Increasing the Intensity of Sensory Input

A sensory diet is when additional sensory input is added into the child's daily activities. This might include making sure the child runs around or swings at recess as opposed to them just sitting there on a bench. It might also include a child wearing a weighted vest or backpack while on an outing. The list is never ending of how sensory input can be weaved into a child's daily routines: marching between locations, vibrating pen, "heavy work" activities such as cleaning the chalkboard or carrying groceries for parents, or even extra trips to the neighborhood park.

So what is a parent to do when they have tried a sensory diet and the child still needs more? Well, that is when the occupational therapist (or other clinician trained in sensory integration techniques) analyzes the input the child is receiving. They should be asking about intensity, duration, frequency, and mode of sensation.

Intensity levels can be altered with jumping by adding a mini-trampoline versus just jumping on the ground. This can be made even more intense by the child jumping on a large outdoor trampoline. Another way intensity could be increased is to buy special suspended equipment such as swings with bungee cords that allow extra resistance as the child swings. These can be found at:

www.southpawenterprises.com

Some of the families I work with already have the outdoor play gyms that have a swing, slide, ladder, and "rock" wall. Often, suspended equipment could be used with these play gym systems. So a regular sling seat swing could be replaced with the "frog" swing which is also a sling seat, but has bungee rope at the top so the child is bouncing up-down in addition to being able to swing front-to-back.

Intensity could be added to marching by adding 1-2 pound leg weights around the child's ankles as he marches. Other ideas include: Joint compressions, a game of tug-of-war, deep massage vs. light touch, songs with words versus just instrments...and the list is never-ending!

Duration: length of time of sensory input. So, if the family tends to let the child play at the park for 20 minutes, maybe the time should be lengthened to 30 minutes or more. This is especially the case for a child who has sensory modulation disorder with the symptoms of sensory seeking or sensory under-responsiveness.

Frequency: means the amount of times during the day. If the child only gets one "wiggle" break at school/home then maybe the child needs more "wiggle" breaks. The average adult attention span is only 45 minutes of listening, and for children it is even less. So, we know that many special needs children can't focus as long as a typically developing child...so, more "wiggle" breaks are needed! If breaks are not possible, then fidgets for the hands or a cushion for the bottom such as the Movin' Sit (R) could be helpful.

Mode of sensation: is the input tactile? auditory? visual? movement (vestibular and/or proprioceptive)? smell/taste? oral-motor? Changing up a sensory diet with various types of input may be necessary. This can be frustrating to teachers and parents because after a few months of the ideas given by the therapist they aren't getting as good of results. Altering the sensory diet can be a guessing game especially when the child fluctuates from day-to-day or even hour-to-hour!
Maybe if the child tends to like motion that is up-down such as bouncing on a ball or jumping on a trampoline, then a different kind of movement could be added to the sensory diet. Examples of more intense motion include rotary/spinning or upside down movement. Examples of less intense motion include front-to-back or side-to-side motion at a predictable pace.

I hope this article got you thinking! Once a sensory diet is in place, it probably will have to be tweaked here and there...especially if there are lots of changes in that child's life.

Sense-Able Baby Website

Home Page

Great resource on sensory processing problems in infants. Also provides ideas on calming babies, understanding why they are crying, and body signals they give off to let you know when they are hungry, sleepy, or ready to play. Great links page on a variety of resources for babies who are typically developing and special needs.

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 http://www.sense-ablebaby.com/ . 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.

Sensory Strategies for Adapting the Environment to Help Young Children with Sensory Processing Problems / SPD: Part One

Since I work for an early intervention program, I get the opportunity to work in the homes and daycares of many young children under the age of three years. Even though I am providing ways for the child to improve his skills directly, I also provide ideas for altering the environment to help these children. For children with sensory processing problems, we may go through numerous ideas before something works for that child and family...after all intervention should be individualized. But there are some basic ideas that pretty much work for everyone (minus someone here or there). In my blog today, I am going to share a few of those basic ideas.

Sensory processing is the brains ability to detect and respond to sensory input it receives from the body, other people, and the environment. Young children (toddlers and preschoolers) often respond well to adapting the environment in order to help them process sensations better. Below are some categories of sensory processing problems and some possible ways to adapt their surroundings:

1. Over-responsiveness: these children over-respond to sensations by getting upset, avoidance, shut-down, and/or anxiety.
Adaptations include:

• Reduce clutter on the walls and floor: this can over-stimulate these children. Organize the room and remove the excess wall decorations. Put toys in containers and baskets versus scattered all over.
• Go shopping at times that are less crowded versus a chaotic time like Saturday
• Give them plenty of space when they are playing next to another child, this reduces the chances of accidentally getting bumped or hearing noises perceived as annoying
• Don't let them be a loner, this is a sign of being over-whelmed. Pair them up with a calmer child on the playground or a calmer sibling at home

2. Sensory Seeking: these children can't seem to get enough of movement, touch, noise, etc. It is like they are driven by a motor. Adaptations include:

• Make sure they have lots of toys and opportunities for movement: swing set, trampoline, tunnels, bicycles, scooterboards
• Give a variety of opportunities for play during daily routines: bath tub toys while bathing, textured fabric on high chair seat or chair cushions, bag of toys to fidget with during car rides, bag of toys to fidget with while in a cart/stroller for shopping trips, etc.
• Look through catalogs that sell sensory integration products. There are many toys made especially for these children. Look for the words "vestibular" and "proprioception" equipment
• Let them sing songs with motions: "wheels on the bus" or "ring around the rosie" are good choices
• As you play with them, have them pretend to be an animal and set the room up for such. If they are crawling around pretending to be a bear, then add large pillows to the floor or crawl through tunnels. Make believe play is good, especially at home when you don't have the expensive sensory integration equipment that is at therapy clinics

Stay tuned for Part 2 to cover the other categories of SPD/ sensory processing problems. Also check out some ideas for working with babies with sensory processing problems at

http://www.sense-ablebaby.com/

Would finish now, but I am off to go play with my two children on the floor as we pretend to be snakes slithering on our bellies to provide imaginative play and tactile input to our bellies!