The Zone’in Child Development Series newsletter for education and health professionals profiled teleEducation in June 2010, and now turns to telehealth for July’s topic.  As a pediatric occupational therapist concerned about the overuse of technology by children, I have recently received a number of requests for information regarding the efficacy of telehealth, e.g. the use of telecommunication systems to facilitate the delivery of health-related information and services.  A school principal questioned the efficacy of telehealth for speech and language services; an occupational therapist was told by her school district that she was required to use telehealth to deliver OT services to reduce her travel expenditures, and questioned efficacy in a pediatric school-based population; a speech and language pathologist who has been providing telehealth conjointly with 1:1 therapy services stated her telehealth service “wasn’t working” and she wondered whether she was doing it “correctly”.  The intent of this article is to raise awareness regarding the increased use of telehealth services as they apply to treating the pediatric population, and raises concerns regarding the utilization of telehealth services with children.

What is telehealth?

The term “telehealth” is broadly used in research literature, and could reference any or the following: video conferencing between health care professionals and clients, client education or training, and may reference client assessment, treatment intervention and follow up consultation.  Related terminologies found in the literature are ehealth, telemedicine, telerehabilitation and teleoccupational therapy.  This generalization of the term “telehealth” in the literature creates obvious difficultly when considering the scope of therapeutic practice.  Variability in client parameters (age, diagnosis), choice of assessment and treatment type, competency level of therapist, frequency/duration/intensity of intervention, and treatment environment are but a few factors to consider regarding telehealth service delivery.  Trying to determine cost-effectiveness and efficacy of a telehealth service requires research that is specific to each variable parameter encountered.

Who is doing telehealth?

It appears that telehealth is present to some degree in almost all health care disciplines, yet exactly what type of telehealth is offered, and whether this telehealth is actually effective, is difficult to determine when reviewing existing telehealth research.  In the field of paediatrics, telehealth is present in ‘virtually’ all child care centres, hospitals, mental health clinics, private therapy clinics, and even many schools are now using telehealth.  As telehealth technology expands its role from video conferencing into areas of assessment and treatment, more and more health professionals are using telehealth with limited knowledge regarding above noted usage parameters.  Careful design of implementation protocols, and preliminary review of evidenced-based research is imperative prior to wide scale use of telehealth, particularly with the pediatric population.  A brief google search indicates that a number of private practice pediatric occupational and speech and language clinics are currently offering telehealth services, yet not one of these websites cited evidenced-based research outcomes, nor did they delineate telehealth service delivery protocols or procedures.  Telehealth is a relatively new treatment modality, and requires careful evaluation of existing relevant research and extensive planning prior to implementation.

Does telehealth work?

The National Initiative for Telehealth Guidelines, Environmental Scan of Organizational, Technology, Clinical and Human Resource Issues, prepared by the NIFTE Research Consortium published April 30, 2003 is a comprehensive document on telehealth and ultimately recommended that health care systems move forward to implement telehealth services, despite also citing research that profiles the lack of evidence-base for clinical efficacy and cost-effectiveness.  This document may be helpful to readers who are seeking to design implementation protocols with outcome measures for the use of telehealth in their school or clinic settings.  The following statement is excerpted from the NIFTE Executive Summary located at http://www.cranhr.ca/pdf/NIFTEEnvironmentalScan-ExecutiveSummary-May72003.pdf.

The clinical efficacy and cost-effectiveness of telehealth has been demonstrated for some but not all applications (e.g., Hersh et al., 2001; Roine et al., 2001; Whitten et al.,2002). It has been asserted that technological improvements are overcoming many current limitations (e.g., Bashshur, 1998) such that there are or soon will be no important clinical difference between face-to-face and telehealth consultations.

The following conclusion statements are excerpted from abstracts of above cited research studies on telehealth.

• Hersh, W.R., Helfand, M., Wallace, J., Kraemer, D., Patterson, P., Shapiro, S., & Greenlick, M. (2001). Clinical outcomes resulting from telemedicine interventions: a systematic review. BMC Medical Informatics and Decision Making 1(5): http://biomedcentral.com/1472-6947/1/5, 2001. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. Conclusion: Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.
• Roine, R., Ohinmaa, A. & Hailey, D. (2001). Assessing telemedicine: a systematic review of the literature. Canadian Medical Association Journal 165 (6), 765-771.  Interpretation: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.
• Whitten, P.S., Mair, F.S, Haycox, A., May, C.R., Williams, T.L., & Hellmich, S. (2002). Systematic review of cost effectiveness studies of telemedicine interventions. British Medical Journal 324, 1434-1437.  Conclusion: There is no good evidence that telemedicine is a cost effective means of delivering health care.

There are likely a number of research studies in progress that will show specific areas where telehealth utilization is an effective method of occupational service delivery.  An  occupational therapist is investigating the use of telehealth to service children with disabilities in remote locations http://www.otworks.ca/otworks_page.asp?pageid=751.  Delivering Developmental Occupational Therapy Consultation Services Through Telehealth is a study conducted by the University of New Mexico’s Center for Development and Disability http://findarticles.com/p/articles/mi_7520/is_200909/ai_n39229849/?tag=content;col1.  The University of Alberta’s Centre for Telerehabilitation http://www.uofaweb.ualberta.ca/telerehab/research.cfm profiles a number pediatric-related areas of telehealth research such as assistive technology, FASD, preschool mental health, school-based teams and wheelchair seating.  I would caution use of telehealth for assessment and treatment interventions in the pediatric population until such time as evidence-based research supports such.

Telehealth Clinical Issues

The following considerations for clinical practice are excerpted from the NIFTE Executive Summary, ‘Clinical Issues’ section located at http://www.cranhr.ca/pdf/NIFTEEnvironmentalScan-ExecutiveSummary-May72003.pdf.

Communication – As there is no consensus as to whether telehealth enhances or attenuates the therapeutic relationship or the traditional practice of medicine, further research is urgently needed on the nature and content of the communication process.

Standards/Quality of Clinical Care – There is diversity of opinion regarding whether there is a need for telehealth-specific practice guidelines, or if existing guidelines from the various professional licensing bodies and associations serve the purpose. The “appropriate” standard of care delivered via telehealth should be equivalent to the standard expected in traditional provision of care. If equivalent standard of care cannot be met, the telehealth practitioner needs to consider what the alternatives are and decide if it is acceptable to proceed.

Clinical Outcomes - Telehealth systems require assessment of relevant outcome data to promote and support the sustainability of telehealth programs. Telehealth networks need to have a systematic method of collecting, evaluating and reporting meaningful outcome data, which would include indicators of efficiency of service and clinical effectiveness between telehealth practitioners and patients.  Telehealth should be integrated into the normal provision of health care services to enhance, not replace existing health care services and to improve access, appropriate use, and efficiency of health care services.

Telehealth Considerations

“…there are or soon will be no important clinical difference between face-to-face and telehealth consultations”.

Creating a technological interface between therapist and child removes the ‘human element’, an energetic connection that requires face to face interaction.  Occupational therapists are trained in the ‘therapeutic use of self’ which is the true gold standard for achieving effective therapy.  In the absence of a therapeutic relationship, the role of the therapist is reduced to that of an observer which while useful, yields limited information and may significantly alter treatment.  If telehealth is used for the purpose of interactive communication between therapist and child, how might children interpret the concept of ‘self’ when viewing their therapist through the screen?  The therapist might be perceived by the child to have an appearance similar to a TV character.  Interacting with a real therapist vs. a virtual image could change the ways in which the child performs or verbalizes.  To consider the term ‘self’ (child or therapist) is the same concept whether using a technological interface, or face to face interaction, is denying the fact that we are all human beings whose survival and well being depends on our ability to form healthy attachments and connections with each other.  Can a child actually form an attachment with a character on a screen, and can communication be therapeutic when the therapist is not perceived as real?

In pediatric occupational therapy, the use of touch, movement and human connection are three critical modalities used to facilitate child development and ensure efficacy of treatment techniques.  These critical modalities are not achievable using telehealth, significantly limiting use of  specific types of assessment and treatment interventions.  Relying solely on the therapist’s ability to observe, and not interact, with a child will yield a poverty of information which may result in misguided treatment interventions.

Just as with teleEducation, the rapid advancement of technology into the health care system has caught professionals unaware and unprepared regarding the consequences of unrestricted and pervasive use of telehealth services.  Thinking that telehealth will prove effective (eventually) in every setting with every individual is short sighted and will likely result in client harm.  For example, proceeding forward with telerehabilitation services in school-based settings without adequate evidenced-based research to support such initiatives, may prove to increase the wait time until the client actually receives his/her research proven 1:1 therapeutic interventions.  There are inherent problems associated with the idea that technology is useful for every condition and situation, and even more inherent problems when society chooses to ignore the detrimental consequences of technology overuse on children.  30% of children enter school developmentally delayed and 15% have a diagnosed mental illness, both associated with sedentary technology use.  Yet – we are using technology to assess and provide interventions to address these very disorders that are a result of technology overuse.

Restrictive use of telehealth is imperative until such time as specific research provides evidence to support implementation.  Specific guidelines regarding utilization of telehealth must be developed to promote ‘best practice’ and result in improvements (not erosions) in occupational therapy service delivery.

Cris Rowan, OT (Reg), BScOT, BScBi, SIPT, Approved Provider for ACTBC, AOTA and CAOT
CEO Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.
6840 Seaview Rd. Sechelt BC V0N3A4
604-885-0986 O, 604-740-2264 C, 604-885-0389 F
crowan@zonein.ca
websites: www.zonein.ca, www.suncoastot.com

Technology Overuse or Management?  It’s time to face the facts!

Balanced Technology Management for Schools of the New Millennium

The 21st century has borne witness to nothing short of an explosion in use of electronic technologies, both at home and in school settings. Education systems have joined the race to stock their schools with the latest and greatest new technologies, striving to provide their students with up to date learning tools and techniques. Unfortunately, there is limited research regarding the actual effectiveness of these electronic devices to facilitate learning, empirical evidence the education systems once used as the gold standard to determine teaching methods. More worrisome is the existing research regarding the long term effects of technology overuse on the developing child shows detrimental effects on physical, mental, social and academic performance. Another parameter worth considering regarding the issue of technology overuse is the fact that education systems throughout North America are experiencing whole scale financial crises. While school districts lay off teachers, close schools, and cordon off playgrounds with yellow tape due to disrepair, one has to question educators choice to continue to spend escalating amounts of money on student technologies that are antiquated before they even comes out of the box! It’s time to face the facts regarding the impact of technology overuse, and work together to manage a balance between activities children need for growth and success with technology use.

So how much technology use is too much when considering the developing child, and what measures can the education system take to ensure children who overuse technology are still achieve optimal growth and academic performance?    A quick review of the research is imperative if educators are to understand the impact of technology overuse on child health and academic performance. Children now use an average 7.5 hours per day of entertainment technologies, largely unsupervised due to the fact that 75% of children have either a TV or computer in their bedroom (Kaiser Foundation 2010). The subsequent impact of this sedentary yet chaotic technology overuse on a child’s physical, mental, social and academic performance is astounding, to say the least.  Child obesity is a North American epidemic (Tremblay M 2007). One third of children entering school are developmentally delayed (Kershaw P 2009) and 1 in 6 children have been diagnosed with a mental illness (Waddell C 2007).  Child aggression and acts of violence in schools are at an all time high (Vancouver Sun 2010), while ability to communicate and socialize at an all time low (Christakis D 2007).  Academically, literacy is declining as attention and learning disabilities escalate, leaving educators wondering how they can possibly teach children who are also sleep deprived and hard wired for high speed.

While all these above noted statistics are causally related to child technology overuse (see Zone’in Fact Sheet), few brave souls are willing to walk the path toward promoting wide scale recognition and development of effective solutions. The virtual lure is so strong and technology use so pervasive, that everyone seems to have adopted the illusion that technology may actually be good for children, a widely circulated idea amongst educational technology producers. The wide spread and escalating use of computers in school settings, without any empirical evidence to show they do nothing more than simply entertain children, is literally bankrupting the education system. Universal denial by educators that technology overuse is putting children’s existence in peril, along with the blinded persistence to allow children unrestricted use, could actually be termed a form of abuse and/or neglect in a legal sense. Caution and adherence to research evidenced facts will help guide educators back on the track toward optimizing child health and literacy. So how do education systems get on the same page and begin the difficult task of managing balance between activities children need for growth and success, with technology use?

Activities Children Need to Grow and Succeed

Build Sensational Classrooms, Gyms and Playgrounds

With one third of a child’s day spent sedentary, schools can provide organized activity that incorporates the three critical factors to ensure optimal child development and academic performance.  These activities can be performed in the classroom, gym or on school playgrounds and should include sensory and motor components:

• Touch – deep pressure tactile input promotes praxis (planned movement patterns) essential for printing, and reduces anxiety to promote learning.
• Movement – vestibular and proprioceptive input determines core posture, motor coordination, and optimizes arousal states – essential for printing, reading and academic performance in all subjects.
• Connection – student relationships with educators can promote healthy attachment formation, integral for attention and learning.

Sign up for the Foundation Series Workshops (available in webinar or DVD format) and learn everything you need to know to optimize student learning to successfully bring your school into the 21^stcentury.  Purchase the Zone’in Program to improve attention and learning through self regulation of energy.

Teach Children to Print

Chalk boards have disappeared from the primary setting, with many teachers under the illusion that because of computers, children don’t need to learn to print. Educators in the primary sector spend an average of 13 minutes per day teaching children to print, and utilize inconsistent and non-standardized instruction and evaluation methods.  The result is that children don’t know how to make their letters and numbers, slowing down output and increasing student frustration.

Purchase the Move’in Program to teach children how to print at their own developmental level.

School learn to manage balance with…

Technology Use

Identify Indicators of Technology Overuse

The first step is to identify children who overuse technology, either through use of a technology screening tool and/or record of technology overuse indicators. The Technology Screen provides an average daily technology usage as reported either by parents or the student themselves. Recording the total number of technology overuse indicators as listed below on a student’s file would guide teachers toward technology management interventions, as opposed to use of psychotropic medication. The greater number of technology overuse indicators a student has could be indicative of a possible technology addiction, requiring school counseling for the student and family.

• Obesity
• Developmental delay
• Sleep deprivation
• Mental illness
• Behavior disorder
• Aggression
• Social isolation
• Speech or communication delay
• Poor academic performance
• Attention difficulty
• Learning disability

Purchase the Unplug’in Program to build alternate skills to technology, allowing students to develop technology reduction strategies.  Purchase the Live’in Resource Guide to assist your school in developing a yearly one week intervention to raise student and staff awareness regarding the detrimental effects of technology overuse.

Technology Overuse Impact Parent Education Sessions

Education and health systems may want to team together to plan education sessions and support for parents of children who overuse technology.  The Unplug’in Parent Brochure and the Ten Steps to Successfully Unplug Your Child from Technology are two documents that can be sent home with children as parent education initiatives.

Develop Technology Usage Policy Guidelines

1. Prohibit entertainment technology use AT ALL TIMES. Children are already using 8 hours per day at home, so don’t allow additional use at school.
2. Only use technology products that are evidenced based without conflict of interest e.g. research that was not conducted by the technology production company.
3. Establish risk/harm reduction policies regarding technology use.  These policies should take into account that children with photophobic conditions such as autism are at risk for seizures.

Working together as a team – parents, educators, health professionals, government, researchers and technology production corporations can ensure sustainable futures for all children by enacting Balanced Technology Management initiatives. We can move children away from the virtual toward a healthy new reality.

Cris Rowan OT (Reg), BScOT, BScBi, SIPT, Approved Provider for ACTBC, AOTA and CAOT
CEO Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.
6840 Seaview Rd.  Sechelt  BC  V0N3A4
604-885-0986 O, 604-740-2264 C, 604-885-0389 F
crowan@zonein.ca
websites: www.zonein.ca, www.suncoastot.com

Schools of the New Millennium – Declining Literacy – A learning disability or a teaching disability?

The escalating proliferation of untested technology in education systems to the detriment of child literacy.

I was consulting in Northern BC in a remote Native community, and was working with a bright and energetic grd. 4 student who had “learning difficulties”.  The resource teacher stated that she thought he was underperforming, and had this year exhibited significant defiance and difficult behaviour.  I was observing this child doing math, and when he looked at me and asked if the number he just produced was a “5” (it looked a bit more like a backward “7” to me), I realized he didn’t know how to print.  I asked the resource teacher to scribe for this child, and he literally jumped to the challenge and proceeded to fly through math sheets getting all correct answers.  Here was a delightful, smart and now extremely frustrated child trapped in a system that had not taught him how to print.

I would like for you to do a small task to help illustrate how children who are not taught to print feel on a minute by minute basis in our school systems.  Write or print your name.  Now do the same mirror image backward.  Now print this way for the next week.  How do you feel right now, having been given a task you neither know how to do, nor want to do?  Confused, frustrated and a bit defiant?  Might you eventually evolve into a child with “behaviour problems” if asked to continue with this ridiculous task?   Hopefully, you would eventually develop a “motor plan” for this new way of producing output, but that’s because you are an intelligent adult with average motor skills, and not a developmentally delayed child, as 30% of our primary children are today (Kershaw P 2009).

Declining interest by educators to teaching printing skills continues to astound me.  When children’s grades are based largely on output produced by printing, one would think that some effort to teach this essential skill would be warranted. Instead, far too often, lack of printing skill is perceived as a ‘learning disability’ when really it is a ‘teacher disability’, and the consolation prize is to hand children who can’t print a computer.  Steven Graham in a 2008 survey of primary teachers found that average time spent on a daily basis teaching children to print is 13 minutes per day. In the 1970’s it was 60 minutes per day. Also reported in Graham’s study was that teachers reported methods for teaching printing were highly diverse and inconsistent, and evaluation of printing non-standardized.  The illusion of the “quick fix” by handing children who struggle with printing a laptop is ignorant and short sighted, and is resulting in soaring rates of illiteracy.  Half of grd, 8 students do not have job entry literacy for math, reading and printing (National Centre for Education Statistics 2005), yet instead of going back to the ‘tried and true’ McLean’s method of teaching printing, the education system continues to invest scarce resources on unproven and untested educational technologies (Fast Company April 2010).  When I say “unproven” and “untested” I am referring to something more than a ‘conflict of interest’ document provided by the manufacturer.  These devices require rigorous research that is reliable and reproducible over the long term.  This becomes exceptionally difficult when technology is advancing at such a rapid pace (see http://www.youtube.com/watch?v=cL9Wu2kWwSY ).  With dwindling resources, it might be wise to ask the question “Is it the job of the education system to provide children with updated computer applications, at the expense of not teaching ‘the basics’?”  This line of thought is likely to bankrupt the Education Ministries in short order, and is presently contributing to declining literacy!  Children with developmental delays and subsequent poor motor coordination, largely due to technology OVERUSE in the home setting (average use of entertainment technology is now 8 hours per day for the elementary child – Kaiser Foundation 2010), can no more manipulate keyboards than a pencil.  We are raising a generation of children who are largely illiterate, and as a result, are being mislabelled with behaviour diagnoses.  How long would you keep going to a job where your skills were deficient and you didn’t know what you were doing?

I recently completed a six week pilot project designed to enhance literacy and printing skills in two school kindergarten classrooms on the Sunshine Coast. This project consisted of the following components: 1) development of a K screening tool to determine sensory and motor components that limit acquiring literacy, 2) design a 3 hour teacher/SETA workshop on methods to promote literacy, 3) design and pilot test 12 twice weekly sessions to enhance attention, gross motor, oculomotor, fine motor, visual motor, praxis, and hand function skill components, 4) perform final evaluation using initial screening tool.  Approximately 30% of each classroom was identified as developmentally delayed and subsequently referred for the intervention by resource and classroom teachers, a statistic congruent with Paul Kershaw’s 2009 15 X 15 UBC HELP study findings.  Limitations were only 7 out of the total 12 session were conducted, screening and sessions required extensive revisions with consistent pattern established session 5, (largely due to unanticipated poor spatial concepts and inability to pay attention), use of printing “rules” and use of wall surface inconsistent with classroom experience (classrooms did not have chalk or white boards).  Results indicated 12% and 18% improvements in two schools, with 29% and 26% improvements in hand function, and 16% and 26% improvements in visual motor skills (the two most significant skill deficit areas).  While this pilot project was just a start toward a far more expansive printing program, it illustrated that a minimal intervention (two ½ hour weekly sessions) can go a long way toward improving children’s ability to print.

At this crucial point in time, when educators are actively making the decision to not teach printing skills, and instead turn the job of literacy over to computers, they would be wise to ask the question “Where is the evidence?” that supports this choice.  I have long and hard championed the return of printing as a curriculum-based subject with all our Canadian provincial Education Ministries.  If printing were curriculum, this would provide teachers with much needed consistency in teaching and evaluation methods.  The continued escalation of use of computers in school settings is further contributing to rising rates of ADHD and illiteracy (Christakis D 2007).  In his book “iBrain – The technological alteration of the human mind”, neurophysiologist Gary Small reports that children who use high speed technologies are rewiring their brains to not access frontal lobe (the longer neuronal tracks), and poses the question “How will educators teach children with poor executive functioning and limited impulse control?”  Whole school districts in the US are supplying every elementary aged child with TeacherMates (Fast Company April 2010), calling it the “$100 curriculum in a box” and referencing the teacher as a mere “moderator”. One has to wonder about the future longevity and rapidly changing role of the teacher.

On May 3, 2010 I will have the opportunity to speak with 20 representatives from the Ministries of Education, Health, and Children and Families in Victoria on the impact of technology on the developing child.  During this “technology craze” period, educators might want to revert to use of teaching tools that are evidence based and backed by reliable and replicable research studies, and not spend dwindling resources on technology that is antiquated before the box is even opened.

Research references can be located on www.zonein.ca under Fact Sheet.

Cris Rowan OT (Reg), BScOT, BScBi, SIPT, Approved Provider for ACTBC, AOTA and CAOT
CEO Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.
6840 Seaview Rd.  Sechelt  BC  V0N3A4
604-885-0986 O, 604-740-2264 C, 604-885-0389 F
crowan@zonein.ca
websites: www.zonein.ca, www.suncoastot.com

Download the article in pdf format here.

Forget about the notion of creepy older guys targeting young children in a park. With the anonymity and ease of going online to connect with hundreds of children, predators can now forgo the schoolyards.

http://www.canada.com/news/More+predators+prefer+target+kids+online/2764338/story.html

In response to Michele Whiting’s letter (Coast Reporter, March 26), don’t throw the baby out with the bath water.

http://www.coastreporter.net/article/20100402/SECHELT0303/304029987/-1/sechelt0303/technology-is-invading-schools

Re: Violence against school staff is on the rise, March 27

http://www.vancouversun.com/health/children/2747155/story.html

Please consider the following newly revised 300 word letter to the editor submission for the Coast Reporter, responding to Stefanie Samaras, Chatelech math teacher.

Where is the evidence?

The education system’s illusion that technology promotes learning fails to be supported by any empirical research, yet Stefanie Samaras vehemently advocates for its continued use in school settings (Coast Reporter April 16, 2010).  Elementary aged children are now using an average 8 hours per day of a variety of entertainment technologies (Kaiser Foundation 2010), resulting in 30% developmental delay (Kershaw P 2009), 30% obesity (Tremblay M 2007), and 15% mental illness (Waddell C 2007), with incidence of child, adolescent, and adult internet addiction soaring (Block M 2008). Half of grade eight children do not have job entry literacy for math, reading and printing (National Centre for Education Statistics 2005), yet the education system continues to invest scarce resources on unproven and untested educational technologies.  In his book “iBrain – The technological alteration of the human mind”, neurophysiologist Gary Small reports that children are rewiring their brains to not access frontal lobe, and poses the question “How will educators teach children with poor executive functioning and limited impulse control?” Whole school districts in the US are supplying every elementary aged child with TeacherMates (Fast Company April 2010), calling it the “$100 curriculum in a box” and referencing the teacher as a mere “moderator”. One has to wonder about the future longevity and rapidly changing role of the teacher.  On May 3, 2010 I will have the opportunity to speak with 20 representatives from the Ministries of Education, Health, and Children and Families in Victoria on the impact of technology on the developing child.  During this “technology craze” period, educators might want to revert to tried and true teaching tools that are evidence based and backed by reliable and replicable research studies, and not spend dwindling resources on technology that is antiquated before the box is even opened.

Cris Rowan,

Pediatric Occupational Therapist
Cris Rowan, OT (Reg), BScOT, BScBi, SIPT, Approved Provider for ACTBC, AOTA and CAOT
CEO Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.
6840 Seaview Rd.  Sechelt  BC  V0N3A4
604-885-0986 O, 604-740-2264 C, 604-885-0389 F
crowan@zonein.ca
websites: www.zonein.ca, www.suncoastot.com

No Touch, No Connection – No Learning!

iTeach and ITV are two new ways to use technology in school and therapy based settings.  “iTeach” refers to the use of computer devices to teach children, also termed “Virtual Teaching”.  Increased use of TeachMate, ClassMate and XO computer devices as replacements for teachers is rapidly becoming the norm in both the US and Canada  http://www.fastcompany.com/magazine/144.  “ITV” is a term applied to the use of satellite TV linkage of occupational, physical and speech and language therapists to remote locations for the purpose of assessment and treatment of children.  I was recently speaking in Oklahoma to a group of therapists who informed me of this new and rapidly growing practice.  One therapist reported she was concerned regarding poor results yet continued use of this method, being told by the school system that “It’s better than nothing”!

While many of these technologies could eventually prove to be beneficial for some children, it appears as if many school systems are throwing the baby out with the bathwater, and charging ahead without adequate research to support their technological choices.  The illusion that technology will “fix” all the children with developmental problems and learning difficulties is not only short-sighted, but may result in more significant behavior management problems down the road.  Reflecting on what research and time has shown to be effective and useful techniques to facilitate attention and learning, might be wise.  Putting the “breaks” on the Technology Train to allow for research to catch up, would likely benefit all children.

Separating children from human touch and connection through increased use of technology has already had a profound effect on child behavior and mental health.  Children now watch an average 8 hours per day of technology (Kaiser Foundation 2010) resulting in 30% entering the schools developmentally delayed (P. Kershaw 2009).  Charlotte Waddell reported in 2007 that 14.3% of Canadian children have a diagnosed mental illness.  It has been theorized by many child psychiatrists and neurologists (P. Breggin 2009, F. Baughman 2009) that the underlying causal factor in all mental illness is dysfunctional attachment between the child and primary parent(s).  Autism and ADHD incidence (both consider disorders of attachment) are now at 2% and 10% respectively, and are escalating yearly (CDC/NIMH 2009).  These statistics are important to consider by educators, as any time children with attachment disorders spend connected to a device, is time spent disconnected from humanity, and could result in a worsening of their disorder.

Human touch and connection are biological needs, without which humans die. In the late 60’s, Ashley Montagu a physiology researcher from France discovered that infants in orphanages who received touch and human connection survived, whereas those who were deprived, died. Dr. Montagu began his life study of human touch and connection, and went on to author his famous book “Touching – The Human Significance of the Skin”.  Dr. Monagu’s research determined that children who were exposed to “adequate touch” were calm and relaxed, and children who were touch deprived demonstrated anxiety and depression.  Tactile input and human connection are both power tools when it comes to helping children feel safe and secure in school based settings, both salient predictors of attention and learning.

We live in world that seems to have forgotten the need for touch and human connection.  In fact, many educators have recently banned touch from schools settings, enacting “No Touch” polices.  While these policies are well meaning, and presumably put in place to protect children from what might be termed “inappropriate” or “sexual” forms of touch, removing all touch from children who have attachment disorders or difficulty learning could be disadvantageous (to say the least).  While one can certainly follow this line of reasoning, I wonder if indeed there is adequate evidence to back “No Touch” policy initiatives.  Are children actually safer from inappropriate or sexual touch in schools who prohibit all forms of touch?  Would it not be prudent to explore the idea that possibly prohibiting all touch with a “No Touch” policy might leave children more vulnerable, because they wouldn’t understand the difference between touch that is appropriate and touch that isn’t?

In my workshops I teach a form of appropriate touch termed “Deep Pressure Touch” (DPT) that I recommend combining with attachment techniques.  Protocol for this procedure requires the educator or therapist first make an “I see” or “I hear” observation of the child, which helps the child to feel seen or heard.  The educator or therapist then asks the child permission to give them a “shoulder squeeze”.  The educator positions themselves well off to the side of the child, and administers a sustained squeezing motion of both shoulders, while pressing their forearm across the child’s back.  The child can at any time move out of this position.  The shoulder squeeze has proven to be exceedingly relaxing for children, and works to ground hyper and charged energy states.

As many children are currently already falling off the Technology Train, I suggest trying a few appropriate touch and human connection techniques prior to engaging children in increasing amounts of disconnection from humanity.  Empathy requires human connection.  With increasing problems with child aggression in school-based settings (Vancouver Sun March 27, 2010), causing harm to teachers and students alike, trying a little appropriate touch and human connection are certainly more humane than locking children in seclusion rooms or restraining them with medication.

Cris Rowan, OT (Reg), BScOT, BScBi, SIPT, Approved Provider for ACTBC, AOTA and CAOT

CEO Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.

6840 Seaview Rd.  Sechelt  BC  V0N3A4

604-885-0986 O, 604-740-2264 C, 604-885-0389 F

crowan@zonein.ca

websites: www.zonein.ca, www.suncoastot.com

Don’t throw the baby out with the bath water!

There is no empirical evidence that shows computers enhance learning, and mounting evidence that they don’t, yet school systems throughout North America are investing heavily in their use. Teachers are becoming a remnant of the past, rapidly being replaced by TeacherMates and XO’s, but at what cost? We don’t know, and that’s the problem.  Technology is invading home, school and work spheres at a rapid pace, without necessary empirical data to guide application. Studies show screen reading results in poorer retention, comprehension and increased distractibility over book reading (Mangen 2008). High speed technology is hard wiring children’s neurology to use short distance tracks, not long distance tracks to the frontal lobe (Small G 2008), a favored brain structure for learning due to its role in impulse control and executive function.  Tossing the baby out with the bath water, educators in primary school settings have reduced teaching printing to a mere 10 minutes per day (Graham S 2008), assuming computers will replace the need to print. Yet these same educators grade children based on their printing output! Math, spelling, sentence production, and short answer fill-in, all require printing skill. Technology is raising our children to be illiterate, delayed in development, obese, detached from humanity, mentally ill, unable to socialize verbally with their peers, aggressive, lacking in empathy, and unable to pay attention or control their impulses (www.zonein.ca Fact Sheet).  The fact that these children might be advanced in certain aspects of cognition is a paltry consolation. Encouraging children to detach from humanity and attach to devices will result in dire consequences, and raises the question “Will children of the 21^st century be sustainable”?

Cris Rowan, Occupational Therapist

6840 Seaview Rd.

Sechelt, BC  V0N3A4

604-885-0986

crowan@zonein.ca