Sensory Processing Let's Put the Pieces Together Presented by: Heidi McLarty, OT Reg. (Ont.).

1. Sensory ProcessingLet's Put the Pieces TogetherPresented by: Heidi McLarty, OT Reg. (Ont.).

2. Defining Terms.. • Parents often hear many different terms and names for things, which can be overwhelming • Autism/PDD/ASD • Self Regulation • Sensory Integration • Sensory Problems • Sensory Seeking/Avoiding • Hypo or Hyper Responsive • Vestibular System/Proprioceptive Systems

3. Our Senses are like the foundation of building our house • We all have sensory systems made up of our senses. The process of how we make sense of it is called Sensory Integration. *Visual is from Yack, E., Sutton, S. & Aquilla, P. (1998). Building Bridges through Sensory Integration.

4. Far Senses • Vision (Seeing) • Auditory (Hearing) • Olfaction (Smell) • Taste • Touch *Visual is from Kranowitz, C.S., (2005) the Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder

5. Near Senses • Vestibular (Balance) • Tactile (Touch) • Proprioception (Muscles, joint receptors, etc.) *Visual is from Kranowitz, C.S., (2005) the Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder

6. Picture from: Wilbarger, Patricia. (2006). Sensory Defensiveness: A comprehensive Treatment Approach. Conference manual, Toronto, ON.

7. What is Sensory Processing or Sensory Integration? • We received messages from all of our senses and respond to this info • Examples: Reading a book at home • Not noticing noises going on around us • Not being bothered by the feeling of the chair under us • Not having to think about how to keep ourselves balanced • Adjusting the temperature if we are cold, getting a blanket, etc.

8. What is Sensory Processing or Sensory Integration? • We are able to make an “adaptive response” and keep our teeter totter (our body) balanced or “regulated” • For many kids this is very hard to do!

9. Optimal ArousalPicture from: Wilbarger, Patricia. (2006). Sensory Defensiveness: A comprehensive Treatment Approach. Conference manual, Toronto, ON.

10. Defining • Problems with sensory processing can be present in children and adults of all ages with no other identified difficulties • Problems with sensory processing is very Common for those diagnosed on the Autism Spectrum, but not always

11. Sensory Integration – The Process • Sensory Registration: “Hey what’s that?” *Awareness of input > Threshold reached • Can be Hyper or Over Responsive to an input in any of the senses OR… • Can be Hypo or Under Responsive to an input in any of the senses • Every child is different • Behaviours and meltdowns may not have a “set pattern” and can be very confusing

12. Sensory Integration – The Process • Orientation: Pay attention to input > filter out what’s important info • Over Responders > respond to too much, view things are threatening, very rigid in routines/behaviours, often over reacts • Under Responders > need more input to respond, may not seem to pay attention, or does not respond at all

13. Sensory Integration – The Process • Interpretation: Is this important? Threatening? *Flight, fright or fight • Over Responders > may be quick to avoid input because of previous negative experiences, not receptive to trying new things, etc. • Under Responders > will likely not learn from experiences because input wasn’t registered > hot stove example *Big safety issues!

14. Sensory Integration – The Process • Organizing of a Response: How to respond? Physical, emotional or cognitive • Over Responders > will likely respond in physical and emotional ways, not able to rationalize an “appropriate response” • Under Responders > may not respond at all because not aware of the input (no response to scrapped knee) or may not know how to respond

15. Sensory Integration – The Process • Executing of a Response: Depends on ability to motor plan a response. • The process begins again in a loop fashion

16. Sensory Processing Disorder (SPD) • This is a term to mean that there are difficulties with processing sensory input which affects functioning in day to day life • Sensory signals do not get organized like they should > there is a “traffic jam” in the body!

17. *Visual is from Kranowitz, C.S., (2005) the Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder

18. Picture from: Wilbarger, Patricia. (2006). Sensory Defensiveness: A comprehensive Treatment Approach. Conference manual, Toronto, ON.

19. Arousal Levels • The “Balanced teeter totter” • Stacking phenomenon and variability from day to day > puzzling • Meltdowns and causes

20. Every Child is Different! • What may be organizing for one child, may be VERY disorganizing for another! Be careful. This is not a “cookie cutter” approach. • Put on your sensory hats and think more about the situation and what the underlying potential contributors to the behaviour you are seeing.

21. Is it Sensory OR is it Behaviour? • Difference between typical behaviour management and helping with sensory based needs has to do with filling the sensory need versus just getting rid of the behaviour • Every behaviour has a purpose and root from something else

22. Antecedent: John and Sally are playing in the sandbox Behaviour: John hits Sally Consequence: John gets the toy Sally was playing with Antecedent: John and Sally are playing in the sandbox. Sally brushes up against John Behaviour: John hits Sally Consequence: Sally leaves the sandbox and John plays alone Is it Sensory OR is it Behaviour?

23. Behaviours • Tangible rewards: To have a want or need met • Attention: Positive or negative • Escape: To avoid a demand OR for **protection > Fight or flight behaviours • It feels good > more sensory based *Think about a challenging activity or behaviour and what strategies you use.

24. Occupational Therapist’s Role • Empower you to be sensory investigators • Figure out more about your child’s sensory based needs • Suggest regular, daily activities to attempt to help keep your child regulated • Work on helping the child to increase their self awareness and adaptive response to input

25. Big Concerns • Lack of pain awareness > child does not develop appropriate awareness of safety • Self injury behaviours • Frequent meltdowns

26. Strategies to Help • What your child likes and what strategies work best for your child is a puzzle to figure out • What is regulating for one child may be very disorganizing for another!

27. Calming Power Tools • Think about your own calming activities. What helps you to wind down after a long day? • Think about your own alerting activities and how you help to wake yourself up when you feel tired. • Think about things that are disorganizing to you? Things that make you feel “frazzled” or make you mad. How do you calm down after these times?

28. Calming Power Tools • What are some calming activities you use with your child? • What are some alerting activities you engage in with your child? • What disorganizes your child?

29. Calming Power Tools Different ways to approach calming input. We can: • Engage in activities with your child • Adapt the environment • Teach your child self regulation concepts > “Engine speed visual, cues”, social story about what to do when their engine is high or low (This may take a long time to try to attain this level of self awareness and doesn’t always develop)

30. Typical Signs of Overload • Holding their breath > may help to “shut off” pain receptors (why we hold our breath when we are expecting to get a needle) • Tightened muscles in the body > look tense • Dilated pupils

31. Calming Activities: Engagingyour Child • Including regular calming times during the day may be helpful to keep their “teeter totter” balanced • Calming input may do a lot to “prevent” meltdowns and overload from sensory input • Calming strategies will likely be useful to pass on as hints to others about how to support your child’s optimal functioning

32. Calming Activities: Engagingyour Child • When do we need calming? Example 1: Your child had so much fun at the park, swinging for half an hour, going down the slide and spinning on the merry go round. It’s time to go and your child has a HUGE meltdown and can’t calm down. You find them hard to calm for the next couple of hours. What to do?

33. Calming Activities: Engagingyour Child Example 2: You are at the Early Years centre with your child and all of a sudden the fire drill goes off. Your child shows a huge startle reaction and starts to cry uncontrollably. Her breathing is very fast and she can’t seem to catch her breath. What to do?

34. Calming Activities: Engagingyour Child • It may take some time for the child to “get used to” being in a calm/regulated state of arousal because they may be used to their norm of being on the edge of overload much of the time > narrow band of arousal • We need to give them the experiences to feel calm and safe > want to expand their band of arousal

35. Calming Activities: Engagingyour Child • Breathing is one of the “power regulators” and helps our body get back to a calm state > for example during yoga for relaxation • Breathing is important in our ability to pay attention because oxygen is delivered to our brain. • A lot of children do not breathe deeply enough to get a lot of oxygen (possibly due to posture, anxiety, etc.)

36. Calming Activities: Engagingyour Child • Some breathing activity ideas: • Playing games with straws such as blowing feathers, pom poms, and ping pong balls. *Cutting the straws in half may make it easier for your child to blow and point at a target. • Using straws to blow ping pong balls or other items in the bath • Using rubber tubing or long straws to blow bubbles in the bath • Blowing pinwheels

37. Calming Activities: Engagingyour Child • The Mouth is a power regulator too! This is why we see kids like bottles and soothers and chewing/sucking on things • Sucking input gives strong deep pressure input to the mouth and brain • Children are often discouraged from chewing and sucking on things past a certain age > we need to be check out if this is helping the child to calm. To take that away may lead to meltdowns! Let’s think of age appropriate examples to try to provide this same sucking input.

38. Calming Activities: Engagingyour Child • Sucking Activities: • Using short straws to eat snacks such as pudding, yoghurt, apple sauce, etc. • Sucking/chewing on special “chewalery” or special pendant around the neck • Sucking on the end of a pen or rubber end • Sucking on a piece of rubber tubing • Sucking on a piece of fruit before eating it

39. Calming Activities: Engagingyour Child • Sometimes children suck on things for other reasons > to explore and learn through their mouth. • Their mouth may be more sensitive than their hand or their mouth may be under sensitive so they are seeking more input. • Sometimes children put lots of non edible food items in their mouthes or eat these things > Pica. Could be sensory seeking behaviour or a sign that their diet is deficient in some nutrients *Would warrant further medical investigation

40. Calming Activities: Engagingyour Child • Deep pressure massage is often very calming. Also special program with a surgical brush > therapressure program • Weighted items provide this deep pressure > blankets, lap pads, vests, snakes, etc. • Creating a “womb like” space to retreat to is often helpful • Slow linear rocking in a rocking chair • Lowering your voice • Using a drum with rhythm may help with calming

41. Calming Power Tools – Environmental Considerations • Considering the environment is often VERY helpful. We can possibly make some changes that will help the child a lot with staying calm. Things to consider: • Lighting > fluorescent lighting is “annoying” to the body, especially if there is also flickering! • Dim the lights, use flame resistant light covers to deflect lights, get rid of fluorescent lights, provide lamps as lighting, use natural light

42. Calming Power Tools – Environmental Considerations • Visual distractions > lots of stuff on the walls, on shelves, etc. is actually telling the body to pay attention and register all the stuff. • Try covering bookshelves with a solid sheet to limit distractions, clean up clutter if possible, organize things into special bins for intended purpose > that way you can take out limited things at a time and teach child to clean up before taking out another bin. • Painting rooms “cool” colours such as blue or green. (Bright colours can be alerting)

43. Calming Power Tools – Environmental Considerations • Noise > Lots of noise in your home, community, etc. We are multi-taskers by nature! • Turn off the TV/music, etc. • Try soothing sounds like a table fountain, methodical ticking sound, a rain stick, nature sounds CD, etc. • Try out regulating music with regulating beat (examples shown) > drumming Music • Try out noise cancelling headphones, an ipod with favorite music, or earphones

44. Calming Power Tools – Self Awareness • “Engine speed” Concept to refer to in activities to aim to increase self awareness • Adult points out when the child’s engine is running fast, slow or just right and cues them about what they can do to get back to just right or stay at just right • Hopefully, but not always, progresses to the child developing that self awareness and ability to cope and think of ways to keep their engines at just right

45. Calming Power Tools – Self Awareness • A child may not be aware that they are always bouncing and moving, try to be constructive with them to give them more ideas of things they can do to move > you can help them to “change it up” and not be so repetitive about the movement they are doing. They are doing the movement because it feels good or fills a sensory need they have. • Please try to educate others about your child’s sensory needs > they shouldn’t begin to feel bad about fufilling these sensory needs. We eat when we’re hungry, the child may move when s/he feels the urge!

46. Calming Power Tools – A Sensory Diet • A sensory diet consists of regularly planned sensory based activities within the context of natural activities or routines. • Aims to keep your child regulated/ orgranized throughout the day. • Created usually with the help of an occupational therapist trained in Sensory Integration therapy. • Created based on the sensory profile you filled out, based on the child’s needs.

47. Calming Power Tools – A Sensory Diet • Activities you can incorporate on your own: • “Heavy work” activities > include any activities that involve the muscles pushing, pulling, carrying, crawling, etc. where the muscles have some sort of resistance *See handout for more details> these activities are calming to the body! • Touch experiences in play • Playing at the park on the swings (not overdoing the swinging) • Swimming

48. Calming Power Tools – A Sensory Diet • A Sensory diet should be “balanced” and have combination of calming, organizing and alerting activities included • Calming > as we discussed • Alerting > Activities that “wake the body up” Highly dependent on the child’s resting arousal level. *Need to be careful because the child may have a really hard time coming back down to the calm level • Fast music, bright lights, lots of movement, visually busy environment, bright paint colours, sour, spicy foods, fast swinging in different directions, etc.

49. Calming Power Tools – A Sensory Diet • Organizing > bringing the child back to the “just right” level. • Need to figure out what works for your child > think back when your child was having the most fantastic day • Why do you think it was? • Activities? Did something “special” happen? • What they ate? • Routine? • Increased awareness of what is organizing and what isn’t so we can plan accordingly. With pointers and strategies to pass on to others, you may feel more comfortable leaving your child with someone else. • Might be a good idea to create a profile to give to others to help them know what helps to support your child.

50. Other Suggestions – Social Stories • Social stories aim to give a child more perspective about a situation and explain what they can do in that situation. • Meant to be read with the child pretty frequently to allow them to remember and “get” the concept. • Cues can be given back to the story > oh remember what happened in the story?