Sensory Processing Skills and Self-Regulation Processing Skills and Self-Regulation Abigail...
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Transcript of Sensory Processing Skills and Self-Regulation Processing Skills and Self-Regulation Abigail...
Objectives
Brief overview of terminology
Review and information on sensory systems
Under Responsiveness vs. Over Responsiveness
Sensory processing skills in relationship to self-regulation and function
Sensory Systems
How many sensory systems do we have?
Sensory Systems – All 8 of them
Touch (Tactile)
Auditory
Vision
Taste (Gustatory)
Smell (Olfactory)
Proprioceptive – input received from our muscles and joints that tell us where we are in space.
Vestibular – located in the inner ear and it coordinates your body’s movement and balance as well as movement of your eyes separate of your head (e.g. visual tracking, saccades, convergence/divergence).
Interoception – Sensation relating to the physiological condition of the body. These receptors are located internally and provide a sense of what our internal organs are feeling. For example, a racing heart, hunger, thirst, etc.
Sensory Systems are our “foundation”
Sensory Processing
“Sensory processing is a term that refers to the way our nervous system receives and
interprets messages from our senses and turns them into appropriate motor and
behavioral responses.” (“About SPD, 2017”)
Sensory Integration
“The ability of the nervous system to organize sensory input for meaningful adaptive
responses.” (Ayres)
“Typical” Sensory Integration Process
Sensory input
Brain
Meaning is given to the
input
Information is combined
with previously stored info
Adaptive Response
Sensory Integration Process with SPD
Sensory input
Brain
Meaning is given to the
input
Information is combined
with previously stored info
Maladaptive response
Sensory Processing Disorder
“Sensory Processing Disorder (SPD), exists when sensory signals are either not detected or
don't get organized into appropriate responses.
Pioneering occupational therapist, educational psychologist, and neuroscientist A. Jean
Ayres, PhD, likened SPD to a neurological "traffic jam" that prevents certain parts of the
brain from receiving the information needed to interpret sensory information correctly.
A person with SPD finds it difficult to process and act upon information received through
the senses, which creates challenges in performing countless everyday tasks. Motor
clumsiness, behavioral problems, anxiety, depression, school failure, and many other
problems may impact those who do not have effective treatment.” (About SPD, 2017)
Umbrella of Sensory Processing Disorder
Sensory Modulation
“Sensory modulation is a neurological function and is the organization of sensory
information for on-going use. Efficient sensory modulation is the ability to effectively
regulate the degree to which one is influenced by various sensory inputs.” (Northshore
Pediatric Therapy, 2017)
Think of modulation as the “dimmer switch” we can grade our reaction to sensory input.
Who felt their socks this morning? Who noticed them all day long?
Sensory Modulation
Often over (e.g. fearful of movement) or under responsive (e.g. decreased auditory
awareness or constantly moving) to sensory input.
Poor modulation skills results in kids often being in fight, flight, or freeze.
High levels of stress, anxiety, perfectionism, rigidity, etc.
“Over-reactors”
Umbrella of Sensory Processing Disorder
Sensory Discrimination
Sensory discrimination is the ability to interpret and make meaning of input from your
different sensory.
“A disorder of discrimination means that you have difficulty interpreting information (i.e.,
differentiating stimuli in the affected sensory systems).”
For example:
Auditory: Did she say cat, cap, or pack?
Tactile: Is that a quarter or a nickel in my pocket?
Visual: Where is the key that looks like this?
Proprioceptive: How hard should I push this forward to move it, but not break the glass?
Vestibular: Which way am I turning?
What can SPD look like?
What can SPD feel like?
Occupational Therapist’s role with SPD
“Provide intervention to help children respond more appropriately to information coming
through the senses.” (Amy Johnson, OTD, OR/L, 2017).
Sensory Systems – “Powerhouse” Senses
Touch (Tactile)
Auditory
Vision
Taste (Gustatory)
Smell (Olfactory)
Proprioceptive – input received from our muscles and joints that tell us where we are in space.
Vestibular – located in the inner ear and it coordinates your body’s movement and balance as well as movement of your eyes separate of your head (e.g. visual tracking, saccades, convergence/divergence).
Interoception – Sensation relating to the physiological condition of the body. These receptors are located internally and provide a sense of what our internal organs are feeling. For example, a racing heart, hunger, thirst, etc.
Proprioception & Vestibular – “Powerhouses”
Our proprioceptive and vestibular systems are considered our “powerhouse” senses
because receiving input to these systems can last for hours.
Proprioceptive: After engaging in a heavy work activity (proprioceptive) we may see
benefits to the central nervous system (CNS) for up to 2 hours.
Examples: DPPT (brushing), crashing, crawling, jumping, exercising, heavy work, etc.
Vestibular: Input to this system can impact the CNS for up to 8 hours.
For example, Swinging, Astronaut Training, riding roller coasters, etc.
Auditory “Powerhouse Booster” Sense
Auditory – Research indicates that “Therapeutic Listening in combination with a sensory
diet appears effective in improving behaviors related to sensory processing in children
with SPD and visual-motor impairments.” (Hall & Case-Smith, 2007)
Therapeutic Listening (TL) – Changes are on a case to case basis. I’ve seen this work
extremely well with some kids, moderately well with others, and have minimal to no effects
with a few kids.
Always consult with your child’s OT or SLP when considering TL.
Real life experience says – music impacts your arousal level and as adults we use it as a
tool for self-regulation.
Umbrella of Sensory Processing Disorder
Sensory Over vs. Under Responsiveness
Under Responsiveness Over Responsiveness
Input is not perceived by the CNS when
present
“Drama” in response to sensory input as a
result of overactive CNS
Needs more input to register that something is
happening
Difficulty “tuning out” non-important sensory
input (easily distracted)
Sensory Over vs. Under Responsiveness
Sensory Over vs. Under Responsiveness
Response to sensory input varies through the day and is different based on type of sensory
input.
For example, your child may be very under responsive to gustatory input (taste) so they may seek
out foods that are crunchy, spicy, and full of flavor
At the same time, your child may be over responsive to auditory input and is easily distracted by
sounds that you may not even notice (i.e. the lights buzzing, someone talking in the hallway,
others breathing, etc.)
Real life examples – “Camping with friends” and “lights on all day until bedtime”
Proprioception
Information sent to the CNS from one’s muscles and joints. Helps determine where you are
in space.
Under Responsive
Seeks crashing
Falls into objects
Excessive force used
Clumsy/Accident prone
Moves quickly and often
Proprioception
Kids with Autism and SPD are often under-responsive to proprioceptive input
These kids may be scared of the dark because they are overly reliant on their visual system
to move in space.
Always want a night light
Clumsier in low lighting
Proprioceptive Considerations
Under Responsive
Provide input they are seeking
throughout their day
Allow oral motor proprioceptive
input if this is organizing (i.e. use of
a chewy, chewing gum,
crunchy/chewy snacks, etc.)
Allow opportunities for crashing
and jumping to help create better
awareness of body in space
Vestibular
Under Responsive Over Responsive
Seeks movement constantly Fearful of feet leaving the ground
(gravitational insecurity)
Spins excessively Moves entire body rather than head to look
towards the ground (doesn’t dissociate eyes
from head to look down)
Fearless Quick to get sick from movement
Vestibular Considerations
Linear movement (back and forth) is typically calming
Rotational movement (spinning) is typically alerting
Under Responsive Over Responsive
Allow frequent movement breaks
throughout the day
If the child is fearful of movement
introduce it very slowly and watch
for signs of distress
Vestibular Example
Real life example: I have been working with a kid for 5-6 months now, previously, swinging
for any amount of time resulted in him being immediately overstimulated (hysterical
laughter, unsafe decisions, increased impulsivity)
Now, swinging for 6-8 minutes (linear) is very calming and organizing to him
Expanding tolerance of vestibular input: scooter board
Initially was fearful of “feeling calm” and still fears it often – teach it is okay to feel calm
Vestibular and Core Strength
Vestibular input can elicit changes in muscle tone.
Long sitting, straddling, prone, crawling, etc.
For kids that have poor core strength and oculomotor control it may be a good idea to
start prone in suspended equipment.
This position works on strengthening the extensor musculature (muscles in the back), can
improve bilateral upper extremity coordination and strength, and can improve
oculomotor coordination and strength.
Auditory
Under Responsive Over Responsive
Slow to respond or does not
respond when name is called
Easily distracted by noises that
others may or may not notice and
may cover ears frequently
Poor or no orienting response to
sounds
Startled by unexpected noises
*May make noises to block out
auditory input secondary to
hypersensitivity
May make noises for enjoyment Increased anxiety/agitation in
crowded/noisy environments
Auditory Considerations
Under Responsive Over Responsive
Visual/Gestural Cues Be cognizant of noises in
environment (even if they don’t
both you)
Contrasting colors to draw visual
attention to written or visual
instructions
Simplify instructions
Gain visual attention prior to
giving auditory instructions (does
not have to be eye contact)
Calm voice
Type of visual supports (real
pictures, Boardmaker pictures,
representational, etc.)
Provide access to a quiet place
and/or headphones
Tactile prompts
Therapeutic Listening/Music
Vision
Under Responsive Over Responsive
Seeks visual stimulation Limited eye contact
Looks directly into lights Moves away from light or covers eyes
with bright lights
Prefers objects with moving/spinning parts Difficulty with clutter or competing
background
Flicks objects/flaps hands close to eyes Notices any movement in the room
Vision Considerations
Under Responsive Over Responsive
Bright lights, contrasting
colors/patterns, etc.
Decrease clutter
Visuals that move (i.e. spinner
toys, fidget spinners, etc.)
Seating near the front of the
room
Gain visual attention prior to
giving auditory instructions
(does not have to be eye
contact)
“Tent space” to calm and
decompress
Allow use of peripheral vision Use soft/natural lighting
Alerting colors – red, yellow,
orange, etc.
Calming colors – blue, green,
grey
Taste
Oral input is one of the most calming, organizing, and/or alerting sensory inputs. Think of
the pacifier, a child sucking their thumb, sucking on a lollipop, chewing gum, etc.
Often times children on the ASD have a very restrictive diet because they two things they
have control of are what goes into their body and when that comes out.
Restrictive diet
Bowel issues (i.e. constipation)
Taste
Under Responsiveness Over Responsiveness
Constantly mouthing objects or chewing things Gags easily especially when presented with
non-preferred foods
Frequently puts fingers, clothing, or objects in
their mouth
Restrictive Diet (may be a sign of oral
defensiveness, oral motor weakness, or poor
proprioceptive awareness intra-orally)
Taste Considerations
Under Responsive Over Responsive
Try foods that are crunchy,
chewy, and/or have bold
flavors
If a child is orally defensive
and a picky eater do not
force them to try/eat non-
preferred foods
May need appropriate items
to chew on such as gum or a
chewy
Things that we may consider
lacking flavor still may be
overwhelming to the child
Sensory Break – Poll
Movement/break or power through the rest of the power point (approximately 15-20
slides)?
Sensory Defensiveness
Sensory Defensiveness: “A constellation of symptoms that are the result of defensive
reactions to non-noxious stimuli across one or more modalities” (Wilbarger & Wilbarger,
1991).
Individual’s may exhibit sensory defensiveness to one, some of, or all of the sensory
systems.
Sensory defensiveness often results in an avoidance of interaction with the environment.
Impacts of Sensory Defensiveness
Limited interaction/exploration of the environment
Easily distracted by a variety of sensory input
Oral defensiveness (picky eater, hates brushing teeth, fearful of the dentist)
Poor respiration rate/pattern (shallow, rapid, etc.)
Constant hypervigilance
Difficulty changing or maintaining level of attention
Poor peer interaction
Withdrawn
Resistance to participating in activities (especially ones that are new)
Techniques for Sensory Defensiveness
First and foremost – OT
DPPT (Brushing)/Beckman Oral Motor Stretches
Sensory Diet
Build trust/rapport with the patient so that sensory experiences can be introduced when the child
feels safe and ready to experience these sensations that were previously a “threat”
Therapeutic Listening
Heavy work
Compression garments
Weighted garments
“Chill out” spaces
Sensory Diet
Creating and updating a sensory diet requires:
Collaboration with parents, teachers, counselors, outpatient therapists, and school therapists
Information from all disciplines is vital
Sensory diets should be proactive and implemented during “key points” of the child’s day.
Won’t always be proactive so we also need to know what is beneficial when the child is
overstimulated.
Sensory diets need to include activities that are: alerting, organizing, and calming.
Sensory Diets – Adults vs. Children
As adults we are able to think about what we need to stay alert, focused, and attentive. If
we need to get up to go get a drink we are able to come up with that idea, sequence
the steps and actions necessary to go get a drink, and carry out that motor plan.
Our children can’t always express or determine what they need, sequence the steps
necessary to achieve this input, or carry out the motor plan. They often find dangerous or
disruptive ways to regulate their sensory systems.
Crashing into things/people, chewing on shirts, touching everything, jumping from high places,
running away/fleeing, etc.
Sensory Diets – Adult’s Role
It is our job to help read out children to:
Determine what they are feeling
Give them the language to support and affirm their feelings
Give a choice or have them implement sensory or coping strategies to regulate their sensory
systems in a more appropriate and safe manner
Review how their feeling/body has changed after carrying out the sensory/coping strategy
Sensory Diet Components
Movement – side to side, rotational, back and forth,
Auditory – music, noise canceling headphones, quiet spaces, etc.
Visual – visual supports, limit visual clutter, allow time for visually stimulating activities (e.g. light up toys, etc.)
Gustatory (taste)/Oral Motor – “brain food” crunchy/chewy snacks (e.g. gum, pretzels, granola, etc.), alerting flavors to increase alertness
Proprioceptive input – crashing, banging, hanging upside down, crawling, etc.
Vestibular – swinging, rocking, etc.
Arousal Level vs. Self-Regulation
Arousal Self-Regulation
The state of the nervous system,
describing how alert one feels.
(Williams and Shellenberger, 96)
The ability to attain, maintain, and
change arousal appropriately for
a task or situation.
(Williams and Shellenberger, 96)
Arousal Level
Levels of Arousal - Overstimulation
Overstimulation can present in one of two ways – sensory shutdown or as “hyper”
Overstimulation
Sensory Shutdown
*Lethargic*Disengaged
Hyper
*Hypervigilant *Impulsive
*Unsafe
Levels of Arousal – Understimulation
Understimulation can present in one of two ways – disengaged or hyper
Understimulated
Lethargic
*As a result of not receiving enough
sensory input
Hyper/Sensory Seeking
*Seeking sensory input to try and keep alert
Level of Arousal
A child’s level of arousal changes throughout the day and is different on a daily basis
It Is important to work as a team to create and implement a sensory diet
Sensory diets will change as the child’s sensory system changes and self-regulation skills
improve
Open and frequent communication between the child’s teachers, parents, and
therapists, is vital for determine what sensory supports are working for a child and what
changes may need to be made for the sensory diet to be more effective
Self-Assessment of Sensory Strategies
Morning shower vs. evening shower
Workout in the morning vs. evening
Cup of coffee (or more than one) – time of day
Radio on/off on the way home – does it depend on the day/traffic?
Down comforter/heavy blanket vs. light blankets
Sensory Processing and Self-Regulation
Per Amy Johnson, OTD, OTR/L, reports that the majority of children do not begin to truly
understand their nervous system and what they are in need of to self-regulate until around
the age of 12 years old.
It is suggested to provide language all kids with language as early as possible to illustrate
how he/she is feeling.
Suggested language and emotional regulation curriculums are located on the next slide.
Self-Regulation Recommendations
The Zones of Regulation curriculum
The Incredible Flexible You (Now called “We Thinkers”)
Routinely scheduled sensory breaks
Therapeutic Listening
DPPT (Wilbarger Brushing Protocol)
Provide visuals to help the children more independently request a break
Often times when these kids are in “fight or flight” they are unable to access language efficiently
and quickly. Visuals help them communicate what they need to focus and learn. Some kids may
have to be taught explicitly how to use a “I need a break” card.
Sensory Processing Disorder Recap
Sensory Processing Disorder Recap
Address at an early age for better outcomes
Sensory Modulation
Dimmer switch” that allows us to tune in/out input. Poor sensory modulation results in frequent fight, flight, freeze response.
Sensory Discrimination Disorder
Difficulty making sense of the world around them
Sensory Defensiveness
Frist, try and correct and “retrain” the brain to response appropriately
If that doesn’t work to teach adaptations to deal with sensory discrimination disorder or defensiveness
Resources
SPD Info: https://www.spdstar.org/
Zones of Regulation: http://www.zonesofregulation.com/index.html
We Thinkers Volume 1: https://www.socialthinking.com/Products/WeThinkersVolume1-
FiveStorybookSet
We Thinkers Volume 2: https://www.socialthinking.com/Products/WeThinkersVolume2-
FiveStorybookSet
Therapeutic Listening: https://vitallinks.com/therapeutic-listening/
Questions, Comments, Suggestions?
