How to help your child with intellectual deficiency or comprehension difficulties during lockdown
Reference Center for intellectual disabilities of rare causes - Robert-Debré
Esther Chalain and Faustine Ageorges, psychologists
Dr David Germanaud and Dr Domitille Gras, child neurologists
Dr Anna Maruani and Pr Richard Delorme, child psychiatrists
Dr Laurence Perrin, clinical geneticist
Harmful virus, maintaining a healthy lifestyle and lockdown: a lot of new challenges for all of us to face, especially for children suffering from neurodevelopmental disorders affecting their abilities to understand, either because of a lack of ability to understand concepts and/or a lack of communication abilities. This is typically the case if your child suffers from intellectual disability that can be associated with other disorders. This sheet aims to help you by providing advice that you can adapt to your child depending on the nature and level of their disability. You know this better than anyone else.
This article has embedded URL addresses to pages and documents which you can print off.
How to explain the situation and the rules to my child who has comprehension difficulties?
There are two ways to make your child’s adaptation to the lockdown and the pandemic easier:
- make the situation as understandable as possible
- explain safety gestures (hand washing etc …)
It is important to take as much time as required while adapting to your child’s abilities.
- Explain to them as many times as they need it, during several days to make sure the situation is clear to them.
- If your child understands the concept of time, tell them that things will soon get back to normal
# If your child suffers from light intellectual disability and understands oral language, you can explain the situation to him by taking inspiration from the following document, written in Easy To Read and Understand (Facile À Lire et à Comprendre, FALC), which becomes Easy French once read. Do not hesitate to rephrase. Identify the new words that quickly become obvious to us but not to your child, and associate a picture with them.
Here is how you can explain it simply to them.
“What is the new coronavirus everyone is talking about?”
- The new coronavirus is a new virus
- Viruses are very very small
- You cannot see it
- But the coronavirus looks like this
- Coronavirus appeared in China at the end of last year
- That is why it is called Coronavirus-19
- It has now arrived in France
- This virus can make people ill
- The illness can be:
harmful if people are fragile, like old people
not dangerous if people are in good health
- Coronavirus can cause:
- How is the virus caught?
through touching things with your hands
- It is very easy to get the virus if you are next to a sick person
- How do I protect myself from the virus?
I wash my hands very often
I use hand sanitizer that kills the virus
I do not shake hands
I avoid hugs and kisses
§ out of my home
§ with sick people
I do not need to wear a mask
§ at home
§ if I am at more than two steps from other people
- How to treat coronavirus?
There is no medication to treat the virus yet
There is no vaccination to protect us from the virus
Our body eliminates the virus in one week
Very sick people have to go the hospital
- That is why I cannot go out of home, except:
To go to work when I cannot work at home
to buy food if the shop is next to my home
to go to the doctor’s or the pharmacy
to take care of someone who needs me
to walk my dog next to my home
# If your child suffers from severe intellectual disability or has limited access to oral language, you can use the Augmentative and Alternative Communication. You can accompany your words with gestures, signs or objects, photographs and images.
# Explanation and rules are understandable when they have a visual support and are divided into steps. You can make your own pictograms by drawing them or taking pictures. You can ask your child to help you in making them. Pictures and pictogram are used to indicate:
- what is the function of each space in the house (you can stick them to the wall or furniture)
- what is allowed in each space and what is not
- safety gestures to prevent infection by the virus.
Example of explanation of barrier measurements using pictograms: hand washing, sneezing in his elbow, use of disposable tissues
Example of sequential action: It allows the child to understand what must be done and in what order to do it.
You can use the following support to explain your child how to wash their hands properly.
Example of explanation of authorized and prohibited places and activities: Explanatory plates from (Demerville M).
How to deal with personal obligations (shopping, working) and unexpected events during this unprecedented period?
Stay confident in your abilities as parents to deal with this unexpected situation. Do not be too harsh towards your child and yourself.
Take time for yourself, it is important. In the day during your child’s nap or in the evening, take some time to relax and do pleasant activities.
Keep in touch with your relatives and people who have children in the same situation as yours. It is important for your child to keep in touch with the other members of the family and their friends, you can organize video calls to make this happen.
You can also contact a parents’ association. There are plenty of groups led by these associations with lots of advice. You can find them on social media like Facebook©.
Point out that you need time to work:
- add your time of work in the timetable, using pictures or pictograms
- use a ringtone or a timer to identify your work time
- show clearly to your child that you are not available. You can use a label “available” / “not available”
Seek help if you need some. Your child’s specific needs and their level of disability can be challenging and you can face real problems taking care of yourself or to organizing yourself to sustain your family (e.g. going shopping).
How to be organized during the lockdown while helping my child with their specific needs?
6 strategies to help you.
Strategy number 1 # Communicate with your child and be vigilant to any change in their behaviour.
Not understanding the situation and the loss of routines can result in emotional crises, avoidance or compulsive behaviour. To prevent such difficulties, it is important to:
- explain simply and clearly
- set clear rules. They can be made more acceptable by establishing a contract with a delayed reward (refer to the corresponding practical sheet).
- ask your child about how they feel to help them manage their anxiety. Be vigilant to their anxiety in assessing their body language, their voice, their breath. There are tools to help assess emotions: sheets using simple words assessing your child’s feelings, the dragon exercise, the emotion wheel.
If your child shows any unexpected or unexplained changes of behaviour during the lockdown, check their temperature. Indeed, even if it is not the most probable, it is possible that fever, a strange sensation (for example the loss of smell), discomfort (for example a mild breathing discomfort) or pain (sore throat) can lead to a change of behaviour.
If your child is very opposing, there is advice available on another sheet on our website.
Strategy number 2 # Adapt the environment to everyone at home
Organize the day.
With the lockdown, routines can be modified which can disturb your child. It is important to put these routines back in place, as close as possible to your child’s usual rhythm:
- stable and usual times for waking up, breakfast, nap, bedtime …)
- set up routines in the daytime: when to wash, when to get dressed, when to go to sleep) to help your child stay aware of the time
- you can make a timetable using pictures and put it on the wall or a board.
my timetable Here is an example
Define spaces in your home
Try to define spaces in your home so each of them is dedicated to a specific activity: a space for work, a space for playing and a space to relax. Use pictures and pictograms, even drawings made by your child, to indicate the function of each space. You can have a look at the sheets: “How to organize school time at home?” and “Autism Spectrum Disorder: what to do at home during lock-down?”.
Strategy 3 # Maintain school and after-school activities.
Explain to your child why they are not attending school or special school anymore.
Some children and teenagers can show distress and do not understand why they do not go to special school anymore. Start by asking them “Do you know why you are not going to school anymore?”. By asking this question, you know what your child’s beliefs are and you can identify wrong interpretations like thinking they were expelled or punished. Use simple words to explain to them that staying at home is “obligatory” & what is “best” at the moment. Remind them that they will go back to school as soon as the virus will not prevent kids going to school.
How to maintain school at home?
Following your child’s specific needs and the kind of school they attend, school at home can be different to meet their needs.
Here are some useful general advice:
- make a timetable that indicate the different times in the day and when each activity take place
- quality is better than quantity : you can reduce the amount of work time depending on your child’s abilities
- start with their favourite activity to make them confident
- try to stick as much as possible to their teacher, school assistant (AVS) and specialist educator
- use a reward system to encourage them to work
- use one notebook so your child can see what they have done
If your child attends a special school (“IME”), you can contact the team who takes care of them. They can give you your child’s precise timetable that you can adapt at home
- if your child have cooking class, you can maintain this activity at home
- if a specific skill is being learnt at the moment, keep working it at home because it can help your child generalizing their skills.
- if an alternative way of communication is being learnt, it is also a good opportunity to generalize it.
Strategy 4 # Alternate between school time and relax time
It is better to alternate school time and relax time to avoid your child being tired or fed up, which can lead to violence. Do not feel obliged to keep the same amount of time as in school, it is not necessary when you work individually with your child. You can make a list of tasks and activities for the day that you organize in the timetable, alternating between work times and relax time.
It is important to make your child work step by step: each exercise must be short to avoid your child being tired or fed-up. Always change the type of activity: a difficult exercise must be followed by an easy one. Set 3 to 4 sessions of work per day, 4 to 5 times in the week.
Tell your child in advance that they are going to change activity.
- change space for each new activity
- use ringtones : clock, timer (Kids Timer®, available on Google Play®), say it out loud, give them a card “end of activity”
Here are some ideas for fun activities
- adapt the games to their abilities
- ask them what games they would like to play, you can add them on the time table
- organize creative activities : painting, drawing, stickers, salt dough, modelling clay, mosaic … .
Do not forget physical activities. Make your child wear their sports clothes so they understand it is time to do some sport. Join them in the activity, sports help keep fit and healthy, physically and mentally.
Here are some ideas of activities: motor pathway, ball game (if you have enough space), dance…
You can have a look at the sheet about how to train psychomotor skills at home
It is useful to have quiet and relax time (relaxing music, active relaxation, yoga, listening to a story) in the day for your child and yourself, given the stressful events we are facing. According to your child’s abilities and needs, you can suggest them a quiet time in their bed, in the sofa, on a carpet on the floor, in a tent made with bedsheets and pillows. You can have a look at the sheet “how to help your anxious child facing coronavirus”.
Strategy 5 # Make your child participate in home tasks
Daily home tasks help developing autonomy. Moreover, they are practical activities that you can reward easily.
- Cooking : peel and cut the vegetables, cut the bread and put it in the basket, help to make easy recipes
- Tidying up : empty the dishwasher, tidy cutlery, tidy socks and clothes …
- Fold napkins
- Set the table: it makes your child count the number of people sitting at the table, how many glasses, plates … are needed. If your child does not know how to count, you can help them by putting table sets for example.
- Tidy their room
- Emphasize their autonomy: brushing their teeth, washing their hands, help to putting clothes on and taking them off … Some websites offer tutorials to help you.
Use the opportunity of developing your child’s autonomy: it will be a great victory for them and for you!
Strategy 6 # Moderate access to screens (TV, Ipad®, video games, social media)
Screen exposure can increase with lockdown and it is totally acceptable, do not feel guilty about it! However, be vigilant and do not let your child exposed to screens all day long. Screens are authorized by settling a reward contract to avoid conflict. Try to keep screens out of sight when your child is not allowed to access them.
Moreover, you can use screens as reward after your child has shown good behaviour or has accomplished work.
Adapt the TV programs and the video games to your child’s age and abilities to understand. For example, TV news or radio programs are not suitable for children and can provide violent sounds and images.
If you struggle with screen time management, you can have a look at the sheet “how to manage screen use for my child during lockdown”.
NB: Regarding the right to mental and physical health, spending some time outside can be authorized if it is delimitated in space and time. It can help you child. Please, check the government’s guidelines concerning this matter because they can change. It is essential to follow official governmental rules.
What to do if my child struggles with the current situation, despite the previous advice?
# Ask for an online consultation
Ask the professional people who are usually in charge of your child if they can provide you an online consultation (psychiatrist, neurologist, speech therapist, psychologists, occupational therapists, educators, psychomotricians …). They can help you with your child’s specific needs.
# Concerning your child’s medication
- Do not change their treatment by yourself with the doctor’s advice
- Try to respect as much as possible the times of administration
- No self-medication! Whatever new situation occurring, do not self-medicate yourself or your child.
# Attending Emergency Department
Avoid attending Emergency Department without let them know you are coming. In case you doubt whether you need to take your child to the Emergency Department, try to call your family doctor or call 15 if you fear a problem related to Covid-19. In case of behavioural issues increasing because of lock-down, call your child’s specialist.
Be careful, do not delay medical help! Do not let your child’s state worsen because you want to avoid going to the Emergency Department, especially if your child show the following symptoms:
- they cough a lot
- they struggle with breathing : quick breathing, tiredness after a physical effort, weaker voice than usual, unusual sound when breathing.
The best during this period is to call your child’s paediatrician or general practitioner. Ask them what to do. Go to the Emergency Department if recommended by your child’s doctor.
Translated by Dr. C. LANDEL (psychiatry resident) and W. Lapworth