June 2015
Volume 1 - Issue 7
Teaching Tips and Strategies:
How to Desensitize your Students to ADLs
Learning to tolerate and perform activities of daily living (ADLs) like dressing, grooming and personal hygiene are
important to a student’s health, independence and self confidence. Yet mastering such tasks can be especially
challenging for those with sensory dysregulation. Through our work with students at Crotched Mountain School,
we have developed techniques to help students with sensory issues overcome their aversion to these tasks.
Getting Started
Begin by conducting a task analysis - a systematic review to break down ADLs into their smallest components. The
occupational therapist then observes the student doing the task and notices at what point the student begins to
experience difficulty. For example, if a child dislikes getting a haircut, the first thing to ask is: Can they sit in a chair
in close proximity to the person who will be doing the haircut? Can they feel safe in that space? If not, then it is
important to start with desensitizing that first step to overcome the aversion to physical proximity. The occupational
therapist can then create a treatment plan that outlines how to address the discomfort and progress through it, then
move on to working on the next component in the task analysis.
Communication
If your student is verbal, it’s helpful to ask them about
their sensitivities. What things or activities bother them
the most? What are they scared of? What tasks do they
need help with? Incorporating the student’s
perspective, as well as those of parents and staff, is
crucial to the therapy process. If a student is nonverbal,
the therapist can pay attention to facial expressions,
body language, vocalizations and other behavioral clues
to determine when the student first becomes
uncomfortable. It is also important to rule out any
medical conditions that may impact the student’s
performance.
Developing a plan
Once the occupational therapist has completed the
assessment, an action plan is developed. This could
include formal goals and objectives in an IEP, step-bystep ADL protocols for parents and staff to follow, as
well as a treatment plan for the therapists themselves.
To begin, it is most effective if the therapist is the only
person to work on a specific ADL, since routine,
structure and a student’s clear understanding of what to
expect are important factors for comfort and success.
Breaking down the process, step-by-step
Start with a small, achievable goal. Nail clipping, for
example, can feel like torture for someone with
sensory issues. The feeling of having someone sitting in
close proximity, the anticipation of nails being clipped
and the pressure of the clippers on the nail can send
the student into an autonomic fight or flight state.
This need to protect oneself often results in a pattern
of maladaptive behaviors. For nail clipping, it might
be beneficial to simply sit for a few seconds with the
nail clippers on the other side of the table without the
student demonstrating any unsafe or avoidance
behaviors. The moment the student manages this for
the first time, reward, reward, reward! Repeat as many
times as needed until the student has comfortably
accomplished this goal. This may take one session, a
few days or a few weeks. Progressing with small goals
eases your student into the process and prevents a task
from being overly intimidating or frightening.
Practice and patience are key factors in desensitizing a
student to ADLs. Taking it slow, keeping sessions
consistent and rewarding every success are key factors
in helping your student feel comfortable. Ultimately,
this will move him or her one step closer to finding
success and increased independence at school, at work
and for years to come.
Gwen Rumburg has worked
at Crotched Mountain for
26 years, starting as a licensed
nursing assistant and, for the
past 14 years, as a licensed,
registered occupational
therapist for students aged
8 - 22. In addition to her
work as a school OT, Gwen is the OT intern
program coordinator and runs the Crotched
Mountain Equine Collaborative.
For more Teaching Tips and Strategies, visit www.cmf.org/tips
David Etlinger, Director of Admissions
admissions@crotchedmountain.org / 603.547.3311, ext. 1894
1Verney Drive, Greenfield, NH 03047 / www.cm-school.org
Crotched Mountain School does not discriminate on the basis of race, color, age, gender, sexual orientation, religion, national origin or disability.
Rev. 7/2015