Britt Collins, MS OTR · processing sensory information properly, resulting in problems planning and carrying out new motor actions. These individuals are clumsy, awkward, and accident

Britt Collins, MS OTR

Copyright, Collins 2013

SPD 6 Subtypes

Building Relationship/Engagement

Creating a Sensory Lifestyle

Red Flags/strategies

How to Coach Parents


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



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


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


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


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


Dyspraxia – difficulties with ideation, sequencing, motor planning and/or execution

Postural Disorder – difficulties with overall tone, trunk strength


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.


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


Motor Planning Activity


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.


◦ Tactile

◦ Visual

◦ Auditory

◦ Taste/Smell

◦ Vestibular (position)

◦ Proprioception (movement)

◦ Interoception


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?).


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.


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


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


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)


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


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)


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


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!


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


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


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


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


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?


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


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?


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


Deep pressure/proprioceptive input

Acupressure squeezes

Calming techniques

Weighted vests, lap toys, blankets

Jumping jacks/jump rope/mini-trampoline

Self-Body hugs


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)


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


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:


◦ 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


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.


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


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


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


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


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

Audience Examples and Questions?


www.spdstar.org

www.funandfunction.com

www.abilitations.com

www.otdvds.com

www.sensoryparenting.com


http://www.spdstar.org/

http://www.ourjourneythruautism.com/

http://www.funandfunction.com/

http://www.abilitations.com/

http://www.otdvds.com/

http://www.sensoryparenting.com/

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


Documents

Britt Collins, MS OTR · processing sensory information properly, resulting in problems planning and carrying out new motor actions. These individuals are clumsy, awkward, and accident