Sensory Strategies! By Corinna Laurie- Occupational Therapist. 16/01/2013 Corinna Laurie- Write Trak Therapy

Transcription

1 Sensory Strategies! By Corinna Laurie- Occupational Therapist

2 Why Occupational Therapy 60-70% of children with ASD present with Sensory Modulation Disorder (Adamson 2006) High co-morbidity between ASD and Developmental Coordination Disorder (DCD) Green (2009) suggests up to 90% of those with ASD have motor deficits.

3 Feeling Just Right

4 Simple Neuroscience!

5 Neuroscience Temple Grandin 2012 Temples brain volume is significantly larger than that of control matched neurotypical brains Temple has abnormally large Amygdala- this processes emotion (including flight or flight) Increased white matter in the region processing memory and visual spatial skills. Weak connections in frontal gyrus which includes Broca s area for Language, and region for processing faces. When somebody speaks to me, his words are instantly translated into pictures Grandin

6 Simple Neuroscience cont 2010 Scientific American Magazine have carried out research using brain scans etc. Those with ASD are slower to integrate input coming in from one sense Increased neuro-receptors leading to increased intensity of each sense.

7 The brain locates, sorts and orders sensations, somewhat like the way a traffic light directs moving cars. When sensations flow in a wellorganized or integrated manner, the brain uses those sensations to form perceptions, behaviours and learning. When the flow of sensations is disorganized, life can be like a rush-hour traffic jam. Adapted from Jean Ayres, OT

8 Seven Senses Sight, Sound, Smell, Touch, Taste, Balance (Vestibular)and Body in Space (Proprioception) - in order to make sense of our environment we need to combine our senses

9 The Auditory System Sound

10 Our auditory (sound) system, or sense of hearing allows us to hear someone talking to us (i.e. the teacher in a classroom!) It also allows us to hear possible dangers, or to enjoy our favourite music.

11 Behaviours you may see/notice Covers ears for a fire drill or when class is loud. Runs from loud area. Complains of noises in room or outside of window (i.e. lawn mower, heat blower, insects on window, students writing on paper). Complains that others are constantly yelling. Covers ears in the cafeteria or cannot go into the gym when there are many people in it. Doesn t respond to verbal prompts when putting on noisy clothes (i.e. rain coat). Hums or sings to self. Demands that only one person talks at the dinner table. Talks louder than anyone in the class. Prefers very loud music or none at all in the car. Runs out of toilet as toilet flushes.

12 Strategies for Children Sensitive to Sound Give warnings ahead of time, if going into a place or situation where there will be more noise. Use visual timetable, PECS etc When sitting to do work (e.g. at school), seat the person farther from sounds/noise if possible Mask out external stimulation. Use earplugs, or during the winter time (ear muffs) Use calming strategies to help the child better deal with any unexpected stimulation. Be aware that certain situations may be more of a trigger, e.g. enclosed spaces such as gymnasiums, cafeterias, school buses, machinery such as vacuum cleaners, or lawn mowers, echoing in bathrooms such as from hand dryers Place felt pads/cut tennis balls under furniture legs.

13 Make use of quiet sanctuaries E.g. dressing rooms or rest rooms provide a nice escape area Allow the student a quiet space where they can go to if they feel they need it, or a place where the teacher can ask the student to go if the student appears to be getting overwhelmed. At home have a quiet area with beanbags, cushions, duvets etc. Their special space. Pop up tents are great for younger children.

14 Strategies for kids who are more calm, alert and focused with sound Allow the person to listen to background music, or background noise when needed, e.g. through headphones, or through turning on the television, radio, or stereo, white noise (via a fan, or white noise generator (a device whose sole purpose is to make background noise) To help the person to sleep, consider background noise through a fan, white noise generator, radio, or stereo.

15 The Touch (Tactile) System

16 The sense of touch allows us to feel the world around us Unlike other senses such as vision, or hearing, our sense of touch is not located only in certain parts of the body, but is located all over. Through our skin, we can sense temperature, and whether something is hot, or cold. Through our hands, we can touch someone, pick up an object. Our sense of touch lets us be gentle when picking up an egg, or firm when picking up a heavy book.

17 Behaviours you may see/notice Throws arms back when about to be picked up by adult or pulls away when trying to hold child s hand. Is always hanging on adult or laying under his mattress/cushions Keeps large personal space away from others. Avoids touching certain surfaces or textures (i.e. fabrics, carpets). Prefers to touch specific fabrics. Crashes into people or walls Uses one's finger tips rather than whole hands to manipulate objects. Dislikes getting hands or feet messy (i.e. sand, creams, paint). Touches everything in sight. Avoids being touched on the face, hair or head (i.e. washing face, hair cut). Doesn t react to pain such as cuts, shots, bruises, or breakage of bones. Person may bite his or her own skin. Reacts negative when approached from behind. Wears shorts even in extreme cold temperature. Need to look at objects in order to correctly identify or manipulate them.

18 Strategies for the child who is sensitive to touch Deep Pressure : Massage, or having a person press down on the child s shoulders Lie under heavy cushion, or weighted blanket over the child. Snuggling into a couch/beanbag Weighted vests Backpack (ideally with 10% of the student s body weight) for 20 min periods an adult can ask the student to put on their backpack during stressful times, e.g. transitions Asking the student to carry objects, e.g. books, shopping,

19 Avoid situations where there will be unexpected touch Place the student in the front or the back of a line-up, but try to avoid placing student in the middle Allow the student to have a larger personal bubble compared to others. Carpet Square/plastic hoop Warn the student ahead of time when the he/she will be touched Seamless clothing. Making allowances for sensitivity to clothes by cutting off tags Allow for deep pressure oral stimulation, e.g. by chewing gum, chewellry, chewy tubes Therapeutic Wilbarger Touch Pressure Protocol which is a technique that needs to be taught by a trained Therapist to parents/education staff. It consists of methodical, deep brushing on the skin combined with joint compressions, can eventually help to reduce hypersensitivity.

20 Olfactory Hypersensitivity (smell)

21 May say you stink to staff when wearing a strong perfume or cologne or if can smell onions on staff s breathe from lunch. Won t use the toilet at school. Breathes through their mouth instead of their nose. Won t visit certain environments (i.e. farms, zoos, fish stores). On the opposite extreme, student may smell everything they touch to become orientated and comfortable with the object or thing. This could include peers and staff. Does not mind smell of own bowel movement or dirty nappy.

22 May seek out smells, even disgusting or gross smells, e.g. body wastes such as urine/faeces. Person reports that all foods taste the same Sniffs people or objects Does not notice offensive smells

23 Strategies for kids who are oversensitive to smell Limit exposure to smells, help the child be aware of strategies to assist them with avoiding smells that are unpleasant If the child has aversions to certain smells, it may be helpful for them to carry around a pleasant smell (in a film container with a hole in the top) to use when bombarded with smells they can t handle Use calming smells, such as those recommended in Aromatherapy

24 Strategies for kids who are under sensitive to smell: Provide healthy ways for smell stimulation Incense, Scented candles,perfumes Place drop of desired smell on sweat band Scratch and sniff stickers Consider alerting smells, as used in Aromatherapy Take part in regular activities that have a strong smell component smelly play-dough, playing in fresh-cut grass, cooking with strong smells etc.

25 Gustatory (Taste) and Oral

26 Behaviours you may see/notice Won t eat certain foods (i.e. texture or taste) or eats extreme tasting foods (i.e. lemons, hot sauce). Limited diet Gags when told to eat food doesn t like. Licks or tastes toys or has never mouthed toys.

27 Behaviours of those hypersensitive to oral stimulation may include: Refusing any contact with their mouth, for feeding, tooth brushing or play. Preferring to only eat one food at a time, and have troubles eating more than one texture at a time (mixed consistency foods such as meat in gravy) Gagging all the time on foods, or on eating utensils Extreme distress during feeding time, such the child may, push food away Refusing to chew food, or drooling all the time A need to control the mealtime experience, and may want only certain food textures, certain spoons, certain plates, and certain cups

28 Strategies for oral hypersensitivity Before eating: Allow the child to get used to oral stimulation by allowing the child to explore his/her favourite toys orally. Dip them into flavoured water, puréed foods, etc. Allow the child to play with his/her food. Food Play Consider calming background music during meals. Ensure your child has good sitting posture ensure that the child is sitting up properly and feels secure I.e. feet flat on the floor. Because many oral hypersensitive children may also have touch hypersensitivities, they may benefit from soothing deep pressure or firm touch, particularly if they are given advance notice about being touched.

29 During eating: So that the child doesn t feel overwhelmed, do not present foods one at a time. When your child gestures or says that they are all done with that food, clear all of it away from the table. Pay attention to food temperature in general, room-temperature foods are easier. Pay attention to food textures when switching or changing foods, change gradually. Consider mixing one food gradually with the other until you have transitioned from the starting food, to the target food.

30 After eating: Give lots of praise for whatever success s/he had. Even if your child did not eat very much, praise him/her for trying ( I appreciate that you tried! )

31 Proprioceptive System

32 The Proprioceptive sense is our position sense. It allows us to know where our body parts are without looking at them. This sense underlies a person s ability to place body parts in a position in space and to grade movements (i.e. the ability to judge direction of force and pressure). Proprioception aids motor planning and coordinating movements, emotional security and confidence.

33 Behaviours you may see/notice Pulls, twists, or chew on things (i.e. shirt, gum, pencil). Frequently breaks toys or hurts classmates when didn t mean to. Leans, bumps, trips or crashes into objects. Walks along touching walls. Too much pressure when writing (i.e. writes letter over and over again until puts a hole in paper). Deliberately falls or crashes into things. Constantly seems to physically tackle everything. Stands too close when talking to others. Seeks deep pressure hugs. Walks stiff and uncoordinated. Pulls on fingers or crack knuckles. Self injurious behaviour to get desired input

34 Steam roller, with student lying down, roll large gym ball up and down their body. Keep pressure firm. Deep Pressure (squeezing) - starting at the fingertips-shoulders and toesthighs... Deep hugs (bear hugs) lots of times a day. Blowing activities e.g. bubbles, through straw, blowing feathers. Swimming Wearing a weighted vest for 20 min periods (max 10% of body weight). Weighted lap pad, and wearing weights Wall push - Push-ups against the wall x 20. Can also do with two students either pushing against each other s hands or feet Weighted Blankets Weighted pencils, pens and cutlery.

35 Give the student an opportunity to move as much as possible, e.g. allowing for toilet breaks, or asking the student to do errands as fetching things, being a messenger, cleaning the blackboard, etc. Alternate thinking activities with movement activities.thinking activities for minutes, followed by movement such as a bouncing on a therapy ball for 2-5 minutes or different types of physical movement, e.g. jumping jacks, squeezing a stress ball, push-ups against a wall. Letting the student stand up and wiggle around whenever possible Allowing the student to switch seats Chair push-ups Consider the use of special seating which gives hyperactive students an opportunity to move and thus receive sufficient stimulation so that they can stay focused, without having to wiggle in a standard seat. e.g. wobble cushions, ball chairs.

36 Movement (Vestibular System) Our vestibular system includes structures in our inner ear (semi-circular canals) that let us know how our body is moving, and what position it is in. e.g. Gross or large body movements such as walking, sitting, running, and other activities. Fine or smaller body movements such as using our hands to write, use forks and spoons, tie shoelaces, or button a shirt.

37 Behaviours you may see/notice May seem to be a thrill seeker (i.e. jumping from high places, driving fast) Enjoys being upside down Trouble staying seated Clumsy May be sedentary or cautious or hesitant to take risks,avoid movement Difficulty coordinating movements of the eyes Constantly leans head on hand or arm Prefers to lie down than sit upright Feels seasick, when riding in car, boat, train, aeroplane, escalator or lift. Easily looses balance when riding a bike or climbing stairs.

38 Strategies for the child who is over responsive to movement Limit unnecessary movement Slowly introduce different movements into the child s life in a safe way Teach the child self-regulation strategies to assist with staying calm

39 Strategies for the child who requires increased vestibular input Give the student an opportunity to move as much as possible. Alternate thinking activities with movement activities.thinking activities for minutes, followed by movement such as a bouncing on a therapy ball for 2-5 minutes or different types of physical movement, e.g. jumping jacks, squeezing a stress ball, push-ups against a wall. Letting the student stand up and wiggle around whenever possi Chair push-ups Consider the use of special seating which gives students an opportunity to move and thus receive sufficient stimulation so that they can stay focused, without having to wiggle in a standard seat. e.g. wobble cushions, ball chairs. Gym ball activities. Swings, rounderbouts etc

40 Visual Sense Imagine sitting in class, and trying to pay attention. But your eyes hurt because it feels like there s a bright floodlight being shone in your eyes. Now as you feel a headache building, the teacher is telling you Pay attention! T Grandin

41 Behaviours you may see/notice Stares at spinning objects. Spins their own bodies. Turns opposite direction from where teacher is lecturing. Demands to wear sunglasses indoors. Extremely organized or disorganized room (i.e. knows when an object has been slightly moved). Looses place when reading. Touches everything to make up for lack of visual input Can't read body language. Gives no eye contact or looks beyond person s face. Misses visual clues Trouble locating desired toy on cluttered shelf. Turns or tilts head when reading across a page. Misjudges spatial relationships so bumps into people or things.

42 Strategies to help the visually overstimulated child: Minimize visual stimulation for the child who is overwhelmed Teach the student to only put on their desk, what they need for the task at hand. Clear pencil case. Use natural lighting whenever possible (but place student away from window because they may be sensitive to direct sunlight) For a time-out, soothing place, consider using dimmed lighting. Consider getting the child sunglasses or being assessed for coloured lenses or allow them to cup their hands around their eyes to block peripheral vision. Consider using a slanted writing or reading surface so the student is reading things more head on as opposed to at an angle Give frequent breaks Consider tinted overlays

43 Strategies to help the visually under stimulated child: Increase visual stimulation when teaching/playing with child Use hand gestures, bright lights, lots of colour and movement. Highlight text. Use different coloured papers, or headings. Use natural lighting or bright lighting Add different visual components to tasks. For example: clapping or jumping when teaching maths, bright colours for teaching tools, use of films/videos etc.

44 Classroom Treasure Chest Wobble cushion Ear Defenders Privacy Board Weighted items such as- blanket, lap weight, weighted vest etc Large Gym/peanut Ball Vibrating snake/tube Vibrating creatures Stress Balls/tangles/fidget toys Chewable items commercially available Aroma Pots Scented Dough Oil Jars/liquid timers Glitter sticks Spinning toys/old Cd s

45 Selected References Ayres, J.A 1979 Sensory Integration and the Child. Western Psychological Services. Bogdashina,O 2003 Sensory Perceptual Issues in Autism and Asperger Syndrome. Jessica Kingsley Publishers Grandin, T 1996 Emergence Labeled Autistic. Warner Books Krannowitz, C.S 1998 The Out of Sync Child. Skylight Press Winter Matt 2003 Asperger Syndrome- What Teachers Need to Know