CCE Understanding Sensory Processing for Children with...

1

Puzzling Pieces: Understanding Sensory Processing for Children with Autism Spectrum Disorder

Jenny Clark, OTR/L, BCPAOTA Board Certification in Pediatrics

www.SPDconnection.com

Learning Objectives

1. Examine sensory processing disorder characteristics and discuss practical sensory interventions that can be implemented into daily routines

2. Outline the neurological differences in the brains of children with ASD and how this impacts functional daily living skills

3. Recognize the importance of engagement for children with ASD and the role of the rehab therapist with facilitating engagement

What is Sensory Processing Disorder?

• Definition: SPD is a neurological condition that interferes with the daily lives of approximately 1 in 20 children (Ahn, Miller, Milberger, & McIntosh, 2004)

• Sensory information confusing, upsetting, not meaningful.• Poor organization of sensory input for adaptive responses.• Misinterprets sensation from touch, sounds, sights, scents,

movement, from the environment and from the body.• Interferes with participation in daily activities.

2

Proposed Diagnostic Taxonomy Miller et. Al. (2007) Concept evolution in sensory integration: A proposed nosology for diagnosis AJOT, 61, 135-140.

• Sensory Modulation Disorder • 1. Overresponsivity (sensory defensiveness)• 2. Underresponsivity • 3. Sensory Seeking

• Sensory-Based Motor Disorder• 1. Dyspraxia• 2. Postural Disorder

• Sensory Discrimination Disorder• Visual, auditory, tactile, proprioception, taste/smell

Sensory Modulation Disorder (SMD)

• Define Sensory Modulation: “The ability to regulate and organize reactions to sensory input in a graded and adaptive manner”. (Bundy et. Al. 2002 Sensory Integration Theory and Practice 2nd edition)

• Balance between Inhibition vs. Facilitation

• Effects attention & behavior

Sensory Modulation Disorder (SMD)

• Difficulty regulating/adjusting responses to sensory input to match the situation

• Difficulty achieving and maintaining optimal range of performance in daily life

• Must be severe enough to disrupt ability to adapt to challenges

• Resource: Miller, L.J., Schoen, S.A.

• SPD Foundation• www.spdfoundation.net

3

Sensory Overresponsivity (SOR)

• Sensory Overresponsivity = over-notice sensory input• Responds to sensation faster, more intensely, longer

duration.• Aggressive or impulsive when overwhelmed by sensory

stimuli• Difficulty in new environments & transitions• Unsociable; avoids group activities, difficulty with

relationships• Excessively cautious, afraid to try new things• Sensory Defensiveness:Sensory overload causes a “Figh

Flight, or Freeze” reaction. • Autonomic Nervous System (sweat glands, heart rate,

digestion, blood vessels, release adrenaline & cortisol)

Sensory Overresponsivity (SOR)

• Examples: • Covers ears to

moderate and loud sounds

• Withdraws from unexpected touch

• Behavior rigid & controlling

• Bothered by having hair/fingernails cut

• Does not like to be high up off the ground

Sensory Underresponsivity(SUR)

• Sensory underresponsivity = poor registration • Decreased awareness, orientation & response to sensory

input • Requires intense sensory input to notice• Appear sedentary, lethargic, apathetic• Mislabeled “lazy” or “unmotivated”• Passive, quiet, withdrawn• Difficult to engage in conversation/social interaction• Takes longer to respond to directions

4

Sensory Underresponsivity(SUR)

• Examples: • Doesn’t cry when seriously

hurt• Doesn’t seem to noticed

when touched• Prefers sedentary

activities• May have toilet accidents

Research

• Children with ASD fall into both SOR and SUR in multiple sensory systems.

• Tomcheck, Dunn (2007) Sensory processing in children with and without autism: A comparative study using the short sensory profile AJOT, 57.

Sensory Seeking/Craving

• Sensory Seeking = Prefer intense & extreme sensory input. Needs much more stimuli than most

• Constantly moving, careless, restless, unsafe• Impulsive, intense, highly energetic• High pain tolerance• Viewed as “Dare Devils” • Displays attention-seeking behavior• Explosive, aggressive• Constantly wants control over every situation• Does not wait turn, interrupts constantly• Excessively affectionate physically• May be discharged from schools if behavior is intense enough• SS disrupts attention profoundly – compromises learning and

completion of daily tasks

5

Sensory Seeking/Craving• Examples: • Makes vocal sounds to

stimulate auditory system• Plays roughly with toys• Prefers spicy food• Spins or rocks self• Fidgets with objects• “On the go”• Constantly touches and/or

intrudes on people• Likes rough-housing• Trouble turn-taking in

conversation

Sensory-Based Motor Disorder: Dyspraxia

• Praxis=(Motor Planning) Conscious attention to task while relying on stored sensory info from sensory systems. Goal directed response, sequencing unfamiliar actions related to dailyoccupations.

• Dyspraxia=Difficulty executing unfamiliar motor actions affecting oral, fine gross motor

• Poor body awareness in space• Destructive in play, tends to break toys• Difficulty with motor tasks using more than 1 step• Clumsy, awkward, accident prone• Prefers “talking” to “doing”• Need excessive repetition to learn a new motor skill

Sensory-Based Motor Disorder: Dyspraxia

• Examples: • Bumps into people or

objects• Poor articulation• Delayed motor milestones• Slow to roll over, sit up,

crawl, walk and/or run• Extremely messy when

eating• Frustrated when unable to

complete tasks due to poor motor skills

6

Sensory-Based Motor Disorder: Postural Disorder

• Define: “Difficulty stabilizing the body during movement or at rest to meet the demands of the environment or of a given motor task.” (Miller et. Al. 2007)

• Difficulty with movements against gravity• Appears weak and limp• Gives up when challenged physically• Difficulty with endurance

Sensory-Based Motor Disorder: Postural Disorder

• Examples: • Difficulty holding prone

position• Difficulty sitting upright• Frequent falling• Gets tired very easily• Difficulty ‘waking up’• Performs motor tasks very

slowly

Sensory Discrimination Disorder

• Define: Difficulty perceiving details of sensation for differences or similarities

• Highest level of a sensory-based problem• Difficulty making sensory information

meaningful so responses are appropriate• Can occur in one or more sensory system• Requires additional time to process

information • Impacts learning, self-esteem, behavior

7

Sensory Discrimination Disorder: Examples

• Visual: Difficulty recognizing an object if part of it is covered

• Auditory: Difficulty hearing when there is background noise

• Tactile: Difficulty telling the difference between temperatures

• Taste: Unable to tell what is being eaten without looking

• Smell: Difficulty recognizing foods and beverages by smell

• Proprioception: Difficulty judging amount of force required for a task

• Difficulty knowing body position when eyes are closed

© 2010

Mission of SPD Foundation

SPD Foundation enhances the quality of life for children with SPD and their families by:– Conducting rigorous research into the

causes, diagnosis and treatment of SPD– Educating individuals with SPD, their

families, healthcare providers, policymakers, and the public about a broad range of SPD-related issues

– Advocating for the recognition of SPD as a diagnosis, and for early identification of SPD so that effective treatment can be initiated

www.SPDFoundation.net

SPD Foundation ResearchLucy Jane Miller, PhD, OTRExecutive Director, SPD Foundation

• Multisensory integration in typically developing childrenCompletion of the first study of multisensory integration in children, representing an important and fundamental step toward the goal of understanding multisensory integration in children with Sensory Processing Disorder.

• Multisensory integration in children with SPD compared to typically developing childrenResearch related to determining whether the different subtypes of children with SPD show evidence of atypical multisensory integration at the cortical level is ongoing. To date, SPDF researchers have collected data on 18 children with the Sensory Over-Responsivity (SOR) subtype of SPD, and 3 children with the Sensory Under-Responsivity (SUR) subtype. Preliminary inspection of the data suggests that unisensory processing (auditory, tactile) as well as multisensory (audio-tactile) integration is atypical in children with SOR. SPDF Researchers are currently increasing the sample size and analyzing the statistical differences between children with SPD and those who are typically developing.

8

SPD Foundation ResearchLucy Jane Miller, PhD, OTRExecutive Director, SPD Foundation

• Treatment effectivenessTwo studies on treatment effectiveness using OT with a sensory integration framework have been completed. Their findings were published in the March-April 2007 issue of the American Occupational Therapy Journal. Planned is a new treatment effectiveness study measuring multisensory integration and electrodermal activity before and after treatment. The purpose will be to obtain behavioral data and determine if any variables in these measures will be useful outcome measures of treatment effectiveness. To date SPDF has pre- and post-case study data on 10 subjects.

• Gold standard for diagnosis of SPDWork on the Sensory Processing Disorder Scale (e.g., measuring Sensory Over- and Under-Responsivity and Sensory Seeking/Craving) continues. These scales are performance measures administered directly to the child (not parent-report measures as are currently used). A manuscript has been accepted for publication by the American Journal of Occupational Therapy with research from two separate samples on the SPD scale (Sensory Over-Responsive subtest (n > 200). The Sensory Under-Responsive and Sensory Seeking/Craving subscales are under construction. Having a performance measure for SOR, SUR, and SS is critical for collecting a homogeneous sample in research, for clinical precision in identifying children who need services, and for designing appropriate treatment services.

• For more information on the SPD Foundation please go to www.spdfoundation.net

ASD Definition

• “ASD’s are developmental disabilities that are defined by considerable impairments in social interaction and communication and the presence of unusual behaviors and interests. ASD’s include autism, PDD, and Asperger syndrome.” (Center for Disease Control Press Release)

Prevalence: Center for Disease Control

• 1 in 88 U.S. 8 yr.-old children have ASD

• Ratio 5 times more common in boys than girls

• 23% increase since 2009• Largest increase among

Hispanics (110%) & African American (91%)

• Most children not diagnosed until after age 4, but more are being dx by age 3

9

Early Indicators of ASD• Physical risk markers of ASD; accelerated head

growth in first 3 years of life, thinner bone structure, low birth weight (<5.5 lbs.), low muscle tone.

• Motor and sensory characteristics in toddlers later diagnosed with autism were good predictors of the diagnosis along with social skills. (Baranek, 1999)

• Children later diagnosed with ASD often mouth things excessively, react aversively to touch, demonstrate atypical eye contact, don’t imitate similarly as typical children.

• Behavioral indicators; lack of joint attention, lack of pretend play, not responding to their name.

• www.FirstSigns.org

Red Flags of ASD in the 2nd Year of LifeAmy Wetherby, PhD, CCC-SLP, and Julian WoodsFlorida State University

• Lack of coordination of non-verbal communication

• Lack of sharing interest of enjoyment

• Repetitive movements with objects

• Lack of appropriate gaze

• Lack of response to name

• Lack of communicative vocalizations with consonants

• Lack of warm, joyful expressions

• Unusual prosody (Rhythm, intonation, stress on words. Speech sounds chopped, monotone, robotic, sing-song)

• Repetitive movements or posturing of body

• Lack of pointing• Lack of playing with a

variety of toys• Lack of response to

contextual cues

Possible Causes of ASD

• Genetics– Inherited: Several genes coming together– Twins 90%-95% of cases

• Biological– Increased risk higher for first born to older

mothers (>35) & fathers (>40)

• Environment (Risk Factors)– Toxins: Food, water, cleaners

• Atypical Brain Development

10

Anatomy of an Autistic BrainTime Magazine May 15, 2006 “Inside the Autistic Mind”

• Frontal Lobes – Higher reasoning: Enlarged

• Corpus Callosum – Links left/right hemispheres: Undersized

• Amygdala – Plays role in emotion & social behavior: Enlarged

• Hippocampus – Memory: 10% larger• Cerebellum - Coordination: Overloaded

white matter• Too many local connections

Mirror Neurons in the Mind Scientific American Journal November 2006

Mirror neurons provide a direct internal experience, and therefore understanding, of another person’s act, intention or emotion.They may underlie the ability to imitate another’s actions, and thereby learn.

11

Mirror Neurons & AutismScientific American Journal November 2006

• Studies of people with autism show lack of mirror neuron activity in several regions of the brain.

• Mirror neurons are involved with social interaction; dysfunction could explain symptoms of autism including isolation and absence of empathy.

• A complementary hypothesis, the salience landscape theory, may account for secondary symptoms of autism including hypersensitivity.

Autism Spectrum Disorder• 50%-90% of children with ASD have

problems with motor coordination…• Balance, bilateral coordination, motor

planning, body scheme, and fine motor skills.

• Affects activities: Handwriting, shoe tying, cutting, riding a bicycle, jumping rope, skipping, playing ball, and extracurricular sports.

Autism Spectrum Disorder• 40% of children with

ASD have sensory sensitivity to touch, sound, taste, light, and smell…

• …and sensory Under-Responsiveness to vestibular, proprioceptive and tactile input.

• = Poor MODULATION, Regulation, and Processing.

12

Therapist Role with Autism

• Evaluate & determine developmentally appropriate skills

• Suggest accommodations/modifications• Integrate service delivery in natural

environments and routines for daily living activities

• Provide interventions: Developmental activities, self-care, sensory integration/processing

• Facilitate play activities for social interactions• Devise transition strategies • Collaborate with family & community• Assist with engagement in meaningful tasks the

increase quality of life

ASD & Engagement adapted from Tomcheck NATTAP conference 2007

• Engagement is…Performance in occupations or activities as the result of:– Self-choice– Motivation– Meaning– Purposeful

• Four Elements of Engagement– 1. The ability to choose– 2. Intrinsic motivation to engage– 3. The individual’s experience of meaning– 4. Performance skills and patterns


• Sensory Processing and Engagement– Effective SP is critical for receiving,

interpreting, and utilizing sensory information for functional performance.

– Effective SP provides a foundation for adaptive behavior.

– Initiation and maintenance of engagement involves organization, regulation, motivation and skill.

13


• Research findings indicate children with ASD have sensory modulation disorder (Tomcheck & Dunn 2007)

• Poor sensory modulation is theorized to impair a child with autism’s ability to sustain active engagement with people or activities.

• Active engagement is identified as the “key component to all intervention programs for children with ASD” (National Research Council 2001)


• Educating Students with Autism– Sustained attention to an activity or person – Ability to attend and respond to the

environment– Sensorimotor Intervention:– Modulation and controlling arousal– Direct and share control during treatment– Provide concrete meaningful materials– Graded introduction of tasks– Support for combination of sensory & behavioral interventions

• With a better understanding of engagement we can better support participation!

Therapist Role with Autism• Intervention helps children improve

FUNCTIONAL ENGAGEMENT and PARTICIPATION in every day life.

• Intervention helps children with ASD physically, emotionally, and socially through sensory integration intervention, sensory diets, and environmental strategies…

14

Therapist Role with Autism• …which helps

children:• modulate their

nervous systems to “just right”

• improve motor coordination

• increase self-esteem through success

• acquire social skills, prevocational skills, academic skills and play skills.

Efficacy of OT-SI with Children with AutismAOTA Annual Conference St. Louis, MO 2007; AOTA Evidence-Based Practice Literature

Review of OT for Children with SPD/SID

• OT-SI was effective in improving play skills, social interaction, adult interaction, approach to motor tasks, and decreasing sensory sensitivities. No changes were found in peer interactions. (Baranak, 2002)

Research: Autism & AspergerAOTA Annual Conference St. Louis, MO 2007; AOTA Evidence-Based Practice Literature Review of OT for Children with SPD/SID

• Embedded figures and detecting objects in visual search task are strengths, but when attention is required visual search becomes deficient. (Jarrold, et. al. 2005)

• Rely on visual input to maintain balance –may suggest difficulty with vestibular and somatosensory or proprioceptive systems (Minshew, et al., 2004; Malloy et. al. 2003)

• A relationship b/w sensory hypersensitivity and anxiety; relationship b/w hpyosensitivity and depression ( Pfeiffer, et. al., 2005)

15

Touch therapy reduces symptoms in preschool children with autismField et al (1997) Brief report: Autistic children’s attentiveness and responsivity improve after touch therapy. Journal of Autism and Developmental

Disorders, 27, 333-338.

• Touch Therapy involved “moderate pressure and smooth stroking movement on each of the following areas: head/neck, arms, hands, torso, and legs/feet”. (p334)

• 22 children (12 boys & 10 girls) Age 4.5• 15 min. a day/2 days a week/4 weeks• Touch aversion & off task behavior significantly

decreased in both groups• Orientation to irrelevant sounds & stereotypic behaviors

decreased significantly more in therapy group• Touch therapy group significant improvement on

Autism Behavior Checklist sensory scale, relating scale, total scale, no significant changes with control group

• Touch therapy group significant changes on Early Social Communication Scale, no significant changes with control group

Sensory Processing and Classroom Emotional, Behavioral, and Educational Outcomes in Children With Autism Spectrum Disorder (Ashburner, J., Ziviani, J., & Rodger, S. (AJOT Sept./Oct. 2008)

• Method: 28 ASD children (average IQ), compared with 51 age and gender-matched peers

• Results: Short Sensory Profile scores for ASD children Underresponsive/Seeks Sensation & Auditory Filtering explained 47% variance in academic performance. Negative correlations were found b/w:

– Auditory filtering & inattention to cognitive tasks– Tactile hypersensitivity/hyperactivity and inattention– Movement sensitivity and oppositional behavior

• Conclusion: Children who have difficulty processing verbal instructions in noisy environments, and who often focus on sensory seeking behaviors appear more likely to underachieve academically.

Dyspraxia in autism: association with motor, social, and

communicative deficitsDziuk et. al. (2007) Developmental Medicine & Child Neurology

• 47 high fx children w/ASD • Control 47 typically developing children• Physical and Neurological Assessment of Subtle Signs –

test for motor skills• Praxis exam – gestures to command & imitation• Results

– ASD group significantly poorer praxis– Praxis performance strong predictor of autism (measured using

Autism Diagnostic Observation Schedule)– Dyspraxia in autism cannot be entirely accounted for by motor

skill impairments suggesting additional contributing factors– Praxis in children w/ASD correlates with social, communicative

and behavioral impairments that define the disorder…suggesting that dyspraxia may be a core feature of autism or a marker of the neurological abnormalities underlying the disorder

16

Motor PlanningStrategies

• 5 repetitions – Feed Forward

• Keep classroom arrangement consistent

• Break task into small steps and practice

• Use pictures to sequence students through task

• Give child checklist to i.d. task/schedule

• Let other children go first to model action

• Practice skill repeatedly

Animal-Assisted Therapy• Research – Occupational

Therapy Incorporating Animals for Children With Autism: A Pilot Investigation Sams et. al. AJOT 2006

• Results: Significantly greater use of language and social interaction in sessions incorporating animals.

• Single case study-5 yr old child w/ASD & dog named Henry

• Results: Child spoke his first sentence, began to make social interactions with therapists, became more aware of others needs Jennifer Barol graduate student New Mexico Highland University School of Social Work (2007)

• Tools for Pets Diana Henry www.ateachabout.com

Sensory Break

17

• Observation• Teacher/Parent interview• SPD Checklist www.SPDconnection.com• CDC Learn Signs, Act Early program – free

downloads of development checklists tools for parents to track their child’s development

• M-CHAT www.m-chat.org• CSBSDP Infant-Toddler checklisthttp://firstwords.fsu.edu/pdf/checklist.pdf• Occupational Therapy Evaluation

– Sensory Processing Measure (SPM)– Sensory Profile

Identifying SPD in ASD

Sensory Processing Measure (SPM)• SPM (research AJOT March/April 2007)• Standardized norm referenced (ages 5-12)• Easy to score, test/re-test comparison• Obtains info of child’s sensory functioning across

different environments • Home Form • Classroom, Art, Music, PE, Recess, Cafeteria, Bus• Allows comparison of performance between school

& home• Scores 7 areas: Social participation, vision,

hearing, touch, body awareness, Balance & Motion, Planning & Ideas, Total

Sensory Processing Measure (SPM)

• Norm-referenced• Published by WPS (2007)• Grades K-6• Research supports good

reliability and validity and discriminates children with & without sensory processing issues

18

SPM-P (Preschool)

• Published by WPS (2010)

• Ages 3-5• Home & School Form

Sensory Profile• Published by

PsychCorp (1999)• Caregiver

Questionnaire

• Short Sensory Profile• Used for research

• School Companion• Published by

PsychCorp (2006)

• 4 School Factors• Areas of sensory

processing: registration, seeking, sensitivity, avoiding

Sensory Profile School Companion

• Standardized 62-item questionnaire• Collaboration between therapists & teachers• Teaching alternatives, different ways to adjust

curriculum, alternatives for behavior management, data collection strategies

• Divided into 4 areas – School Factors• School Factor 1: Reflects student’s need for supports in

school environment • School Factor 2: Reflects student’s attention and awareness

in classroom• School Factor 3: Reflects student’s ability to tolerate sensory

input in school environment• School Factor 4: Reflects student’s availability to learn

19

Teacher Questionnaire Items• Environmental Sensations

– Auditory• Misses oral directions in class more than other

students– Visual

• Has trouble keeping materials an supplies organized for use during the day

• Body Sensations– Movement

• Rests head in hands on desk or table during class time and seatwork

– Touch• Plays or “fiddles” with objects or school supplies

• Classroom Behaviors– Behavior

• Has difficulty tolerating changes in routine

Sensory Profile School Companion • School Factor 1: Sensory seeking & poor sensory

registration - needs additional input for attention & engagement

• School Factor 2: Sensory seeking & sensory sensitive – modulation – needs help with focusing & staying on task

• School Factor 3: Sensitive & avoids sensation -sensory overload, uncooperative, difficulty listening to instruction & working independently

• School Factor 4: Poor registration & avoids – appear disinterested, miss important details

Intervention for ASD • ABA: Applied Behavioral Analysis;

produces positive gains IQ and academic, but smaller effect on behavior

• TEACCH Treatment & Education of Autistic & Related Communication

Handicapped Children; Enables children to generalize learning to other environments

• DIR: Developmental Individual-difference

Relationship; Floortime – enter the child’s world

• Social Stories (Gray); Visual cues to anticipate events

• Environmental modifications

• Structured developmental play

• Child centered• Positive behavioral

supports have moderate to strong effect on improving behavior

• ASD with SPD benefit from sensory-based interventions

• Sensory Diet

20

OT Direct Intervention for ASDAutism: A Comprehensive Occupational Therapy Approach Chapter 10 Sensory Integration Mailloux & Roley

• Use structured sensory environment with emphasis on proprioceptive, vestibular, and tactile input

• Increase intrinsic motivation, purposeful play• Delivery of intervention in context of play• “Artful Vigilance” from therapist• Child Centered Approach• Elicitation of adaptive responses• “Just-Right level of challenge”• Active vs. passive participation

Sensory Diet Patricia Wilbarger, PhD, OTR

• Sensory strategies & accommodations that a child engages in and uses throughout daily routines as “food” for the nervous system.

• Used intermittently to help a child maintain a “just right” alertness for focusing and emotional well-being.

Alerting Sensory Strategies

• Sit on Ball chair• Sit on Air-filled cushions (Movin’ Sit, Disc O’ Sit,

inflatable camping pillow (www.rei.com), tennis balls, beach ball “chair”

• Allow child to have movement breaks (exp. Office errand, stand at desk- Mayo Clinic studies)

• Incorporate movement activities in teacher lesson plans

• Listen to lively, fast-paced music

21

Alerting Sensory Strategies

• Smell Peppermint/Citrus scents

• Taste sour food/candy (lemon, pickle, WarHeads)

• Look at bright colors, light-up toys

• Use highlighter to draw attention to text

• Use hand fidgets (velcro inside desk, tangle, fidgetz, paperclips)

Modulating Sensory Strategies

• WEIGHTED VEST (www.OTvest.com)• Neoprene pressure vest• Weighted lap bag (fish tank rocks – washable)• Beanbag chair • Naturally occurring “Heavy work” • Therapy band/Bungee rope wrapped around chair legs• Weighted blanket• Lycra under clothes (Under Armour, Benik –

compression vest/shorts, Spio pressure garment)• Weighted wrist band for f.m. tasks

“Weigh” Cool Braceletwww.Abilitations.com

www.Integrationscatalog.com

22

Modulating Sensory Strategies

• Extracurricular activities: Swimming, Martial Arts,Yoga

• Playground - climbing monkey bars• Chew GUM• Suck thick liquids through a straw • Oral motor fidgets (Chewlery, toothpick, straw)• Chores - Cleaning wiping off table, carry

groceries & laundry basket, vacuum• Visual picture schedule Q-Charm• Smell cinnamon, coffee beans, cloves• Listen to classical music - Example: Mozart(60 beats per min.=heart organizing to NS)

www.QCHARM.com

www.spioworks.com

23

Calming Sensory Strategies

• Pet an animal• Deep Breathing• Slow rocking in a rocking chair• Keep to a routine as often as possible• Allow child to stand in front or back of line• Wear tag-less clothing, seem-less socks

Calming Sensory Strategies

• Provide quiet retreat area• Incorporate environmental sounds/white noise

machine• Decrease wall decorations in classroom (exp. Use

flip chart)• Adjust lights/Cozy shades (www.Abilitations.com)• Tools for the eyes; oil & water, lava lamp, fish tank• Smell Vanilla/Chamomile scents • Taste warm bland foods (mashed potatoes, baked

breads)

Strategies for Promoting Auditory Skills in ASD ChildrenCatherine Schneider, OTR

• Be aware of competing background noises

• Name & describe sensory components of objects

• Talk about same and different qualities of objects size, shape, form, smell, texture

• Describe steps you are doing in an activity as you are doing them

• Have child listen & i.d. (recorded) sounds

• Reinforce positional concepts

24

Auditory Strategies

• Headphones (www.coopersafety.com) PelterH7/earplugs• Simplify language, slower rate• Give one direction at a time• Pair directions with physical/visual prompts• Allow longer response time• Stand close to child when speaking• Seating preference away from doors/windows• www.route2greatness.com

Cafeteria

www.route2greatness.com

What is STICKIDS?

A software & activity kit that creates unlimited trackers, planners, activity cards and games

STICKIDS comes in 2 versions:

Home ‘n School VersionFor use by parents and teachers

Therapist VersionAllows for detailed customization related to therapeutic perspectives and individual children’s needs

25

8 Folders & Over 125 Activity / Pictures

MotionMost activities alert & organize

the mind & body

RetreatReduce sensory overload

(visual, auditory & physical)

Pressure ‘n TouchCalms & settles. A get ready or

regrouping strategy

Routines ‘n PlanningBuild in cognitive support strategies,

familiarity, predictability & prewarnings

Heavy WorkMotion & deep pressure for

alerting & calming

Tips Tools ‘n DoingStrategies for task or tool

modification; & activities of everyday “Doing it” events

Suck Chew ‘n BreatheOrganize & alert to help listen &

focus

Clinic TimePromote child participation in selecting,

planning & adapting therapy session activities

This image cannot currently be displayed.








Supplies Guidelines to Alert Regulation Levels

STICKIDS provides self regulation program with “STICKID critter meter”

Each activity has “effect icons” to give an indication as to what the activity will do for alertness and regulation


This image cannot currently be displayed. This image cannot currently be displayed. This image cannot currently be displayed. This image cannot currently be displayed.

Turtle Speed Bunny Speed Just Right Caution

www.Speedstacks.com1-877-GOT-CUPS

Sport Stacking with Speed Stacks

26

Activities of Daily Living for ASD: Sleeping Environmental Variables

• 1. Assess room temperature– Too hot/cold?

• 2. Tactile sensitivities– Bedding; cotton sheets & heavy blankets – Pajamas; fabric, elastic, socks, tight/loose

fit?• 3. Consider noises your child hears

– Running water, barking dog, – Use white noise

• 4. Visual Input– Does your child prefer dark or nightlight?

Activities of Daily Living for ASD: Sleeping Bedtime Routines

• 1. Stick with a set bedtime• 2. Provide a visual picture schedule of the

bedtime routine (4-6 steps)• 3. Implement selected sensory strategies that

are calming to your child• 4. Select relaxing activities prior to bedtime

– Looking at the same story book every night– Saying goodnight to favorite objects– Singing a favorite quiet song– Listening to calming music– Hugging and kissing family members

Activities of Daily Living for ASD: Bath time

• Use a foam visor to keep water out of eyes

• Draw with soap crayons• Keep to a routine; use a

visual pictures for bath time sequence

• Consider a shower instead of bath

27

Activities of Daily Living for ASD: Brushing Teeth

• Use a vibrating toothbrush• Try variety of toothpaste

flavors• Play games with ‘Crocodile

Dentist®’• Read a book about teeth,

such as Hooray for Teeth by Gena Shaw

• Sing a song “If you’re happy and you know it show your teeth” then smile in a mirror

• Ask for x-ray vest at dentist

Activities of Daily Living for ASD: Oral Motor/Feeding• Improving Speech and Eating Skills in Children

with Autism Spectrum Disorders (AAPC 2008) Maureen A. Flanagan, MA, CCC-SCP

• 1. Have child apply lotion to feet, legs, arms, etc.• 2. Have child provide tactile stimulation to lips• 3. Ask child “Get your chew tube”• 4. Instruct child to “put chew tube away and get

your Nuk Brush” (normalizes oral sensitivity & encourages tongue movement independent of jaw movement)– Push down on tongue 10-30 times (adult counts out

loud)– Brush both sides of the tongue, front 3rd top of mouth

• Provide an oral motor time as part of the child’s daily routine; Before or between meals

• Use variety of sensory items– Toothbrushes, Nuk– Vibrating massager– Flavored lip balm– Blowing bubbles– Chew tubes– Flavor sprays– Lollipop, gummy bears, jellybeans – Whistles

Activities of Daily Living for ASD: Oral Motor/Feeding

28

Activities of Daily Living for ASD: Oral Motor/Feeding

• Foods that improve jaw stability; 1. Crunchy foods carrots, pretzels, chips, apples 2. Chewy foods dried fruit, jerky, taffy, meat

• Foods that improve tongue & lip control 1. Sour/spicy foods lemons, pickles, salsa 2. Sucking thick liquids, frozen juice bars

• Avoid foods that combine 2 different textures, foods that stick to teeth (peanut butter), popcorn

Activities of Daily Living for ASD: Playing

• Research: Out of School Participation in Children With High-Functioning ASD Hilton,

Crouch, & Israel AJOT Sept./Oct. 2008

• Results: Significant differences in participation between typical and HFASD groups in number of activities, number of individual’s with whom they participate, and variety of environments

• Conclusion: Findings suggest social impairment impacts participation. Addressing social skills in intervention could increase participation.


• Participation in Sports for Children on the Autism Spectrum Stacey Reynolds, OT Practice 2006

• Benefits: cardiovascular, enhanced muscle tone, maintenance of healthy weight, stress release, sensory modulation, socialization, sense of belonging, developing new skill, accepting rules/consequences, honoring commitments, improved self-esteem for accomplishments.

• OT’s role: encourage community opportunities, support participation, consult with coaches/recreation program directors, suggest modifications and behavioral strategies, attend a game or practice to observe (alt. view video tape)

29

Activities of Daily Living for ASD: Playing• Participation in Sports for Children on the

Autism Spectrum Stacey Reynolds, OT Practice 2006

• Coaching strategies for ASD– Repeat directions, visual modeling– Give choices (exp. “Do you want to get in the game,

keep score, get water for players?)– Do not yell; instead wait until child is off field/court then

give new directions/pointers, speak slowly & clearly, always mention what was done well

– Pair ASD child with typical peer pal during practice drills– Review practice schedule prior to beginning, give

warnings with any change in routine– Ask parents to have their child practice putting safety

equipment on before the first day of practice (motor planning)

– Consider Under Armour® under uniform tactile sensitivity


• Choose sports that are simple & encourage more active participation: (Swimming, martial arts, bicycling, gymnastics)

• Organized sports: (baseball, soccer, football, basketball) sometimes too much standing around and too many rules to follow

• Provide roles in organized sports such as team manager

• ‘Just Right Fit’

It Takes a Whole Village to Raise a Child!• We need to work together!

• School staff• Administrators• Therapists• Families• Community members

30

www.AAPCpublishing.net

Program Philosophy

• Sensory Integration Model

• Theme & Literature-Based

• Transdisciplinary

• Inclusive Environments

CCE Understanding Sensory Processing for Children with...

Documents

Transcript of CCE Understanding Sensory Processing for Children with...