Caring For Children With Sensory Issues May 13, 2015

1. Caring For Children With Sensory IssuesMay 13, 2015 Coalition for Children and Families Deb Buchanan MS, OTR

2. The Common Thread • We’ve all experienced infancy, early childhood, and have a developmental history • Neuroscience has learned what fires together wires together in the developing brain • Coping capacity is supported with co-regulation • http://developingchild.harvard.edu/key_concepts/brain_architecture/

3. Neurological State Dependence • Adaptation to perceived stress and threat occurs over time • Hyper-reactivity and dissociation can occur simultaneously • Heightened state impacts learning and resolving conflict • Play can get under the radar of the stress response, triggers and intimacy barrier

4. ACE Study http://www.cdc.gov/ace/index.htm

5. Influence of Sensory

6. Seven Senses • Our sensory systems help create an internal map of the body and of the world as we know it • We adapt from continued experiences over time • This adaptation contributes to our self-concept, self-esteem, and relating to others • Hear-Auditory • Sight-Visual • Touch-Tactile • Taste-Gustatory • Smell-Olfactory • Muscle-Proprioceptive* • Balance-Vestibular* *Hidden senses

7. Sensory Processing Model

8. Sensory Needs and Regulation When sensory needs are met, we can better regulate and achieve purposeful goals, engage and participate in our environment

9. What isSensory Modulation? Brain’s regulation of its own activity Matching the body’s energy level and attention to the demands of the environment Requires brain to filter information and attend to certain information while disregarding others

10. Stress Response and Sensory Modulation/Regulation

11. Sequence of Engagement Reason Regulate Relate

12. Preferences Play a Part in Activity Choices • Movement • Touch • Sound • Sight • Smell • Taste

13. Behaviors to Consider for Infants and Toddlers • Problems eating or sleeping • Refuses to go to anyone but me • Irritable when being dressed; uncomfortable in clothes • Rarely plays with toys • Resists cuddling, arches away when held • Cannot calm self • Floppy or stiff body, motor delays

14. Behaviors to Consider for Pre-School • Over-sensitive to touch, noises, smells, other people • Difficulty making friends • Difficulty dressing, eating, sleeping, and/or toilet training • Clumsy; poor motor skills; weak • In constant motion; in everyone else's face and space • Frequent or long temper tantrums

15. Behaviors to Consider in School-Age • Over-sensitive to touch, noise, smells, other people • Easily distracted, fidgety, craves movement; aggressive • Easily overwhelmed • Difficulty with handwriting or motor activities • Difficulty making friends • Unaware of pain and/or other people

16. Behaviors to Consider for Middle/High School • Over-sensitive to touch, noise, smells, and other people • Poor self-esteem; afraid of failing at new tasks • Lethargic and slow • Always on the go; impulsive; distractible • Leaves tasks uncompleted • Clumsy, slow, poor motor skills or handwriting • Difficulty staying focused

17. Movement & Balance

18. Planning for Fun • Consider child’s interest and current ability • Mastery of play with caregiver first before adding another child • Play is scheduled and semi-structured by proactive and regulated adults • Patterned repetitive play 10 minutes-twice a day

19. What Can Parents/Caregivers Do? • Be aware and observant of the impact of sensory factors with every day activities on child’s behavior • Provide a variety of sensory rich opportunities throughout the day to support sensory needs • Encourage active play such as on playgrounds and limit sedentary activities such as TV and computer games

20. Caregiver Health • Your oxygen mask first • Co-regulation begins with you

21. Situational Frustration • Find your calm • Be present to guide • Maintain safety • The environment gets processed from the bottom up

22. Situational Frustration • Validate feelings expressed or demonstrated • Recognize freeze, fight, flight • Promote patterned-repetitive activity throughout the day • Maintain predictable environment

23. Signals to Track • Hyper arousal: anxious, reduced or vigilant eye contact, overactive, impulsive • Optimal arousal: Reciprocal, good eye contact, organized movement • Hypo (Under) arousal: slowed movement, little affect, low energy, reduced or no eye contact

24. Monitor For Too Much Fun • Dilated pupils • Sweaty palms • Higher pitched voice • Pulling away • Hiding

25. Self RegulationSeeking Behaviors • Hyper-active • Fidgety • Easily distracted • Intrusive • Loud • Aggressive • Risk-taking • Always busy

26. Strategies for Seeking Responses • Provide movement options such as a rocking chair, ball chair if sitting is required • Movement breaks on a trampoline • Bubble wrap • Play dough • Vibration

27. Creating a Sensory Alerting Space on A Shoestring Budget • Movement: trampoline, exercise ball, bean bags • Visual: bright colored walls, disco ball • Auditory: upbeat music using portable player device • Tactile: fidgets, bins with sand, beans, or rice • Smell: citrus or lemon

28. Self RegulationAvoiding Behaviors • Avoidant • Withdrawn • Controlling/Rigid/Stubborn • Hyper-sensitive • Hyper-vigilant • Easily upset • Anxious • Depressed

29. Strategies for Avoiding Responses • Avoid power struggles • Validate • Help to calm . . .cozy corner • Introduce choices of deep pressure • Have child/youth make suggestions • Specific sensory diet for calming may be needed

30. Creating a Safe Space“womb space” • Small enclosed area • Child/youth can retreat when over-stimulated • Props: chairs, tables, blankets, sheets, pillows, mats, large box • Sometimes a safe space is prepared as part of the environment in an early childhood school setting: cozy corner

31. Calming Strategies • Pillow cave • Burrito wrap • Swinging in blanket • Rocking in rocking chair

32. Tools for the Nose • Lavender-calms • Mint-calms • Vanilla-calms • Lemon-alerts • Orange-alerts • Pillow spray, lotion, room fresheners

33. Calming Pets to touch Pets to watch

34. Bedtime Calming Glow Sticks in the Bath Reading a Book

35. Comfort & TLC • Pillow cave • Noise reducing headphones • Calming music and headphones • Trampoline time • Take a walk • Tall kneel-push hands • Pop beads • Play dough

36. Comfort & TLC • Coloring • Using straws with applesauce • Low lighting • Artificial fish tank, etc. • Noiseless party blowers • Rocking chair • Yoga (www.yogakids.com)

37. Creating A Calming Sensory Space on a Shoestring Budget • Movement: rocking chair, bean bag chair • Vision: pastel colors, projection night lights, flashlight • Auditory: nature sound machine, classical music • Tactile: fuzzy stuffed animals, squishy fidgets • Smell: lavender scent; vanilla scent

38. Deep Touch Resources • Bean bag chairs • Pillow sandwich • Blanket roll up • Lotions-child applies • Play dough/clay

39. Movement and Balance Resources • Tug of War • Trampoline • Exercise balls • Yoga • Cushions/pillows • Stomping/Clapping • Bal-A-Vis-X

40. Patterned Repetitive Activities for Infants & Older Babies • Baby rhyme (patty cake) • Peek-a-boo • Music • Caregiver attunement: Nurturing body posture, voice, and touch (serve and return interaction)

41. Patterned Repetitive Activities for Toddlers • Rocking • Sing, dance, move, clap • Drumming • Coloring • Molding clay, play dough, art dough • Finger painting, touch exploration • Stringing beads, tossing games, building, ball play

42. Patterned Repetitive Activities for Ages 4 & 5 • Bal-A-Vis-X • Games with straws • Jumping on a trampoline • Tossing a ball at a target • Jump games • Dominoes • Puzzles • Walking • Swimming

43. Patterned Repetitive Activities Ages 12 & Up • Yoga, martial arts, tai chi • Crocheting, knitting, weaving, building • Writing, reciting poetry, songwriting • Pottery, art exploration • Magic tricks • Performing arts, playing music, improve • Individual sports • Team sports, if tolerated

44. Music • Musical chairs • When played softly in the background at any time=CALM • Classical, New Age, Soundscapes for calming • Clapping • Drumming • Scarves • Rice bottles

45. Relationship Builders • Find the yarn • Find the sticker • Move what I touch • Hot dog/burrito game • Guess what I am drawing • Family handshakes

46. Seven Components to Reduce Chronic Stress and the Survival Response • Relaxation • Rituals • Responsibilities • Routines • Respect • Relationship • Relate to Safety

48. Making a Plan for Action • Consider the context of the environment • What are current routines-add activities? • What is ability and interest of child? • Mirror calm • Consider pattern-repetitive activities minimum twice a day/10 minutes each time • Consider Occupational Therapy in school and/or clinical outpatient

49. Elements of Application • Relationship***** • Repetitive and Rhythmic • Respectful • Calm/Alert • Frequency • Intensity • Duration • FUN & ENGAGING

50. Re-Purpose What You Have • Music • Paper • Straws • Chairs • Play dough/clay/kinetic sand • Parachute/blanket/sheet/tablecloth • Stringing beads • Stamping • Dominoes • Pinwheels • Blocks/Legos/building materials