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Sensory Processing Skills and Self-Regulation

Abigail McKenzie, MOT, OTR/L [email protected] Objectives

 Brief overview of terminology  Review and on sensory systems  Under Responsiveness vs. Over Responsiveness  skills in relationship to self-regulation and Sensory Systems

 How many sensory systems do we have? Sensory Systems – All 8 of them

 Touch (Tactile)  Auditory  Vision  (Gustatory)  Smell (Olfactory)  Proprioceptive – input received from our muscles and that tell us where we are in space.  Vestibular – located in the inner and it coordinates your body’s movement and as well as movement of your separate of your head (e.g. visual tracking, , convergence/divergence).  – Sensation relating to the physiological condition of the body. These receptors are located internally and provide a of what our internal organs are . For example, a racing heart, , , etc. Sensory Systems are our “foundation” Sensory Processing

 “Sensory processing is a term that refers to the way our receives and interprets messages from our 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

Adaptive Response

Information is combined Meaning is with given to the previously input stored info Sensory Integration Process with SPD

Sensory input

Maladaptive Brain response

Information is combined Meaning is with given to the previously input stored info Sensory Processing Disorder

 “Sensory Processing Disorder (SPD), exists when sensory signals are either not detected or don't get organized into appropriate responses.

 Pioneering , educational psychologist, and 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, , , 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 or constantly moving) to sensory input.

 Poor modulation skills results in kids often being in fight, flight, or freeze.  High levels of , 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 , 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 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. & 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 (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 says – music impacts your 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 “Drama” in response to sensory input as a present result of overactive CNS

Needs more input to register that something is Difficulty “tuning out” non-important sensory happening 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  At the same , your child may be over responsive to auditory input and is easily distracted by that you may not even notice (i.e. the 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 and SPD are often under-responsive to proprioceptive input

 These kids may be scared of the dark because they are overly reliant on their to move in space.  Always want a night  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, 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 If the child is fearful of movement throughout the day 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 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 Easily distracted by noises that respond when name is called others may or may not notice and may cover frequently

Poor or no orienting response to Startled by unexpected noises sounds *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 to draw visual Simplify instructions to written or visual instructions

Gain visual attention prior to Calm voice giving auditory instructions (does not have to be contact)

Provide access to a quiet place Type of visual supports (real and/or headphones pictures, Boardmaker pictures, representational, etc.) Therapeutic Listening/Music Tactile prompts 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 Decrease clutter colors/, etc.

Visuals that move (i.e. spinner Seating near the front of the toys, fidget spinners, etc.) room

Gain visual attention prior to “Tent space” to calm and giving auditory instructions decompress (does not have to be eye contact)

Allow use of Use soft/natural lighting

Alerting colors – , yellow, Calming colors – , green, orange, etc. 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 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 Restrictive Diet (may be a sign of oral their mouth defensiveness, oral motor weakness, or poor proprioceptive awareness intra-orally) Taste Considerations

Under Responsive Over Responsive

If a child is orally defensive Try foods that are crunchy, and a picky eater do not chewy, and/or have bold force them to try/eat non- preferred foods

May need appropriate items Things that we may consider to chew on such as gum or a lacking flavor still may be chewy 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/ (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 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  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, The ability to attain, maintain, and describing how alert one feels. change arousal appropriately for (Williams and Shellenberger, 96) 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

Hyper Sensory Shutdown *Hypervigilant *Lethargic *Impulsive *Disengaged *Unsafe Levels of Arousal – Understimulation

 Understimulation can present in one of two ways – disengaged or hyper

Understimulated

Lethargic Hyper/Sensory Seeking

*As a result of not *Seeking sensory input to receiving enough try and keep alert sensory input 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 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?