The therapist and the family must create a stimulating, yet safe experience to practice the necessary skills needed to be independent in the world, a "just right challenge." Creating the just right challenge requires an accurate assessment of a child’s abilities and limitations. What is it that this child can do, and what is it that causes limitations? Is it motoric, emotional, a combination of both or something else? A careful structuring of the task is required.

Like Maia with her violin, encouraging your child to adapt and
"do their best" inspires and empowers children.

A just right task is one that encourages the child maximum independence with minimal adult intervention. Sometimes the task must be broken down to the very smallest increment to find what the child can do independently. It is important to keep in mind that a certain amount of frustration and fear is necessary when approaching a novel task. Therapists should search for ways to validate the child’s feelings while encouraging the child to find inner strength. The therapist’s ability to listen to the child’s family’s fears and concerns are equally as important. Together, a plan can be created to help the child advance through the fears to empowerment.

As the child develops greater mastery over its body, he or she learns that the body is a resource available for an ever-growing array of experiences. The child grows in the belief of its own abilities. A child with a disability will often become overly dependent upon his or her parents, learning to manipulate others to achieve interaction with places and things. Because he or she cannot go out into the world, the world comes to the child through other people, thus reducing their experience of the world. The world, as the child knows it, contracts around him or her. It is sometimes easier for the parents to get the toy their child wants. However, the child’s motor ability is yoked with the parents to accomplish this goal. If done repeatedly, the child learns to "use" the parent’s legs instead of crawling over to the desired goal independently. The child loses power as he or she enters the vicious cycle of learned non-use and passivity.

An empowered child explores the world with wonder and enthusiasm.
Kyle seems to be getting the empowered idea on the monkey bars.

The parent’s own distress and grief over having a child with a disability is overwhelming. Parents need time to become more accepting of the disability and the impact it has on their lives. However, the child’s most valuable motor learning time is in the first years of life, exactly when the parents are dealing with their grief.

Annie, at 8 months of age, could not yet roll from her belly to her back. She was lying on the floor, noisily attempting to roll over. Her mom, Mary, became upset at how hard it was for Annie. She spoke of her sadness about Annie’s future and wondered if everything in Annie’s life was going to be a struggle. The therapist looked at Annie and did not see the same struggle that Mom was upset about. The therapist asked her what did she think Annie was communicating with her complaints. Mary replied, "Mommy, mommy help me. I can’t do this. This is too hard. I need your help." The therapist spent some time listening and empathizing with Mary about how hard it was for her to have a daughter like Annie, a child with a disability.

Mary cried about how she missed her own mom who had passed away, and that she was the one who needed her mom’s help in how to raise this child. Mary, once realizing that it was her own distress that she was seeing, looked at Annie again with a clearer understanding. Instead of rolling Annie over, she gently placed her hand on Annie’s back to reassure her daughter that she was present with her, but that she would not do the work for her. Mom now conveyed a very different message with her touch. The unspoken message in Mary’s touch was, "I’m here with you. You can do this." Annie, much to the delight of her mother and the therapist, rolled over by herself. Mom and baby both gained a newly found confidence in themselves.

The more a child is encouraged and supported to move independently in the world, the freer the expression of movement, language, and choices. The parent’s challenge is to encourage this freedom while offering the boundaries necessary to function in society. 

The child integrates these rules and guidelines with his or her own innate need for self-expression. Response-ability, in other words, the ability to respond, is the capacity to smoothly integrate the rules and guidelines of the environment (societal as well as physical) with self-generated expressions of movement, communication, decisions, choices, and actions. With these skills, the child actively explores an ever-expanding world.

Inner strength and the enlistment of outer support will develop as each new experience unfolds. All of the self (physical, mental, emotional, and spiritual) is available to interact with the environment. A child that can move out into the world is not limited by the selection of another, offering only some part of the world to him/her.

The empowered child explores the world with wonder and enthusiasm. He or she has the endurance, developed over many learning trials, to persist through challenging activities. An empowered child is a learning-abled child. A variety of solutions are available through learning the necessary skills of active problem solving.

Maggie, a spunky two-year-old with developmental disabilities that include upper extremity weakness, decides she wants to get down from a chair that she’s sitting in. She begins to reach forward with both hands outstretched in front of her. Her mom, Deb, comments to the therapist that this is a new movement choice that Maggie is employing in transitioning out of the cube chair. The therapist and mother watch as Maggie continues to lower herself to the ground, hands outstretched and head first, when it becomes apparent that the weight of her body can not be supported by her arms. With her body already in motion, she quickly tucks her head and rolls to the side, as her mother enthusiastically says to her, "Well done, Maggie, good move!" Maggie responds with a delightful giggle and crawls away to her next adventure.

We have found, after working many years with children who have developmental disabilities, that therapists must monitor themselves for their own impatience, frustrations, angers, and unmet needs. When setting a goal for a child, it is necessary for the therapist to ask, "who is this important to and what is this important for?" Watching someone "struggle" requires self care and assessment strategies. It’s important to be aware of our own "projections" about what we are seeing. Does the struggle belong to the child, the parent, or the therapist?

Children significantly benefit from parents having a safe place to express their own feelings and needs about what they are experiencing. Parents must have time for healing. The quality of the time is more essential than the quantity. Parents deserve caring, non-judgmental professionals who can listen to them as they negotiate their way through the grief process.

The just right challenge is created to both stimulate growth and allow for success. The idea is to structure an environment where the child can experience himself or herself differently. This difference will invite change. It is important to remember that change takes time. Time must be given to the child for all the various emotional and physical adventures in learning.

Watching children who have learned to meet life’s challenges in spite of their disability is seeing empowered children. Empowered children are children who have learned to identify themselves for who they are, not just what they can and cannot do.

When they are unable to meet their goal, they don’t let that failure mean that they are a failure. They meet life’s challenges with determination and confidence. They allow their feelings of frustration, anger, and sadness to surface and through expression, transform them into motivation. The same is true for the empowered child’s parents.

Empowered parents identify themselves for who they are, not their child’s successes or failures. They too meet life’s challenges with determination and confidence. They have allowed their feelings of frustration, anger, and sadness to surface and through expression, transform them into motivation. These individuals are powers of example to all they come in contact with, as they share their strength, hope, and experience.

Chris Hammer is a Licensed Physical Therapist working more than 20 years for children with disabilities and their families at UCP. She is currently the agency’s clinical supervisor at their Children’s Center. Chris is also an adjunct professor at SUNY Stony Brook.