Sensory Processing
Let's Put the Pieces Together
Presented by: Heidi McLarty, OT Reg. (Ont.).
Defining Terms..
• Parents often hear many different terms and
names for things, which can be overwhelming
• Autism/PDD/ASD
• Self Regulation
• Sensory Integration
• Sensory Problems
• Sensory Seeking/Avoiding
• Hypo or Hyper Responsive
• Vestibular System/Proprioceptive Systems
• Our Senses are like the
foundation of building our
house
• We all have sensory
systems made up of our
senses. The process of
how we make sense of it
is called Sensory
Integration.
*Visual is from Yack, E., Sutton, S. &
Aquilla, P. (1998). Building Bridges through
Sensory Integration.
Far Senses
• Vision (Seeing)
• Auditory (Hearing)
• Olfaction (Smell)
• Taste
• Touch
*Visual is from Kranowitz, C.S.,
(2005) the Out of Sync Child:
Recognizing and Coping with
Sensory Processing Disorder
Near Senses
• Vestibular (Balance)
• Tactile (Touch)
• Proprioception
(Muscles, joint
receptors, etc.)
*Visual is from Kranowitz, C.S.,
(2005) the Out of Sync Child:
Recognizing and Coping with
Sensory Processing Disorder
Picture from: Wilbarger, Patricia. (2006). Sensory Defensiveness: A comprehensive Treatment
Approach. Conference manual, Toronto, ON.
What is Sensory Processing or
Sensory Integration?
• We received messages from all of our senses
and respond to this info
• Examples: Reading a book at home
– Not noticing noises going on around us
– Not being bothered by the feeling of the chair under
us
– Not having to think about how to keep ourselves
balanced
– Adjusting the temperature if we are cold, getting a
blanket, etc.
What is Sensory Processing or
Sensory Integration?
• We are able to make an “adaptive
response” and keep our teeter totter (our
body) balanced or “regulated”
• For many kids this is very hard to do!
Optimal Arousal
Picture from: Wilbarger, Patricia. (2006). Sensory Defensiveness: A comprehensive Treatment Approach. Conference
manual, Toronto, ON.
Defining
• Problems with sensory processing can be
present in children and adults of all ages
with no other identified difficulties
• Problems with sensory processing is very
Common for those diagnosed on the
Autism Spectrum, but not always
Sensory Integration – The Process
• Sensory Registration: “Hey what’s that?”
*Awareness of input > Threshold reached
• Can be Hyper or Over Responsive to an
input in any of the senses OR…
• Can be Hypo or Under Responsive to an
input in any of the senses
• Every child is different
• Behaviours and meltdowns may not have
a “set pattern” and can be very confusing
Sensory Integration – The Process
• Orientation: Pay attention to input > filter
out what’s important info
• Over Responders > respond to too much,
view things are threatening, very rigid in
routines/behaviours, often over reacts
• Under Responders > need more input to
respond, may not seem to pay attention,
or does not respond at all
Sensory Integration – The Process
• Interpretation: Is this important? Threatening?
*Flight, fright or fight
• Over Responders > may be quick to avoid input
because of previous negative experiences, not
receptive to trying new things, etc.
• Under Responders > will likely not learn from
experiences because input wasn’t registered >
hot stove example *Big safety issues!
Sensory Integration – The Process
• Organizing of a Response: How to
respond? Physical, emotional or cognitive
• Over Responders > will likely respond in
physical and emotional ways, not able to
rationalize an “appropriate response”
• Under Responders > may not respond at
all because not aware of the input (no
response to scrapped knee) or may not
know how to respond
Sensory Integration – The Process
• Executing of a Response: Depends on
ability to motor plan a response.
• The process begins again in a loop
fashion
Sensory Processing Disorder
(SPD)
• This is a term to mean that there are
difficulties with processing sensory input
which affects functioning in day to day life
• Sensory signals do not get organized like
they should > there is a “traffic jam” in the
body!
*Visual is from Kranowitz, C.S., (2005) the Out of Sync Child: Recognizing and Coping with Sensory
Processing Disorder
Picture from: Wilbarger, Patricia. (2006). Sensory Defensiveness: A comprehensive Treatment
Approach. Conference manual, Toronto, ON.
Arousal Levels
• The “Balanced teeter totter”
• Stacking phenomenon and variability from
day to day > puzzling
• Meltdowns and causes
Every Child is Different!
• What may be organizing for one child, may
be VERY disorganizing for another! Be
careful. This is not a “cookie cutter”
approach.
• Put on your sensory hats and think more
about the situation and what the
underlying potential contributors to the
behaviour you are seeing.
Is it Sensory OR is it Behaviour?
• Difference between typical behaviour
management and helping with sensory
based needs has to do with filling the
sensory need versus just getting rid of the
behaviour
• Every behaviour has a purpose and root
from something else
Is it Sensory OR is it Behaviour?
• Antecedent: John and
Sally are playing in
the sandbox
• Behaviour: John hits
Sally
• Consequence: John
gets the toy Sally was
playing with
• Antecedent: John and
Sally are playing in
the sandbox. Sally
brushes up against
John
• Behaviour: John hits
Sally
• Consequence: Sally
leaves the sandbox
and John plays alone
Behaviours
• Tangible rewards: To have a want or need
met
• Attention: Positive or negative
• Escape: To avoid a demand OR for
**protection > Fight or flight behaviours
• It feels good > more sensory based
*Think about a challenging activity or
behaviour and what strategies you use.
Occupational Therapist’s Role
• Empower you to be sensory investigators
• Figure out more about your child’s sensory
based needs
• Suggest regular, daily activities to attempt
to help keep your child regulated
• Work on helping the child to increase their
self awareness and adaptive response to
input
Big Concerns
• Lack of pain awareness > child does not
develop appropriate awareness of safety
• Self injury behaviours
• Frequent meltdowns
Strategies to Help
• What your child likes and what strategies
work best for your child is a puzzle to
figure out
• What is regulating for one child may be
very disorganizing for another!
Calming Power Tools
• Think about your own calming activities. What
helps you to wind down after a long day?
• Think about your own alerting activities and how
you help to wake yourself up when you feel tired.
• Think about things that are disorganizing to you?
Things that make you feel “frazzled” or make
you mad. How do you calm down after these
times?
Calming Power Tools
• What are some calming activities you use
with your child?
• What are some alerting activities you
engage in with your child?
• What disorganizes your child?
Calming Power Tools
Different ways to approach calming input.
We can:
– Engage in activities with your child
– Adapt the environment
– Teach your child self regulation concepts >
“Engine speed visual, cues”, social story
about what to do when their engine is high or
low (This may take a long time to try to attain
this level of self awareness and doesn’t
always develop)
Typical Signs of Overload
• Holding their breath > may help to “shut
off” pain receptors (why we hold our
breath when we are expecting to get a
needle)
• Tightened muscles in the body > look
tense
• Dilated pupils
Calming Activities: Engaging
your Child
• Including regular calming times during the
day may be helpful to keep their “teeter
totter” balanced
• Calming input may do a lot to “prevent”
meltdowns and overload from sensory
input
• Calming strategies will likely be useful to
pass on as hints to others about how to
support your child’s optimal functioning
Calming Activities: Engaging
your Child
• When do we need calming?
Example 1: Your child had so much fun at
the park, swinging for half an hour, going
down the slide and spinning on the merry
go round. It’s time to go and your child has
a HUGE meltdown and can’t calm down.
You find them hard to calm for the next
couple of hours. What to do?
Calming Activities: Engaging
your Child
Example 2: You are at the Early Years
centre with your child and all of a sudden the
fire drill goes off. Your child shows a huge
startle reaction and starts to cry
uncontrollably. Her breathing is very fast and
she can’t seem to catch her breath. What to
do?
Calming Activities: Engaging
your Child
• It may take some time for the child to “get
used to” being in a calm/regulated state of
arousal because they may be used to their
norm of being on the edge of overload
much of the time > narrow band of arousal
• We need to give them the experiences to
feel calm and safe > want to expand their
band of arousal
Calming Activities: Engaging
your Child
• Breathing is one of the “power regulators” and
helps our body get back to a calm state > for
example during yoga for relaxation
• Breathing is important in our ability to pay
attention because oxygen is delivered to our
brain.
• A lot of children do not breathe deeply enough to
get a lot of oxygen (possibly due to posture,
anxiety, etc.)
Calming Activities: Engaging
your Child
• Some breathing activity ideas:
– Playing games with straws such as blowing
feathers, pom poms, and ping pong balls.
*Cutting the straws in half may make it easier
for your child to blow and point at a target.
– Using straws to blow ping pong balls or other
items in the bath
– Using rubber tubing or long straws to blow
bubbles in the bath
– Blowing pinwheels
Calming Activities: Engaging
your Child
• The Mouth is a power regulator too! This is why
we see kids like bottles and soothers and
chewing/sucking on things
• Sucking input gives strong deep pressure input
to the mouth and brain
• Children are often discouraged from chewing
and sucking on things past a certain age > we
need to be check out if this is helping the child to
calm. To take that away may lead to meltdowns!
Let’s think of age appropriate examples to try to
provide this same sucking input.
Calming Activities: Engaging
your Child
• Sucking Activities:
– Using short straws to eat snacks such as
pudding, yoghurt, apple sauce, etc.
– Sucking/chewing on special “chewalery” or
special pendant around the neck
– Sucking on the end of a pen or rubber end
– Sucking on a piece of rubber tubing
– Sucking on a piece of fruit before eating it
Calming Activities: Engaging
your Child
• Sometimes children suck on things for other
reasons > to explore and learn through their
mouth.
• Their mouth may be more sensitive than their
hand or their mouth may be under sensitive so
they are seeking more input.
• Sometimes children put lots of non edible food
items in their mouthes or eat these things >
Pica. Could be sensory seeking behaviour or a
sign that their diet is deficient in some nutrients
*Would warrant further medical investigation
Calming Activities: Engaging
your Child
• Deep pressure massage is often very calming.
Also special program with a surgical brush >
therapressure program
• Weighted items provide this deep pressure >
blankets, lap pads, vests, snakes, etc.
• Creating a “womb like” space to retreat to is
often helpful
• Slow linear rocking in a rocking chair
• Lowering your voice
• Using a drum with rhythm may help with calming
Calming Power Tools –
Environmental Considerations
• Considering the environment is often
VERY helpful. We can possibly make
some changes that will help the child a lot
with staying calm. Things to consider:
– Lighting > fluorescent lighting is “annoying” to
the body, especially if there is also flickering!
• Dim the lights, use flame resistant light covers to
deflect lights, get rid of fluorescent lights, provide
lamps as lighting, use natural light
Calming Power Tools –
Environmental Considerations
– Visual distractions > lots of stuff on the walls,
on shelves, etc. is actually telling the body to
pay attention and register all the stuff.
• Try covering bookshelves with a solid sheet to limit
distractions, clean up clutter if possible, organize
things into special bins for intended purpose > that
way you can take out limited things at a time and
teach child to clean up before taking out another
bin.
• Painting rooms “cool” colours such as blue or
green. (Bright colours can be alerting)
Calming Power Tools –
Environmental Considerations
– Noise > Lots of noise in your home,
community, etc. We are multi-taskers by
nature!
• Turn off the TV/music, etc.
• Try soothing sounds like a table fountain,
methodical ticking sound, a rain stick, nature
sounds CD, etc.
• Try out regulating music with regulating beat
(examples shown) > drumming Music
• Try out noise cancelling headphones, an ipod with
favorite music, or earphones
Calming Power Tools – Self
Awareness
• “Engine speed” Concept to refer to in activities to
aim to increase self awareness
• Adult points out when the child’s engine is
running fast, slow or just right and cues them
about what they can do to get back to just right
or stay at just right
• Hopefully, but not always, progresses to the
child developing that self awareness and ability
to cope and think of ways to keep their engines
at just right
Calming Power Tools – Self
Awareness
• A child may not be aware that they are always bouncing
and moving, try to be constructive with them to give them
more ideas of things they can do to move > you can help
them to “change it up” and not be so repetitive about the
movement they are doing. They are doing the movement
because it feels good or fills a sensory need they have.
• Please try to educate others about your child’s sensory
needs > they shouldn’t begin to feel bad about fufilling
these sensory needs. We eat when we’re hungry, the
child may move when s/he feels the urge!
Calming Power Tools –
A Sensory Diet
• A sensory diet consists of regularly planned
sensory based activities within the context of
natural activities or routines.
• Aims to keep your child regulated/ orgranized
throughout the day.
• Created usually with the help of an occupational
therapist trained in Sensory Integration therapy.
• Created based on the sensory profile you filled
out, based on the child’s needs.
Calming Power Tools –
A Sensory Diet
• Activities you can incorporate on your own:
– “Heavy work” activities > include any activities that
involve the muscles pushing, pulling, carrying,
crawling, etc. where the muscles have some sort of
resistance *See handout for more details > these
activities are calming to the body!
– Touch experiences in play
– Playing at the park on the swings (not overdoing the
swinging)
– Swimming
Calming Power Tools –
A Sensory Diet
• A Sensory diet should be “balanced” and have
combination of calming, organizing and alerting
activities included
• Calming > as we discussed
• Alerting > Activities that “wake the body up”
Highly dependent on the child’s resting arousal
level. *Need to be careful because the child may
have a really hard time coming back down to the
calm level
– Fast music, bright lights, lots of movement, visually
busy environment, bright paint colours, sour, spicy
foods, fast swinging in different directions, etc.
Calming Power Tools –
A Sensory Diet
• Organizing > bringing the child back to the “just right”
level.
• Need to figure out what works for your child > think back
when your child was having the most fantastic day
–
–
–
–
Why do you think it was?
Activities? Did something “special” happen?
What they ate?
Routine?
• Increased awareness of what is organizing and what
isn’t so we can plan accordingly. With pointers and
strategies to pass on to others, you may feel more
comfortable leaving your child with someone else.
• Might be a good idea to create a profile to give to others
to help them know what helps to support your child.
Other Suggestions – Social Stories
• Social stories aim to give a child more
perspective about a situation and explain
what they can do in that situation.
• Meant to be read with the child pretty
frequently to allow them to remember and
“get” the concept.
• Cues can be given back to the story > oh
remember what happened in the story?
Other Suggestions –
Encouraging Flexibility
• Always a good idea to encourage your child to
try new things and do things different ways.
• Balance between wanting them to stay happy
and regulated and giving in to their demands.
Can try to change and adapt gradually.
• Doing the same things, in the same way,
everyday, is actually likely about the child feeling
like they have some control in their life >
something they like, know what to expect, etc.
• Try to add in small bits of flexibility each day,
with things that don’t seem as “important” to stay
the same. Try to gradually build in more.
Other Suggestions –
Encouraging Flexibility
• As much as possible, ignore their protests and use an
animated voice to redirect their focus to something else.
• Focus on quick and easy successes so that the child can
see the world didn’t fall apart with change.
• If it is a major issue and battle, try hand over hand and at
least do one small part and then they are done. Highly
praise them for their effort! *VERY important that you
don’t give in here with their protests and that you end
with success on your terms, even if it’s a little step with
your help.
• Behaviour Momentum > start the momentum of getting
your child going with small successes and they will
continue on with the positive praise.
Other Suggestions – Transitions
• Give warnings
• Use visual timers or sand timers (or
auditory..but you must react right away for
this one!)
• Transition toys/bins in the car
• Visual schedules
• First-then > either visual or verbal
Helpful Websites/Resources to
Check out
•
•
•
•
•
•
Social Networking Site for Parents and Professionals to talk about Sensory
Processing Disorder and Strategies:
http://www.sensoryplanet.com/home.php
Sandbox Learning Social Stories: http://www.sandbox-learning.com/
Free pre-made social stories: http://autismpdd.net/forum/forum_posts.asp?TID=14154&PN=1
Sensory Processing Disorder Foundation (completing lots of research about
Sensory Processing Disorder in Denver, CO): http://www.spdfoundation.net/
Sensory Processing Disorder Canada: http://www.spdcanada.org/
SetBC – PictureSET tons of free boardmaker visuals you can print off as
supports. Also school related ones too under CurriculumSET :
http://www.setbc.org/pictureset/
References Used to Create
Presentation
• Jereb, Genevieve (2009). Getting Kids in Sync Online
Seminar.
• Kranowitz, Carol Stock, (2005) the Out of Sync Child:
Recognizing and Coping with Sensory Processing
Disorder
• Miller, Lucy Jane. (2006). Hope and Help for Children
with Sensory Processing Disorder.
• Wilbarger, Patricia. (2006). Sensory Defensiveness: A
comprehensive Treatment Approach. Conference
manual, Toronto, ON.
• Yack, E., Sutton, S. & Aquilla, P. (1998). Building
Bridges through Sensory Integration.
Questions/Comments?