TOOLS FOR SELF REGULATION
Nancy Drees, OTR/L
Objectives:
Paraeducators will:
Learn to recognize sensory needs in their students
Be able to help develop sensory diet tools for their students
Help students learn tools they can use to self-regulate their behavior
I. Introduction- Information from Ready Approach by Bonnie Hanschu
and How Does Your Engine Run? By Mary Sue Williams and Sherry
Shellenberger
II.
A.
B.
C.
D.
Sensory Processing Problems
Sensory Defensiveness
Sensory Modulation
Sensory Registration
Sensory Integration
III. Arousal Theory/States
IV. Inhibition and Its Relationship to Proprioceptive Input
V. Sensory Motor Checklists
A. For Adults
B. For Students
VI. Treatment of Sensory Processing Problems
A. Sensory Defensiveness
B. Sensory Modulation
C. Sensory Registration
VII. Review of Benefits of The Three Sensations
VIII. Sensory Diet
A. Handouts for Teachers
_______________________________________________________________________
Table 2.5
Indications of Problems With Sensory Perception and
Processing
Behaviors such as rocking, flicking objects, spinning, hand flapping,
Fascination with hands
Sensitive startle response
Lack of response to sensory stimuli
Unusual sleep patterns
Decreased activity level
Decreased attention for that which is salient
Problems shifting attention
Problems with the texture or smell of foods
Unusual or exaggerated fears
Avoidance of eye contact
Difficulties being soothed
Acts of dropping oneself onto or into objects
Clothing Sensitivities
Preference to sleep without covers
Preference to sleep between mattress and box spring
Preference to sleep in small areas such as drawers, boxes, or
shelves
Lining up of objects
Periods of staring at lights or shadows______________________________
AUTISM: A COMPREHENSIVE OCCUPATIONAL THERAPY APPROACH
Occupational Therapy is the therapeutic use
of self-care, work, and play activities to
increase independent function, enhance
development, and prevent disabilities. It
may include adaptation of task or
environment to achieve maximum
independence and to enhance quality of life.
(AOTA 1986)
Sensory Processing
*Most of the information in this handout is from The Ready Approach by Bonnie
Hanschu,OTR
Sensory Processing Problems are broken down into 4 distinct areas:
1. Sensory Defensiveness- Their protective responses are overly active.
Two red flags that indicate defensiveness are 1. Exaggerated avoidance
to sensations you can name; and 2. Unpredictable explosions of
emotions. Can arise anytime in the life span and is a barrier to
everything else.
2. Sensory Modulation-Is about arousal. Being able to be at the right
arousal level to be alert, attend, awake, or asleep. A child who has
trouble with transitions and difficulty staying with the flow of events is a
strong indicator of Modulation Problems. Symptoms appear in infancy
or early childhood.
3. Sensory Registration- It is the inability to appropriately register the
sensory information. Usually under register, or delayed and inconsistent
registration.
4. Sensory Integration- Taking in sensation from multiple sensory fields at
the same time, making sense of the information, and making and adaptive
response. This is the frosting on the cake, you can’t get this if the other
three are impaired.
Sensory Processing Problems involve an impaired ability to process and
make sense of three types of sensations:
1. Vestibular Sensations- registered in our inner ears, tells us we are
moving, and tells us where down is, because it registers the pull of
gravity.
2. Proprioceptive Sensations- registered in receptors in muscles, tendons,
and ligaments that surround joints, tells us where our body parts are and
what they are doing without having to look, provides us with the sense of
our body contents.
3. Tactile Sensation- registered from receptors in our skin when we touch or
are touched by something, provide the body boundaries so we know what
is “me” and what is “not me”. Processed in two separate touch systems
so we can differentiate light touch from pressure touch.
Problems with the Vestibular System:
1. Under-active System- A child may do a lot of propping, leaning, have an
S-curved posture, shuffling gait, weak grip, be wobbly and unstable,
difficulty with weight bearing, frequent falling, slow to catch themselves,
high guard, reluctant to put arms over head, head/neck/body moves as
one rigid piece.
2. Postural and Gravitational Insecurity-Child appears stiff, rooted in place,
body rigid, perform tasks awkwardly, resists moving wide base of
support, prefers lowest place, drops down when walking, looks anxious
and distressed when moving.
Problems with Proprioceptive System:
1. Under-active System- poor motor planning, appear clumsy, with fleshy
muscles, appear fatigued, frustrated, requires conscious attention to what
should be automatic, appears unmotivated, frequently referred to as lazy
and unmotivated.
Problems with Tactile (Touch) System:
1. Poor tactile discrimination
2. Tactile Defensiveness- Over-reactive protective response to touch.
Correlates with distractibility, increased level of activity, and volatile
emotions. Problems that often accompany defensiveness to touch
include: motor planning, auditory defensiveness, oral defensiveness,
attention deficits (inability to pay attention due to preoccupation
concerning the potential for offending sensations), and defensiveness to
movement.
3. Excessive mouthing, “hands in pants”, other maladaptive tactile seekingthe child needs increased tactile opportunities. Give large, strong,
frequent doses of tactile input (deep pressure touch) to non-private areas;
back, arms, legs.
4. Reinforcing the map of me to facilitate more self-awareness- need
pressure touch and proprioception.
Sensory Motor Checklist
A. For Adults- Checklist from How Does Your Engine Run?
How Does Your Engine Run is a program whose primary focus is to help
children learn to monitor, maintain, and change their level of alertness so
that it is appropriate to a situation or task.
Children learn to identify their level of alertness in engine terms. Is their
Engine running on High, Low, or Just Right.
You need all three levels for different activities. High for cheering at a
football game. Low for going to sleep at night. Just Right for listening in
class and doing your seatwork.
As adults we use different sensory strategies to keep our own level of
alertness appropriate to the activity. Examples: fidgeting with something or
doodling to help pay attention in long meetings; chewing on licorce or
drinking from a straw on long drives to stay awake; listening to soft music to
fall asleep.
Everyone’s preferences are different need to help children find out what
works for them.
Top- down inhibition vs. Bottom up inhibition
B. Sensory Motor Checklist for Children
-Sensorimotor History Checklist-completed by parents and teachers
-Touch Inventory for Elementary School Aged Children
1. Most are interview checklist that help identify behaviors that indicate
sensory processing dysfunction.
2. Typically consist of statements or questions about a child’s response to
functional tasks or activities.
3. Often are written so the more frequently a behavior occurs, the more it is
thought to indicate sensory processing dysfunction.
4. Help prioritize issues for intervention planning and enhance discussion of
the child’s skills.
TREATMENT OF SENSORY PROCESSING PROBLEMS
Sensory Defensiveness
1. You need to treat defensiveness first, before you can get anything else. If
a child is on defensive mode, they will not be able to attend or react to
anything else.
2. It is recommend that you use one of the brushing protocols, either
Wilbarger’s Deep Pressure Protocol or Hanschu’s Protective Response
Regimen.
3. AHH’s are Achieved through Hand-Hugs. The ahhhh that gets expressed
when someone feels good.
4. Use lots of AHH’s with as part of their sensory diet, particularly
beneficial for people who have frequent or recurring anxiety or fear
responses, but have not advance to having full blown sensory
defensiveness. People with sensory defensiveness also need the more
powerful Brushing program.
5. AHH’s are intended to elicit positive emotion, to feel good, be
reassuring, soothing, and comforting. That means that there must be a
human component with the pressure touch, someone applying the
pressure touch with the intent to soothe and comfort.
6. AHH’s examples- Hugs, soothing pressure strokes down an arm, or
down the back, Hand-hugs (pressing the surface of the skin from two
opposite sides of and extremity)- can be given going up or down the arms
or legs, firm presses down the back, extremity or body massage,
snuggling, being wrapped tightly and held or gently swayed from side to
side.
7. When someone is stressed, you need to back off and leave them alone for
a while. Stress decreases serotonin, and increases norepinephrine, which
is the fight, flight or fright chemical. So if you continue to push someone
who is under stress, you can get an aggressive response, which the child
could not voluntarily control.
8. Stress Chemistry lasts at least 2 hours in the body.
Sensory Modulation
1. Proprioception is the treatment sensation for modulation.
2. However, you need to start with vestibular to get the brain chemistry setit’s what you use to “turn on the lights”.
3. The vestibular you need it swinging from a one -point swing, with feet
off the floor. Demands the brain to be more alert. It is the fastest way to
get to the best arousal level.
4. Then give more proprioception as you take the child back to the group.
Continue to give hourly doses of proprioception to maintain a ready state.
5. Never swing them if they don’t like it.
6. Vibration and weighted vests or wrist weights are good for sustaining
ready state, but not powerful enough to get you there. But, also to
maintain you need the frequent doses of proprioception through
movement.
Sensory Registration
1. Registration Problems are always about under- registration never over
registration.
2. Modulation problems are usually also seen with vestibular registration
problems. Therefore, the treatment is similar.
3. You start with the swing, but you need to be more specific with your
input. Then you follow it with proprioception on an hourly basis.
4. For under registration of proprioception, you need to give deep pressure
touch and proprioception, body part by body part. This can be given by
joint compressions and deep pressure touch around, above, and below
joints. You need to increase that map of me. Gives a point of reference
for what is relevant and irrelevant. Helps filter out what is irrelevant and
increase modulation and attention, also.
5. An example of good proprioceptive input to increase map of me- Deep
pressure down through the shoulders, rub their back, squeeze down both
arms and pat back up, and have them bend their legs and hop several
times.
REVIEW OF THE BENEFITS OF THE THREE SENSORY
SENSATIONS
A. Touch
1. Defines the map of “me”-gives the body boundaries.
2. Pleasurable- positive emotion
3. Increases the release of dopamine, which is the chemical that makes you
feel good.
4. Enhances long term memory.
5. Helps to focus thinking.
6. Lasts 1 1/2 to 2 hours.
7. Most importantly it decreases stress chemistry.
D. Proprioception
1. Tells the brain where the body parts are and what they are doinggives body contents.
2.Most important is that it increases serotonin activity- which helps with
modulation.
3. Organizes thoughts and helps provide the anchor.
4. Should be given in hourly doses to help with modulation.
5. Sharpens working memory.
E. Vestibular
1. Fastest way to affect alertness and arousal.
2. Tells the brain where down is, because it registers the pull of gravity.
3.The most important is that it puts “me” into my space and tells me where
I’m at. (Perception of Space).
4. Slow rhythmic is calming, fast and unpredictable excites.
5. Spinning is the strongest of the vestibular input- *Don’t use it!
Sensory Diet
Sensory diet is a term first coined by Patricia Wilbarger, and occupational
therapist. Sensory diet is defined as the sensorimotor input required by the
brain to keep it alert for learning. In addition to the commonly known
senses of touch, smell, vision, taste, and hearing, vestibular and
proprioceptive senses are important. The last two systems are crucial to
body awareness.
A child whose sensory diet is deficient in the vestibular or proprioceptive
system may be easily distracted, display increase levels of activity, have
perceptual motor problems, demonstrate poor motor planning skills, and
react to situations in socially unacceptable ways, (e.g. aggressive behavior
such as hitting or pushing). When opportunities for a child to receive an
efficient sensory diet are available, we find it easier for the child to display
acceptable interactions.
Sensory diet activities can be incorporated in the school and home
environments. They may make and important difference for the child. By
observing the child we all gain insight into what supports and compromises
optimal functioning. Children typically seek the sensory input that they
require. For example, children who have difficulty keeping themselves
focused may find that chewing keeps them alert. Chewing their shirt may
provide the sensory input that they need. When this is observed, we may
provide a sensory diet activity of chewing gum, a chewing tube on the end of
their pencil, or snacking on pretzels or vegetable.
All children require a balanced sensory diet for growth and development.
Sometimes a child may need more alerting activities; other times more
calming. The goals of a sensory diet are to decrease sensory defensiveness,
and promote an optimum level of arousal, self regulation, and behavior
organization. With an effective sensory diet you will observe active
participation, a “just right” response/behavior, and adaptive responses that
are child centered.
A sensory diet is not a specific intervention technique. It is rather a
strategy to effect functional abilities. It is not a reinforcement tool. A
sensory diet is a planned scheduled activity program with specific time
oriented activity routines. Each individual requires a certain amount of
activity and sensation to be the most alert, adaptable, and skillful.
Sensory processing is essential in the regulation of arousal and attention,
and in emotional and behavioral control. Attention, alertness, and arousal
are important for basic survival and filtering out irrelevant information.
They help us tune into important environmental elements,process new
information for learning, and engage in purposeful activity.
Use the handouts as a guide in collaboration with the Occupational
Therapist or other professional who has a solid understanding of sensory
integration principles.
REFERENCES and FURTHER READINGS
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Builders. San Antonio, Texas
Arnwine, Bonnie. 2005 Starting Sensory Integration Therapy: Fun Activities That Won’t
Destroy Your Home or Classroom! Future Horizons, Inc. Arlington, Texas
Aron, Elaine. 2002. The Highly Sensitive Child. Broadway Books. New York, NY.
Ayers, J.A. 1979. Sensory Integration and the Child. Western Psychological Services.
Biel, Lindsey and Peske, Nancy. 2005. Raising A Sensory Smart Child. Penguin Books.
New York, New York.
Chara, Kathleen A. and Paul J. Jr. 2004. Sensory Smarts. Jessica Kingsley Publishers.
Philadelphia, PA.
Coster, W. et. Al 1998 School Function Assessment. Therapy Skill Builders. San
Antonio, Texas.
DeGangi, Georgia A. 1994. Documenting Sensorimotor Progress: A Pediatric Therapist’s
Guide. Therapy Skill Builders. San Antonio, Texas
Fuge and Berry. 2004. Pathways to Play! Combining Sensory Integration and Integrated
Play Groups. Autism Asperger Publishing Co. Shawnee Mission, Kansas.
Hannaford, Carla. 1995. Smart Moves: Why Learning is Not all in Your Head. Great
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