Sensory Integration Dysfunction: Whats a Family to Do

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Sensory Integration Dysfunction Whats a Family
to Do?

• Home ideas for students with difficulties with
  sensory processing
• Elisa Wern OTR/L
• Tools for Success February 1, 2003

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Back to Basics What is Sensory Integration or
SI????

• the term SI refers to Sensory Integration, which
  is a normal brain process
• Basically SI is the ability for our body to take
  in information from the world and turn it into
  usable information, helping to orient us, keep us
  attentive, and able to move and be in the world.
• dysfunction in sensory integration is used to
  refer to a child with a problem in the normal
  process of sensory integration, we call that
  Dysfunction in Sensory Integration, or DSI. (Dr.
  Lucy Miller)

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What are some signs of Sensory Integrative
Dysfunction? 

• overly sensitive to touch, movement, sights, or
  sounds
• under-reactive to touch, movement, sights, or
  sounds
• easily distracted
• social and/or emotional problems
• activity level that is unusually high or
  unusually low
• physical clumsiness or apparent carelessness

• impulsive, lacking in self control
• difficulty making transitions from one situation
  to another
• inability to unwind or calm self
• poor self concept
• delays in speech, language, or motor skills
• delays in academic achievement

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SENSORY INPUT
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The Continuum of Processing/Responses to Sensory
Info
Typical
HYPO
Hyper

• In each sensory system, a child may be
  under-responsive hyposensitive or
  over-responsive hypersensitive to input.
• When a person is hyposensitive to input, they
  often need extra input within that sensory system
  to maintain a regulated, calm attention level.
• They may not attend to sensory information
  presented to them, or they may seek out
  additional information.
• When a person is hypersensitive to certain
  sensory information, that input can be perceived
  as painful or uncomfortable.
• They may respond by avoiding or withdrawing or
  become anxious, distressed, or even aggressive.
• Persons who may have unregulated sensory systems
  may also experience difficulties with motor
  planning, postural control, social/ emotional
  functioning, body awareness and scheme, and
  academic skills.

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When are sensory integration problems actually
considered a dysfunction? Doesnt everyone
experience problems at one time or another?

• Yes we all experience problems in processing
  sensory stimuli on occasion.
• Examples
• going to a rock concert with crowds of people can
  be so overwhelming that you have to leave before
  it is over.
• Riding a roller coaster and feeling sick or
  wobbly when you get off means you were probably
  overloaded with vestibular stimuli.
• Being overly sensitive to smells when you are ill
  is another example.
• An occasional experience of disorganized
  sensations is very normal.
• It becomes a dysfunction when the sensations are
  disorganized so much and so often that it
  interferes with activities of daily living.

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Bubble Gum/Tootsie Roll Break
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So what do I do?

• If you think your child may have difficulty
  processing sensory information
• Talk to your childs teacher to see what they are
  seeing
• Try to incorporate activities at home and school
  with assistance of teacher to help your child
  better use and benefit from the information
  he/she takes in by senses

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What Activities do I do?

• Well, that depends on your child
• Remember - There are two very broad categories of
  how children process informationthe hypo- and
  hyper-responses...
• However, each child could be at different ends of
  the continuum for each type of sensory
  information

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So you have to be a detective?!?!

• Investigate your child - when do you see some of
  these behaviors?
• When you do see them - what are they doing?
• Do they avoid an activity most children enjoy?
• Are they overly excited or do you notice they are
  always on the go or involved in particular
  activities?

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Typical
HYPO
Hyper
Look at responses for each area
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Why encourage sensory-based activities at home?

• Children with sensory processing problems can
  benefit from appropriate sensory experiences
  within play or daily activities.
• Most of the following suggestions provide either
  movement, muscle resistance/ "heavy work" or deep
  pressure to the skin and can help reduce touch
  and movement sensitivity, and improve body
  awareness and coordination.
• "Sensory seekers" are very active children who
  are always on the go with a short attention span.
  They typically respond positively to increased
  sensory input in repetitive activities, which
  work muscles- this helps children focus their
  attention and coordinate their actions
• Children who overreact to input may be very
  sensitive or distressed by certain sensory inputs
  (every day sounds like vacuums or blenders, being
  touched lightly, tickling) but find others
  enjoyable and calming (bear hugs, sleeping under
  heavy quilts, massage).

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General guidelines for organizing home
activities for children with sensory processing
disorders

• Keep routines/possessions in the home organized
  and structured as much as possible.
  Predictability and a daily routine can be very
  helpful.
• Be consistent with daily rules and consequences.
  Perhaps all family members can discuss house
  rules, determining appropriate behavior and
  routines (and consequences when they are not met)
  in advance. These can be posted if necessary.

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• Keep a large calendar or schedule posted. The
  calendar can be made with "event" stickers or
  photos for a child not yet reading. The system
  used should highlight the daily and weekly
  routine and allow a visual representation of the
  childs day. In that way, the child can be
  alerted to changes in advance. Perhaps the child
  can go over the schedule for the following day
  each evening before bed.

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• Create specific routines for difficult times of
  the day or responsibilities (e.g., bedtime, bath
  time, morning self care before school). The
  routine can be broken into small steps and these
  can be posted in a checklist form or picture form
  for the child to look at each time the routine is
  performed. If the child is old enough, the
  checklist might help him/her be independent in
  the routine.

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• Make errands and transitions concrete and
  illustrate with pictures, when possible. For
  children who need extreme predictability and
  routine - make a photo book of places you go with
  your child, and keep it in the car, so that when
  a daily schedule is disrupted, you can show the
  child "This is where we have to stop today before
  we go to.." This may help with distress levels
  when the normal schedule is not being followed.

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Choosing Activities
How does your Child Respond?

• Children can have different responses to
  different sensory input - which can make choosing
  what activities to do with your child difficult!

Response
AVOIDER
SEEKER
PROVIDE INPUT IN APPROPRIATE WAYS
EXPOSE TO ACTIVITIES OVER TIME WITH SUPPORT
ENCOURAGEMENT
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Children Who Need Sensory Input to Stay on
Task(HYPO) SEEKERS

• Some children are "sensory seekers" and become
  more organized and attend better to a task if
  they receive periodic movement input, such as  
  
• Sit on a camping/inflatable pillow filled with a
  small amount of air. This allows for movement
  while doing seat work without leaving the desk.
  There are companies that sell wiggle seats, but
  any partially deflated pillow will produce the
  same effect, for less money!
• Suggest 5 minutes of swinging or climbing during
  outside play time before having to concentrate on
  a task such as homework.
• Rhythmical, sustained movement e.g., marching,
  washing windows/tables or bouncing can be
  organizing to the central nervous system.
• Never discipline a "sensory seeker" by taking
  away free play outside at home or P.E. at school
  - you will intensify the random movements,
  fidgeting and outbursts if they are not able to
  get the info they seek and need.

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• Some children also need extra sensory input to
  their mouths (ORAL) and hands (TACTILE) in order
  to organize their behavior, such as
• Drinking from water bottles kept at desk (send
  them home weekly to be washed).
• Chewing on rubber tubing placed on the end of a
  pencil, straw or coffee stir stick. 
• A bucket or fanny pack of "squeezies" in can be
  used by children who like to fiddle with
  something in their hand. A "squeezie" is a small
  object which is soft and can fit in the hand
  e.g., balloons filled with flour, soft balls,
  "dog" toys or koosh balls. 
• Like we have --- You can inexpensively make a
  fidget toy with sand or flour and balloons.

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• Hanging by the arms on the monkey bars for 20-30
  seconds at a time.
• Pushing/carrying heavy objects i.e., books,
  moving desks or "pushing" against walls.
• A reading corner in the childs room with a bean
  bag chair makes a wonderful place to escape from
  too much stimulation and help get ready for more
  focused homework. They might enjoy reading or
  sitting under the bean bag chair more than
  sitting on it.     REMEMBER Some children
  need to move in order to pay attention. Watching
  children can provide cues to choosing activities
  to provide appropriate sensory for organizing
  behavior and improve attention. 

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Children Who are Oversensitive to Sensory Input -
(Hyper) AVOIDERS

• Children who are sensitive to light, unexpected
  sensory input often prefer firm
  touch/pressure/input which helps organize their
  behavior. Keep the following tips in mind
• Approach the child from the front to give a
  visual cue that light touch is coming. 
• Firm pressure to the shoulder or back is
  preferable to a gentle hand placement or a brush
  to the sleeve, arm or face.

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• When working on home work area should be out of
  traffic towards the periphery/sides of the room
  so that the child has a good view of whos moving
  and where they are going. 
• Crowded places and situations can cause
  discomfort because of the possibility for
  unexpected bumps and brushes. Seat a small child
  in the adults lap or next to a quiet child
  during a group gathering. Place older children to
  the side or in back of the group.

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The Alert Program

• The Alert Program teaches strategies for self
  regulation/processing to improve functional
  skills for learning.
• The Alert Program uses the analogy of engine
  speeds to make it easier for children to
  understand.

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How Do We Get to the Just RightEngine Speed?

• Sensory-motor Strategies
• Heavy Work
• Proprioceptive input from the muscles and
  joints
• Can have both a calming and alerting influence
• Can be used when engines are in high or low
  speeds

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Put Something in the Mouth

• Many common strategies used to regulate alert
  state involve the mouth.
• Both children and adults use the mouth to change
  state.
• Foods that are alerting tend to be cold,
  sour/tart, spicy, minty, or crunchy.
• Foods that are calming tend to be warm, smooth or
  sweet.
• There are also foods that provide heavy work to
  the jaw and cheek muscles.

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MOVE

• Gross motor movements are those that hold the
  body up against gravity and allow children to
  move.
• These activities usually use large muscle groups.
• Movement can be used to improve attending/alert
  state.
• Try moving before you need to concentrate.

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TOUCH

• Tactile input can be alerting or calming.
• Light touch can be alerting. Deep pressure touch
  can be calming.
• Many of us may rely on having something in the
  hand for self-regulation.

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LOOK

• Visual input in the environment significantly
  affects our ability to attain, maintain and
  change our levels of alertness.
• Dim lighting, muted colors, and plain walls can
  be calming.
• Bright lighting, lots of color, and variety tends
  to be alerting.

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LISTEN

• Sounds that are most alerting are ones that are
  arrhythmical, of short duration, loud, or novel.
• Sounds that are calming (easiest on the nervous
  system) tend to be rhythmical (in a predictable
  pattern), of long duration, quiet, and familiar.
• White noise is a type of sound that provides a
  filter for the listener.

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Incorporating sensory input in specific home
routines

• Bath time scrub with washcloth or bath brush,
  use a variety of soaps and lotions for bathing
  play on the wall with shaving cream or silly
  soap rub body parts with lotion after bath (deep
  pressure like a massage) or sprinkle powder onto
  body parts and either rub or brush into the skin.
  

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• Meal preparation or baking let your child help
  with mixing ingredients, especially if they are
  thick since this will work arm and hand muscles.
  If baking, let child help mix and roll dough and
  push it flat, if needed. Allow child to help
  carry pots of cold water for the stovetop (with
  supervision of course). If needed, have child
  help tenderize meat by pounding with a meat
  mallet.

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• Grocery shopping have child push the shopping
  cart, carry groceries and help put them away. 
• Mealtime encourage child to drink from a straw
  and provide lots of very chewy and resistive
  foods, if they are tolerated. If you have trouble
  keeping your child seated because she likes to
  jump up for stimulation, try an air-filled seat
  cushion, which will allow motion within the seat.
  Perhaps using a weighted lap blanket will help
  the child remain seated at the table longer.

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• Around the house let the child help vacuum, and
  also help move furniture before and after
  vacuuming. Read books together in a rocking
  chair. Provide a quiet place for the child who
  gets too wound up. This place should be used as a
  "decompression" spot (not as a punishment). When
  you see the child getting a little excited you
  can say"you know, it looks like you could use a
  quiet place now, you seem a little excited." The
  place should be quiet, comfortable, soft, and
  dim.

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• Bedtime if your child has trouble sleeping you
  can try adjusting the linens to add weight and
  texture. Sometimes adding lambs wool or something
  soft allows for deeper uninterrupted sleep. Also,
  heavier blankets and quilts (even if it seems too
  hot) may help. You can also try different fabrics
  for the sheets and pillowcases (cotton jersey for
  example)

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Miscellaneous Home Ideas

• Play the "sandwich" game using couch or bed
  pillows. Sandwich your child between two pillows
  and squish them. Apply pressure to their command
  (ask harder or softer). Some children like a lot
  more pressure then we think they would.
• Make up obstacle courses around the house using
  furniture, toys and other objects to reinforce
  sequencing body movements. Have the child do as
  many steps as they are able to remember and
  complete. You can use crawling, hopping,
  skipping, climbing, rolling, and a variety of
  other movements depending on how much space you
  have available. 

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TACTILE EXPERIENCES

• Making mudpies and sandcakes
• Drawing with wet or dry chalk
• Painting sidewalks and fences with water
• Handling and pedaling tricycles
• Walking barefoot
• Planting in the garden
• Playing in the sink or bathtub
• Building with blocks
• Manipulating small objects such as Legos,
  dominoes and jigsaw puzzles
• Using classroom tools, such as crayons, scissors,
  and brushes
• Examining natural objects, such as pine-cones,
  feathers, sticks, and rocks
• Lying on pillows or beanbag cushions
• Curling up in "secret hideaways"

• Petting and feeding animals
• Finger-painting with paint, shaving cream, or
  chocolate pudding
• Gluing art projects
• Manipulating play dough
• Washing hands with soap and drying hands with
  towels
• Stirring cookie dough
• Eating snacks with different textures, such as
  cheese, pretzels, and fruit
• Handling rhythm instruments
• Playing Dress up
• Hugging and roughhousing gently with
  friends/family

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More Tactile Experiences

• games of "find the buried toy in the shoebox full
  of dry macaroni noodles (or Slime)",
• "draw/write with your fingers in the whipped
  cream (or shaving cream) on the mirror",
  playdough, and similar activities.
• You can let your child play with a vibrating
  massager, or you can give him a massage with it.
• Create critters with gum drops (they're sticky)
  and toothpicks. You can eat them when you're
  done!

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VESTIBULAR EXPERIENCES

• Swinging in circles on a tire swing
• Riding on a playground merry-go-round
• Swinging back and forth
• Riding up and down, walking, and balancing on a
  seesaw
• Jumping on a trampoline or mattress
• Jumping from a step or from the playground
  equipment
• Climbing a jungle gym
• Sliding down a slide

• Ascending and descending stairs
• Rolling and sledding down the hill
• Somersaulting
• Running
• Walking on uneven surfaces, such as grass or sand
  
• Walking on a balance beam, railroad tie, or low
  wall
• Let your child rock in a chair or spin him around
  while holding him tightly
• Get a hammock chair and hang it from the swing
  set for a deep pressure swing.

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Oral Processing Experiences

• Any candy that is resistive or tough to chew -
  for example tootsie rolls or gummy bears
• some children respond well to an electric
  toothbrush when doing their morning/night routine
  - for children who are very defensive - this is
  something which must be done with great caution

• You may want to get one of those lollipops that
  twirl around. They have a handle with a battery
  that makes it spin. It provides good oral input,
  and you can find them at the checkout area of
  department stores like Wal-Mart.

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Other Good Oral Input Sources
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PROPRIOCEPTIVE EXPERIENCES

• Pushing and pulling wagons
• Moving through an obstacle course
• Playing "bumpety-bump" on the tire swing
• Hanging from monkey bars
• Stretching up to the sky, like growing plants
• Playing horsey
• Wheelbarrow walking
• Pouring sand, beans, water, or juice from one
  container to another
• Ripping paper

• Hammering nails into Styrofoam
• Pressing pegs into pegboards
• Getting in and out of seat belts, jackets and
  boots, shoes and socks
• Opening doors without help
• Tumbling on the ground
• Wrestle.
• Make a kid sandwich out of your child. He can be
  the meat. Two cushions can be the bread.
• Encourage the heavy pet dog to sleep and play
  with your child.
• Monkey bars and swinging from a trapeze or rings
  provide pressure to the joints.

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Resources for Parents

• Heavy work list for parents (Deanna Sava and
  Elizabeth Haber both OTs) - FOR ALL THOSE
  SEEKERS OUT THERE!
• Internet sites listing email sign up or I can
  mail it to you if you dont have access to email!
  
• The Out of Sync Child by Carol Stock Kranowitz
• ISBN 0399523863
• There is also a new companion book out with many
  more activities - The Out of Sync Child Has Fun
  also by Carol Stock Kranowitz
• ISBN 0399528431
• Take Five! Staying Alert at Home and School, by
  Mary Sue Williams and Sherry Shellenberger ISBN
  0964304112

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How to find OTs in the School System

• Call your childs school and leave a message for
  the OT who covers that school.
• If you have general questions or are searching
  for a resource in a particular area feel free to
  email me at Elisa_at_alumni.ufl.edu and I will try
  my best to help connect you to resources or other
  assistance...

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ANY QUESTIONS?????????
Have a great time playing with your child - and
helping him or her to better use his sensory
system both at home and at school...
Hopefully you have gained some new understanding
of what sensory processing is, how to determine
your childs sensory needs - and strategies and
activities to use with your child - remember you
are a key to your childs success - be a
detective and then HAVE FUN!