Monday, July 20, 2009

Part Two: Sensory Strategies for Adapting the Environment for Young Children with Sensory processing problems/ SPD

Well, I'll now begin the second part to my blog on helping young children with sensory processing problems or who have a diagnosis of SPD (Sensory Processing Disorder) by making adaptations to the environment. Part One was blogged on July 20, 2009.

Let me start by saying I am a believer in children receiving therapy services at a clinic, but I am also a believer in "home programs". Therapy only occurs a couple of hours per week, but the parents are with the child more of the time and therefore need to learn ways to help the child process sensations more effectively. Therapy helps with the remediation of skills, but that can take awhile. Immediate changes can occur when adapting the environment or altering the way you interact with the child.

Part 1 of this blog gave ideas for children with sensory over-responsiveness and sensory seeking behaviors.

The other categories and ideas are:
  • Sensory Discrimination Disorder: this is when it is difficult to detect the qualities of sensations. A problem with auditory processing may be that the child is unsure of what direction a noise came from or can't discriminate if he heard the sound "p" versus "d". A child with a tactile processing problem may not realize he has a wrinkle in his sock or is unsure where he was touched. A child with a vestibular processing problem may get lost in space easily or look clumsy. There are many more symptoms, but these are some basics. Strategies include giving sensory rich opportunities such as those listed for sensory seeking children in Part One. Other ideas include:

Lots of movement as well as mazes and obstacle courses. This is good for visual, proprioceptive, and vestibular processing.

Take the long way when moving between rooms, and march en route.

Lots of tactile experiences such as play-dough, helping to cook, fingerpaint, bath tub toys, and helping to clean (without toxic cleaners).

In order to climb into the carseat, place a stool in the floorboard.

Place a stool or steps at the sink so that everytime the child goes to wash his hands, he is also working on balance.

In the car during rides, play a music CDs with words and listen to read-along story books- the type where you turn the page when you hear the ding or chime sound.

  • Sensory Under-Responsiveness: seems slow to respond to sensation or being spoken to, may appear not as intelligent as they are because of slow responses, hypotonia (AKA low muscle tone), fatigues easily.

Once again, offer a sensory rich environment such as blankets/pillows for babies to be in tummy time, swings, rocking horse, ride-on toys, exercise balls, ball pit, mini-trampoline, push-pull toys such as a wagon, and tunnels.

Use lots of movement whether it be through toys or marching, running, "roughhousing", or bouncing on adults lap as this movement "perks" up the child. Often, balance reactions are better after participating in such activities.

During bathtime have the toddler climb into the tub if possible. Offer lots of toys during the bath.

Leave toys lying around the room in various spots, because this is a child that if the house is too tidy, they may not explore. When this is the case, they may get bored and start self-stimming (e.g. rocking back and forth, banging head, flicking fingers in front of eyes, etc.), play with same things in a perseverative way (e.g. blocks must be a tower, can't vere and be a train or house when building), watch too much TV, or just sit there passively.

Give time for the child to respond. He may need a few seconds to decide he wants to play with a toy, move, or answer a question. If he still doesn't respond, he may need a tactile cue such as touching his hand which reminds him to reach for the toy. He may need the toys moved to another location or the room re-arranged. But be patient and don't expect quick changes.

  • Dyspraxia and poor motor planning: this is when a child has difficulty with sequencing the steps to an activity or has difficulties executing a task or movement which makes him look clumsy from not knowing where his body is in space. Apraxia is a term used when an adult has lost the ability to motor plan such as after having a stroke (CVA). It is also a term used by speech language pathologists to describe a child who has difficulties with speech and/or oral motor skills due to poor motor planning. These ideas will stick to just the body, from an occupational therapist's (OT) point of view. Adaptations might include:

Set up the room so that things are easily found. Once again, having a home with no toys setting out or in containers high up is not good for this child. Instead put toys in baskets, toy boxes, or low down in invisible containers for easy access to the young child.

Set up the environment for success. These children get frustrated when things become too difficult for him. have the layout of their bedroom be simple to maneuver such as the furniture across the walls and the middle of the room an open space.

Have cabinets or shelves in various rooms with safe items for them to manipulate. For example, have a kitchen cabinet without a safety device on it. Items in it could be plastic or wooden bowls, spatulas, etc.

These children need a certain amount of variety, but start to feel out of control if not having a lot of predictability. So the way you schedule your day should be fairly predictable. For example, after getting dressed and a diaper change then go eat breakfast, then play time, etc. This is why many of these tots do better at good daycares or preschool programs as opposed to when at home. Because at these places, the schedule stays fairly predictable. Although lunch may not be the same food everyday, the child knows that before lunch is circle time and that after lunch it is time for a nap. I don't believe that when at home, it has to be super-structured, just predictable.

When you see a dyspraxic child have a meltdown/ tantrum, know that the task may need to be made easier. Break down the activity. For example, if he is upset about trying to feed himself, maybe give some support at the elbow and help him with spearing the food and bringing it to his mouth for that first bite. Then, the next bite give less help. Do this until you are not helping at all. Often, children with dyspraxia just need a little "jumpstart'. This process just described can be either forward or backward chaining, depending if you retreat your help at the beginning or end of the activity.

  • Poor postural control:

Although lots of balance activities will help this child to remediate his balance problems, he also needs physical support to be successful until his balance and equilibrium has improved.

Choose a high-chair that offers lots of support for the head and trunk. The wooden high-chairs wthat are often seen at restaurants require that the child have good balance, whereas some of the Graco and Evenflo high-chairs that are store bought can recline and have much more support.

Bumbo chair for the infant who can't play with toys simultaneous to sitting up.

Limit time the baby or young toddler spends in positional devices. 15 minute increments should be the most a young child spends in a bouncer (stand in)/ jumparoo or other devices.

Although some people swear by putting their baby in a walker, I am not a fan. Studies show that infants who use a walker are actually less likely to walk sooner than those who do not use one. This is partly due to the position a child is in in a walker is more forward as opposed to being upright with shoulders over feet for independent walking.

That's it for now!

Now there are numerous more ideas for lil' tots to adapt the environment to improve sensory processing skills. These were just a few I thought of off of the top of my head that tend to work with most young children. However, for some tots, I really have to put on my thinking cap and come up with other ideas.

For "red flags" of sensory processing problems in babies visit . Although, with babies it is not always so obvious that they have a problem. Sometimes it starts out as just a developmental delay and it later becomes obvious when they are toddlers that their ability to process sensations is not how it should be.

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