Sensory Processing Disorder - PBIS...
Transcript of Sensory Processing Disorder - PBIS...
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Addressing Misguided Behavior Through Sensory
StrategiesGerry Morgan, M.S.
Early Childhood PBIS Consultant
Sensory Processing Disorder
Sensory Processing Disorder
n Affects 5-10% of typically-developing children.
n Affects 40-80% of children with another diagnosed disability
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Acknowledgements
n Early Childhood CARES Sensory Groupn Lane County NMT Study Group n Dr. Bruce Perry
& the Child Trauma Academy
Training Objectives
n To understand how the brain processes sensory information
n To discuss how sensory elements impact behavior
n To provide an overview of sensory systems and strategies
Why are we doing this?
n Sensory systems impact a child�s world:n Developmentn Focus and Learningn Emotional Regulationn Behavior
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Reflection
Think-Pair-Share:n A sensory element that evokes discomfortn A sensory element that evokes comfort
The Neurosequential Model of Therapeutics (NMT):
a model of brain processing
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Brain Development
Cortex
Limbic
MidbrainCerebellum
Brainstem
Abstract thought
Concrete Thought
Affiliation
"Attachment"
Sexual Behavior
Emotional Reactivity
"Arousal"
Appetite/Satiety
Blood Pressure
Heart Rate
Body Temperature
Sleep
Motor Regulation
Bruce D. Perry, MD, Ph.D.© www.ChildTraumaAcademy.org
Brain Processing
n Our senses filter everything we process
n Our sensory experiences create templates which guide our experiences
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Cortex
Limbic
MidbrainCerebellum
Brainstem
Cognitive
Relational
SelfRegulation
SensoryIntegration
Bruce D. Perry, MD, Ph.D.©ChristineDobson,Ph.D.,LMSW©
Impacting the Brain
Patterned, Repetitive, Sensory-Motor Activities
n Stimulate the brainn Affect foundational systemsn Create change and new templates
Cognitive/Instructive
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Neocortex
Limbic
Diencephalon
Brainstem
Bruce D. Perry, MD, Ph.D.© www.ChildTraumaAcademy.org
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Music and Movement
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Neocortex
Limbic
Diencephalon
Brainstem
Bruce D. Perry, MD, Ph.D.© www.ChildTraumaAcademy.org
Therapeutic Massage
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Neocortex
Limbic
Diencephalon
Brainstem
Bruce D. Perry, MD, Ph.D.© www.ChildTraumaAcademy.org
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ChildTrauma Web Sitewww.ChildTrauma.org
Online Education and Training Materialswww.ChildTraumaAcademy.com
www.ChildTraumaAcademy.org
Integrating Sensory & Cognitive
Impact on Children�s Behavior
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Universal / Primary Prevention:
Program-/Classroom-Wide Systems for
All Children, Families,& Staff
Targeted / Secondary Prevention:
Specialized GroupSystems for Children with At-Risk Behavior
Intensive / Tertiary Prevention:Specialized
IndividualizedSystems for Children
with High-Risk Behavior
~80% of Students
~15%
~5%
PROGRAM-WIDE POSITIVE BEHAVIOR
SUPPORT
Pyramid Model
n Nurturing and Responsive Relationshipsn High Quality Supportive Environmentsn Social Emotional Teaching Strategiesn Intensive Individualized Interventions
Function of Behavior
n To obtainn To avoidn To express emotionn Response to sensory elements
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Cortex
Limbic
MidbrainCerebellum
Brainstem
Cognitive
Relational
SelfRegulation
SensoryIntegration
Bruce D. Perry, MD, Ph.D.©ChristineDobson,Ph.D.,LMSW©
Foundation for Learning
When the child�s sensory systems are in balance, the nervous system is in an optimal state for alertness, attention and learning.
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Over-aroused State
n Active to hyper (jumpy/over excited)n Tense, on edge in appearancen Loud, excited vocalizationsn Misguided physical behaviorsn Fidgety, difficulty keeping stilln Meltdowns
Hypersensitive Child
n Tactile Defensivenessn Difficulty with touch
n Auditory Defensiven Difficulty tolerating noisy environments,
unexpected sounds, loud noisesn Movement Sensitivities
n Uncomfortable with movement, feet off the ground, posture and balance
Under-aroused State
n Overly relaxed/sleepyn Fatigued appearancen Boredom/withdrawnn Quiet, overly calmn Difficult to engage
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Just Right State
n Alert, rested, ready to learnn Not too calm or excitedn Functional tone and speed of speechn Interacts effectively with othersn Body position conducive to activity
Sensory Processing
A Childs View of Sensory Processing: Overview
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Sensory Processing Disorder
n Affects 5-10% of typically-developing children.
n Affects 40-80% of children with another diagnosed disability
Sensory Strategies
Sensory Dietn We all require a certain amount of sensory input
and movement to function.n By providing a person with correct amount and type
of input, prepares to be alert, active and ready to learn.
n Sensory diet is individualized.n Specific to the environment, activity and one�s
temperament.n Part of a normal routine.n Includes scheduled activities with child including:
n Changes in environmentn Calming strategiesn Alerting strategies
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Vision
Vision
n Function - interprets what we see, alertingn Receptors - in the eyes, retinan Visual processing includes
n Motor control, eye movements, what we visually perceive.
n Vision is used forn Alerting & orienting, finding and tracking, scanning
the environment, sustained eye contact, shifting focus, eye hand coordination, depth perception, figure ground
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Sound
Auditory
n Function - interprets what we hearn Receptors in ears, middle/inner earn Auditory processing includes the
perception of and the ability to understand sound
n Audition is used for - Sound discrimination, localization, orientation, decoding, remembering what is heard
Intervention Strategies:Calming strategies for the Over-aroused Child
n Visual - Auditoryn Soft lights, dim lights, no lightsn Minimize cluttern Block distractionsn Play soft classical music or nature soundsn Sing and speak softly
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Sensory Diet
n +: list a sound or auditory element that evokes discomfort
n -: list a sound or auditory element that evokes comfort
Taste & Smell
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Taste & Smell
n Function of gustatory/olfactory systems is for taste & smell of environment
n Receptors in tongue and nosen Used for tastes of food, smell of
foods/environmentn Smell has a powerful effect on our emotions
and evokes powerful memories
Intervention Strategies:Calming strategies for the Over-aroused Child
n Oral Motor Strategiesn Chewingn Suckingn Blowingn Vibration
Smell: Lavender, vanilla, sweet smells
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Intervention Strategies: Alerting Activities for the Under-aroused Child
n Oral Motor Strategiesn Crunchy snacksn Salty, sour, smoky, tart, tangyn Cold- ice, popsicles, ice watern Blowing whistles, bubbles
Smell: Citrus, savory smell
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Tactile
n Function – Information gathering from objectsn Skin receptors, tactile receptors in mouthn Tactile is used for:
n Protective– �fight or flight�n pain, pressure, temperature
n Discriminative – info re: shape, size, texture n Light touch, 2 point discrimination, temperaturen Essential for coordinated manipulation
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Sensory Diet
n +: list a tactile sensory element that evokes discomfort
n -: list a tactile sensory element that evokes comfort
Proprioceptive
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Proprioception
n Function – Awareness of body and limb position in space
n Receptor – joints, ligaments & muscles/tendons
n Proprioception is used for determiningn Joint anglesn Muscle tension and amount of pressuren Rate of movement
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Intervention Strategies:Calming strategies for the Over-aroused Child
Touch Pressure n Hugsn Lap pad, pillow, weighted blanketn Cozy cube, box, break arean Warmthn Heavy/weighted clothingn Heavy/weight blanket, comforter, sleeping
bagn Rhythmic patting on child�s back/leg
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Sensory Diet
n +: list a proprioceptive sensory element that evokes discomfort
n -: list a proprioceptive sensory element that evokes comfort
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Vestibular
Vestibularn Function – awareness of body movement
through spacen Receptors- inner earn Vestibular is used for determining:
n Where head/body is in relation to earthn Whether body or other objects are moving or
standing stilln Helping to maintain a stable base of support
n Balancen Coordination of both sides of body
µ Input primes the entire nervous system
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Intervention Strategies:Calming strategies for the Over-aroused Child
n Movementn Slow, rhythmic swinging/rockingn �Heavy work�n Weight bearing activitiesn Movement opportunities throughout the day
Sensory Diet
n +: list a vestibular sensory element that evokes discomfort
n -: list a vestibular sensory element that evokes comfort
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Interaction Between Sensory Systems
n Vestibular, proprioceptive, visual & tactile inputs work together
n Interact to develop:n Body awarenessn Motor control and planningn Grading of movementn Postural stability/Balancen Emotional security
Yoga
n physical movementn holding posesn breathingn body awareness
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Intervention Strategies:Calming strategies for the Over-aroused Child
n Environmental Strategiesn Quiet area
n Large box with pillowsn Decreased clutter
n Be aware of the effects of screen time on behaviorn Visuals for communicationn Consistency and Structured Routines
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Messy Activities
n Coach parents about the importance of sensory activities n Send letter home explainingn Ask parents to dress children accordingly
n Set up the activity strategicallyn Reasonable expectations, explicitly taughtn Adequate supervision
n Set-up and clean-up as part of the activity
Plan for Sensory Opportunities
n Include sensory activities in the child�s educational plan
n Embed sensory elements in the everyday activities and routines
n Provide parents and other caregivers with a rationale for sensory strategies
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When Attitudes Interferen Sensory needs perceived as �misbehavior�
n Reframe the behavior as meeting a needn Teach the parent and the childn Try sensory strategies first, then re-assess
n Sensory strategies perceived as playn �Everyone�s working on something different�n Erika needs glasses to see. Trey needs a lap
pad to sit at the table
Increasing Engagement Through Choices
Visual Tools for Choices
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Help Me Get What I Need:
go for a walk turtle
stuffed animal sit on lap and be held
Increasing Engagement Through Choices
Visual Tools for Choices
Choice Wheels in MV• Provide children choices to get their needs met• Are tailored to meet the specific needs of each
child• Use pictures of each child doing the activity to
provide visual supports and make it personal to them
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Evaluation
n History – Developmental & Sensoryn Standardized tests based on parent and/or
teacher report (Sensory Profile)n Observation of child�s behavior/activity
Sensory History