Parent Resources For Assisting Children With Sensory Processing Disorder or Autism During This Time of Change

March 24, 2020

Dear Parent,

We know you are going through a very challenging time right now as you make every effort to keep you and your family healthy as a result of the impact of the pandemic in our community. At Kids Therapy Associates, Inc. we want to make every effort we can to assist with supporting our precious clients and their families with the changes related to the COVID-19 virus, and with learning how to have fun, and keep progressing towards functional independence!

If you have a child or adolescent with Autism or Sensory Processing Disorder, who is suddenly facing very significant change in their life due to schools being closed down, and community activities being cancelled, this can be a significant contributing factor to emotional dysregulation. The home environment is often significantly less structured than the school environment, which can also contribute to increased emotional dysregulation in children with Autism and Sensory Processing Disorders. The following are some supports to assist you with setting up your home environment to maximize your child’s ability to emotionally regulate and participate in functional and academic skills at home.

1) Provide Visual Structure within your home. 2) Provide scheduled structured sensory breaks for your child to participate in throughout the day. 3) Engage in strategies to facilitate a good night’s sleep as needed. 4) Provide visually structured activities for your child to engage in within the home environment. 5) As much as you are able, schedule and reasonably limit engagement with video games and movies. 6) Schedule time for you as a parent to take breaks in order to stay healthy and emotionally regulated.

Suggested recommendations will be made below to assist you with setting up and implementing these recommended supports.

1.PROVIDE VISUAL STRUCTURE Providing components of visual structure is a researched based approach to help individuals with Autism understand their environment and daily activities using visual processing, which is usually their strongest learning modality. Specifically,

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visually structured environments allow individuals to: 1) Understand and predict what is happening in their environments 2) Predict the expectations of an environment 3) Acquire new skills 4) Generalize skills from one setting to another.

Structured teaching and learning is a visually based approached to create highly structured support for individuals with autism in a variety of educational, community, and home/living settings (Mesibov, Shea, & Schopler, 2005). Structured teaching is associated with the Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) (Schopler, Mesibov, & Hearsey, 1995). The goal is to create an environment that promotes independence (i.e., decreased need for adult support) by incorporating an understanding of the characteristics of autism and the strengths and interests of each individual (Mesibov et al., 2005). By incorporating visual structure into your home and into specific activities throughout the day, your child will often display significantly improved emotional regulation, improved attention and focus and participation and engagement in daily activities. The five specific components of structured teaching/learning are described below. These are all very important, and they should all be individualized for your child’s age, communication ability, and preferences, as well as the environment that they are in. Please also be aware that visual structure can be developed from materials commonly found in the home environment.

1) Physical Organization / Visual Boundaries – This is the use furniture, rugs, icons, tape, etc. to create physical boundaries in order to make the environment comprehensible and manageable. These boundaries help to define what type of activity will occur in this specific setting, as well as the rules and behavioral expectations for each setting.

This picture defines a work area for academic, leisure, fine motor or other tabletop tasks. The table is surrounded by a table behind it and shelf to the left to help define the proximity where the child should stay during the work time.

2) Schedules – Visual schedules are a visual representation of planned activities in the order in which they will occur using symbols, words, pictures, photographs, icons, or actual objects. The schedule can be kept in a defined area of your home, or it can be mobile so the child carries it throughout the day.

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The child’s schedule can be for one day, or a part of a day, depending on what works most efficiently for your child. The schedule can be displayed in pictures, words (or both), or 3-D objects depending on the child’s ability to understand communication.

3) Routines- Routines, when combined with visual schedules, assist individuals in understanding the environment and in becoming more flexible. Because predictable routines serve as another form of structure, children with ASD can show decreased anxiety within a routine situation. With a lower anxiety level, students often display increased attention to task. Children can display increased independence once they practice and learn a routine. Once the child learns the basic routine, the parent can then make gradual changes to specific content.

4) Work Systems – Work systems are visually structured sequences that provide opportunities to practice previously taught skills, concepts or activities (Schopler, 1005). These can be activities that support academics, leisure activities, functional skills, and development of motor skills.

5) Task Organization – Visually structured tasks are highly organized and incorporate visual instructions. Visually structured activities clearly indicate the activity the individual should complete, the steps for completing the task, and the

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important or essential features of the task. Independent tasks are chosen based on emerging skills or independent skills, depending on whether or not you will be providing support for your child when working, or want him to work independently. The task is developed so that the user knows what to do by looking at the materials and task design. There may be a product sample, written instructions, photos, or a cut-out sample. Limiting the work area into a specific box or tray, helps the student to know where to focus his attention. Materials that can cause distractibility if used incorrectly should be secured. Specific areas of importance should be labeled, bolded, or color-coded.

These tasks are examples of structure leisure / play skills by defining steps to build a Lego structure, and work on cutting skills.

2.PROVIDE SCHEDULED SENSORY BREAKS Provide a choice of movement activities every 60-90 minutes throughout the day to assist your child with regulation of his attention and emotions. The movement breaks should be appropriate to the environment that your child is in, and should be pleasurable. Longer movement breaks, such as playing outside, riding a bike, taking a walk (within a safe environment) can also be very helpful to assisting your child with emotional regulation. It is helpful to provide a choice board for your child with pictures or words, so that he/she can choose a preferred movement activity when he/she sees “Movement or Sensory Break” on his/her schedule. It is helpful to keep the movement activities preferred and to change the choice of activities every few days. Use of visual structure, modeling, and partnering with your child when doing these movement activities can assist with engagement. Sensory/movement activities should be defined on your child’s schedule with words or a picture. Some suggested sensory break activities are: 1) Running 2) Sit-ups or push-ups 3) Jumping jacks 4) Bear crawls or crab walks 5) Jumping rope 6) Stacking books from the floor to a bookshelf 7) Hula Hoops 8) Dribbling a ball or playing catch 9) Engaging in chores that require movement 10) Brain Gym (information available on braingym.org, additional resources are Brain Gym Teacher’s Edition Brain Gym: Simple Activities For Whole Brain Learning by Paul and Gail Dennison) 11) Just Right Road (See additional handout titled: What is the Just Right Road?

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3.ENGAGE IN STRATEGIES TO FACILITATE A GOOD NIGHT’S SLEEP

Why Does Sleep Matter? Sleep is critical for the health of every child, and for the health of the parents as they raise their children. Sleep is vital whether you’re 8 or 80. It's a time for the body to recover and rebuild, and for the brain to process new information. But for children, it's extra important. Their growing brains have a harder time dealing with the effects of sleep loss, says Judith Owens, MD, director of the Center for Pediatric Sleep Disorders at Boston Children's Hospital. Establish A Bedtime Routine: Establish a bedtime and put it on your child’s visual schedule. It is very helpful to write out or use a picture schedule during the evening hours to define the order of events leading up to bedtime. Make your child aware of the schedule and adhere to it during the evening hours. As you progress through your child’s bedtime routine, remember to implement bedtime preparation activities (brushing teeth, reading, etc. in a quiet environment without sibling rivalry and sensory stimuli that can add to accelerated behavior and anxiety. Bedtime Snack: Prior to your child brushing his/her teeth, provide a light bedtime snack of warm milk and turkey (if your child is not allergic to these foods). The milk and meat contain an amino (ah-ME-no) acid — those are the building blocks of proteins — called tryptophan (TRIP-toe-fan). ... High melatonin levels tell your brain it's time to go to sleep. Avoid adding any foods to this snack that have sugar or caffeine. Make sure you give this to your child “warm”, as cold oral input can be alerting. Limit Screen Time Before Bed: At night, the brain naturally produces hormones that help kids (and adults) sleep. But the glow from electronic screens can confuse the brain and stop that process. Keep devices like TVs and video games out of your child’s bedroom, and get them to turn off smartphones, tablets, and other screens about an hour before bed. Make Sure Your Child Has Enough Activity During The Day: It is important for your child to have opportunities to engage in physical activity providing linear movement and proprioceptive / heavy work (resistance to muscles) for at least 60 minutes or more throughout the day. If your child is more sedentary throughout the day, he/she may be less likely to fall asleep. Make sure that physical activity occurs well before bedtime, and your child has lots of time to calm down and engage in quiet play in the hours that precede bedtime. According to Dr. V. Mark Durand, Ph.D., a child’s body temperature rises with vigorous exercise, which can increase one’s arousal level. A child’s natural drop in body temperature in the evening hours seems to be related to our becoming drowsy. According to Dr. Durand, “raising a child’s body temperature (through vigorous play) approximately 4 to 6 hours before bedtime will cause a kind of temperature catch- up whereby the body compensates by lowering its temperature 4 to 6 hours later”. Sleep is more likely to occur when one’s body temperature drops. When You See Signs That Your Child Is Starting To Slow Down, Encourage A Decrease In Activity: Allow your child to begin to know what it feels like to be sleepy. Put language to his/her feelings of being sleepy. If you wait beyond your child’s “sleepy” time, they may get a second wind and very possibly could have difficulty with emotional regulation. Listen To Quiet Music: Quiet music with a slow rhythm and no lyrics can be very calming during the evening hours. However, it is usually not recommended to listen to

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the music with earphones (direct input into the ear), as music provided directly into the ear can be over stimulating and alerting. Keep Your Household As Orderly And Quiet As Possible During The Evening Hours: Children can be very aware of your feelings and the behavior that you model. Your child will be assisted with his/her sensory/emotional regulation if you keep the environment, quiet, free of clutter, predictable, and without surprise events in the evening (as much as possible within our human limitations!) Dim Lights: Use lights as a visual cue to signal, “sleep time”. If your child is afraid of the dark, then still dim the lights and provide a small night light in a nearby hallway. Talk about dimming the lights in your child’s social story, to help him expect this change. Provide A Room To Sleep In That Is Free Of Clutter And Toys: Children often want to respond to what they see. Sometimes just seeing toys increases a child’s arousal level, and facilitates heightened excitability. It is recommended that toys be put in cupboards / toy boxes and out of site at night. It is sometimes very helpful for children to use their bedroom only for dressing and sleeping, and not for playing. You might want to consider setting up your child’s play area in a separate room than your child’s bedroom. Avoid Playing In Your Child’s Bed: According to Dr. Mark Durand, Ph.D., both positive and negative thoughts associated with a bed, can cause sleep problems. For example, if a child just experienced a fun and exhilarating time while wrestling with dad in bed before bedtime, it may be hard for him to now associate his bed with relaxation. Try to limit your child’s activities surrounding the bed to sleeping (stimulus control). Read A Social Story To Your Child (or have your older child compose and read a social/sleep story to himself) About Going To Bed: Read a story about bedtime to your child, as a part or your child’s bedtime routine. Include in the story a simple explanation about why our bodies need to sleep. Individualize your child’s social story to include specific information about things that disrupt his/her sleep, and what they can do in the middle of the night if they have difficulty sleeping or wake up with fear or anxiety. Use pictures and words in the story. If needed (to increase understanding and engagement), use actual photographs of your child in the story. Use A Weighted Blanket Or Heavy Pillows: Increased weight can often provide calming input (deep pressure touch) to a child to help them get to sleep, as well as stay asleep for longer periods. Extra weight (as tolerated) can provide calming input, by lowering the arousal level and allowing for a deeper sleep. This can be accomplished through use of a weighted blanket. Weighted blankets should be used only with therapist recommendation, and should be closely supervised. Do not use a weighed blanket or pillow with a child who is unable to independently move or alter his position or remove the blanket. Provide Deep Pressure Touch Through A Massage: Deep pressure touch can have a calming effect by lowering the arousal level. Putting a massage into the bedtime routine can help to calm your child. When providing deep pressure touch at bedtime, make sure you are not adding other forms of arousing stimuli with the deep pressure touch. For example, playing wrestling and tackling can provide deep pressure touch, but the anticipation qualities, and movement stimuli can serve to arouse the child rather than calm him. Avoid Sleepwear With Aversive Tactile Stimuli: Be aware of your child’s touch sensitivity when choosing sleepwear. Pajamas with an attached foot area often have plastic bottoms or seams that bother a touch sensitive child. Check seams for plastic thread that can feel rough. Choose pajamas with loose waistbands, and no exposed elastic. Also consider the touch of the sheets. Many touch sensitive children prefer silk sheets, but they can also cause a child to slip out of bed. Sheets with 240 threads per inch

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often create a smoother bed sheet. Flannel sheets can be vulnerable to form small bumps and can catch on pajamas. Sleep Apnea: If your child has sleep apnea due to inflammation in the sinus or throat, see a pediatrician to assist you in this area. Sleep apnea can be a major disruptive factor to sleep. Combine Sensory Strategies With Behavior Strategies For More Significant Bedtime Concerns: Consult your child’s psychologist or pediatrician if your child does not respond to simple sensory strategies to assist with sleeping. If your child’s sleep disturbances have developed into habitual behaviors, behavioral support with positive reinforcement can be very helpful in decreasing negative and disruptive behaviors related to sleep disturbance. Behavioral support should be very visually structured and consistent. Behavioral support should also be individualized and set up by a professional who is knowledgeable about behavior and sensory processing. Behavioral support should be delivered with compassion.

4.PROVIDE VISUALLY STRUCTURED ACTIVITIES FOR YOUR CHILD TO ENGAGE IN AT HOME As defined in #5 in the initial section of this consult, PROVIDE VISUAL STRUCTURE, visual structure to define the steps, and materials to use when completing a task can significantly improve sustained engagement and participation of an activity. Visual structure can be incorporated into crafts, academic tasks, chores, functional activities (such as grooming, bathing, cooking, following a recipe), sports, and playing games. Below are pictures of visually structured tasks to give you an idea.

Structure a puzzle Structure how Structure Lego building to don shorts

Structure a walk Structure a chore such as sweeping

5.LIMIT ENGAGEMENT WITH VIDEO GAMES AND MOVIES Research shows that too much screen time can impair brain structure and function; it can cause obesity, insomnia, mood swings, and problems at school. Because children’s brains undergo so much change during their formative years, this excess screen time can be even more damaging. Academic success and social skills can all be negatively affected by excessive screen time. Because of this, it is important to monitor your children on their devices every day. Set limits on duration and frequency of screen time,

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as well as the content of movies and video games that they interact with. Use your child’s daily schedule to define when and how long your child can engage in screen time. Provide a choice board for your child to be able to choose how he/she wants to use their screen time.

6.SCHEDULE TIME FOR YOU AS A PARENT TO TAKE BREAKS/EXERCISE AND STAY EMOTIONALLY REGULATED When you are setting up your child’s schedule, as much as possible, make sure to schedule in time for you to take breaks to keep yourself healthy and emotionally regulated. Research supports that exercise releases chemicals like endorphins and serotonin that improve your mood. It can help to reduce any feelings of loneliness and isolation, and put you in touch with other people (within social distancing guidelines). If you exercise regularly, it can reduce your stress and increase your mental health. It can also improve your sleep, which is important for many different reasons. Exercise pumps blood to the brain, which can help you to think more clearly. It also increases the size of the hippocampus and increases the connections between nerve cells in the brain, which can improve your memory. In whatever way is possible, it is recommended you take exercise breaks or schedule time to assist yourself with emotional regulation.

I hope this consultation is helpful to you. Please don’t hesitate to reach out to me with questions or concerns, or if you need input on how to individualize these recommendations for your child. Remember that these are “recommendations” to assist you during this challenging time, and it is important that you do not get overwhelmed by trying to put “the perfect program” together for your child at home. Implementing any part of these recommendations can be a very positive step forward towards assisting you and your family with staying emotionally regulated and increasing functional independence.

Below are recommended social stories available online.

Time to Come In Bear: A Children’s Story About Social Distancing, https://www.youtube.com/watch?v=DA_SsZFYw0w

My Telehealth Social Story https://www.flipsnack.com/childsplaytherapy/telehealth-social-story.html

What Is The Coronavirus https://littlepuddins.ie/wp-content/uploads/2020/03/The-Corona-Virus-Free-Printable- Updated-2-The-Autism-Educator-.pdf

Jan Dalby, OTR/L Occupational Therapist / Certified TEACCH Practitioner K.I.D.S. Therapy Associates, Inc. [email protected] (858) 208-8228

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References: Sleep Better by V. Mark Durand, October 2005, Paul H. Brookes Publishing Company, Healthy Sleep Habits Healthy Child by Marc Weissbluth, Cora Breuner-American Academy of Pediatrics The Impact of Too Much Screen Time, May Recreation Content Team, American Academy of Pediatrics, Victoria L Dunckley, M.D., July 2019 Exercise and Mental Health, Healthdirect, November 2019 Hume, K., & Odom, S. (2007). Effects of an individual work system on the independent functioning of student with autism. Journal of Autism and Developmental Disorders, 37, 1166-1180. Iovannone, R., Dunlap, G., Huber, H., & Kincaid, D. (2003). Effective educational practices for students identified as having autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18(3), 150-165. Mesibov, G., Shea, V., & Schopler, E. (2005). The TEACCH approach to autism spectrum disorders. New York: Kluwer Academic/Plenum Publishers. Schopler, E., & Mesibov, G. (1995). Introduction to learning and cognition in autism. In E. M. Schopler, G.(Ed.), Learning and cognition in autism (pp. 3-12). New York: Plenum Press. Schopler, E., Mesibov, G., & Hearsey, K. (1995). Structured teaching in the TEACCH system. In E. Schopler & G. Mesibov (Eds.), Learning and cognition in Autism (pp. 243- 268). New York: Plenum Press. Swanson, T. (2005). Provide structure for children with learning and behavioral problems. Intervention in School and Clinic, 40, 182-187. Tien, K. C., & Lee, H. J. (2007). Structure/modifications. In S. Henry & B. S. Myles (Eds.), The comprehensive autism planning system (CAPS) for individuals with Asperger syndrome, autism, and related disabilities: Integrating best practice throughout the student's day (pp. 23-44). Shawnee Mission, KS: Autism Asperger Publishing Company.

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