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Home , Sensory nervous system, Visual processing

Disorder with Strategies for learning Behavior and Social Skills Description: Understanding and learning to recognize the sensory needs of the children who have spectrum processing disorder. Bonnie Vos, MS, O.T.R./L History of Diagnosis

Autism criterion not it’s better defined, # Subtype own diagnostic of diagnosis s are category increased rapidly

DSM I DSM II DSM II DSM DSM IV DSM V 1952 1968 1980 III-R 1992 2013 1987

Autism not it’s Autism New subtypes are own diagnostic becomes its added, now 16 category own diagnostic behaviors are category characteristic (must have 6 to qualify) History of Diagnosis

1. New name (Autism Spectrum Disorder) 2. One diagnosis-no subcategories 3. Now 2 domains (social and repetitive) 4. Symptom list is consolidated 5. Severity rating added 6. Co-morbid diagnosis is now permitted 7. Age onset criterion removed 8. New diagnosis: Social (pragmatic) What is Autism

• http://www.parents.com/health/autism/histo ry-of-autism/

Coding of the

• One theory of how the brain codes is using a library metaphor. • Books=experiences • Subjects areas are representations of the main neuro- cognitive domains: • The subjects are divided into 3 sections: 1. Sensory: visual, auditory, ect. 2. Integrated skills: motor planning (praxis), language 3. Abilities: social and cognitive • Designed as a model for ideal development The Brain Library

• Each new experience creates a book associated with the subject area that are active during the experience • Books are symbolic of whole or parts of experiences • The librarian in our brain – Analyzes – Organizes – Stores – Retrieves

Brain Library

• The earliest experiences or sensory inputs begin the books that will eventually fill the foundational sections of our brain Libraries – Sensory integration begins in-utero – Example: vestibular=14 weeks in-utero – Example: Auditory=20 weeks in-utero

Brain Library

1. All information is taken in through the sensory-nervous receptors 2. The librarian in your brain cross-references new experiences against past experience (stored books) to give context 3. A response is formulated based on current information woven with past experience

Capabilities

Integrated Skills Section

Foundation Section The Brain Library Learning

• While performing higher level integrated skills the must continuously reference the foundation books – Higher level skills rely on foundation shelves to be sufficiently stacked Our successful navigation of modern life is dependent on our capabilities (cognitive and social intelligence)

Brain Library Exposure Delay

• Gaps in the brain library--lack of exposure to sensory-motor & language experiences – Can be mistaken for a dysfunction or disorder – Common in children who are in orphanages – A developmental delay may be compounded by a lack of exposure to crucial experiences (Language) Sensory Integration

• SI issues can be more debilitating to children with ASD since they may not have effective verbal communication skills – SI issues are compounded by lack of communication – Reactions are often over exaggerated by lack of communication abilities

Sensory Processing Model

Sensory Processing Model

Sensory Integration Happens here

smelling

Tasting

Processing Brain Seeing Library Balance

Body touch Action Parts of the Sensory System

1. Vestibular 2. Tactile 3. Proprioceptive 4. Auditory 5. Visual 6. Gustatory 7. Olfactory

• Provides the dominate input abut our movement and orientation in space – Acts to fuse together information from all the organs, inner , muscles and palms and fingertips, sole of feet and jaw • Effects rate and blood , muscle tone and arousal levels Vestibular Auditory and Visual work together give you the sense of space and tell you what fills the space (you are here marker) Vestibular System Difficulties

Dysfunctions in the vestibular system: Abnormal muscle tone (speech) Difficulty with bowel movements Excessive movement: need for self Academic problems (visual/auditory) Increased anxiety/panic attacks Difficulty with coordinated movement (especially slow controlled) Vestibular Processing Strategies

• Physical activities that stimulate the vestibular system • Think recess games – Hopscotch games (vestibular and visual) – Ball games (four square, dodge ball) – Swinging: playground, on hammock swing, rotary swings – Set up Recess: into obstacle courses to encourage movement – Olympic lesson (pick an event that last several weeks) – Animal lesson (practice moving like them)

Vestibular Processing Strategies

• Provide Controlled sensory input – Bouncing large balls – Spinning: swivel chair, sit-n-spin (slow in one direction/change) – Rocking: rocking chair – Scooter board: bungee cord, races

Vestibular Processing Strategies

• Rotary input – Increase tone and arousal – Infuse language activities 93-5 rotations) Walk forward and backward, rolling a large ball Walk to the beat of a drum Get kids on and extending arms/legs like a bird or plane

Vestibular Processing Strategies

• Arm/leg press off teacher (or parent) or wall • Jump over moving rope • Crawl on colored tape • Gross motor movement linked with rhymes • Music – Listening programs – Transition Indicators

Top 10 Vestibular Processing Activities

1. Throw a bean bag or medicine ball at a target while swinging. For the hypo registering child, have them get on and off the swing to get the ball or missed bean bag, this will increase the stop and start input, which is the strongest input. 2. Popping bubbles while swinging! This simple activity can be a great way to get head turns and swings, finger isolation 3. Crossing midline and position in space awareness while swinging

Top 10 Vestibular Processing Activities

4. Visual tracking: do visual tracking activities while swinging using flashlights in a dark room, bright colored toys 5. laterality and directionality skills: have them look up at a distance such as 5-10 feet away at an arrow chart and then have them hold a medicine ball and do movements with arms only to arrow charts while swinging. 6. b,d,p,q,a,m,w, ball: have them read a ball with all different letters

Top 10 Vestibular Processing Activities

7. Body Awareness on the swing: have the child do activities with eyes open or closed is best such as, "flex or bend your right wrist", "touch your right knee with your left thumb 8. Balance code charts on the swing! 9. Prone work: laying on belly to climb rope while on swing, picking up medicine ball 10. Try them on their backs while swinging. Try reaching, rope climbing, and medicine ball activities Touch Tactile System • Receives sensations through receptors in the and hair on the surface of the skin • Protective system: alert us to threats ( touch) and fast emotional response • Discriminative System: allows us to investigate the properties of object and slower response allowing to process information Tactile Processing Difficulties

• Touch Sensitive (defensive) – Touch perceived as threatening – Unusual irritation to certain clothing – Aggressive toward situations that include touch experiences – Picky eater-refusing to eat certain textured foods Touch Craver (discrimination) Seeks out touch Touches everything Does not register or extreme Licking people and objects

Tactile Processing Difficulties

• Lack of exposure • Touch issues • Body Awareness •

Tactile Processing Strategies

• Information Discrimination (crucial for learning) – Rice bag – Treasure hunt (find small things in putty) – Feely Bag: collect small items of different textures to match/sort – Shaving cream on mirror/cookie sheet – Blindfold games: pin the tail on the donkey – Matching stickers on body – Build a sensory fort –box and sensory strings Tactile Processing Strategies

• Link Tactile with proprioceptive strategies (decrease defensiveness) • Think tactile input for lesson plans – Include a tactile portion to lessons Fidgets-something to move around in your hand or mouth Body Position Proprioceptive System • Body Position Sense-This system tells us about movement in relation to our own bodies • Proprioceptive receptors are located in the muscles, joints ligaments and connective tissue

Proprioceptive Processing

• Poor sense of body awareness/body position • Sensory Seeking – Squeezing other – Pushing or pulling objects or others – Self injuries behaviors (biting self, hitting self) Motor Planning Difficulties with self help skills such as dressing Bumping into things Proprioceptive Processing

• Poor sense of body awareness/body position • Motor Planning-sequencing and planning movement Proprioceptive Processing Strategies

• Focus on different body positions without movement • Crawling activities = compression • Add different colored stickers, balloon or yarn on each arm or leg (yellow up = 3 points) • Jump through pattern on the floor (colored tape, hula hoops, twister with colored hoops) Proprioceptive Processing Strategies

• Imitate hand movements-fingers to thumb, fingers walking on desk • Adding weights and sounds to limbs • Cobra position while making sounds • Tummy on ball, reaching for objects • Change body positions=call out body parts • Body parts directionality (red circle over heart) Proprioceptive Processing Strategies

• Increase body awareness and body positions – Stairs – Playing pulling or pushing games – Weighted ball – Arm/upper body games • Provide calm weighted organization – Joint compressions – Chewing resistive foods – Pressure: wearing spandex undergarments, headbands, shorts Visual

• Information received through the eyes and processed by the brain • Provides visual info about the environment – , size, motion, shape, etc – Distances of objects form you as well as one another Critical for academics and behavior Visual skills: teaming, eye pursuits, saccades : visual closure, figure ground, position in space Visual-Motor Skills: writing, copying ball skills How it develops

• Visual skills develop from big to small – • As a child grows his eyes become more effective at focusing on ever small objects/details as well as tracking moving objects • A child’s visual system will continue to become more refined as the child moves and interact with their environment Examples of Vision Examples of Vision

Examples of Vision

Visual Processing Difficulties

• Visual Discrimination – Difficulty finding an object form background objects – Difficulty coping – Drawing, • Visual tracking/Scanning – Difficulty connecting visual info to movement (balls) – Scanning games – Awareness of environment and movement • Visual-Spatial Ability – Puzzles, building blocks designs – Objects same size with distance • Eye Teaming Visual Processing Strategies

• Visual Processing – Shapes to find shapes – Half the story (pix) – Creating a story with pix – Game: what do you see? – Camouflage game: find a penny on carpet of same color – What is missing game=on a tray, tae or part of the room

Visual Processing Strategies

• Which container goes with which lid—a bucket of containers and lids—have the kids tell you and then try it • Who’s the leader—child leaves room and guesses who is the leading new action Visual Processing Strategies

• Visual discrimination – Block or pegboard designs – Matching and separating and shapes • Visual tracking/scanning – Make a pretend magnifier or eyes with large opening to look through – Throwing and catching different colored or sized balls – Where’s Waldo – Hitting moving objet on a string with stick or bat – Walking on line (use color tape) • Dark paper/colored overlays to isolate visual information Auditory hearing sense • Gives information related to sound: – Hear – Locate – Discriminate • Receptors in the – Shares some of fibers with vestibular system (8th cranial nerve) • Critical for academic success – Act on auditory information (follow motor directions) – Attention to pertinent auditory information – We ready with our eyes and our Auditory Processing Difficulties

• There is a difference in auditory vs. language processing – Auditory processing impacts language • Auditory (In)Sensitiity – Alarmed by certain everyday sounds – Overwhelmed by too much sound (church, amusement park) – Responds negatively to different voice pitches (high vs. metallic) – Sensitive to changes in acoustics (space issues) • Auditory Discrimination – Misunderstands-misses some words and replaces with others – Difficulty discerning alarm bell from “change class” bell • Repeats other words out loud – Limited use of language as tool – Auditory strategy Auditory Processing Strategies

• Think vestibular activates combined with auditory/language – Therapist stimulate the vestibular system with movement or vibration to improve auditory and language processes • Name objects in the area and describe how they look, feel, sound • Prepositions and me—use prepositional space concepts Auditory Processing Strategies

• Practice language exercise while moving (sign language/movement)-early verbs • Listen to a sound and create that sound while listening to it • Lose eyes, listen to sound, open eyes and match sound to person/object making that sound • Speak in a whisper—then louder—then whisper Auditory/Organization Strategy

• Musical suggestions: – Wiggly scarecrow, by Coles Whalen – Say G’Day by Genevieve Jereb – Cool Bananas by Genevieve Jereb – Jumpin’ Jelly Bean by Genevieve Jereb – Kidz Jam (Peach) by Vital links Sensory Modulation and Autism

Sensory Modulation Behavior Disorder Direct Indirec t Sensory Sensory Impacts Processing Discrimination education Disorder activities

Impacts Play & Sensory- Social activities Based Motor Disorder Sensory Modulation and Autism

• Over stimulation triggers stress reactivity and can lead to defensive behavior Fight Argumentative Violent

• Fright Flight Hyper Arousal Panic

Fort Avoidant/Eye fixated Covers face, eyes, etc Sensory Modulation and Autism

• The fright reaction automatic survival/stress reaction to perceived threat • The response to perceived threat is triggered by the amygdale however it is tempered by the frontal cortex (executive function) • Both the amygdale and frontal cortex are know to effected in children with autism spectrum disorder Typical vs. Non-Typical

• Typical Non-Typical Infants understand that the -Tend to use others as objects behavior of others is goal (ex: grip an adults hand to use directed it to get something) -Intentional communication -Less likely to use joint begins in infancy through attention gestures and simple -Use of gestures to language communicate is less present --joint attention -At 2 years old do not engage in pretend play at the same -2 year old engage in pretend play and can begin to level predict the behavior of others Typical vs. Non-Typical

• Typical Non-Typical 3 year olds begin to understand -2 year old has difficulty simple emotions of others pretending an object is (but not emotions such as something is it not (a block as surprise) a car) -5 year old recognize feeling of -5 year old struggle with false unexpected outcomes of belief concepts (example of others different colored cups)

Autism and Motor Development

• Teaching new skills – Understand how the nervous system sets us up to respond with a motor action to information – Utilize a forward chaining method with full physical prompt the first few trials – Continue forward chaining – Continue chaining –prompt only when the child seems stuck – Video tape the successful completion of the activity – Show the child the video tape right away – Have the child repeat the action again

Cartoon

Motor Planning

• Motor planning=organization • Organizing the body in appropriate sequence to partake in given action – Catching and throwing a ball Components of motor planning -requires (tactile) and body awareness ( and vestibular) -imitation is key -adaptive response (feedback used to dictate next step) Motor Planning Strategies

• Intense input to the foundation • Have children assist with set up and putting away equipment • Establish a clear beginning, middle ad end • Reach activities over and over to assure experiences are stored in the Brain library • Do not plan too many steps ahead • Use concrete labels #1, #2, #3 – Instead of first, second, third – First or then do not use Cartoon

Strategies Preschool • Use sensory fixation to expand play – Object trains – Object acting on something – Object with friend • Use sensory activities to elicit language – Ready, set….go! Strategies: Early grades

• Sensory input should be used to increase focus on a task • Sensory motor stations can be set up in the classroom: – Such as handwriting station – Visual motor station – Gross motor stations (following the dinosaur feet to the next station) – The tactile station (san art or shaving cream letters) Strategies: early grades

• Student can begin to identify their own sensory needs and attribute moods to sensory issues – Decreased in attention = sensory need – An be taught positive ways to meet those needs • Teach change (therapist/parent choice) • Use sensory strip so child has a picture schedule of sensory input to follow work • First/Then cards with pictures of sensory as reward or as the first with edible or preferred activity as the reward Strategies: Middle School

• Social sensory stories that the student helps create for different situations • Emergency Sensory Kit: crucial for trips/new activity – Fidget toys – Items to chew, book to flip through, spinning light – Consider a sensory/social set of cards with child picture in different settings Strategies: Middle School

• Signal card (like the red card) quiet hideout • Heavy work activities as part of daily routine: vacuuming, stacking chairs, carrying the laundry • Use video tape to build visual in their Brain Library of success in social situations as well as engage in sensory based activity • Home/school: make a quiet pace dedicated to cognitive activities (a good pace to have some sensory fidgets or a ball) • Teach Change SI Do’s and Don’ts

• DO Don’t • Include sensory inputs as much as makes sense -Talk about things not related to current activity • Use clear language or pictures for -Once the activity is set up don’t direct directions/feedback the child any more than necessary • Set up rooms to encourage -Overload with strategies without sensory enticement asking “why?” • Create a safe hang-out -Expect skills to be generalized without (sign) guidance and practice • Remember that more -Expect “fast acclamation to novel complex activities require stimuli-layer in novel stimuli bottom up skills • Recognize your own sensory needs

Questions?

Resources

• Resources and Bibliography • Ayers, A. Jean. Interrelations among perceptual-motor functions in children. American Journal of Occupational Therapy, 20, 68-71. • Ayers, A. J.. (1994) Sensory Integration and the Child. Los Angeles: Western Psychological Services. • Ayers, A. J. Tactile functions: their relation to hyperactive and perceptual motor behavior. American Journal of Occupational Therapy, 18, 6-11. • Bissell, J, et al (1988). Sensory Motor Handbook: A Guide for Implementing and Modifying ActivitiesintheClassroom,Torrance,CA: SensoryIntegrationInternational. • Cheatum, B. & Hammond, A. (2000) Physical Activities for Improving Children's Learning and Behavior. Champaign, IL: Kinetics. • Cooper, Heron & Heward (2007) Applied Behavior Analysis 2nd Upper Saddle River, NJ • Dawson, P., Guare, R. (2010) Executive Skills in Children and Adolescents. New York, NY, The • Guilford Press • DeGangi, G.A. (1995) Infant/Toddler Symptom Checklist: A Screening Tool for Parents. Tucson, • AR: Therapy Skill Builders. (1-800-0763-2306) • Delaney, Tara (2008) Sensory Processing Disorder Answer Book. Naperville, IL, Sourcebooks • Delaney, Tara (2009) 101 Games and Activities for Children with Autism, Asperger’s and • Sensory Processing Disorder, McGraw-Hill • Fink, Barbara E. (1989) Sensory Integration Activities. Therapy Skill Builders. 3830 E Bellevue, Tucson, AZ 42050 • Making Sense-ory® Out of Autism

Resources

• Resources and Bibliography • Hanschu, Bonnie (2000) The Ready Approach, Evaluation & Treatment of Sensory Processing Disorder from the Perspective of. Phoenix, Az • Hannaford, Carla (2005) Smart Moves, Why Learning Is Not All In Your Head. Salt Lake City, UT, Great River Books • Hong, SH, Gabriel, H & St John, C (2006) Sensory Motor Activities for Early Development. Bicester, Oxon, UK; Speechmark Publishing Ltd. • Huettig, C., Pyfer, J. & Auxter, D. (2001) Gross Motor Activities for Young Children with Special Needs. St.Louis:McGraw-Hill. • Kranowitz, C. (1998) The Out-of-Sync Child: Recognizing and Coping with Sensory Integrative Dysfunction. • May-Benson, Teresa (2009) Clinical Assessment and Practial Interventions for Praxis, TMB Educational Enterprises, Watertown, MA • Schetter, Patricia (2004) Learning the R.O.P.E.S. fro Improved Executive Function. Galt, CA Autism & Behavior Training Associates • Trott, Maryann Colby et al. (1993) SenseAbilities: Understanding Sensory Integration. Tucson, AR: Therapy Skill Builders. • Trott, Maryann Colby et al. (2000) Sensory Integration and Behavior Strategies Can Work Together. Tucson, AR: Therapy Skill Builders. • Wilbarger, P. & Wilbarger, J. (1991). Introduction to Sensory Defensiveness in Children Aged 2-12: An Intervention Guide for Parents and Other Caregivers. Santa Barbara, CA: Avanti Educational Programs.