Resources on Sensory Processing Disorder - Free Downloads

I am the handout queen...not really, it is just a title I have given myself. I love to provide families with handouts, website links, and other resources. When parents take the time to read up on topics that are related to their child's developmental delays, it is SO much easier for me to have a meaningful conversation with them about how to better help their child. My time with families is very limited, 1-2 times per week usually, and unfortunately this is not enough time to teach families everything they need to know.

One website that I am fond of is "sensory street". Here is a link to this site's resource page that includes many free downloads on topics related to nutrition/feeding problems and sensory processing disorder/ sensory integration dysfunction:

free sensory downloads

I especially like the download of "Do You Know Me?". Not only does it come in English and Spanish, but it is concise and easy to understand especially for visual learners. This handout can be given to family members, caregivers, teachers, and any other professional working with children with learning problems or other special needs.

Indoor Gross Motor Activities

Today it is cold and rainy outside. That means my kids didn't get to play outside like they typically do before and/or after supper. Now that it's November, there will be more and more days like this where we have to be entertained indoors.

Here are a few ideas that I use to keep my kids involved in gross motor activities while staying indoors, and maybe they will work for you too:

1. "Simon Says": I usually start out as Simon while playing with just my 7 year old daughter, then my 2 year old son usually joins us and tries his best to imitate everything his big sis does. I tend to call out these commands: standing on one foot, animal imitations (bird, cow, donkey, bear, crab, snake, etc), twirling, jumping jacks, clap while jumping, tip-toe walk, heel walk, jump from side-to-side, clap hands over their heads or behind their backs, touch one hand to the opposite foot, and walk backwards.

2. Obstacle course: We have a big space in our living room and entry way that makes a great location for an obstacle course. We use our fabric tunnel, mini-trampoline, fabric tent, blankets draped over the back of chairs, large pillows, couch cushions, and a hula-hoop to either jump in-an-out of or to climb through. I have the kids go through the obstacle course consecutively together or to do it individually while "racing the clock". Motions involved include climbing over, under, and through, jumping forward and backward, crawling forward or backward, and rolling (log or forward).

3. Kids yoga or other exercise videos: my children's favorite video is from Yoga Kids (R); the poses on the video are fun and in alphabetical order, A-Z. "A" is a pose that looks similar to an alligator and "R" is a pose that looks similar to a rocking horse. The suggested ages are 3-5 years, but I think many 2 year olds can at least try it. My son probably is motivated to try the poses because his sister and I are doing them as well.

4. Chores: I completely believe in child labor and teaching kids to be responsible for chores! They are good for building strength and coordination! My kids help carry bags from the car as well as clean their rooms or any other area where they have played and made a mess. Both of my kids like to help fold towels, not that they are excellent at it, but at least they are active and trying! My older child is also expected to make her bed and help "set the table" before dinner.

5. Cooking: stirring batter and rolling out dough is lots of upper body gross-motor fun! Pounding over the food chopper can be quite a blast also!

6. Dress-up: My kids like to play dress up and then act out the character. We have costumes for Peter Pan, Captain Hook, various princesses, cowboy, police man, baseball, soccer, as well as random hats, scarves, and shoes to play with.

7. Playing games in various positions: I like to play card games with my daughter while we are facing each other and propped on our forearms lying on our bellies. I like to draw and color with my son while we are standing at his easel. It is also fun to draw while on paper taped to the bottom of a table or chair while lying under it, but I am not sure I trust him with this yet, maybe as he gets closer to 3 years of age! Sometimes my daughter and I sing songs while we are hanging off of the couch with our heads on the floor...can only do this one for a short amount of time!

8. Sing songs with body actions: "Wheels on the Bus", "Ants Go Marching", "Row, Row, Row, Your Boat", "Getty Up Horsie", and "Ring-Around-the-Rosie". These are fun as long as you have energy to keep up with your kids!

Use your imagination to keep the kids active! Just remember not to over-use video games and television during the autumn and winter months. Keeping kids moving is important for motor and cognitive development as well as to reduce chances of obesity!

For ideas of indoor activities for children with sensory processing disorder (SPD) or autism (ASD) known as a sensory diet, check out the following website www.sensorysmarts.com Also, ask your child's occupational, physical, and/or speech therapist for a handout on activities to do at home to keep your child busy. This will also greatly impact behavior because they won't be bored!

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!

Fidget Toys

My family and I just returned from a week long vacation (3 hours ago to be specific). The one thing that helped my husband and I survive the 9 hour drive each way with two young kids was bags of toys, including fidget toys. I had a large bag of toys for each child to sort through and play with. So when my son got tired of playing with his cars, magna-doodle, and puzzle, the fidget toys were his next choice. He especially liked the stretchy, light up caterpillar fidget. On one of the "pit stops" I purchased a visual fidget; it is a 5 inch ball with a small fish and glitter inside it.

The term fidget basically just describes what a person would do with that toy...fidget. Fidgets are fun to turn around, pull, squeeze, shake, etc. Some children can benefit from them in the classroom to help them "wiggle" with their hands instead of getting out of their chair. For some kids, they have to be moving in order to listen or they zone out, so a fidget allows them to still be moving, just it is with their hands instead of their entire body. Fidgets are also beneficial for long car rides or waiting in doctor's office lobbies. When the child is playing with it, it keeps their mind off having to keep their body still. Some fidgets are textured which stimulates the tactile sense, whereas others are aiming at the visual, auditory, oral, or proprioceptive sensory systems. But you have to be careful with the auditory fidgets depending upon where you will use it, because you wouldn't want it to be too loud! Although fidgets are beneficial for many children, they are especially helpful for kids with sensory processing disorder (SPD), autism spectrum disorder (ASD), and ADD/ADHD.

Some things I had for my 2 year old son in his fidget bag for our long car ride included: small cars, fuzzy ball, stretchy caterpillar, zip up bag full of various action figures, wind-up fish, mini See-n-Say, aquarium tubing (for chewing), and other odds-and-ends that were too large for him to swallow had he decided to put them in his mouth. I'm not going to falsely say that for the entire 9 hours my son forgot he was strapped into his car seat against his will and was as happy as a lark, but I will say when he fussed, having toys as a distraction helped immensely! Now for my six year old daughter, she enjoyed her bag of toys also, but she has always been a champion traveler and wouldn't fuss even if she had nothing to do at all. But the fidgets made it more fun for her!

Still not sure what to use with your little one? Here is a link I found for some fidget toys that might stimulate some thought:

Toys for Learners: Trainers Warehouse Product Departments

I have also seen some great fidget toys at Walgreen's, Wal-Mart, and other retail stores. The dollar stores sometimes have good fidgets- just have to dig! Try to get a variety of fidget toys, because what works at one moment may not at the next, so it is nice to have quite a few in your bag of toys. I even save party favors from birthday parties my children have attended and toss them into the bag of toys. You might even want to go through your children's toy boxes to find fidget treasures. Another thing that makes good fidgets is the toys that come with a child's meal from a fast food restaurant as well as the prizes from cereal boxes. One of my favorite fidgets came from McDonald's over 4 years ago; in fact, I would go through the drive through to buy more kid's meals just for more of this toy; it was one of those intriguing toys that helps visual and fine-motor skills. By the way, I rarely eat fast food!

Improving a Toddler's Balance & Vestibular Processing Skills During Play

My 23-month old son is like most toddlers, he's busy and likes to climb. If I leave the room and return a few minutes later, I am likely to find him standing on a chair or behind the couch. Yet, even though he loves to be in motion, he sometimes still falls. The good thing is, he doesn't fall as often as he did when he had just learned to walk. But, somehow he gets "bobos" on his forehead at least once a month.

Many parents ask me "How do you help a toddler's balance skills?". Well, first of all, know that most toddlers still fall from time to time, but if a child is falling excessively then discuss this with the pediatrician. If that doctor feels that the toddler is falling excessively, then maybe a physical therapy (PT) evaluation will be suggested. PT can look at to see if there are any possible problems orthopedically, neurologically, developmentally, or with the child's level of strength. If these problems have been ruled out, then the child's sensory processing skills should be evaluated, in particular the vestibular system. This can be done by either a PT or occupational therapist (OT), depending upon the therapist's training. The vestibular system has receptors in the inner ear that detect which direction the head (and body) is moving. The possibilities for directions of movement include: up-down, front-to-back, side-to-side, upside down, and in circles. If a child has difficulties processing vestibular input, it may be because he over-reacts, under-reacts, or overly craves the input. Examples of overly reacting would be the child not wanting to be tossed in the air or being scared of swinging. An example of under-reacting, would be a child who seems lethargic and needs extra time running or jum[ing to detect that he is moving. In comparison, a child who overly craves vestibular input can be described as the "Energizer Bunny", and doesn't seem to tire of the motion. Although toddlers should like to move around some, eventually they should move onto to a sit down activity such as rolling cars, feeding a doll, or stacking blocks. A toddler who overly craves vestibular input, may not be able to focus while staying seated more than 20 seconds. Vestibular problems may also be because the child has poor: postural control, the ability to discriminate the input, or an ability to motor plan his actions. An additional problem could be visual processing and/or a poor ability to see far or near; if this is the case, the chid should be evaluated by an eye doctor. For more on understanding sensory processing problems in toddlers or older children visit: www.spdnetwork.org and www.sensorysmarts.com and for more on understanding sensory processing problems in babies visit: www.sense-ablebaby.com

Also, I wanted to share this article that I wrote almost 9 months ago on an informational site. I purposefully simplified the description of vestibular input so that the average person could understand it. It gives ideas on how to help with balance and vestibular processing for toddlers:

How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com

I purposefully kept the list of activities simple and short, and suggestions are things that can be done anywhere not just in a therapy clinic. Feel free to comment on any fun ideas you have found that help to develop balance and stimulate the vestibular system. The more ideas, the better!

The Drive-Thru Carwash, What's Not To Like?

My two children love to go through the car wash after I fill up my car tank with gas. What's not to like about the drive-thru car wash anyways? The car gets sprayed with water, soaped up, and "blow dried" before you leave the tunnel. Well, it is quite the sensory rich experience, because the car is moving while all of these noisy machines are coming at you!

Although my typically developing kids think it is fun, I can see why a child with sensory over-responsiveness, poor motor planning (AKA dyspraxia), and/or anxiety would not think it is fun. If lots of noise, sights, movement, and smells tend to be over-whelming to a child, then the car wash is not the place to go for entertainment!

This gets me thinking, how many common daily or week events would be over-whelming to these children. Well, just to name a few: going to the grocery store, taking a bath including washing hair, mealtime (preparation and eating), singing at church, going to the local park, and playing with other children. Then, there's always the events that tend to happen on a monthly or quarterly basis: birthday or holiday parties, haircuts, zoo, and going to the movie theater. How fun would life be, if these things created more anxiety?

Children who over-respond to sensory input to the point where it interferes with functioning in life events, could benefit from occupational therapy services. Children who have difficulties with motor planning and learning new activities or with transitions could often benefit from occupational therapy as well; these kids tend to be clumsy and may need physical therapy, and may also have a speech delay requiring speech therapy.

One thing that is beneficial to do at home for these children is to make routines predictable. This helps them to feel in control because they know the order of events. But we all know that the unexpected can happen, so the best thing to do is be calm and provide calming sensory input (see www.sense-ablebaby.com ). Realize that the child gets upset and reacts the way he does because of the "fight, flight, or fright" response. If attending occupational therapy treatment, ask the therapist for a home program and ideas on how to handle tough situations. This is especially the case if the child has been diagnosed with sensory processing disorder (AKA sensory integration dysfunction).

Well, I'm off to go cook a new recipe- not a predictable experience. And I'm doing this after I attended a sporting event, took my child to a roller rink with her friend, and cleaned up my son's vomit...none of which are predictable experiences! Wow, and it's not even 5 pm yet!

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.

Ambidextrous Versus No Hand Preference

Most children begin to prefer using one hand over the other for skilled activities (e.g. eating meal with a spoon, throwing a ball at a target) by the time they are in preschool (age 3-5 years). Technically, they aren't considered "behind" if they haven't done this even up until the age of 7 years when their brain becomes fully myelinated. Yet, some developmental standardized tests show that it's a skill that should be present at 2 years of age. It helps if the child has chosen a hand dominance by preschool and kindergarten when they are learning to write letters and draw pictures. Since 96% of people are right-handed, chances are you can put the crayon in the child's right hand and be correct about your choice. But definately, don't fight with the child if they start using the left hand, just let them do it. Maybe they can perform an activity such as cutting out shapes by taking turns with each hand. And eventually, one hand will feel "just right" to them, and they will choose a preference.

Not having chosen a hand preference yet should not be confused with being ambidextrous, which is being highly skilled in each hand such as writing just as neatly with either hand, manipulating chop sticks with either hand, or hitting the baseball with the bat in either hand. Often, it may not be known if a child is ambidextrous until middle elementary school years, since preschoolers are just learning to perform fine-motor activities.

So what is dominance confusion? Well, this is when the child isn't that skilled in either hand, and may only use the side of the body that is convenient for that moment. For example, if you placed a spoon to the left side of the child's plate, then he would eat with his left hand...and would probably be messy with it. If you had placed the spoon on the right side of the plate, he would have used the right hand to feed himself. He may not cross over the middle of his body as noted by not transferring items from one hand to the other and only reaching with the hand closest to the item he is about to grasp. This might also accompany other problems since crossing the midline of the body requires that the two sides of the motor hemispheres of the brain "talk" to one another. Often, I see global muscle weakness in these kids and a poor ability to perform 2-handed activities such as holding the paper with one hand while the other writes on/cuts paper or one hand holding Mr. Potato Head's (R) body while the other hand inserts body parts . This is known as poor bilateral (two sides of the body) coordination which is often seen with certain syndromes (e.g. Down), cerebral palsy, sensory processing disorder (AKA sensory integration dysfunction), prematurity, and developmental delay. Anytime you see poor bilateral body coordination, there is a tendency for the child to have a speech and language delay, since the mouth is on both sides of the body. These children might also be clumsy such as with climbing, falling when running, not jumping well, and delayed with learning to ride a bicycle.

If you are wondering if your child is ambidextrous, get a checklist of fine-motor skills a child his/her age should be able to do. Then, have the child perform all of the skills with the right hand, then later do the same with the left hand. If he could do good with both sides, then he may truly be ambidextrous.

Also, remember that a person with a right hand preference could be good at using the left hand for certain things, especially when taught a certain skill with the left hand. For example, I was taught to tie my shoelaces by my left-handed sister, so I do that skill like a left-handed person would do. I have tried to change how I tie shoes, shoot pool, and perform the other numerous skills she helped to teach me, but my brain has already learned those things using the left hand. Now, if I were ambidextrous (which I'm not), I would have been able to generalize those skills to the right hand and make the switch easily. So are you a lefty, righty, or amby?

Head Banging

When a young child bangs his head repeatedly, it can be scary to us parents. My 15 month old son recently went through a stage in which he wanted to bang his head on the stroller and high-chair. I don't think he was doing it for any particular reason; he did it once and seemed to like it, so he kept doing it. I nipped this behavior in the bud by completely reclining the back of the stroller and the high-chair. This meant if he was to throw himself back, nothing was immediately there to bang his head on. He tried it once, and realized it made him lay down. So, he quit trying it.

It is not considered abnormal to head bang, however, many children with special needs bang their head and do so excessively. Some kids do it to the point that you are left wondering how they aren't in excruciating pain. More than one book on raising infants and toddlers reports that up to 10% of typically developing young children head bang in order to fall asleep. This statistic sounds a bit high to me, but maybe it included children in the statistics who were similar to my son where they just tried it for a month or so. Yet, many of the kids I work with are chronic head bangers. I try to put my thinking cap on and help the parents come up with solutions to diminish the head banging. Often, we are successful, but sometimes not. Many of those kids eventually outgrow the behavior when they were ready. Listed below are some tips that have worked for some kids that I have worked with over the years. Consider why the child is head banging:

• Is the child frustrated with a toy or person? If so, help him come up with other ways to appropriately release anger. One idea includes a place to retreat to when he is upset such as a tent. Within this tent provide toys or music that are typically calming and/or fun for him. For some kids, don't place anything in the tent other than a pillow or bean bag because they may need only minimal input.
• Is he upset that you don't understand his wants and needs? If he is completely non-verbal, then PECS, sign-language, augmentative communication devices, or other strategies taught by a speech-language pathologist, ABA therapist, or other special educ. staff may need to be implemented. If he is verbal, but just can't express himself when upset, then give a couple of choices. This makes him feel validated as well as helping him express his wants and needs. The choices can be with words, sign language, gestures, or pictures.
• Is the child just bored? Many kids, especially those with sensory processing disorder (SPD) or an autism spectrum disorder (ASD), need lots of movement opportunities or they get bored. Indoor activities may include: trampoline, tunnel, rocking horse, help clean and do chores, and obstacle course. Outdoor activities include: playground equipment with swings, slides, and climbing structures; swimming, walking/running, bikeriding, wagon rides, and yard work. Even a toddler can "help" dig weeds or water the flowers. Maybe the child is bored because he doesn't know how to play with toys or by himself. Get suggestions from your special education staff (OT, PT, SLP, ABA, developmental teacher, EIS, etc.) on toys and activities that may be easier for the child to learn to play.
• Is the child a sensory seeker and needs that deep input head banging provides? Try lots of "rough housing" (supervised), jumping, and the other activities listed in the previous question-answer. Head massage or vibration may be helpful too.
• Does he have seizures or migraines on a regular basis? Even if he is on medications that doesn't mean these problems are under control. I have had numerous kids over the years head bang, eye poke, & nose poke during, before, or after a seizure. Some kids have mixed types and although they may usually stare off, that may not always be the case.
• Does the child have a visual impairment or functional visual deficit? For children with some vision (low vision) or who see double (diplopia), they may get eye aches and think it feels good to bang their head. In this case, darken the room and minimize the work the eyes must do. If the child is head banging as you are having them work on puzzles or other fine-motor activities, then give frequent breaks or cut the session short. If the child should be wearing glasses, then insist they do. Build up to all day starting with 30 minute increments; but don't skip a whole day or play with toys up close without the child wearing the prescription glasses.
• Is he dependent upon head banging to rock himself to sleep because he has no other strategies? If so, help teach self-reglation and self-calming activities. Some kids suck their thumbs until they fall asleep whereas others hum, sing, or hold a soft toy. For this child, provide lots of motion activities throughout the day which may shorten the length of time the child head bangs in the evening. Some kids do well with compression such as tightly tucked in sheets, large heavy pillows placed around their bed, and tight pajamas.
• If the head banging is so severe that the walls or furniture are getting damaged, then this is excessive force. Consider having the child wear a soft helmet to protect his own head as well as the surfaces he hits. Try using lots of pillows too.
• Is the child head banging for attention or avoidance? If so, behavioral strategies may be needed to stop this behavior. If it is for attention, then quit being the audience and try your best to ignore it. Now, everyone in the family and at school (preschool) must be on board, or the child thinks he just has to head bang harder or longer in order to gain your attention. Try to give attention to him when he is not head banging...save the computer, TV, and phone talking that you do for another time, and give the child lots of positive attention during his waking hours.
• Does the child have a reason to have an itchy head? Lice, eczema, dandruff, scabbs, etc. should be considered. If you do not know what lice or their eggs look like, then search the Web and I'm sure you can find loads of information. Discuss treatment for lice with your child's physician. If eczema is a possibility, then discuss this with your child's physician; the child may need prescription shampoo and lotion for his head.

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.

Bus Rides

My daughter thinks it is just the funnest thing riding the school bus. Yesterday, she glowed so big as she stepped off & as I took a photo! I wanted to know all about her first day at kindergarten, but all she wanted to discuss was how she loved the bus and that she sat next to one of the neighborhood girls. As I watched her "climb aboard" early this morning I stopped to think of how hard it is for some of the kids I work with to get on/off a school bus for preschool or to ride public transportation buses/subways. It takes balance (climbing steps, sitting in seat, and maneuvering between aisles/ seats), ability to wait in line, sensory processing (not getting motion sickness, not being bothered by visual input out of window and within bus, not being bothered by noises or the touch of anothe kid on the seat next to them, discrimination, alertness, self-regulation), sequencing and problem-solving (when to get off of the bus or when to stay seated, timing ( the exact timing to step up and walk or wait for door to close/ open), language (to talk to peers or bus driver), receptive communication (listen to peers, follow verbal instructions given by bus driver or other staff), attention span, & social skills. What a list! But so many of the kids with developmental disabilities such as autism (ASD), cerebral palsy, and other diagnoses have such a hard time in all of these areas! The bus ride is like therapy in which it gives these children opportunities throughout the school year to make progress in all of these areas of development!

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.

Haircuts & Sensory Processing Problems

Today I went for a haircut...it was much needed! You know you need a haircut when you are wearing your hair up everyday because it won't do a thing. Yet, this is exactly why I keep my hair at a medium to medium long length ... if I am running behind or having a bad hair day, I just twist my hair up and secure it with a clip. Today, I was smart. I left the two little ones at home with Daddy. After all, I wanted to enjoy every moment of the haircut. I love the smell of the shampoo and conditioner rinses that are used at the salon I go to. I thoroughly enjoy my hair being washed by someone else and my scalp being massaged...relaxing! Then, I enjoy for the stylist to "fix" my hair! Sometimes, oddly enough, I enjoy the gossip and conversations I over hear as I am getting my hair done. Not because I am a gossiper, but because I just find other people's situations interesting.

This whole process gets me thinking of the young children I work with who have sensory processing problems and how they must really dread haircuts. Some of the kids I work with are sensitive to touch, noise, and smells....this would not exactly make for a fun outing when going to a hair salon. Some of the moms of these children have told me that a few of their tricks for making haircuts tolerable are:

• Go to the salon at a less busy time when there is less noise and commotion
• Go to the salon on a Tuesday earlier in the morning when the smell is less pungent or "loud". Most salons are closed on Sundays and Mondays, so by Tuesdays alot of the shampoo, hairspray, and hair dye smells have lessened
• For the very first visit to a hair salon or for a visit that has had a long lapse in time, have the child visit a day or two before the hair appointment. This helps the child to get familiar with the person and surroundings including the large mirrors, chair up off of the ground, etc.
• For the child who has touch (tactile) sensitivity, make sure the stylist knows to apply firmer pressure to the head as she is cutting. Bring a favorite blanket or towel to wrap around the child's shoulders instead of the plastic cover up typically used.
• For the child with an auditory sensitivity, maybe a pair of scissors that make less noise could be chosen. Another idea is at home, let the child hear the sound of snipping scissors near his/her ears so that at the salon it is less scary.
• For the child with anxiety due to sensitivities, poor discrimination, or poor motor planning, then consider making a social story. A social story is an individualized story about a particular situation. In this case, staple 3-4 pieces of typing paper together after folding the paper in half. Then, on each page list out what will happen at the salon. Keep the story positive such as saying "NAME gets to sit in the special chair while she gets a haircut" but don't say "NAME doesn't stand in the chair and jump off". Read the story every night for a few days or longer, before going to the hair cut appointment. This way the predictability about what will occur should lessen some of the anxiety. When children are less anxious, then the sensory sensitivities may not be as extreme.
• For the child with poor balance or fear of heights, then consider getting a stool under the child's feet so he/she can feel more posturally secure. If necessary, have the haircut take place in a child's chair from the lobby as opposed to the taller adult chair. For these children, it is not recommended to tilt their heads back much when getting the hair washed.
• Consider washing the child's hair at home before the haircut (that day or day before) so that the child only has minimal things done to his/her head at the salon
• If you are lucky enough to live in a larger town, consider going to a hair salon that specializes in children. Some of these facilities even have "racing car" chairs to sit in to make the haircut more playful and fun
• At the end of the visit, make sure the child is rewarded whether it be with a sticker, hug, verbal compliment, or special toy

Preventing the Toddler From Taking Off His Diaper & Playing with Its Contents

One question I get asked alot is "How can I prevent my toddler from taking off his diaper during his nap or when I am not looking?" and some even proceed to tell me that their little one smears the poop or picks apart the diaper. This is especially the case with a child with a global developmental delay, autism spectrum disorder (ASD), or sensory processing disorder (SPD).



Some of my tips include:

• Have the child help clean up the mess. This grosses some kids out, however others think it is fun. So in the later case, helping to clean up would be a reward
• I don't recommend the duct tape idea that many try. I have seen children's skin react to the adhesive. Remember that body heat makes adhesive stick to the skin more so if the diaper scoots around and the adhesive is on the skin, this could be bad. One child I know of even had the skin tore off...ouch!
• My most common suggestion is to put the child in footed pajamas with a zipper, but put them on backwards. If you live in a hotter area like I do, then it is a good idea to cut off the feet to the pajamas. I do not have the shoulder range of motion to undo a zipper that goes from my neck to my buttocks, so I doubt that any toddler does either. Yet, if the pajamas are too large on the child, he could wiggle it around, so make sure the pajamas are a little tighter in the bodice and neck.
• Depending upon the child's cognition level, use rewards after each nap that he left his diaper on or didn't smear the poop
• If the child has touch sensitivity and the awareness of his bowel movements, it may be time to start potty training and he is just giving of readiness signals. I had one mom even put a potty in the child's bedroom so that he would use it when she wasn't around (like at nap or night) and choose not to play with the diaper or pull up
• Some children still find away to pull off the diaper and play with its contents, in this case behavioral strategies and techniques such as those suggested by a psychologist or applied behavior analyst (ABA) may be necessary

Self-Stimming

Do you twirl your hair, tap your fingers on the table, or bite your fingernails? If you do, then you partake in self-stimming (AKA self-stimulating behavior). Many children with developmental delays, poor sensory processing, autism spectrum disorders (ASD), visual impairments, or mental retardation "self-stim", too. It is when a person perseverates on a particular behavior repetitively. They are sometimes odd behaviors, but not always. Many children with special needs do these types of behavior when they are bored, over-whelmed, upset, sensory seeking, unable to motor plan how to do an activity, or just do the self-stimming just to do it. Many children will become upset if you try to stop them from doing the behavior. Some children self-stim so excessively it is obsessive-compulsiove.



The following are some common self-stimulating behaviors:

• flicking fingers or waving hands in front of their face


• spinning toys continuously


• watching ceiling fan


• staring at lights


• staring at lines on the wall, floor tile, or within the furniture (e.g. legs of table)


• shredding paper


• pacing


• rocking


• spinning or swinging


• head banging


• teeth grinding


• playing with spit or fingernails


• acting out a movie scene or telling the same story repeatedly


• repetition of odd noises including throat sounds


• pinching or scratching self

A few ideas on how to stop or reduce the self-stimming behavior are:

1. If the child is self-stimming because he is bored or a sensory seeker, then provide activities that provide sensory input such as jumping on a trampoline, rocking horse, ride-on toy, tunnel, finger paint, play-dough, musical toys or instruments, etc. Also, make sure to leave toys setting out in baskets or containers that are visible, because some kids won't play with toys that are stored away in closets or drawers.


2. If the child is self-stimming because he is over-whelmed or upset, then figure out what could reduce his overloaded feeling. When he is upset because he can't express his needs or wants, then get ideas from his/her speech therapist. Also see the previous post this month on this blog on helping a child to talk if he is delayed in communication skills. If the child is upset because he is hungry or has another basic need, then help the child with it. If he is upset because he "Can't get his way", then hopefully working on behavior managment along with offering other things to do and play will help.


3. If the child is self-stimming because he is unsure of what to do or unable to motor plan well, then help him with doing something else or redirect it. For example, if a child with limited play skills perseverates on jumping, then jump next to him and say "You must want to be a frog, ribbit, ribbit" and encourage him to imitate a frog. Then, after a few minutes change animals and see if he can imitate you. Doing this helps with the motor planning problem by showing him what else can be done.


4. Some kids with limited play skills will only play with toys in simple ways. For example, mabye the child will only build blocks into a tower and become upset if asked to build a different structure. This can be slowly redirected such as to build a train next to his tower, and push the block train with "choo-choo" sounds. He may not build a train that day, but maybe will the next time you try this. Do not feed into the child's limited patterns of play! This is not helping his development in terms of cognition, social-emotional, language, or fine-motor skills. Teach him how to plan in other ways.


5. You can also redirect self-stimming by providing a distraction.


6. Be aware that some children will begin the self-stimming behavior as soon as you walk away. Others may stop the behavior you redirected but then gain a different self-stimming behavior; if that is the case, consider that the child needs more sensory input (AKA sensory diet) and is doing the self-stimming because he is a sensory seeker.

Often redirecting self-stimming or helping the child to play with toys in a new way requires a lot of thinking outside of the box and getting down on the floor to play with the child, such as with the DIR / floortime approach.