sensory integration dysfunction: what s a family to do

1. Sensory Integration Dysfunction: What’s a Family to Do? Home ideas for students with difficulties with sensory processing Elisa Wern OTR/L Tools for Success February 1, 2003

3. What are some signs of Sensory Integrative Dysfunction?  overly sensitive to touch, movement, sights, or sounds under-reactive to touch, movement, sights, or sounds easily distracted social and/or emotional problems activity level that is unusually high or unusually low physical clumsiness or apparent carelessness impulsive, lacking in self control difficulty making transitions from one situation to another inability to unwind or calm self poor self concept delays in speech, language, or motor skills delays in academic achievement

4. SENSORY INPUT

5. The Continuum of Processing/Responses to Sensory Info In each sensory system, a child may be under-responsive “hyposensitive” or over-responsive “hypersensitive” to input. When a person is hyposensitive to input, they often need extra input within that sensory system to maintain a regulated, calm attention level. They may not attend to sensory information presented to them, or they may seek out additional information. When a person is hypersensitive to certain sensory information, that input can be perceived as painful or uncomfortable. They may respond by avoiding or withdrawing or become anxious, distressed, or even aggressive. Persons who may have unregulated sensory systems may also experience difficulties with motor planning, postural control, social/ emotional functioning, body awareness and scheme, and academic skills.

6. When are sensory integration problems actually considered a dysfunction? Doesn’t everyone experience problems at one time or another? Yes we all experience problems in processing sensory stimuli on occasion. Examples: going to a rock concert with crowds of people can be so overwhelming that you have to leave before it is over. Riding a roller coaster and feeling sick or wobbly when you get off means you were probably overloaded with vestibular stimuli. Being overly sensitive to smells when you are ill is another example. An occasional experience of disorganized sensations is very normal. It becomes a dysfunction when the sensations are disorganized so much and so often that it interferes with activities of daily living.

7. Bubble Gum/Tootsie Roll Break

8. So what do I do? If you think your child may have difficulty processing sensory information… Talk to your child’s teacher to see what they are seeing Try to incorporate activities at home and school with assistance of teacher to help your child better use and benefit from the information he/she takes in by senses

9. What Activities do I do? Well, that depends on your child… Remember - There are two very broad categories of how children process information…the hypo- and hyper-responses... However, each child could be at different ends of the “continuum” for each type of sensory information…

10. So you have to be a detective?!?! Investigate your child - when do you see some of these behaviors? When you do see them - what are they doing? Do they avoid an activity “most” children enjoy? Are they overly excited or do you notice they are always “on the go” or involved in particular activities?

12. Children with sensory processing problems can benefit from appropriate sensory experiences within play or daily activities. Most of the following suggestions provide either movement, muscle resistance/ "heavy work" or deep pressure to the skin and can help reduce touch and movement sensitivity, and improve body awareness and coordination. "Sensory seekers" are very active children who are always on the go with a short attention span. They typically respond positively to increased sensory input in repetitive activities, which work muscles- this helps children focus their attention and coordinate their actions Children who overreact to input may be very sensitive or distressed by certain sensory inputs (every day sounds like vacuums or blenders, being touched lightly, tickling) but find others enjoyable and calming (bear hugs, sleeping under heavy quilts, massage).

13. Keep routines/possessions in the home organized and structured as much as possible. Predictability and a daily routine can be very helpful. Be consistent with daily rules and consequences. Perhaps all family members can discuss house rules, determining appropriate behavior and routines (and consequences when they are not met) in advance. These can be posted if necessary.

14. Keep a large calendar or schedule posted. The calendar can be made with "event" stickers or photos for a child not yet reading. The system used should highlight the daily and weekly routine and allow a visual representation of the child’s day. In that way, the child can be alerted to changes in advance. Perhaps the child can go over the schedule for the following day each evening before bed.

15. Create specific routines for difficult times of the day or responsibilities (e.g., bedtime, bath time, morning self care before school). The routine can be broken into small steps and these can be posted in a checklist form or picture form for the child to look at each time the routine is performed. If the child is old enough, the checklist might help him/her be independent in the routine.

16. Make errands and transitions concrete and illustrate with pictures, when possible. For children who need extreme predictability and routine - make a photo book of places you go with your child, and keep it in the car, so that when a daily schedule is disrupted, you can show the child "This is where we have to stop today before we go to….." This may help with distress levels when the normal schedule is not being followed.

17. Choosing Activities Children can have different responses to different sensory input - which can make choosing what activities to do with your child difficult!

18. Children Who Need Sensory Input to Stay on Task(HYPO) SEEKERS Some children are "sensory seekers" and become more organized and attend better to a task if they receive periodic movement input, such as:   Sit on a camping/inflatable pillow filled with a small amount of air. This allows for movement while doing seat work without leaving the desk. There are companies that sell “wiggle seats,” but any partially deflated pillow will produce the same effect, for less money! Suggest 5 minutes of swinging or climbing during outside play time before having to concentrate on a task such as homework. Rhythmical, sustained movement e.g., marching, washing windows/tables or bouncing can be organizing to the central nervous system. Never discipline a "sensory seeker" by taking away free play outside at home or P.E. at school - you will intensify the random movements, fidgeting and outbursts if they are not able to get the info they seek and need.

19. Some children also need extra sensory input to their mouths (ORAL) and hands (TACTILE) in order to organize their behavior, such as: Drinking from water bottles kept at desk (send them home weekly to be washed). Chewing on rubber tubing placed on the end of a pencil, straw or coffee stir stick.  A bucket or fanny pack of "squeezies" in can be used by children who like to fiddle with something in their hand. A "squeezie" is a small object which is soft and can fit in the hand e.g., balloons filled with flour, soft balls, "dog" toys or koosh balls.  Like we have --- You can inexpensively make a fidget toy with sand or flour and balloons.

20. Hanging by the arms on the monkey bars for 20-30 seconds at a time. Pushing/carrying heavy objects i.e., books, moving desks or "pushing" against walls. A reading corner in the child’s room with a bean bag chair makes a wonderful place to escape from too much stimulation and help get ready for more focused homework. They might enjoy reading or sitting under the bean bag chair more than sitting on it.     REMEMBER: Some children need to move in order to pay attention. Watching children can provide cues to choosing activities to provide appropriate sensory for organizing behavior and improve attention. 

21. Children Who are Oversensitive to Sensory Input - (Hyper) AVOIDERS Children who are sensitive to light, unexpected sensory input often prefer firm touch/pressure/input which helps organize their behavior. Keep the following tips in mind: Approach the child from the front to give a visual cue that light touch is coming.  Firm pressure to the shoulder or back is preferable to a gentle hand placement or a brush to the sleeve, arm or face.

22. When working on home work area should be out of traffic towards the periphery/sides of the room so that the child has a good view of who’s moving and where they are going.  Crowded places and situations can cause discomfort because of the possibility for unexpected bumps and brushes. Seat a small child in the adult’s lap or next to a quiet child during a group gathering. Place older children to the side or in back of the group.

23. The Alert Program The Alert Program teaches strategies for self regulation/processing to improve functional skills for learning. The Alert Program uses the analogy of engine speeds to make it easier for children to understand. If your body is like a car engine, sometimes you may feel like your engine is running in high speed, in low speed or just right.If your body is like a car engine, sometimes you may feel like your engine is running in high speed, in low speed or just right.

24. When your engine is in high speed, you have difficulty paying attention, sitting quietly to ourselves or getting your work done.When your engine is in high speed, you have difficulty paying attention, sitting quietly to ourselves or getting your work done.

25. When your engine is in LOW speed, you may also have find it hard to concentrate, you may “daydream” easily or feel like a “couch potato.”When your engine is in LOW speed, you may also have find it hard to concentrate, you may “daydream” easily or feel like a “couch potato.”

26. When you are at the “JUST RIGHT” speed, it’s usually easier to pay attention, to get your work done and to have fun. If you want change your engine speed from HIGH or LOW to get into “JUST RIGHT”, you may want to try the following... When you are at the “JUST RIGHT” speed, it’s usually easier to pay attention, to get your work done and to have fun. If you want change your engine speed from HIGH or LOW to get into “JUST RIGHT”, you may want to try the following...

27. How Do We Get to the Just RightEngine Speed? To understand the sensory-motor strategies that will be suggested to help students self-regulate, the concept of “heavy work”, which is nothing more than PROPRIOCEPTIVE INPUT from the muscles and joints must be understood. If you will recall, earlier we discussed the POWER SYSTEMS of VESTIBULAR, PROPRIOCEPTION AND TACTILE as being power base of our sensory processing abilities. These are our foundation. For purposes of this presentation, I will briefly have you consider the BRAIN. The top part of the brain is called the CORTEX and is responsible for our thinking. The center section is called the BRAIN STEM and is responsible, in part, for how alert we feel. The back section of the brain is called the cerebellum. One of its jobs is to take in information, called proprioceptive input from the muscles and joints. We can get this proprioceptive input from heavy work. These activities include pushing, pulling, lifting, hanging, climbing carrying weighted objects, climbing, etc. When engines are in HIGH gear, a message is sent to the brain and body that essentially say to calm down. We can then relax and focus. On the other hand, if the child is in LOW gear, these same heavy work activities send a message to the brain and body to be alert, wake up, we need to get going and focus. To understand the sensory-motor strategies that will be suggested to help students self-regulate, the concept of “heavy work”, which is nothing more than PROPRIOCEPTIVE INPUT from the muscles and joints must be understood. If you will recall, earlier we discussed the POWER SYSTEMS of VESTIBULAR, PROPRIOCEPTION AND TACTILE as being power base of our sensory processing abilities. These are our foundation. For purposes of this presentation, I will briefly have you consider the BRAIN. The top part of the brain is called the CORTEX and is responsible for our thinking. The center section is called the BRAIN STEM and is responsible, in part, for how alert we feel. The back section of the brain is called the cerebellum. One of its jobs is to take in information, called proprioceptive input from the muscles and joints. We can get this proprioceptive input from heavy work. These activities include pushing, pulling, lifting, hanging, climbing carrying weighted objects, climbing, etc. When engines are in HIGH gear, a message is sent to the brain and body that essentially say to calm down. We can then relax and focus. On the other hand, if the child is in LOW gear, these same heavy work activities send a message to the brain and body to be alert, wake up, we need to get going and focus.

29. Put Something in the Mouth See copy of list.See copy of list.

30. MOVE

31. TOUCH

32. LOOK

33. LISTEN

34. Incorporating sensory input in specific home routines Bath time: scrub with washcloth or bath brush, use a variety of soaps and lotions for bathing; play on the wall with shaving cream or silly soap; rub body parts with lotion after bath (deep pressure like a massage); or sprinkle powder onto body parts and either rub or brush into the skin.

35. Meal preparation or baking: let your child help with mixing ingredients, especially if they are thick since this will work arm and hand muscles. If baking, let child help mix and roll dough and push it flat, if needed. Allow child to help carry pots of cold water for the stovetop (with supervision of course). If needed, have child help tenderize meat by pounding with a meat mallet.

36. Grocery shopping: have child push the shopping cart, carry groceries and help put them away.  Mealtime: encourage child to drink from a straw and provide lots of very chewy and resistive foods, if they are tolerated. If you have trouble keeping your child seated because she likes to jump up for stimulation, try an air-filled seat cushion, which will allow motion within the seat. Perhaps using a weighted lap blanket will help the child remain seated at the table longer.

37. Around the house: let the child help vacuum, and also help move furniture before and after vacuuming. Read books together in a rocking chair. Provide a quiet place for the child who gets too wound up. This place should be used as a "decompression" spot (not as a punishment). When you see the child getting a little excited you can say…"you know, it looks like you could use a quiet place now, you seem a little excited." The place should be quiet, comfortable, soft, and dim.

38. Bedtime: if your child has trouble sleeping you can try adjusting the linens to add weight and texture. Sometimes adding lambs wool or something soft allows for deeper uninterrupted sleep. Also, heavier blankets and quilts (even if it seems too hot) may help. You can also try different fabrics for the sheets and pillowcases (cotton jersey for example)

39. Miscellaneous Home Ideas Play the "sandwich" game using couch or bed pillows. Sandwich your child between two pillows and squish them. Apply pressure to their command (ask harder or softer). Some children like a lot more pressure then we think they would. Make up obstacle courses around the house using furniture, toys and other objects to reinforce sequencing body movements. Have the child do as many steps as they are able to remember and complete. You can use crawling, hopping, skipping, climbing, rolling, and a variety of other movements depending on how much space you have available. 

40. TACTILE EXPERIENCES Making mudpies and sandcakes Drawing with wet or dry chalk Painting sidewalks and fences with water Handling and pedaling tricycles Walking barefoot Planting in the garden Playing in the sink or bathtub Building with blocks Manipulating small objects such as Legos, dominoes and jigsaw puzzles Using classroom tools, such as crayons, scissors, and brushes Examining natural objects, such as pine-cones, feathers, sticks, and rocks Lying on pillows or beanbag cushions Curling up in "secret hideaways" Petting and feeding animals Finger-painting with paint, shaving cream, or chocolate pudding Gluing art projects Manipulating play dough Washing hands with soap and drying hands with towels Stirring cookie dough Eating snacks with different textures, such as cheese, pretzels, and fruit Handling rhythm instruments Playing Dress up Hugging and roughhousing gently with friends/family

41. More Tactile Experiences games of "find the buried toy in the shoebox full of dry macaroni noodles (or Slime)", "draw/write with your fingers in the whipped cream (or shaving cream) on the mirror", playdough, and similar activities. You can let your child play with a vibrating massager, or you can give him a massage with it. Create critters with gum drops (they're sticky) and toothpicks. You can eat them when you're done!

42. VESTIBULAR EXPERIENCES Swinging in circles on a tire swing Riding on a playground merry-go-round Swinging back and forth Riding up and down, walking, and balancing on a seesaw Jumping on a trampoline or mattress Jumping from a step or from the playground equipment Climbing a jungle gym Sliding down a slide Ascending and descending stairs Rolling and sledding down the hill Somersaulting Running Walking on uneven surfaces, such as grass or sand Walking on a balance beam, railroad tie, or low wall Let your child rock in a chair or spin him around while holding him tightly Get a hammock chair and hang it from the swing set for a deep pressure swing.

43. Oral Processing Experiences Any candy that is resistive or tough to chew - for example tootsie rolls or gummy bears some children respond well to an electric toothbrush when doing their morning/night routine - for children who are very defensive - this is something which must be done with great caution You may want to get one of those lollipops that twirl around. They have a handle with a battery that makes it spin. It provides good oral input, and you can find them at the checkout area of department stores like Wal-Mart.

45. PROPRIOCEPTIVE EXPERIENCES Pushing and pulling wagons Moving through an obstacle course Playing "bumpety-bump" on the tire swing Hanging from monkey bars Stretching up to the sky, like growing plants Playing horsey Wheelbarrow walking Pouring sand, beans, water, or juice from one container to another Ripping paper Hammering nails into Styrofoam Pressing pegs into pegboards Getting in and out of seat belts, jackets and boots, shoes and socks Opening doors without help Tumbling on the ground Wrestle. Make a kid sandwich out of your child. He can be the meat. Two cushions can be the bread. Encourage the heavy pet dog to sleep and play with your child. Monkey bars and swinging from a trapeze or rings provide pressure to the joints.

46. Resources for Parents Heavy work list for parents (Deanna Sava and Elizabeth Haber – both OT’s) - FOR ALL THOSE SEEKERS OUT THERE! Internet sites listing email sign up or I can mail it to you if you don’t have access to email! The Out of Sync Child by Carol Stock Kranowitz ISBN # 0399523863 There is also a new companion book out with many more activities - The Out of Sync Child Has Fun also by Carol Stock Kranowitz ISBN #0399528431 Take Five! Staying Alert at Home and School, by Mary Sue Williams and Sherry Shellenberger ISBN # 0964304112

47. How to find OT’s in the School System Call your child’s school and leave a message for the OT who covers that school. If you have general questions or are searching for a resource in a particular area feel free to email me at Elisa@alumni.ufl.edu and I will try my best to help connect you to resources or other assistance...