Self Regulation Through

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Nov 14, 2013 (3 years and 7 months ago)

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Self Regulation Through
Sensory Experiences












Katie
Mangus

M OTR/L

Session

Objectives


Address Sensory Integration and Self Regulation


Sensory Processing Disorder



Provide you with tips to improve and deal with
everyday sensory and self
-
regulation issues



Adapt daily life activities and family routines to be
more effective in consideration of these difficulties






Sensory


Sensory
Integration
“Refers broadly to the
central nervous system processes by which
incoming sensory data are organized
within
each sensory system, as well as across
different sensory systems”
(Ayers, 1972, 2005
).



Sensory Integration is thus a key aspect of
S
ensory
P
rocessing,
defined as the complex
ways in which the nervous system imports
and organizes sensory information”
(Miller &
Lane, 2000)
.

We All Process Sensory Input!


Adults have certain sensory preferences


Habits to keep us focused


Help us sleep


Food preferences



Sensory Processing Disorder (SPD)


Can stand alone, but is common in:


ADHD


Autism Spectrum Disorders



Difference in brain neural
pathways


Makes every day life activities challenging



Rule
out any medical or psychological reasons for the
problem


Sensory Processing Disorder

(Yack,
Aquilla

& Sutton, 2002)


Hyper
-
sensitivity, hypo
-
sensitivity or mixed sensitivities to
sensory stimulation


Avoids or seeks sensory input


Unsure of body position and poor motor



planning


Difficulty learning new motor tasks


Easily distracted, limited attending skills


Over
-
aroused, high activity level, hyper vigilant


Under
-
aroused, low activity level, self
-
absorbed,
passive

The Body’s Senses


1.
Vision

2.
Taste

3.
Smell

4.
Touch

5.
Hearing

6.
Proprioception (body awareness)

7.
Vestibular (balance and motion)

Proprioceptive Processing


Body Awareness”



The body’s position in space


We know where are body parts are with out
looking!


Processed through joint receptors



Important part of coordinated movements
(ex: kicking a ball, holding a pencil)


Difficulty Manifests as: appearing clumsy, playing
too rough, always moving, etc.



Nose to fingertip activity

Vestibular Processing


Balance and Motion




Our body's ability to sense
speed and direction of
movement with respect to gravity


Detected through the inner ear




Difficulty manifests as:


Uncoordinated movements,


appears weak or clumsy,

fear of feet off the ground, rocks back and forth,
avoids movement, etc.


What does sensory
regulation do?


Organizes our body systems


Helps us learn by paying attention (brain can
focus if body is organized)


Interact with the environment


Act “appropriately” in social settings (frustration
tolerance and balance of emotional reactions)

Self
-
Regulation


“Self Regulation is the nervous system’s ability to
attain, maintain and change levels of arousal or
alertness”
(Williams and
Shellenberger
, 1994).



Arousal is our level of alertness


Maintaining a “just right” arousal level develops
from being able to modulate sensory input




Ex: Work day

Sensory Modulation Problems


Under
-

R
esponsiveness


not noticing or not using sensory information



1
-

Hypo Reactive:
Manifests as a lack of an expected
response, or indifference to a sensory experience



2
-

Sensory Seeker
:
Manifests as searching for more sensory
input






(
SPM; Parham
,
Ecker
, Miller
Kuhaneck
, Henry &
Glennon
,
2007)

Sensory Modulation Problems


Over
-
Responsiveness



being
overwhelmed or overstimulated by sensory
input



1
-
Hyper Reactive:

Manifests as impulsive, aggressive
behavior, negative affect and high arousal level.



2
-

Sensory avoider
:
Manifests
as
fearful, anxious, hyper
vigilant behavior
, or avoidance of
certain
sensory
experiences.







(
SPM
; Parham,
Ecker
, Miller
Kuhaneck
, Henry &
Glennon
, 2007
), (Williamson
, G. G.,
Anzalone
, M. E.
,
2001)



Sensory Input Through
O
ut the Day

Under
-

Responsive


Each sensory input is like a drop
of water into your cup



You want your cup to be full
and not spill over!

Over
-
Responsive

Sensory Input Through Out the Day

Under
-

Responsive


Each of your senses are
their own cup and they are
different sizes

Over
-
Responsive

Vision, Touch,
Hearing

Proprioception,
Vestibular


Self Regulation is the Goal


Process of recognizing and filling needs


Unable to truly self regulate until age
8



We can provide opportunities



and
ideas that are
acceptable



Different ways to teach it



(Alert program, social stories,



break books, etc.)



Zone of Optimal Arousal


Organized movement
-

not a free for all

http://
www.sensorimotorpsychotherapy.org/articles.html


Alert Program


Too High


Difficulty staying in seat, always touching
others, constantly running or bumping into
things, unable to focus on task



Just Right


Able to focus and work, happy in what they
are doing



Too Low


Head down, not paying attention, low tone,
lethargic

Tigger

Winnie
the
Pooh

Eyore


Engine Speeds


Too

High


90+ Mph



Just
Right


45
-
75 mph



Too l
ow


0
-
7 mph


Key Points


Sensory responses are not willful
-

they are automatic,
unconscious physiologic reactions to sensation



Self
-
generated stimulation is easier to handle vs.
unexpected



Sensory input has a cumulative effect! A sudden
response may occur because of an accumulation of
events through out the day



Too much sensory stimulation if unstructured may
increase state of arousal and increase disorganized
behavior

When and How to use Sensory
Strategies in the Classroom/Home

1.
Reinforcer

2.
Preparation

3.
Task Support

4.
Prevention

Ideas for Sensory Seekers


Vision


bright colors, bright lights and designs


Flashlights, spinning tops



Taste & Smell
(chemical senses)


Oral motor input (sucking on, blowing, chewing)


Frozen starbursts, gum, cold water, straw, tubing on end of
pencil


Bubbles, blow toys, blowing through a straw



chewlery



Alerting smells ( air fresheners, candles, lotions)



Hearing


Upbeat music









Ideas for Sensory Seekers


Touch


Fidgets


Velcro strips


Pencil grip


Vibration: wiggle toys, wiggle pens,
massagers


Paperclips, rubber band, watch, ring



Proprioceptive input


Heavy work (carrying things, pushing, pulling, jumping,
crawling
)


Slow and controlled movement



Deep pressure


Weighted object (vest, stuffed animal, lap pad, blanket)


Joint compressions


Hand massage



Ideas for Sensory Seekers


Vestibular


Swinging on swings and ropes


Spinning on Sit n’ Spins, work chairs


Move body around (running, playing)


Allow movement


Stand at desk


Work on the floor in prone on elbows position


Kick band around front legs of chair


Seat cushions


ball chair


Ideas for Sensory Avoiders


Vision


Soft and neutral colors, soft lights


Watch calming things like a lava lamp, or fish tank



Taste & Smell
(chemical senses)


Oral
motor input (sucking on, blowing, chewing
)


Chewy tubes


Comfort foods



Calming
smells


air fresheners,
candles,
lotions


Ideas for Sensory Avoiders


Hearing


Calming music


Soft tone of voice


Forewarn them of any loud noises (bells, alarms)


Reduce noise level


Provide white noise or ear
phones or noise reducing
headphones



Touch
-

tactile defensiveness


Warn them when you are going to touch them


W
ear gloves


Stand at the end of the line


Arrange classroom seating to decrease amount they are
bumped by others


Use tools during art activities so they don’t have to touch
the
materials.



Ideas for Sensory Avoiders


Proprioceptive input


Heavy work (carrying things, pushing, pulling,
jumping, crawling
)


Provide quiet safe place
(not a reward or punishment)


Deep
pressure


Weighted

objects (vest
, stuffed
animal,
lap
pad,
blanket)


Joint compressions


Hand massage





Ideas for Sensory Avoiders


Vestibular


Do preparatory activity (proprioceptive input) to
prepare body


Slowly introduce movement activities and provide
feeling of safety


Provide vestibular opportunities


(trampoline, dizzy disc,
physio

ball, swing
)



Movement


Rotary = Alerting


Linear = Calming


Linear vertical = organizing


Equipment Use


Introducing something new= let everyone try it


Those who need it will keep using it and those who
don’t will loose interest



DO NOT use
weighted equipment
for more than 20
minutes at a time
because the child will get use to it
and it will no longer be
effective!


Ex
: when you first put on a
tight watch
you notice it
and then
your body adjusts to it and you get use
to
it


Sensory Breaks


Transition times
-

Make them a part of the routine
!



Only need to be 1
-
3 minutes long



Slow and controlled =
O
rganizing



Incorporate movement into learning activities



Needs
to happen at regular intervals through out
day



Have
the whole
family/class
do it
!



Sensory Break Ideas


Animal Walks


Deep
Breathing


Chair Push ups


As If
(
perform
an action
“as if” they were feeling a
certain
emotion)


Heads, Shoulders,
Knees and Toes


March in place


Popcorn


Music


Hold up the
Walls


Quiet
Time


Silent Wave


Simon Says


Stretch


Yoga


Bounce on the ball




Break



Squishes (
massage or
joint compressions)



Read a book


Wall push ups


Sensory Diet


Individualized


Determined by sensory preferences


Can be sensory avoiding in some areas and sensory
seeking in others



Consult with an occupational therapist



If unsure of what to try:


Go
through senses and pick which one
you think it might be
and
then use an activity that
correlates


Use proprioceptive input!


It is a trial and error process!

Time

Daily Events

Activities/

Accommodations

Comments



Wake
-
Up


Massage

feet and back to help
wake up





Self
-
Care


Use

vibrating toothbrush






Breakfast


Eat

crunchy cereal





Go to school


Listen to calming music in the car
ride





School


Take sensory breaks





After School


Do ball

exercises





Dinner


Wear

weighted lap pad during
dinner





Self
-
Care


Joint compressions

and warm
shower





Bedtime


Sleep with white noise












Sensory Diet

Visual Strategies


Visual Schedule


A
ctual pictures, clip art or have somewhere to draw it
out (notebook, phone, tablet)



Include “sometimes the schedule changes”


Change in routine card. Emphasize that activities can
be changed or cancelled and share backup plans


Broad pictures to represent



Social Story book





Control Strategies


Offer choices between 2 acceptable things
(ideally visual
choices)



Prepare them for transitions!
“5 minutes, 1 minute, 10, 9, 8. . .”



Use a timer that goes off when time is up
(Time Timer or kitchen
timer)



Inform child when you plan to touch them or do something
to them (3, 2, 1, . . . )



Count
the number of times you are going to do something
so they understand when it will be
over



Promote independence
-

let them try to do it



Provide a predictable routine








General Strategies

Applicable to
A
ll Areas


Rule out any medical or psychological reasons
for the problem


Provide
deep pressure prior to activity
!


Use motivators


Sing the steps of the activities


Role play with dolls, toy animals or action figures


Offer favorite toy during difficult activity



Home Accommodations


Provide large, open area with unbreakable items
for roughhouse play


mattresses



pillows


beanbag chairs


outdoor swing set


Indoor swing




Offer a “safe place” such as a bean bag chair,
tent, pillow corner



Organized room with neutral colors on the walls


Case Example:


Max is a 4 year old boy who has high functioning
Autism and SPD



He has a very hard time staying in his seat and is
moving constantly. He crashes and bangs into
things and people. He chews
on everything.



Max hates to be touched and is highly sensitive to
auditory stimuli and startles to unexpected noises.



What are a few ideas of things that might help Max
to participate in school?

Pediatric Occupational Therapy


We provide
Individualized
occupational therapy services
for
the
child addressing specific
needs


Parent Education
-

Parent attends therapy session to learn
how to implement techniques at
home


Katie
Mangus

MOTR/L

C/O The Children’s Center

350 S. 400 E. Salt Lake City, UT 84111

801.946.1860

kathleenm@esgw.org



Play and Language for Autistic
Youngsters (P.L.A.Y.)


The P.L.A.Y. Project is a home
visiting model of
intervention based on DIR/
Floortime

principles
.


P.L.A.Y. Services


3 Hours of home instruction monthly including:


Instruction in the model


Practice in the principles during play with the parent and
child


Video
-
taping segments of the play for review


Formal video review with written report for the family










Early
Intervention
Federal
and State
program that falls under Part C of the IDEA law



Services
for children birth to 3 years old
(with
delays and or
disabilities) and
their families
.



Provided for severe
delays in
development and/or
have a qualifying medical
diagnosis.



W
ork
with the child’s primary caregiver(s)

in the
home to
develop individualized goals and
strategies.

Resources
-

Books:



Building Bridges Through Sensory Integration
by
Ellen, Y., Sutton, S., &
Aquilla
, P.



How does your Engine Run? A Leader’s Guide to
the Alert Program for Self
-
Regulation
by M.
Williams
ans

S.
Shellenberger
,
Therapy Works, 1994



Simple Strategies That Work! Helpful Hints for All
Educators of Students with Asperger Syndrome,
High
-
Functioning Autism and Related Disabilities

by
Brenda Myles, Diane
Adreon

and Dena
Gitlitz
.


Resources
-

Websites


Sensory Processing Disorder Foundation
-

Resources


www.spdfoundation.net



Pocket
Full of Therapy
-

Pediatric and school based
products



http://shoponline.pfot.com/




Fun and Function


Sensory toys and therapy equipment


http://funandfunction.com
/



Southpaw Enterprises
-

S
ensory
integration dysfunction
and
neurodevelopmental products

http://
www.southpawenterprises.com/Default.aspx



References

Ayres, A. J. (2005).
Sensory integration and the child, 25
th

anniversary edition.
Los

Angeles, CA: Western Psychological Services.


Ellen, Y., Sutton, S., &
Aquilla
, P. (2002).
Building Bridges Through Sensory Integration,

Arlington Texas: 2
nd

Edition.


Miller
, L.J., & Lane, S. J. (2000). Toward a consensus in terminology in sensory

integration
theory and
practice
: Part 1: Taxonomy of
neurophysiological

processes
.
Sensory Integration Special Interest
Section
Quarterly
,
23(1),1
-

4
.



Parhan
, L.D.,
Ecker
, C., Miller
Kuhaneck
, H., Henry
,
D.A.,
&
Glennon
,
T.J. (2007
).

Sensory
Processing
Measure (SPM): Manual.

Los Angeles: Western

Psychological
Services
.


Williams, M.S.,
Shellenberger
, S. How
D
oes Your
Enginge

Run?: A Leaders Guide to

the Alert Program

for Self Regulation.


Williamson, G. G.,
Anzalone
, M. E. (2001).
Sensory Integration and Self Regulation
in

Infants
and Toddlers
: Helping
Very Young Children Interact With
Their

Environment
: 1
st

Edition.