors

3 years:
Hand preference
Copies circle, imitates cross
Builds a nine block tower
Screws a lid on a jar
Places 10 small pellets in a bottle in 30 seconds
Turns a door knob with their forearm muscles
Unbuttons clothing, buttons large buttons
Puts on shoes, but they may be on the wrong feet
Can cut on a line that is 6 inches long

4 years:
Traces diamond with angles rounded
Representational drawing of themselves
Can cut a circle and square

Occupational therapist can help identify the underlying skill areas contributing to fine motor difficulties. At Therapeutic Approach for Growth, the occupational therapists use a child directed, play based, and relationship focused approach to therapy. We frequently use a “just right challenge” to build self esteem, focus on the relationship with the therapist, and offer developmentally appropriate engaging activities to support the growth process.

Therapeutic Approach to Growth is in network with many insurance companies. If you have any questions regarding occupational therapy at TAG, Inc. please call us at (858) 689-2027 for more information.

Kristine Ching, M.S. OTR/L


When to seek Speech Therapy for your Child

Many parents ask the question, “How do I know if my child needs speech therapy?” While a Speech Language Pathologist (SLP) has many areas of expertise, (fluency/stuttering, social language, overall language development including grammar, vocabulary, understanding concepts, following directions, etc.), the concept of articulation, or sound production, may warrant the most questions for parents of school-aged children.

Many parents notice sound errors in their child’s speech and wonder, “What’s normal for children of similar age?” “Will these errors resolve on their own?” and “How do I address this issue without bringing too much attention to it?”

Speech therapy for articulation can start with children as early as 3 years old (for sounds like /k/, /g/, etc.) and ages 4 and up and for most other sounds. An articulation chart below shows the varying age at which children typically acquire mastery of different sounds.

With articulation therapy, early intervention leads to an increase in positive outcomes, meaning less time and money spent on therapy.  Studies show that the age of the child significantly impacts the outcome and duration of therapy.  With each year that passes, the length of time needed to remediate sound errors with therapy significantly increases, especially after a child reaches 8 years of age.

Many parents wonder whether some articulation errors may resolve on their own. Certain types of articulation errors can resolve by age 4, but typically do not resolve spontaneously if the sound is still in error by age 5-6.  In addition, when there is more than one sound in error, or if there are unusual substitutions for sounds (which can be determined by an SLP), it is far less likely that the sound errors will resolve without therapy.

When determining how you can help your child without drawing too much attention to the errors, a speech pathologist can help parents identify strategies to practice articulation at home that can be fun and which also remove pressure from both parents and child.  One way to begin practicing sounds with your child is to model correct and incorrect productions while speaking and to invite them to play a game identifying which are correct and which are not. This takes the pressure off of them and allows them to observe the difference between the two sounds in a non-demanding, playful way.

The frequency and duration of therapy needed varies significantly based on the age of the child, the number of sounds being addressed, and whether or not there are other diagnoses present.  A general range of duration would be 8 weeks to one year.  If you have concerns about your child’s speech, most speech pathologists offer an initial screening for articulation to determine if therapy is needed and to answer questions specific to your child. Articulation therapy can be fun for your child and can take the pressure off of you as a parent.  At Therapeutic Approach to Growth, we address speech issues from a Relationship Development Intervention (RDI®) perspective, choosing to focus not only on remediation of speech deficits, but on strengthening and developing the therapist/child relationship and increasing the child’s sense of competence. Please call us today at (858)-689-2027 for more information or to schedule a complimentary consultation with one of our speech therapists.


Karrie Johnson, M.S. CCC-SLP


Using the Work of RDI® to Create an Unstoppable School Team

In the first part of our “Making this your child’s best year yet!” series, we discussed the importance of using the principles of Relationship Development Intervention (RDI®) to establish a strong, secure relational foundation moving into the new school year. In part two of the series, we focus on how to use those same principles to form strong, meaningful, collaborative relationships with school staff to work together towards jointly-written goals which take into account the needs and desires of both the teachers, parents and student.

The principles of RDI® apply across contexts and situations and provide helpful tools for building relationships from the ground up. An RDI® consultant can work to add to the richness of the educational team by providing teachers with information that will help them establish and strengthen their relationship with their students. When home and school collaborate together, the student has the benefit of accessing similar supports in home and school and is given the appropriate level of challenge to help them grow and progress in the best way possible.

Step 1: Establish and Strengthen Relationships

Spend time building rapport with your child’s school team. Take time to get to know each team member and their strengths and expertise. Value each member for their work and share those positive feelings with them. Taking the time to strengthen these relationships will prove invaluable to you as you find that their connection to you leads to their ability to have a stronger connection to, and better outcomes for, your child.

Step 2: Work Collaboratively

Research shows that maintaining a collaborative home/school team proves to be significantly more successful in improving positive outcomes for students than when home and school work independently of one another. Be a part of the goal setting for the year and make sure that your values and principles are represented in the plan. By educating your team on the value of RDI®, you can reinforce the concepts you have introduced at home. Be open to the work and ideas of others as well, and you may see that as each team member adds their thoughts, you are left with an insightful and comprehensive plan that is acceptable to all parties.

Step 3: Set clear and consistent goals

Work with the school team to develop goals that are clear. Each person on the team should understand how to support your child in their desire to be successful in their goals. Additionally, team members can make goals for themselves. For example, a parent may set a goal that she connects with a member of the team at least once per month to stay in the loop and strengthen relationships.  Deciding on a goal for mastery for each goal helps members to more clearly see and celebrate progress as it occurs.

Step 4: Celebrate accomplishments and reflect

Everyone loves to feel appreciated. Even if your team may be struggling, taking the time to acknowledge strengths and effort can make a big difference. People are more motivated to be helpful when they feel like their efforts do not go unnoticed, and taking the time to reflect upon successes not only helps teachers and staff feel appreciated, but it provides them with valuable information as they move forward in their work.

By working with your school team to start your year off with a few simple relationship-building activities, you can begin to form bonds that will serve you and your child throughout the year and will ensure that your team works collaboratively towards your child’s increased growth and success.

For more information on how an RDI® consultant can collaborate with you and your child’s school team, please contact us at (858) 689-2027 or at to learn more.

-Amber Sobrio-Ritter

Feeling nervous about the challenges of a new school year?

 Read on to find out how using the principles of RDI® can make this your child’s best year yet.

Parents all over the world toss and turn with the start of a new school year. Parents of children with special needs have additional fears about the quality of their school, the appropriateness of their child’s placement and the endless worry about making sure their child is able to enjoy meaningful, authentic relationships. The great news is that by using the principles of Relationship Development Intervention (RDI®), parents can more efficiently support themselves, their children, and their school team as they move through this year with new joys, discoveries and accomplishments.

This two part series will give you information on new ways to support your child and your child’s team of professionals during this time of transition, and how you can make this year the best year yet.  Part one below focuses on starting the year off right with your child using the relationship-based focus of RDI®, while the focus of part two is bringing the principles of RDI® into your work and collaborative efforts with your child’s school team.

RDI® is based on strengthening relationships, working collaboratively, spotlighting discoveries and growth while reflecting on and adjusting to challenges. RDI® principles are not only for use with students, but will be equally helpful for you as you seek to work with a diverse team of school professionals toward the common purpose of making this a wonderful year for all.

Step 1: Establish and Strengthen Relationships

Begin the school year with a strong sense of emotional engagement with your child. Take the pressure of the new academic year as you connect on an emotional level with few demands. Take time to really reconnect and strengthen your relationship as you move into this year of new experiences. Some ideas to achieve this may involve reading books together, taking a walk, cooking together or playing a fun game of Tag, for example. What is most important is that the experiences are mutually enjoyable and authentic.

Step 2: Work Collaboratively

Employ collaborative methods of conflict resolution with your child. Take time to identify your, as well as your child’s, needs and find a way to meet in the middle.  If your concern is that the homework gets done, and your child’s concern is that the work is too lengthy, identify a solution that can serve both needs. In addition, take the time to identify core deficits that might be contributing to problems. In other words, look beyond the behaviors and determine a deeper reason for breakdowns. Help your child develop increased self-awareness so that they are more able to identify and work with their strengths and challenges.

Step 3: Set clear and consistent goals

Help your child develop and plan their own goals and then support them in their endeavors. When children feel as though they are able to set their own goals, they are more internally motivated and successful.  Research shows that people who write goals down are significantly more likely to succeed than those who don’t, so take a vague goal and make it clear, measurable and observable, as well as criteria for mastery. This allows you to gauge growth and mastery, and enables your child to see more clearly their amazing progress and accomplishments.

Step 4: Celebrate accomplishments and reflect

Take time to acknowledge successes and focus on growth and the process. Taking a process/progress-based focus instead of an outcome-based focus decreases the pressure and allows you to celebrate progress over perfection. This provides an opportunity to reframe challenging situations to focus on growth and what can be learned from the obstacle. Additionally, children often do not understand or notice their growth, which highlights the importance and benefit of clear feedback. For example, a parent may remind their child of how far they’ve come, or help them to understand how they handled a social situation well. Children can then use that feedback as they are presented with similar future situations.

At Therapeutic Approach to Growth, we value collaboration, relationships, goal setting and celebration. By taking these principles and applying them to your interactions with your child, you may see that the anxiety and fear over a new school year melts away as you look forward to a year of growing, learning and celebrating. We wish you a wonderful school year! To learn more about how we can support your child’s school team give us a call at 858 689-2027.

Stay tuned for part 2 of the series “Making this your child’s best year yet,” where we will offer helpful information to incorporate the principles of RDI® into your collaborative efforts with your child’s school team.

-Amber Sobrio-Ritter


Learn how TAG encourages internal motivation to connect and learn!

June 28, 2016

It’s that time of year again: the days are long and filled with endless summer activities and, if you’re an RDI® family, there are tons of amazing opportunities to help your child grow! Instead of seeing RDI® as something that you do during a specific time of the day, or seeing it as another item on the “to-do” list, reframe your thinking to reflect on how you might make each activity of the day a discovery moment for your child. The RDI® program should not add something new to your schedule, rather it is a focus on rethinking and reframing the things you already do so that guiding moments are peppered throughout the day naturally. Dr. Steve Gutstein, the founder of RDI®, said, “One important thing is to remove the word ‘get’ from your parenting; as in ‘how do I get him to…’ The alternative is, ‘how do I set the stage for a new discovery?”

It’s important to keep this in mind and to take time to think about how ordinary daily tasks can be set up to lead your child to a discovery moment. This not only creates a surplus of learning and growing opportunities, but it takes the pressure off of you as a parent to add something new to your already busy schedule. The minutiae of everyday life contain powerful discovery moments, which can be harnessed to aide in the growth of your child.

Below is an idea of how to reframe an activity we all have to do: laundry! Here are some ideas of how to reframe this activity from a trivial everyday happening to a powerful learning opportunity.


-Establish emotional engagement: Take a little time to emotionally connect throughout the activity. By adding moments of silliness to the routine, the focus is not only on the task, but on relationship strengthening. For example, “We’re going to do the laundry. Uh oh, I’m wearing pants on my head!”

-Create meaningful roles: Establish clear roles in the beginning. Give your child an authentic role. For example, “I’m going to take the laundry out of the basket, and you get to put it in the washing machine.” Make sure the level of challenge is appropriate and not too overwhelming for where your child is developmentally. It is important that the laundry is actually dirty and that your child’s role is authentic, meaning that without their help during this activity, the laundry would not successfully be done.

-Provide small challenges: Introduce developmentally appropriate variations to the routine to provide opportunities for growth. For example, by adding a small change to the routine, you can give your child an opportunity to adjust to changes and to strengthen their dynamic intelligence. A small variation can be using a different laundry basket, tossing it instead of passing it, doing laundry in different rooms, switching roles, or can be something different such as adding a non-clothing item to the basket to give your child an opportunity to discriminate.

There are no shortage of activities and ways to frame teachable opportunities, so be creative and enjoy it! No matter how to you choose to lead your child to discovery moments this summer, remember the most important goal is to have fun!

-Amber Sobrio-Ritter


The Importance of the Guided Participation Relationship

May 31, 2016

Think back to a special childhood moment when you were able to achieve a difficult goal.  Maybe you caught your first fish, successfully mastered a two-wheeler or baked your first batch of cookies. Thinking back to those moments, for many, something very special made that achievement possible. Since the beginning of time and observed in every culture in the world, is the Guided Participation Relationship (GPR). The GPR is the authentic collaboration between a more experienced “Guide” and a willing “Apprentice.”  The GPR provides the apprentice with an opportunity to learn and grow alongside a teaching guide who provides learning opportunities and an appropriate level of challenge to foster a growth-seeking mindset.  One core deficit of those affected by autism is the reduced ability to participate in, and to take advantage of, the GPR. For typically developing children and their parents, this relationship naturally develops and serves as the child’s main point of reference as they develop during their early years. A child affected by autism begins to withdraw from this rich and beneficial relationship around 9 months of age and thus suffers the loss of growth that takes place within this rich and essential relationship.

Research by Hobson et al. provides more information about how a child’s withdrawal from the GPR affects parental interactions and solidifies the child’s path down an atypical development trajectory. In a 2015 study, Hobson et al. set out to observe whether families participating in an Relationship Development Intervention (RDI®)  program were able to progress towards re-establishment of the GPR through the protocol set forth by the program founder, Dr. Steve Gutstein. Hobson et al. first studied differences between the interaction styles in typically developing versus atypically developing dyads and found that parental interactions in atypically developing GPR relationships were found to be more directive in nature, of lower quality and with a reduced capacity to co-regulate and share experiences. Hobson et al. found that children-parent dyads participating in the RDI® program experienced improvements in baseline ratings of parent-child interaction and that improvements in these ratings inversely correlated with Autism Diagnostic Observation Schedule (ADOS) severity scores.

Though the initial loss of the GPR is a disappointing shock to parents, leaving many unsure of how to function as a guide for their disengaged child, the RDI® program systematically addresses core deficits and aims to reinstate the the parental guide role. Dr. Gutstein calls RDI® “A second chance,” meaning that one main goal of the program is to re-establish the GPR, which in turn brings the child closer to a more typical development trajectory. There isn’t any person on earth more qualified, more consistent and more able to serve as a guide to your child than you. RDI® empowers parents, enabling them to restore their role and to enthusiastically guide their child through the challenges of life.

As you become more comfortable in your guiding role, you are more able to provide your child with those same sweet memories you enjoyed in childhood, including the proud feelings of accomplishment and the shared joy of a hard-earned victory.

-Amber Sobrio-Ritter


Hobson, J. A., Tarver, L., Beurkens, N., & Hobson, R. P. (2015). The Relation between Severity of Autism and Caregiver-Child Interaction: a Study in the Context of Relationship Development Intervention. Journal of abnormal child psychology, 1-11.


Finding Balance

April 26, 2016

In our busy, dynamic world, it’s easy to feel like you’re being tossed from one obligation to another without any real sense of control or purpose.  While trying to provide the best care for your child with special needs, you may also be busy with personal research, meeting with professionals, driving to miscellaneous therapies, involvement in school and extra-curricular activities and many more things may occupy the day until you find yourself collapsing into bed totally exhausted and confused wondering where the day (and all your lofty goals) went. Finding balance and self-alignment is difficult and often feels impossible. Many people wonder how to regain a sense of control and purpose and live each day with enthusiasm instead of starting the day filled with fear over what challenges the day may hold. The most effective tool to regain this sense of control is to create and adhere to a schedule.

In his 1999 study evaluating the efficacy of journaling as a self-evaluative measure, W.A. Howatt found that people who construct their goals in concrete terms by planning them out and writing them down were 50 percent more likely to feel they had the ability to attain their goals and 32 percent more likely to feel in control of their lives (Howatt, 1999). Further research comparing students of similar ability found that the most significant feature between those who maintained a strong work ethic in their studies and those who gave up was a sense of control. Those who expressed a sense of control received scores that were a full letter grade higher than those who do not (Mendoza, 1999). As important as thinking about and planning the future is the use of self-reflection as a tool to increase future success. In a study by Sparrow et al, researchers found that persistent people spent twice as much time thinking, not only about what had to be done, but also about what they had already accomplished, the fact that the task was doable, and that they were capable of success (Sparrow, 1998).

Taking into consideration the importance of writing goals down, believing in the ability to control the environment and self-reflection, you may be wondering how this research translates into real-life benefits for you and your child with special needs. Read on to find helpful tips on how to organize your life in a way that makes you more efficient, more successful, and happier.

Tips for creating a parent schedule:

  • Wake up early- If possible, wake up before everyone else to give yourself time to go over your plan for the day and mentally prepare yourself for success. Taking some time in the morning to ease into the day and meditate will set the pace and mood for the rest of the day.
  • Write it down: plan the schedule for the whole week at the beginning of the week. Take into consideration your personal needs and schedule self-care every day.
  • Prioritize: Look at the most important activities in your life and plan those first. Many people are most productive 2-4 hours after waking, so plan to get high demand tasks done during that time and save repetitive tasks for later in the day.
  • Slow down: Plan recovery time. Alternate between activities that are demanding and calming. Scheduling down time and self-care into the day will increase productivity.
  • Relax in the evening- take this time to enjoy calming and relaxing activities. Reflect on the day and adjust the next day’s schedule based on what did and didn’t work well the previous day.

Tips for creating your child’s schedule:

  • Wake them up early: Allowing your child to have a calm, slow morning will help them be prepared and regulated for the day ahead. Making extra time in the morning also reduces stress and pressure bringing your child into the day optimally prepared for learning.
  • Write it down: Developing a physical schedule for your child will help them approach the day with confidence and a full understanding of the plan. Having something stable and predictable (but that also allows for some flexibility) will give them something to hang on to when feeling unsure or overwhelmed.
  • Prioritize: Look at your child’s needs and make sure the things that are most important are done earlier in the day before fatigue and burnout set in. Break up activities based on themes (sensory, gross motor, fine motor, music and movement, meal time, snack time, cooking together, reading together,quiet time, etc) and address themes as needed throughout the day.
  • Slow down: Just as you need to decompress from demanding and overwhelming activities, so does your child. Alternating between sensory activities and more demanding or stressful activities will increase your child’s ability to cope with challenges.
  • Relax in the evenings: Plan time in the evening to relax and reflect on the day. Reflection is an integral part of success and increases self-awareness and self-reflection skills.

-Amber Sobrio-Ritter



Howatt, W. A. (1999). Journaling to self-evaluation: A tool for adult learners.International Journal of Reality Therapy.
Barker, E. (2014, July 23). Here’s the Schedule Very Successful People Follow Every Day. Retrieved April 22, 2016, from
Mendoza, J.C. 1999. “Resiliency Factors in High School Students at Risk for Academic Failure.” Ph.D. dissertation, California School of Professional Psychology.
Sparrow, K.R. 1998. “Resiliency and Vulnerability in Girls During Cognitively Challenging Tasks.” Ph.D. dissertation, Florida State University, Tallahassee.

Believing in a Second Chance

April 1, 2016

At the heart of the Relationship Development Intervention program is belief in change. Even before scientific findings confirmed it, Dr. Gutstein and his wife Dr. Sheely believed that the brain of a child on the autism spectrum had great capacity for change. While looking at the current state of autism therapy, they wondered if this was the best available. They wondered if there could be such a thing as a second chance. They wondered if there would be a therapy that would not only change the observable behavior of a child on the spectrum, but something that could actually change the brain. They wanted to develop a therapy that would allow a child to have access to the most important and meaningful joy in life- guiding relationships.

Over many years of development and research, the RDI® program was born. RDI®  has been developed with neuro-typical human development in mind and goals and milestones follow that natural pattern. The problem is that as an infant on the autism spectrum grows, instead of becoming more open to the world and embracing change and challenge, withdrawal occurs in an attempt to keep the world more predictable and static. In response to this, parents suffer confusion and are often unsure of how to proceed to teach their child that does not seem open to guidance. The RDI® program was developed for a child and his/her parents to have another chance at accessing that precious, sacred relationship.

RDI® accomplishes this goal through the increased development of an individual’s ability to access their Dynamic Intelligence. Dynamic Intelligence is the ability to adapt one’s behavior to a changing world. Dynamic Intelligence is in opposition to static intelligence, where life is predictable and unchanging. The dynamic brain needs to have the ability to function in the real world, which is often complicated, ever-changing and fast paced.

Dynamic Intelligence is developed through MindGuiding, which is the ability to develop our child’s mind to be geared specifically towards the culture in which we are living. When we refer to the mind, this does not simply refer to static accumulation of information or IQ score. In thinking about the mind, we are thinking about mental processes which allow us to:

-Envision the future
-Engage in counter-factual thinking
-Look at different ways we might approach situations
-Imagine productively
-Engage in perspective-taking
-Generate multiple solutions
-Use feelings productively to judge situations
-Use decision making to choose between many variables

The graphic below shows the steps that a child in the RDI® program will go through as they become more able to think independently. Parents and their children may move through some steps quickly, while others may take more time, but it is a very systematic process that doesn’t just have the illusion of change from the outside, but is actually changing the child’s brain from the inside.


*Graphic graciously provided by RDI® Connect at http://www. RDI®

To learn more about Relationship Development Intervention and how Therapeutic Approach to Growth can help you and your child begin the amazing journey of a guiding relationship, please contact Amabelle at (858) 689-2027 to schedule a complimentary consultation.

-Amber Sobrio-Ritter

Teaching Strategies for the Messy, Imperfect, Dynamic World of Real Life

February 19, 2016

Everyone has heard the saying “repetition is the mother of all learning,” but new research suggests that for individuals on the autism spectrum, repetitive learning styles may actually impede the ability to learn and generalize new information.

Researchers at Carnegie Mellon University recruited adults diagnosed with high- functioning autism for a study to determine their ability to adapt to new information. Participant’s processing time for a computerized task was measured against the processing time of a neurotypical control group.

Participants were shown 3 horizontal bars in a specific location on a computer screen. They were then presented with the same image in the same location and were asked to determine the location of the bars while researchers measured their ability to quickly and correctly locate the bars. For the first four days, the bars remained in the original location and both the control group and the ASD group performed the task quickly without issue. Researchers then switched the location of the bars and measured speed and accuracy of location for both groups.

Those in the ASD group not only had more trouble finding the bars once they changed locations, but the participants’ previous learning impeded their ability to adapt to the new information. This indicated that their learning became so fixed and hyper-specific that it adversely affected their ability to generalize previously learned information. Some participants were never able to learn the second location as well as the first, which indicated that the initial repetitive teaching of the concept without variation was a detriment that affected participants’ ability to adjust to the changes in their environment.

New York University researcher David Heeger concluded that “Repeated stimulation leads to sensory adaptation which interferes with learning and makes learning specific to the adapted conditions. Without adaptation, learning is more efficient and can be generalized.”

Applying this information to the practical world of autism therapy is imperative to increasing positive outcomes for children who have a tendency towards fixedness and rigidity. Professor of psychiatry and neurology at the University of Pittsburgh summarized by saying that, “Individuals with autism need to be taught in ways that support or promote generalization rather than in ways that reinforce over specificity.”

Tips for parents to promote generalization:

  • Give your child opportunities to increase their dynamic thinking by introducing just noticeable differences to your routine.
  • Teach new concepts using a variety of materials and stimuli.
  • Practice new skills in multiple environments and with different people.
  • Spotlight your child’s ability to handle dynamic situations and encourage their willingness to try new things.
  • Keep things silly! Introduce games and silliness to your routine to encourage your child to find joy in little changes.

Harris, H., Israeli, D., Minshew, N., Bonneh, Y., Heeger, D. J., Behrmann, M., & Sagi, D. (2015). Perceptual learning in autism: over-specificity and possible remedies. Nature neuroscience.

-Amber Sobrio-Ritter

Learn More about Our Peer Match Programs!

September 28, 2015

Peer matches

This program is facilitated by an RDI® trained extender and supervised by a consultant (RDI® consultant or Occupational Therapist). Two to three clients that appear to be a good fit are matched for peer interaction. Carefully selected structured activities are provided to promote play, communication, and overall interaction. The focus is on supporting the participants to engage with each other in natural and authentic ways. An emphasis is placed on using natural situations to explore the various aspects of interaction, become aware of others’ intentions and actions, calmly communicate needs and wants, collaborate, repair break downs, and remain regulated in the process. The participants are given opportunities to respond in their own way. Declarative communication, such as making comments, sharing opinions, observations and thoughts is used to promote engagement and experience sharing between the peers. Data is collected in specific goal areas determined and agreed upon by the parents and consultant. Parents receive a weekly completed data sheet so they can be apprised of their child’s performance/progress and to support their child in a similar manner during other peer interactions. Goals are updated and revised as necessary.

Peer matches can be a great way to target goals that may have been mastered on an individual level, but not with others.

Meet Daniel and Miles!

Daniel is 14; he loves soccer and Angry Birds. His best friend is his twin brother whom he spends most of his free time with. Someday, he is hoping to become a professional soccer player or maybe write books.

Miles is 13; he loves to cook and build with Legos. His best friend is his twin brother whom he spends most of his free time with. Someday, he would like to be a Lego designer or a chef.

Both boys had been receiving a variety of services through TAG for several years. They had met each other from time to time, but had not become friends. Both had acknowledged wanting to make more friends. They struggled considering other people’s perspectives, tended to either be too controlling or too passive, had difficulty reflecting on their own actions, tended to become upset quickly, and were often disorganized when tackling an activity. After careful consideration of their personalities, strengths and challenges, we decided to create a Peer Match, where Daniel and Miles would get to meet on a weekly basis with each other under the guidance and facilitation of one of our trained extenders (tutors).

Based on our knowledge on the boys, we developed individualized goals that targeted areas that interfered with their development.

Daniel and Miles started meeting over the summer of 2014. Every week, I met with our extender to reflect and discuss what had taken place in the last group, and to plan for the following group. Every group and activity was carefully analyzed and planned. Our goal was to create a safe and nurturing environment where the boys would be motivated to try new activities, get to know their peer, start developing greater self awareness, and become more comfortable interacting with others in meaningful ways.

What happened then was quite wonderful! Under our careful guidance, Daniel and Miles developed a genuine friendship, where they looked forward to spending time together on a weekly basis. They engaged in a variety of activities that included cooking, board games, making videos, physical challenges and sports, and many more! They became used to reflecting on their emotions, actions, intentions and achievements. After a few months, Miles shared, “I used to hate basketball because I used to be so bad at it, but now I’ve gotten better at it, and I really enjoy it.” Daniel often reflects on how lucky he feels that he and Miles have become such good friends.

Like with any good friendship, Daniel and Miles do not always agree with each other. One day they were working on a film project that involved quite a bit of planning and decision making. Both boys were very excited, and had very strong opinions of how the project should proceed. They experienced quite a bit of difficulty in coming to an agreement with how things should be done. After several sessions of trying to resolve their disagreements, the boys and their extender came to the realization that this project was a bit too challenging for now, and they decided to postpone it. Under the guidance of their extender, both boys reflected on their experience and their emotions. They realized that although they were very invested in the film project, they cared more about their friendship. They now look back at that event and genuinely smile at how upset they became, but how well they were able to recover and maintain their friendship. This was one of many powerful lessons that Miles and Daniel learned through their peer match groups.

Their friendship has now expanded beyond the TAG clinic, as the boys have met at each other’s house on several occasions, each time very successfully. It has been a joy to be a part of and witness their relationship blossom and develop.

To learn more or to set up a complementary consult please call us at (858) 689-2027.

-Chris Vinceneux

Learning More about Self-Regulation

August 25, 2015

Self-regulation refers to the child’s ability to develop his or her own strategies to develop attention, to self soothe when upset, to inhibit impulses, and to organize his/her behavior for the task at hand. The child learns to gradually develop self regulation strategies since birth, initially through the actions of the primary caregiver, and later on by himself.

Children with sensory processing differences quite often have a very difficult time with self-regulation due to various reasons and factors. Adapting to the environment and constantly changing demands requires very complex processing in the brain, which is often difficult for children with sensory processing difficulties. When children struggle with self-regulation, we often observe maladaptive behavior or responses to the environment and sensory stimuli. It is very important to understand these signals of self-regulation before jumping to conclusions that it is behaviorally driven.

While we can always teach children helpful strategies to regulate themselves, it is important to understand that a component of self regulation relies on unconscious neurological processes that the child has no control over. When addressing self regulation, we need to commit to fully understanding the root of the problem, so that we don’t end up using a “Band-Aid” approach. An approach limited to teaching a child a few calming strategies will rarely work. A comprehensive approach is often needed to help the child improve his or her self regulation abilities. Our occupational therapy services will allow you to determine whether your child’s behavior is sensory driven or not.

Children with sensory processing difficulties often have challenges with sensory modulation, which is one of the many complex processes taking place in the brain. Sensory modulation is an unconscious process that takes place in the brainstem. It gives the individual the ability to maintain an optimum level of arousal (calm but alert) throughout the day, and the ability to focus and maintain organized behavior, regardless of the demands. It also supports the individual’s ability to easily engage in tasks, to transition easily between places, activities, people, etc., and to rapidly process quickly changing information. Poor sensory modulation frequently results in states of under or over arousal in which the individual is unable to attend to the presented tasks and can subsequently experience decreased motivation, frustration, and meltdowns.

Individuals with poor sensory modulation may engage in repetitive actions to tune out their overwhelming environment and gain a sense of order, organization, and predictability. They may also display “all or nothing” types of behaviors and difficulty adjusting their actions to the demands. An individual with sensory modulation difficulties often tends to over react or under react to a variety of situations. Difficulties with sleep, digestive problems, and other disturbances of autonomic functions may also be present. Another common consequence of deficient sensory modulation is the difficulty to quickly shift attention back and forth between several tasks, as required, for example, in social situations, or to maintain focus during familiar tasks. Sensory modulation can contribute to great anxiety in some individuals, as they are unable to cope with the demands of constantly changing information and expectations during their daily activities.

Some signs of dysregulation include, but are not limited to difficulties in the areas of:

  • Behavior (outbursts, tantrums, aggression, self injurious, etc.)
  • Attention
  • Engagement (child may struggle interacting with others due to being overwhelmed)
  • Patterns of too much or not enough activity
  • Transitions
  • Sleep/wake cycles
  • Eating patterns (i.e. too much or not enough)
  • Patterns of avoidance or seeking of sensory input

Occupational therapy is the main form of treatment for individuals with regulation issues.

Based on a thorough analysis of the individual’s difficulties, abilities, and needs, we design individualized therapy programs to promote the development of behavior regulation to support the child in all areas (home, school, play, etc.). The goal of our approach is to produce immediate improvement as well as permanent long lasting changes that will help the individual reach their full potential.

For more information about our occupational therapy services, please call our main office at 858-689-2027, or email us at


Electronics & Autism

July 21, 2015

My experience over the years working as an RDI® consultant has motivated me to address an area that I find an obstacle to most children’s dynamic growth. This is the amount of time spent using electronics or involved in other special interest activities. This is a pervasive problem in our society today, one which is not limited to children on the autism spectrum. However, for children on the spectrum who are delayed in their development, spending lots of time using electronics or in other special interest activities can be a huge obstacle to apprenticeship and to increasing their dynamic intelligence. For many, using electronics is like an addiction, because the child feels so much more competent when using electronics than engaging in dynamic interactions. Because there is often so much uncertainty with engaging and interacting, these children choose participating with electronics or other special interests over most anything else. Furthermore, it is not only the time spent on electronics, it is the time these children spend thinking about what they do when engaging with them and often how this thought process influences what they say and how they interact with people that is of great concern. Another important point is that a child may be able to think pretty dynamically within a special interest area such as electronics, however, typically, this type of thinking does not carryover to other areas.

A data collection sheet can be seen attached, which gives families an easy way to track how much time their child spends using electronics and/or is engaged in special interest activities. It is important to become aware of this amount of time and understand that time spent in this way takes away from time spent in dynamic activities and interactions that will lead to your child’s social/emotional growth.

Electronics data

The following resources may be helpful to parents and professionals:

“My fears for the future are rooted in a growing body of scientific research. A study done in the United Kingdom, for example, found that young males who spent several hours playing online, role-playing video games exhibited the same personality traits as people with Asperger’s syndrome, a high-functioning form of autism. The more time people spent playing these games, the researchers found, the more likely they were to show three specific traits usually associated with Asperger’s syndrome: neuroticism and a lack of extraversion and agreeableness. People with high levels of neuroticism have a propensity toward persistent negative states, such as anger, anxiety, and frustration. Low levels of extraversion and agreeableness correspond to a mindset that is unsuited to positive and mutually-beneficial interactions with others. The fact that excessive video games can produce these tendencies shows that they impact the brain, at least temporarily. What is unknown is whether or not this impact can become permanent over time.” Kevin J Roberts

Gail Ludwig, M.A.
RDI® Program Certified Consultant
Licensed Speech/Language Pathologist
Certified HANDLE™ Screener

Therapy Pets

June 23, 2015

Therapy pets and therapy dogs in particular can have a positive and significant impact on many individuals, including those with developmental disabilities, autism spectrum disorders, depression, and anxiety. According to Katcher, Friedmann, Beck & Lynch (1983), evidence supports the idea that the presence of companion animals can reduce stress.  Physiological measures such as a reduction in heart rate, lowered blood pressure, and other observable signs of anxiety levels show that interacting with a dog can moderate and reduce stress.  Furthermore, in the review of literature completed by Friedmann, Thomas, and Eddy (2000), the researchers found that the presence of calm, attentive dogs can reduce stress responses more than the presence of an adult and even more than the presence of a supportive friend when children were reading aloud or having a routine medical exam.  There is ample research to support the use of therapy pets and particularly dogs to reduce anxiety, stress and encourage sharing (conversations, reading aloud) from kids and adults.

At Therapeutic Approach to Growth (TAG, Inc.), a certified therapy dog is available to support the needs of a variety of clients. Nala received her therapy dog training alongside her handler Kathryn Bovino. Together, the pair trained extensively while attending several therapy dog classes and participating in supervised visits to individuals in a variety of therapeutic environments.  As a result, Nala and Kathryn attained their certification as a therapy dog team through Love on a Leash in April 2014. The team has experience working together providing therapy in a variety of settings such as nursing homes, veteran’s facilities, reading programs, as well as at the TAG office with many clients.

Many individuals have benefited from Nala’s support and therapeutic approach. One example of success took place with one little boy through eight sessions with the therapy dog team.  After working with his mom at home and in the office with the team, he was able to reduce his significant fear of the dog.  During the first session, the boy remained a total of 20 feet away from the dog and was only able to look at her and watch Kathryn interact with her.  With his mom’s support at home (working on social stories, looking at books, talking about dogs, looking at pictures of Nala, etc.), he was able to take on more responsibility in reducing his fear and getting closer to the dog during each session.  During the final session, he was able to brush and pet her, sit next to her and talk to her!  He was even able to walk with her while he held the leash with Kathryn.  Other examples of how Nala has worked with clients at TAG include times when her presence encouraged the client to participate in more conversation and sharing about himself, as well as when Nala participated in a peer match where both kids offered their toys to share, included her in their play and conversation, while sharing with each other about what she was doing and how cute she was.  Nala always brings a smile to everyone she meets and it is clear that the effects of interacting with a therapy dog are evident every day at TAG!

If you or someone you know is interested in learning more about how utilizing a therapy dog may help you or your child, please contact TAG at or 858 689-2027


Increasing Intrinsic Motivation in Academics and other Areas

May 23, 2015

Ideally it would be great if we did things, even challenging things, because we were all motivated intrinsically, or internally. Research shows that when external rewards are involved, intrinsic motivation decreases and when verbal feedback is used intrinsic motivation increases (Click here for full research article).

As most parents will admit, it can be a challenge to find ways to help school age children be motivated by academics without resorting to the use of external rewards. Parents, who have children with special needs, may find it particularly difficult to find ways to help their children learn to become intrinsically motivated when it comes to academic activities.

We are always reminded of the idea that if children are not learning the way we are teaching them, then we need to teach them how to learn because in fact, all children can learn! By using a variety of RDI® strategies, it is possible to help students with various ability levels feel more competent and connected to academic tasks.

Here are a few ideas that can help students feel more connected and want to participate in academic tasks more readily:

1. Discover your child’s passion or interests. Tap into these for academic activities.
2. Create a trusting environment.
3. Give choices whenever possible. One idea would be to let your child choose the order in which to complete academic activities.
4. Add energy to your activities. Try to be enthusiastic and give your child opportunities for movement if possible.
5. Slow down to give your child time to process the information and engage with you.
6. Demonstrate, show, describe and engage with a purpose. This will allow your child to understand the why behind the work.
7. Use games, music and art activities to achieve academic goals or to make academic activities more fun and interesting.
8. Allow the student time to reflect and so they can remember their successes. Model this when needed by highlighting their success for them at first.
9. Share your child’s successes with others!

By using some of these strategies, students can begin to develop intrinsic motivation and display less of a need for external rewards during academic activities. As teachers and parents, when these strategies are used we will begin to see children who feel more confident and competent. Increased competency will lead to fewer negative behaviors and anxiety and a desire to learn, achieve, and develop in academic learning.

If you feel like your child would benefit from academic support or educational consultation, please feel free to contact our office. We offer support to children with a variety of developmental disorders.

Sensory Processing Disorder

March 23, 2015

Sensory processing disorder is a condition in which the brain has trouble receiving and responding to information that comes in through the senses. The condition used to be called sensory integration dysfunction. Sensory processing disorder can affect all areas of functioning, including behavior regulation, academic learning, motor skills, social interaction, vocational success, and overall development of independence.

Individuals with sensory processing problems may or may not have other conditions or developmental disorders such as autism, ADD/ADHD, or various learning disabilities.

Symptoms of Sensory Processing Disorder

Individuals of any age can be affected by this disorder. The presence of a Sensory Processing Disorder may include difficulties in the areas of:


  • Behavior problems (outbursts, tantrums, aggression, self injurious, etc)
  • Attention
  • Engagement
  • Patterns of too much or not enough activity
  • Transitions
  • Sleep/wake cycles
  • Eating patterns (i.e. too much or not enough)
  • Patterns of avoidance or seeking of sensory input


  • Issues with clumsiness, balance, posture, coordination, strength, etc
  • Bumps into things and people
  • Breaks things (not intentionally); spills and drops things
  • Easily tired
  • Tends to look, touch, talk, and walk aimlessly, as opposed to engaging in more complex purposeful actions
  • Fine motor; handwriting

Social emotional

  • Lack of confidence
  • Easily frustrated
  • Gives up; loses interest
  • Resistant to trying
  • Resistant to change
  • Helpless attitude
  • Resistant to following directions
  • Controls interaction
  • Poor awareness of personal space
  • Does not seem to tune into others when they speak
  • Overly talkative
  • Resolving conflicts


  • Initiating
  • Planning and organizing
  • Problem solving
  • Self-evaluating
  • Making decisions
  • Inhibiting impulses
  • Prioritizing


  • Poor learning; difficulty understanding concepts and remembering
  • Poor attention
  • Poor organization; time management


  • Sensitivities (haircutting, face washing, clothing textures, picky eater, etc)
  • Reliance on others to complete daily activities; resistant to doing things on their own
  • Messy eater
  • Resistance to completing certain tasks


  • Time management
  • Money management
  • Planning and organizing
  • Living independently
  • Transportation
  • Managing relationships
  • Developing work skills

Like many illnesses, the symptoms of sensory processing disorder exist on a spectrum.

Many children with sensory processing disorder start out as fussy babies who become anxious as they grow older. Children and adults with sensory processing disorders tend to be more anxious, and tend to have to work harder to obtain the same results.

Many children and adults have symptoms like these from time to time. However, therapists consider the existence of a sensory processing disorder when the symptoms become severe enough to affect normal functioning and disrupt everyday life.

Occupational therapy is the main form of treatment for individuals with Sensory Processing Disorder.

Based on a thorough analysis of the individual’s difficulties, abilities, and needs, we design individualized therapy programs to promote the development of attention, behavior regulation, social interaction, motor skills, confidence, and overall learning. The goal of our approach is to produce immediate improvement as well as permanent long lasting changes that will help the individual reach their full potential.

For more information about our occupational therapy services, please contact call our main office at 858-689-2027, or email us at


Homework Strategies

February 23, 2015

Homework can be a frustrating time for many students and their families. Many students with learning disabilities, ADD/ADHD, Autism, Asperger’s, and other conditions tend to become dysregulated during challenging tasks such as homework. The reasons for struggling with homework can be different for every student; however, we have found that certain strategies tend to be helpful with most students.

Here are some strategies that may be helpful:

Setting up the optimum environment

  • Identify the best room and location in the house where your child should do his or her homework; a quiet room without siblings, TV, and computer games is usually best
  • Providing a work space free of clutter can be important in setting the stage for success; attention should also be given to having a chair that provides adequate postural support, proper height ratio between chair and desk, and a work surface that is large enough for the child’s homework needs

Creating a homework routine

  • Most children respond better to having a predictable homework routine. For example, the expectation of coming home after school, having a snack, and starting homework is likely to help decrease the resistance to doing homework. While a short snack break before homework is often beneficial, a longer break where the child gets to play can make it more difficult to stop the fun stuff and start homework

Utilizing movement breaks

  • Many children with attention difficulties and sensory processing issues can benefit from taking movement breaks. When you feel that your child is no longer able to focus on the task and is becoming increasingly distracted, fidgety, or resistant, it maybe time to take a short movement break. The parameters of the break should be well defined in advance (location, activity during the break, duration)
  • An example of a break may be to walk around the house to get a sip of water, check on the pets, walk out to the yard, etc. It should be kept to a few minutes (under 5 minutes is often sufficient). Activities should not be too entertaining as for example playing with the computer, as it would most likely make it more difficult for the child to return to homework

Providing organizational supports

  • Many students can struggle organizing themselves, which can lead to frustration. Providing organizational supports can allow the child to achieve better success with less frustration
  • Schedules can be helpful in identifying the sequence of the various homework tasks and help the student realize that there is an end to this difficult task
  • Checklists can be used to help the child remain focused on what needs to be done, and how much is left to do
  • Timers can often be helpful to boost attention, increase focus, and introduce the concept of time management
  • Present information in a way that is less overwhelming. For example, consider breaking down assignments in small sections that will look more achievable to your child

Using effective communication strategies to give directions, feedback, and to set limits

  • We often tend to talk too much! A child who is overwhelmed by the homework tasks may become even more overwhelmed by being given too much information, even when done with the best intentions. Parents may become frustrated in response to their child’s frustration and focus on the child’s difficulties and negative behaviors. Avoid power struggles; consider talking less, using a neutral and calm tone of voice, and acknowledging the child’s efforts and accomplishments. Give your child plenty of time to process information. For example, instead of saying, “You need to focus better,” you may say, “I know this is hard… I can tell you’re trying to focus”

We provide a variety of individualized services to help you address your child’s homework difficulties. If you would like more information, please contact us at 858-689-2027, or