Sensory Supports & Strategies for Common Classroom Difficulties Due

to Sensory Processing DifficultiesPresentation by

Bailey Dahms, MS, OTR/L

• “Learning, thought, creativity, and intelligence are not processes of the brain alone, but of the whole body. Thinking and learning are not all in our heads. The body plays an integral part in all our intellectual processes from our earliest moments through to old age. It is our body’s senses that feed the brain environmental information with which to form an understanding of the world from which to draw when creating new possibilities.”

Hannaford, .Carla, Smart Moves-Why Learning is not all in our head. Great Ocean Publishers, VA.

Objectives

• Understand that sensory processing is a normal neurological function

• Understand basic sensory processing terminology• Understand that sensory processing issues are

common underlying causes of some challenging classroom behaviors

• Learn about sensory tools and strategies to address these challenging classroom behaviors

Sensory Processing is a normal neurological function

We are all sensory processors and we are sensory processing at all times.

Like with all abilities and processes, we have varying degrees of sensory processing efficiency.

This efficiency varies between people and within people depending on the situations.

The desired end result is sensory integration.

Sensory Processing Terminology• Sensory Processing is used interchangeably with sensory integration,

sensory-motor processing, and sensory-motor integration

• The term sensory integration from which sensory processing evolved was first used in 1970’s by Dr. A. Jean Ayres. We will use sensory processing for this presentation.

• Problems in sensory processing also termed sensory integration or sensory processing dysfunction/disorder/delay/or difficulty: irregularity or disorder in brain function that makes it difficult to interpret, organize, and act on sensory input from the environment effectively. Sensory Processing difficulties are common in, but not limited to, the special education population, particularly those with Autism Spectrum Disorders, ADHD, FAS, Prematurity, Developmental Delays, and Learning Disabilities.

Terminology continued• Sensory processing: a normal brain function enabling us to take in

and make sense of sensations coming into the brain along different channels at the same time. Adequate sensory processing then gives us ability to make adaptive responses from this information.-Through adequate sensory processing the many parts of the nervous system work together so a person can interact with the environment effectively and experience appropriate satisfaction.

• Sensory registration: neurological recognition that a sensory event has occurred (i.e., I was touched lightly, I heard my mom call, I’m leaning, my muscle hurts)

Sensory registration problems: kids look clumsy, often with delayed responses (sometimes too quick or with too much or not enough force), poor coordination, poor motor planning, poor grading of movements. OT referrals are common

Terminology continued• Sensory modulation: unconscious process by which we

regulate our brain’s activity level by filtering what we need to pay attention to versus what we need to ignore so we can stay in the correct arousal state for the situation Also known as “volume control” Occurs when there is a balance between facilitation and

inhibition Helps us maintain a calm, alert state (i.e., pay attention to a

phone conversation while ignoring TV; attending to teacher’s voice while ignoring feel of clothing)

Sensory Modulation problems : very common in those with ADHD, Autism Spectrum Disorders: overarousal, underarousal, fluctuating arousal. Difficulty maintaining calm alert state ideal for learning, social skills, etc. OT input needed.

Terminology continued

• Sensory Defensiveness: aversive or defensive reaction to non-noxious sensory stimuli (i.e., tactile defensiveness, auditory or visual defensiveness) Reactions involve primitive fight, flight, or fright survival and arousal

mechanisms that can have potentially negative effects on every aspect of a person’s life. See extreme avoidance of specific sensations (sounds, touch) and/or escalating anxiety/agitation leading to dramatic behaviors such as outbursts, fleeing, self-injury

Very common in those on Autism spectrum Will need input from OT and often treated with gradual

desensitization and sensory diet

Terminology continued

• Sensory seeking: a behavior in which a particular sensation is sought to met a sensory need (a craving)

• Sensory avoiding: a behavior in which a particular sensation is avoided

• Sensory diet: a planned and scheduled daily activity program of sensory activities, equipment, toys, or food designed to meet a person’s sensory needs. – Often behaviors we see through the FBA process which serve as clues

The 7 Senses

• 5 familiar senses: visual (sight), auditory (sound), tactile (touch), olfactory (taste), gustatory (taste)

• Also vestibular (movement) and proprioceptive (body position)

• Sensory processing treatments primarily focus on tactile, proprioceptive and vestibular senses as these are the most primitive senses and the foundation from which the other senses develop

Eye-HandCoordination

Central Nervous System

Tactile Vestibular Proprioception

Auditory GustatoryVisualOlfactory

Motor PlanningAwareness of two

Sides of bodyPostural Security

Body Scheme Reflex Maturity Sensory Filtering

Postural Adjustment

Ocular MotorControl

Eye-HandCoordination

Taylor/Trott (1991)

Auditory Language Skills

Visual Spatial Perception Attending

Daily LivingSkills Behavior

Academic Learning

Vestibular• Sense of movement and orientation of body in space• Receptors in inner ear tell us when we are moving (direction and

speed), when we are still, and changes in head position• It develops our relationship to the earth. Fundamental to all our

actions. Modulates all other systems by turning up or down what we need to pay attention to. Critical role in attending. Coordinates eyes, head, neck, 2 sides of body Maintains muscle tone Holds head upright against gravity; stabilizes eyes when moving Talks to and influences other systems (volume control) Critical for attending and regulating behavior Input can be calming, organizing, & alerting depending on the

direction, speed, and duration of the movement Input has most powerful effects—may last 12-14 hours per 15 min. of

input.

Proprioception• Unconscious awareness of body position• Proprio=me/self: puts me in the picture• Receptors within muscles, joints, tendons tell the brain when and

how the muscles are contracting or stretching; when and how joints are bending, extending, being pulled or compressed

• Enables brain to know where each part of the body is and how it is moving for motor planning

• Basis of body image• Movement is needed to keep receptors from “going to sleep”• Safest treatments (rarely too much): calming, organizing, and

alerting effects• Makes sense of touch and movement experiences. Give through

heavy work, deep pressure, firm touch, movement especially against resistance

Tactile• Sense of touch• Receptors in skin send information about light touch, pain,

temperature, & deep pressure• Protects us from danger• Provides boundaries to differentiate “me” from “not me”• Powerful effect on emotions-directly influences chemistry

in the limbic system• Pervasive effect on the whole nervous system• 2 pathways: protective and discriminative• Issues with light touch: commonly noxious and can lead to

fight, flight, or fright reactions. Best to touch firmly.

Patterns of Response

• A body’s response to sensory events are cumulative over time.

• Responses can be exaggerated; either under-responsive or over-responsive.

• A child who is in sensory overload looks similar to a child who is under-responsive or has sensory registration problems.

Sensory Processing ApproachProvides framework for understanding and addressing common classroom difficulties:• Lack of interest or motivation• Difficulty with transitions• Aggression• Self-stimulation or self-harmful behaviors • Poor work performance• Difficulty maintaining body in designated space • Chewing on non-nutritives• Over-touching• Difficulty sitting still• Difficulty maintaining upright posture at desk• Avoidance of messy materialsProvides professionals and parents with another way of looking at and solving

behavioral challengesProvides strategies to improve attending, motivation, communication, and interaction

for all kids

Examples of Sensory Seeking

• Seeking proprioception: pushing, rubbing, head banging, hitting/pinching self or others, biting, teeth grinding, hair twirling/pulling, hand flapping

• Seeking vestibular: rocking, spinning, running, jumping, rolling, stomping, fidgeting, head shaking

• Seeking touch: touching everyone/everything, repetitive rubbing

• Seeking visual: eye rubbing, blinking• Seeking auditory: humming/noisemaking, hands

on/off ears

Examples of Sensory Avoiding

• Withdrawal from touch• Rejection of tactile experiences (finger foods,

glue, mess, dirt, grass, sand, clay, play dough)• Covering ears/eyes• Gaze aversion, squinting• Avoidance of movement, climbing, heights• Retreating to dark, quiet, enclosed • Mouth breathing• Finicky eating: textures, temperature, flavors

Avoidance via Overstimulation/Hyperfocus

• Signs of stress/need to retreat: Some examples:– Repetitive actions/verbalizations/fixations– Fleeing, crawling under desks– Staring at lights– Spinning objects– Self stimulation esp. self-injury– Masturbation

Helping those with sensory processing difficulties & everyone else for that

matterAdapt the environmentIncorporate movement activities into the

classroom routineProvide sensory tools, strategies & activities

as neededImplement a sensory dietEducate parents, staff, & child

Adapting the Classroom Environment

Organize a womb space or quiet cornerProvide ear plugs, headphones (noise-blocking or with

calming music, sounds from nature)Use natural or low lightingDecrease clutterProvide bean bag chair, large pillows, sleeping bag or

blanketsFidgets, tubing for chewing, theraband on chair legs,

wiggle cushions, weighted devices, ball chairs, water bottles with straws, & other alerting/calming tools

Discourage dangling art, instructions from ceiling

Adapting classroom (cont.) Put artwork on bulletin boards behind desks Post clear schedule Place child on end of aisle or with an extra desk on one side

for tools, additional organizational space Avoid placing child facing or next to window Keep doors, drawers oiled; omit or decrease misc. noise as

much as possible (i.e. close door) Avoid wearing strong scents Add kinesthetic and visual modalities with auditory

instructionsSee also handout: S/I Based Tips for Working with Children

with Sensory Processing Disorders

Why The Brushing Technique Works

• Brushing: – Pressure touch releases and enhances dopamine in the pleasure center of the

limbic system– Pressure touch enhances nerve growth factor which increases density of

neuro connections• Decreases stress chemistry by enhancing parasympathetic chemistry

• Proprioception: – Gets serotonin from the reticular formation– Modulates arousal– Endorphins from strong doses of proprioception are released– Enhances GABA chemistry—which is inhibitory and tones down sensory input– Puts “me in the picture” better self- awareness– Mediation in the frontal lobe resets the interpretation of what is noxious

(from feeling non-noxious is noxious to feeling non-noxious is non noxious– Neuropeptides can hang around for 1-1/2 to 2 hours so want to counteract

with stimulation that keeps these in check (inhibitory) before stress is activated

Incorporating movement & proprioceptive work into routine

Do morning wake-up: walk, stretch, body shake, tighten/release, stomp feet to prep brain for attending & promote posture

Use music and movement for transitions Do isometrics as a class (see handout) to bring calm, alert state

when agitated or sluggish Provide access to rocking chair, swivel chair, wiggle cushions, ball

chairs, theraband or old bike inner tubes to door/stable object for pulling

Regularly scheduled recess is essential—recess should never be used as a regular punishment or as consequence for poor attending, sluggishness

Assign classroom or school jobs, e.g., empty recycling bins, carry/stack milk crates, carry materials to office, stack library books, move chairs/desks, wash desks (see handout: Classroom Remediation Strategies for more)

To promote seated cooperation/work

Allow student to chew on tubing, straws, gum, jerky, or suck on sour candy for calming & organizing benefits

Provide wiggle cushions, t-stool, rocker, ball chairs, etc. to allow movement while sitting to stay alert

Allow alternative postures to complete work: standing, propped on elbows while lying, kneeling

Provide proprioception via weighted products: chair wrap (chair buddy), vest, blanket, lap weight via theraband around chair legs

Provide fidgets for group time, assemblies, waiting times, transitions, stressful times (See Sensory Survival Pack handout)

Provide headphones w/wo music; ear plugs

Calming Techniques See “My Relaxation Book” handout—use with stress ball/flour

balloon Desensitization brushing for sensory defensiveness: deep pressure

brushing followed by compressions/tractions (under training/guidance of OT)

Deep breathing, drink of water through straw Slow linear rocking in chair, etc. Use of tight lycra undergarments Weighted devices: vests, chair wraps, snakes, wrist & ankle bands Vibration Hand soak in warm soapy water Calming music Retreat space Bean bag/pillow sandwich

Implement a Sensory Diet or Social Story with sensory tools

Sensory Diet: Sensory based activities, therapeutic equipment, household objects, toys, or food that have been selected to meet a person’s sensory needs & are available on a daily basis.

Sensory diet is developed by the OT, or ideally the IEP team with consultation from OT (see form)

Social Story can include using sensory tools to address target behavior ( see example)

Transitions to & from school

• If needed a sensory diet before and after bus with proprioceptive/vestibular activities

• Headphones with or without music • Theraband/tubing on backpack for stretching/chewing• Add weight to backpack for calming (total no more

than 5% of child’s body weight)• Use sensory survival pack• Prepare calming or alerting activity as child gets off

bus. • Transition before or after crowd.

The Home ConnectionChild will likely be exhausted after-school as it is so

much more effort for children with sensory processing difficulties to cope in the demanding school setting

A home sensory diet can be a critical difference between success and failure at school

Most children will need time to de-stress after schoolMay need a decreased homework loadFamily may want to pursue private sensory integrative

therapy as the schools do not have the clinical emphasis, equipment, or session lengths to provide this type of intensive therapy.

Obstacles to success

• Resistance• Lack of sufficient time trial• Fairness issue• Lack of equipment• Lack of time

References & ResourcesSensory Integration and the Child, by A. Jean AyresBuilding Bridges through Sensory Integration: Therapy for Children with Autism and other Pervasive

Developmental Disorders, by Ellen Yack, Paula Aquilla, & Shirley SuttonAsperger Syndrome and Difficulty Moments: Practical Solutions for Tantrums, Rage, and Meltdowns, by

Brenda Smith Myles and Jack SouthwickUnderstanding Sensory Processing/Integration with Remediation Strategies for Home/School/Clinical

Environments, course by Cynthia Clemens at Good Samaritan Children Therapy UnitUnderstanding Challenging Behaviors from a Sensory Processing Perspective Perspective, course by

Bailey Dahms, Patty Ambrose, Amy Okeze, Kerri Inglin, Wendy PlatzerBest Practice Interventions for Sensory Processing Disorder, course by Delana HonakerThere’s Always a Reason for the Behavior!, course by Kim Barthel at Good Samaritan Children’s

Therapy UnitTool Chest: For Teachers, Parents, & Students , by Diana Henry, Henry OT Services, Inc.

www.ateachabout.com Sensory Integration Tools for Teens, by Diana Henry, Henry OT Services, Inc. www.ateachabout.comAbilitations Integrations Sensory Solutions catalog, 2008 & 2009

Talk to me if you are interested in more resources. I have pages and pages of recommended books, websites, products etc…