Sensory Processing Skills and Self-Regulation. Abigail McKenzie, MOT, OTR/L

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1 Sensory Processing Skills and Self-Regulation Abigail McKenzie, MOT, OTR/L

2 Objectives Brief overview of terminology Review and information on sensory systems Under Responsiveness vs. Over Responsiveness Sensory processing skills in relationship to self-regulation and function

3 Sensory Systems How many sensory systems do we have?

4 Sensory Systems All 8 of them 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 inner ear 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.

5 Sensory Systems are our foundation

6 Sensory Processing Sensory processing is a term that refers to the way our nervous system receives and interprets messages from our senses and turns them into appropriate motor and behavioral responses. ( About SPD, 2017 )

7 Sensory Integration The ability of the nervous system to organize sensory input for meaningful adaptive responses. (Ayres)

8 Typical Sensory Integration Process Sensory input Adaptive Response Brain Information is combined with previously stored info Meaning is given to the input

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

10 Sensory Processing Disorder Sensory Processing Disorder (SPD), exists when sensory signals are either not detected or don't get organized into appropriate responses. Pioneering occupational therapist, educational psychologist, and neuroscientist 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, anxiety, depression, school failure, and many other problems may impact those who do not have effective treatment. (About SPD, 2017)

11 Umbrella of Sensory Processing Disorder

12 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?

13 Sensory Modulation Often over (e.g. fearful of movement) or under responsive (e.g. decreased auditory awareness or constantly moving) to sensory input. Poor modulation skills results in kids often being in fight, flight, or freeze. High levels of stress, anxiety, perfectionism, rigidity, etc. Over-reactors

14 Umbrella of Sensory Processing Disorder

15 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 cat, 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?

16 What can SPD look like?

17 What can SPD feel like?

18 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).

19 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 inner ear 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.

20 Proprioception & 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 central nervous system (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.

21 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 experience says music impacts your arousal level and as adults we use it as a tool for self-regulation.

22 Umbrella of Sensory Processing Disorder

23 Sensory Over vs. Under Responsiveness Under Responsiveness Over Responsiveness Input is not perceived by the CNS when present Drama in response to sensory input as a result of overactive CNS Needs more input to register that something is happening Difficulty tuning out non-important sensory input (easily distracted)

24 Sensory Over vs. Under Responsiveness

25 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 flavor At the same time, your child may be over responsive to auditory input and is easily distracted by sounds that you may not even notice (i.e. the lights buzzing, someone talking in the hallway, others breathing, etc.) Real life examples Camping with friends and lights on all day until bedtime

26 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

27 Proprioception Kids with Autism and SPD are often under-responsive to proprioceptive input These kids may be scared of the dark because they are overly reliant on their visual system to move in space. Always want a night light Clumsier in low lighting

28 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, chewing gum, crunchy/chewy snacks, etc.) Allow opportunities for crashing and jumping to help create better awareness of body in space

29 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

30 Vestibular Considerations Linear movement (back and forth) is typically calming Rotational movement (spinning) is typically alerting Under Responsive Over Responsive Allow frequent movement breaks throughout the day If the child is fearful of movement introduce it very slowly and watch for signs of distress

31 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

32 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 position 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.

33 Auditory Under Responsive Over Responsive Slow to respond or does not respond when name is called Poor or no orienting response to sounds May make noises for enjoyment Easily distracted by noises that others may or may not notice and may cover ears frequently Startled by unexpected noises *May make noises to block out auditory input secondary to hypersensitivity Increased anxiety/agitation in crowded/noisy environments

34 Auditory Considerations Under Responsive Over Responsive Visual/Gestural Cues Be cognizant of noises in environment (even if they don t both you) Contrasting colors to draw visual attention to written or visual instructions Simplify instructions Gain visual attention prior to giving auditory instructions (does not have to be eye contact) Type of visual supports (real pictures, Boardmaker pictures, representational, etc.) Tactile prompts Calm voice Provide access to a quiet place and/or headphones Therapeutic Listening/Music

35 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

36 Vision Considerations Under Responsive Over Responsive Bright lights, contrasting colors/patterns, etc. Decrease clutter Visuals that move (i.e. spinner toys, fidget spinners, etc.) Seating near the front of the room Gain visual attention prior to giving auditory instructions (does not have to be eye contact) Tent space to calm and decompress Allow use of peripheral vision Use soft/natural lighting Alerting colors red, yellow, orange, etc. Calming colors blue, green, grey

37 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 times 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)

38 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 their mouth Restrictive Diet (may be a sign of oral defensiveness, oral motor weakness, or poor proprioceptive awareness intra-orally)

39 Taste Considerations Under Responsive Over Responsive Try foods that are crunchy, chewy, and/or have bold flavors If a child is orally defensive and a picky eater do not force them to try/eat nonpreferred foods May need appropriate items to chew on such as gum or a chewy Things that we may consider lacking flavor still may be overwhelming to the child

40 Sensory Break Poll Movement/break or power through the rest of the power point (approximately slides)?

41 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.

42 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/pattern (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)

43 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 experiences 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

44 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.

45 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.

46 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 feelings 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

47 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.

48 Arousal Level vs. Self-Regulation Arousal Self-Regulation The state of the nervous system, describing how alert one feels. (Williams and Shellenberger, 96) The ability to attain, maintain, and change arousal appropriately for a task or situation. (Williams and Shellenberger, 96)

49 Arousal Level

50 Levels of Arousal - Overstimulation Overstimulation can present in one of two ways sensory shutdown or as hyper Overstimulation Sensory Shutdown *Lethargic *Disengaged Hyper *Hypervigilant *Impulsive *Unsafe

51 Levels of Arousal Understimulation Understimulation can present in one of two ways disengaged or hyper Understimulated Lethargic *As a result of not receiving enough sensory input Hyper/Sensory Seeking *Seeking sensory input to try and keep alert

52 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 communication 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

53 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

54 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.

55 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.

56 Sensory Processing Disorder Recap

57 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

58 Resources SPD Info: Zones of Regulation: We Thinkers Volume 1: FiveStorybookSet We Thinkers Volume 2: FiveStorybookSet Therapeutic Listening:

59 Questions, Comments, Suggestions?

60

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