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Britt Collins, MS OTR
Copyright, Collins 2013
SPD 6 Subtypes
Building Relationship/Engagement
Creating a Sensory Lifestyle
Red Flags/strategies
How to Coach Parents
Copyright, Collins 2013
Taste – oral motor
Touch- tactile processing
Sight – visual motor/perceptual
Sound- auditory processing
Smell – olfactory
Vestibular – governs balance, where your head is in space, how fast you are moving
Proprioception- input to the muscles and joints that tells us where our bodies are in space
Interoception- sense of internal organs
Copyright, Collins 2013
Copyright, Collins 2013
SENSORY PROCESSING DISORDER (SPD)
Sensory Modulation
Disorder (SMD) Sensory - Based Motor
Disorder (SBMD)
SOR SUR SC Postural Disorders Dyspraxia
Sensory Discrimination
Disorder (SDD)
SOR = Sensory Over-responsivity
SUR= Sensory Under-responsivity
SC= Sensory Craving
Visual
Auditory
Tactile
Taste/Smell
Position/ /Movmt
Interoception
L.J. Miller 2007
3 subtypes
◦SOR
◦SUR
◦SC – may have heard this called Sensory Seeking
Copyright, Collins 2013
SOR- these kids have responses that are too quick, too big or last too long than typical kids
It is hypothesized that their threshold is too low and the therapist is working to raise that threshold ◦ Examples: clinging to you when you try to toss
your child into the air ◦ Tactile defensive to barefoot in grass or touching
sticky and gooey ◦ She covers her ears when something seems too
loud
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SUR: this kid feels things too late and too little. He is low and slow almost lethargic.
It is hypothesized that these kids have a high threshold and therapists want to lower this ◦ Examples: he doesn’t hear his name being called
◦ She falls down and doesn’t cry or notice she hurt herself
◦ Hard to motivate to move
◦ Your child may not be able to tell whether the water is too hot or too cold
Copyright, Collins 2013
SC –Even if a child seems to be seeking deep pressure or input, we don’t want to give them too much as this will disorganize them.
◦ Examples: always on the go, constantly moving
◦ Crashing, giving hard high fives
◦ Spins a lot, jumps a lot
◦ Over stuffs their mouth with food
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Dyspraxia – difficulties with ideation, sequencing, motor planning and/or execution
Postural Disorder – difficulties with overall tone, trunk strength
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Individuals with Dyspraxia have trouble processing sensory information properly, resulting in problems planning and carrying out new motor actions.
These individuals are clumsy, awkward, and accident prone. They may break toys, have poor skill in ball activities or other sports, or have trouble with fine motor activities.
They may prefer sedentary activities or try to hide their motor planning problem with verbalization or with fantasy play.
Copyright, Collins 2013
Praxis is the ability to self-organize
◦ Starting with an idea (ideation)
◦ Sequencing how to carry out the idea (organization)
◦ Making your body complete the activity (execution)
Examples –
◦ Crawling across the room
◦ Making a craft project (cutting, writing etc)
◦ Getting dressed
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Motor Planning Activity
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Individuals with postural disorder have difficulty stabilizing his/her body during movement or at rest in order to meet the demands of the environment or of a motor task, e.g. poor “core strength”.
When postural control is good, the person can reach, push, pull, etc. and has good resistance against force.
Individuals with poor postural control often do not have the body control to maintain a good standing or sitting position, especially when attempting functional tasks.
Copyright, Collins 2013
◦ Tactile
◦ Visual
◦ Auditory
◦ Taste/Smell
◦ Vestibular (position)
◦ Proprioception (movement)
◦ Interoception
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Process of identifying specific qualities of sensory stimuli and attributing meaning to them. Individuals with SDD difficulties have problems determining the characteristics of sensory stimuli.
Poor ability to interpret or give meaning to the specific qualities of stimuli (Do I see a “p” or a “q”? Do I hear “cat” or “cap”? Do I feel a quarter or a dime in my pocket? Am I falling to the side or backwards?).
Copyright, Collins 2013
Those with SDD have difficulty detecting similarities and differences among stimuli. Individuals with poor sensory discrimination may appear awkward in both gross and fine motor abilities and/or inattentive to people and objects in their environment. They may take extra time to process the important aspects of sensory stimuli.
Copyright, Collins 2013
We don’t use the term “Sensory Diet” anymore
A Sensory Lifestyle is how you incorporate the sensory tools that you have into every day life
It is not a specific “diet” for a child because every child is different
We will talk about activities and strategies, but its best to learn through trial and error what works best for the child you are working with
Copyright, Collins 2013
Vestibular activities: jumping, swinging, hanging upside down, running, riding a scooter board or bike, zip line, riding in a car, spinning, swimming, bouncing on a ball, jump rope and more
Copyright, Collins 2013
Suck applesauce through a straw Tie theraband around the front legs of a chair that the
child can kick with his legs Animal walks (crab walk, bear walk, army crawl) Use heavy quilts at night Swimming. Have child dive after weighted sticks thrown
in pool Use beanbag chairs in their classroom, allow a child to
use them during silent reading time Prior to seat work, have child pinch, roll, pull theraputty;
use hand exercisers, balloons filled with four. Give child firm pressure on shoulders.
“Hot Dog” game where child lies across end of a blanket and is rolled (ends up inside the rolled up blanket)
Copyright, Collins 2013
Rice and bean tub or bird seed
Shaving cream Finger paints Sidewalk chalk Bath paints Water play Water balloons Gluing projects Making cookies and using
hands to mold sticky dough Thera-putty or play-doh Walking barefoot in grass Sand box Playing in the dirt
Copyright, Collins 2013
Providing crunchy and or chewy snacks to help increase focus
Chewy tubes/chewelry bracelets
Blowing bubbles, pinwheels, whistles, cotton balls
Drinking through a straw (smoothie, applesauce, pudding)
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If you know your child is sensitive to loud sounds; ◦ Always carry sound cancelling headphones
with you ◦ Allow them to wear them when needed (i.e.
grocery store, movie theater etc)
If your child is easily distracted by sounds; ◦ When they hear something, acknowledge it,
but re-direct them back to the current task
Copyright, Collins 2013
Focus on Engagement/Relationship Obstacle courses Mini-trampoline Indoor swing set Treasure Hunts Therapy ball activities Organized sports/activities (karate, baseball,
dance, swimming, gymnastics) Jumping jacks, chair pushups, sensory breaks YOGA!
Copyright, Collins 2013
Sleep is very important for a child and for the whole family
Bed time tips ◦ Consistent bedtime routine
◦ Comfortable bedding (weighted blankets)
◦ Calming music or lights (nightlight)
◦ Try to have the child sleep in their own bed
◦ Create a tent over the bed if needed
◦ Body pillows can be comforting
Copyright, Collins 2013
Eating healthy is also very important for the child
If you have major concerns about a child’s limited food repertoire or “picky eating” seek out a therapist who is trained by Dr. Kay Toomey SOS Approach to Feeding
Children need at least : ◦ 10 sources of protein
◦ 10 fruits or vegetables
◦ 10 other/starches
A total of at least 30 different foods
Copyright, Collins 2013
Dinner time tips ◦ Family style dinner
◦ Make Eating Fun!
◦ Try different textures, colors, smells
◦ Have something preferred for after the child touches or tastes a new food
◦ Always present a protein source, fruit or vegetable and starch at every meal/snack and one preferred food
◦ Don’t allow your child to “food jag” eat the same foods over and over again
◦ If they have chicken nuggets on Monday, they can’t have them again until Wednesday
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Engagement is probably the most important aspect of interacting with a child
You want to make sure you can get the child to engage with you (the therapist) as well as the parent
If a child cannot engage with others, what good is it to teach them skills
A child needs to be able to interact with adults, peers, professionals/teachers to learn the skills of life
Copyright, Collins 2013
The first time you work with a child, you want to follow their lead, find out what they are interested in
Then engage them in play activities Also you want to engage with the parents
but also watch how the child and the parent interact together
Are they good interacting with their mother, but are afraid of their father’s loud voice and big personality?
Are they able to engage with their mother, but you as a new person does not exist?
Copyright, Collins 2013
Building a trust relationship between you and the child is important because then you can ask them to do things they are normally scared of
If you want to try and help them challenge their sensory systems (like touch something gooey they do not like) the child is going to have to trust you
You also begin to build that relationship with the parents/caregivers so they trust you when you give them home ideas, advice for their child and educate them on sensory based techniques
Copyright, Collins 2013
How to tell the difference You can’t force a sensory activity You can follow through with
behavior strategies for a task/demand
What are affective behavior strategies?
What are affective sensory strategies?
Copyright, Collins 2013
Watch their facial expressions and body language
Watch that you are not overwhelming them to the point of shut down
Pay attention to their arousal level so they don’t get too wound up and you can’t bring them back down
If they are melting down, help calm them using whatever strategies seem to work for that specific child
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Deep pressure/proprioceptive input
Acupressure squeezes
Calming techniques
Weighted vests, lap toys, blankets
Jumping jacks/jump rope/mini-trampoline
Self-Body hugs
Copyright, Collins 2013
The parents are the most important factor in that child’s life
It is our job as educators to coach the parents to carry over into the home the sensory strategies that we think will best help their child
If you feel that this becomes out of your realm of expertise, then refer out (referral list to come)
Copyright, Collins 2013
In the beginning, build a relationship with the child and parents/caregivers
Get the child to trust you, so you can discover what sensory strategies work best
Model for the parents how to engage and work with their child
Then begin to have the parents engage with you and the child
Eventually you begin to fade yourself out and have the parents conduct most of the therapy session
Sometimes this takes awhile for the parents to be ready
Copyright, Collins 2013
ASD Criteria for DSM-V
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
Copyright, Collins 2013
◦ Deficits in social emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions and affect and response of total lack of initiation of social interaction
◦ Deficits in nonverbal communicative behaviors used for social interaction
◦ Deficits in developing and maintaining relationships
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B. Restrictive repetitive patterns of behavior, interests or activities as manifested by at least 2 of the following
◦ Stereotyped or repetitive speech, motor movements, or use of objects
◦ Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change
◦ Highly restricted, fixated interests that are abnormal in intensity or focus
◦ Hyper- or Hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects.
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Symptoms must be present in early childhood (but may not become fully manifested until social demands exceed limited capacities)
Symptoms together limit and impair everyday functioning
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Child is aversive to touching sticky, gooey, doesn’t like tags in their clothing, is over-responsive to certain touch
Child is a picky eater and is losing weight or only eats a few foods
Child is hard to motivate, low, lethargic, hard to engage
Child is not making friends, or being social with parents
Child is having difficulty communicating
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Child is constantly on the go, cannot stop moving, has no concern for safety
Child has no impulse control
Child has poor balance, falls a lot, has trouble with gross and or fine motor skills
Child covers his/her ears with loud noises, or is always loud themselves
Child will not try new things, resistant to movement, swings, playground equipment
Copyright, Collins 2013
If you are noticing several of these above listed red flags and feel that the parents have concerns that you are not qualified to address, refer them to be evaluated by OT, PT, or SLP
OT covers any sensory concerns, motor concerns and feeding
SLP covers speech, language, and feeding and cognition
PT covers gross motor, walking, gait
Copyright, Collins 2013
There are many places in town that can provide services for your children
If they have medicaid or medicare, Children’s Hospital has outpatient therapy, Sensory Pathways 4 Kids, St. Lukes Presbyterian Children’s hospital, and other outpatient clinics.
Have parents talk to their pediatricians, and even when pediatricians say “wait” I would rather them NOT wait if there are concerns.
Copyright, Collins 2013
Copyright Collins 2013
Audience Examples and Questions?
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www.spdstar.org
www.funandfunction.com
www.abilitations.com
www.otdvds.com
www.sensoryparenting.com
Copyright, Collins 2013
Sensory Parenting: Newborns to Toddlers by Britt Collins and Jackie Linder Olson
Sensory Parenting: The Elementary Years by Britt Collins and Jackie Linder Olson
Sensational Kids by Lucy Jane Miller
No Longer a Secret by Doreit Bialer and Lucy Jane Miller
Raising a Sensory Smart Child by Lindsey Biel
Growing an In-sync Child by Carol Kranowitz
Parenting a Child with Sensory Processing Disorder by Christopher Auer and Susan Blumberg
Copyright, Collins 2013
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