Free Downloads on Sensory Processing Disorder

Since October is Sensory Awareness Month, I thought that I would share an awesome resource which is a link to free downloads on sensory processing disorder (SPD):

SPD free downloads

Let's do all we can this month to make more people aware of the symptoms of SPD! One easy way to do that is to share handouts that are written in simple and precise language. More people are likely to read a one to two page handout than a long book. Go ahead, print some of these handouts off and pass them around to teachers, friends, parents, caregivers, and anyone else that could benefit from the information.

October is National Sensory Awareness Month

I have been happily surprised lately while talking to some of the staff at daycares and Mother's Day Out (MDO) programs where I work with some children for occupational therapy services. They ACTUALLY have heard about sensory processing disorder (SPD)...yeah, it is not a foreign concept to them! At one MDO program I was at last month, the teacher even asked me if I thought she should refer another child for an OT evaluation due to him possibly having sensory processing problems. Now before you get overly elated that the OTs in our community have done the most amazing job ever, I have to let you know that this woman has a nephew with Asperger's and SPD. But still, it was exciting to have her initiate the topic.

I live in a suburban area outside of a large city with a school district that is well known for its great support of children with special needs. In fact, there is a special program just for children with Autism Spectrum Disorders. You know what that means don't you? It means we have people moving into our district at increasing rates each year. It also means that many community members are more aware of learning disorders and other special needs than in some of the other places. Many of the preschools/MDO programs, daycares, and babysitter organizations go out of their way to be inserviced on learning problems and in particular SPD. Now, I am not going to go so far as to say us OTs and special education/ early intervention staff have done everything we can do to educate our community. Of course we haven't! Everyone can always do more.

If you would like some ideas on how to raise awareness of sensory issues in your community, go to this link that provides contact information for a free electronic packet full of ideas to help you:

S. I. Focus

Since October is National Sensory Awareness Month, I will be doing a little extra educating on the topic. I've already done a 90 minute presentation to the new staff at my job last week, and I plan to do something at least once a week this month to bring awareness to SPD.

I do public speaking quite a bit on various therapy related topics including SPD. One thing that I have learned is to keep it simple when explaining SPD to people who have never heard of it, but don't over-simplify it either. If you plan to go out in the community and speak to groups about SPD, then make sure you know your audience. A group of doctors may not need the same explanation as a group of elementary school teachers. Doctors tend to want to know about "proof" through research whereas teachers like to know the functional implications and simple strategies to help the children.

Good luck with spreading the word about Sensory Processing Disorder!

Do colicky babies have sensory processing problems? | Family Anatomy

"Colic" is just a description of a babies behavior...lots of crying for a certain amount of time. This term is not a clinical diagnosis. So often I see that babies with reflux or other digestive problems get labeled as colicky until they get treatment (e.g. formula change, medication, positioning, etc). But sometimes, especially with the babies born extrememly prematurely, there is still a fussiness about the baby including a poor ability to calm down once upset. Typically, we expect a baby to become organized when an adult attempts to calm them such as picking them up and/or rocking them, feeding them, repositioning, etc. The following link suggests that many babies with colic later become diagnosed with sensory processing problems. I tend to agree. I see this pattern often since I work with children under the ages of 3 years old.


Do colicky babies have sensory processing problems? | Family Anatomy

My personal experience with my son's fussiness was resolved with multiple reflux medications as well as eliminating from my diet the foods he was found to be allergic to that he was consuming through my breastmilk. So, by no means do I think every child with fussy behavior will one day have sensory processing problems. Yet, I do think fussiness that can't be explained by other things may lead to a later diagnosis of SPD. For more information on sensory processing in infants, visit:

http://www.sense-ablebaby.com

This link provides strategies on calming a baby. It also gives descriptions of why a baby could be crying which better helps a parent to read the infant's signals allowing the parent to have more accurate attempts in calming the baby. Sometimes for a baby who over-responds to sensory input it might be taking away toys, whereas sometimes our instinct is to shake a rattle to give the baby a distraction. But this can make it worse, which in turn causes the baby to become more upset.

Defying Gravity...Carnivals Should Be Fun!

Today my family of four along with my sister-in-law went to the carnival. Within the "kiddy" section, there were simple rides like the carousel but there were some more gravity-defying rides as well. My husband enjoyed riding the rides with my 6 year old daughter while my 21-month old son stayed in the stroller and I took pictures of everyone. But I did manage to get on one ride with my daughter, and boy was it fun! It was a ride that went in a circlular pattern while the kids/adults layed two people to an "airplane". While on our airplane, we were lying on our bellies and strapped in from behind. Not only did the ride go in a forward circular pattern, but it also went up/down making you feel as if you were "losing your stomach". Now, I grabbed my little one's hand, because I was thinking she may freak out. But I was wrong, she squealed with laughter. She had so much fun! And she should have. Once kids are of a certain age, they should think it is so much fun to move in various ways against gravity. It is not uncommon to see a toddler trying to be upside down off a couch or jumping off of furniture!

There are five directions to move within space: up/down, forward/backward, circles (rotary and axial), upside down, and sideways. Swinging on a swingset back and forth is a simple way to move, whereas riding the carnival ride today as described above was more complicated because it combined movements. When we move in these various directions, vestibular receptors in the inner ear are stimulated. The vestibular system can be a tricky sense. When a person has an ear infection or vertigo, this system can go haywire and throw the person's balance off. It is quite scary to feel off balance. That is why some kids with vestibular disorders don't like carnival rides. In fact, some would probably whether do anything but get on that ride!

If you have a child who doesn't like to play at the park on the swings, slides, or climbing devices, it is possible that he has difficulties with vestibular processing. If the child also has a gross motor delay or falls often, this should be discussed with the child's physician. Physical or occupational therapy services may be necessary to help the child. It may seem trivial when the child is only 2 years old, but if the problem is not corrected, the child ends up being a grade schooler who can't ride a bike or roller skate with his peers. He may also be the type who is clumsy, making him be the last one chosen to play games during school recess such as for soccer or dodge ball. If you suspect that your child has problems with vestibular processing, it is definately worth checking out.

Some other signs of the problem could include: low muscle tone, delayed development with two handed activities, clingy to parent when should be playing with peers (especially at birthday parties), fatigues easily, scared to sit in chair or on potty due to dangling feet, short attention span, and delayed eye-hand coordination. Those were all symptoms of kids who are over-responsive to vestibular input or who have sensory based motor disorders. Kids who are under-responsive are more lethargic and passive. Kids who are sensory seekers are described as the energizer bunnies and can never seem to get enough movement unless they are asleep. Some of these kids are even known to tire out the family's energetic dog! They tend to jump from high surfaces, fidget, and spin around. All of this over activity needs to be directed, especially if the child has a language or fine-motor delay. These children may or may not have a sensory processing disorder (SPD, AKA sensory integration dysfuncton), but should be checked out by a therapist. I don't think that every child with the above-mentioned symptoms necessarily has a vestibular disorder, there could be other things going on including neurological deficits, other disabilities, or environmental factors. An example of an environmental factor is lack of or decreased stimulation such as being at home all day with a mom who is on bedrest and can't help the child get the necessary exercise he needs, so he overly seeks out movement such as jumping off of high surfaces. This is the case where it is well worth it to pay extra for a young babysitter to come over to play or to invest in a mini-trampoline for the living room. So, not every referral to a therapist will mean the child needs intervention, but maybe at least some ideas can be generated for helping the child.

Washing a Kid's Hair Who Has Tactile Sensitivity

My two young kids absolutely love bath time. When they hear Daddy start the water, they dash upstairs to crawl in. They have fun during bath time for many reasons: playing with one another, splashing, playing with bath toys, singing & laughing. My 15 month old son could care less if the water is poured over his head in order to rinse out the shampoo. My daughter on the other hand, acts as if she is dying if any water touches her face. I have her wear a cloth over her eyes and tilt her head back to minimize the damage. If I am washing her hair, all goes well because I am careful to not get any water on her face. When Dad rinses the shampoo, she puts up more of a fight because he typically gets water in her eyes. My child doesn't have sensory processing disorder (SPD) or an extreme tactile sensitivity that I know of, but she is still sensitive to getting water on her face. Once she is upset about the water in her face while bathing, she is over it within 10 seconds after it has stopped. But unfortunately for a lot of the families I work with, once their toddler or young child with SPD or tactile sensitivity becomes upset, it is meltdown city, and then the child is so upset that he can't fall asleep for well over an hour.

While applying shampoo to the child's (with SPD or tactile sensitivity) head, it is a good idea for the adult to put the shampoo in their own palm before applying it to the child's head. The trickle of shampoo over the child's head may be aversive whereas the deeper touch of a palm full of shampoo isn't as aversive, usually. When rubbing in the shampoo, use firm massage strokes. If using organic shampoo without lauryl sulfate, the shampoo may not create suds, therefore suds can't fall into the child's eyes. To minimize water in the face while rinsing shampoo from the sensitive child's hair, try the following tips:

• Have them tilt their head backwards as you rinse the shampoo out



• Have them put a dry washcloth over their eyes as if it is a blindfold. It can catch any stray sprinkles of water



• Use a sun visor to catch any water that would fall down the child's face



• Use a Lil' Rinser (R). They have a website; I purchased one at Target (R). I have only used it a few times, and if put on properly, it helped minimize water in the eyes even if the head isn't tilted back



• Only wash a young kid's hair up to 2 times per week unless they are extra dirty. Since they do not produce as much oil (pre-puberty) as an adult does, they don't need their hair washed as often.



• Get tear-free shampoo and/or shampoo with natural/organic ingredients; this way the shampoo won't be as harmful



• Wash the kid's hair earlier in the day or before supper, not at bedtime. This way if he is upset about it, it won't delay his ability to fall asleep. Many kids with SPD have a hard time winding down to fall asleep on any evening much less on an evening when they became upset



• Consider showers. The deep pressure of water coming from a shower head may be less aversive than water trickling from the faucet or a cup used to rinse out shampoo



• If you are concerned that the your young child may have sensory processing disorder but you are not sure, go to http://www.spdfoundation.net/ for information on kids and http://www.sense-ablebaby.com/ for information on babies.

Auditory Sensitivity

Tomorrow is the first day of school for my daughter. This gets me to thinking where did the summer go? Then, I reflect back on the 2 vacations we had, the various barbeques and outings we attended as well as the various relatives who came to visit. The summer flew by! During this chain of thoughts, I got to thinking back to the last family vacation we took back in July. Although it was fun overall, I didn't get the best quality sleep. The reason was multi-fold. Who really sleeps that great in a hotel? No matter how nice it is, it isn't the bed you are used to. Another reason my sleep wasn't the best quality, we were overly tired from all of the tourist activities. But I do believe the number one reason was the snoring I endured was the number one culprit to my sleep problem. My sister-in-law joined us on the trip...so I had 2 snorers, my husband and her. My husband has been using a CPAP machine and slowly getting used to wearing it, so he doesn't last through the night with it. So, I used the earplugs I brought along, but for some reason I could hear a man (I assume it was a man by the voices I had heard) snoring in the next room over....I have always been unsure of why hotel staff would have the two neighboring rooms with beds along the same wall. I heard these people's late night and early morning (6 am!) conversations in addition to the not so lovely snoring. In the middle of the night when all you want is sleep, you have to wonder if it just wasn't meant to be when you hear 3 people snoring! Now, I am not usually one of those people who can hear ever little ticking of the clock or chirping of a bird.

This did let me get a small glimpse of what the kids with auditory sensitivity go through. No wonder so many of them are grouchy! So many of these children can't tune out the background noises (e.g. lights, other conversations, air conditioner) from the foreground noises (e.g. teacher's voice, TV), therefore all noises seem to be the same volume and intensity. Also, some of these noises are actually perceived as painful to them. Thank goodness I only perceived the snoring as annoying, but definately not painful. These children may cover their ears due to the pain or may shutdown by tuning everyone out. That is why they may not respond quickly when their name is called. They may also seem to be in their own little world. Now, some of these children have autism spectrum disorder (ASD) but many do not. And because of their "shutting down" and tuning people out, they may get wrongly diagnosed. This is one reason it is so important to address the sensory processing problems (SPD), so that the child gets the accurate kind of help. Some of these children may or may not have a central auditory processing disorder (CAPD), but this can only be tested for once the child is 7 years old by an audiologist. There are accomodations to help the child with noise sensitivity (e.g. flush the toilet after they leave the bathroom, change the ringer tone on the telephone, etc.), but that can't help in all environments. Intervention from an occupational therapist or speech language pathologist with training in sensory integration treatment may be necessary. Also, sound therapy may help such as Tomatis, Therapeutic Listening, AIT, and other programs. I am trained in the Therapeutic Listening program and have seen many children benefit from it. These sound therapies not only help with noise sensitivity, they often help with coordination, muscle tone, attention span, and language skills.

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!