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Integrating Sensory and Motor LearningDeveloping a Framework to Improve Somatosensory, Vestibular-Motor, Vision, and Auditory Systems in Childhood Development

Presented by Nisha S. Sanghvi, OTR/L

Practical and Effective Strategies for

Disclosures• Guidelines exist whereby all speakers must disclose any relevant relationships. All relevant relationships are published in the

workshop brochure.

• Summit Professional Education does not accept commercial support of any kind.

• Approvals of this activity refer only to continuing education activities and do not imply that there is real or implied endorsement of any product, service, or company referred to in this activity nor of any company subsidizing costs related to the activity.

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• FINANCIAL: Nisha Sanghvi is compensated as the owner of Integrated Pediatrics and by Summit as an instructor.

• NONFINANCIAL: Nisha Sanghvi serves on the DuPage Interagency Council on Early Intervention Steering committee and the Illinois Interagency Council on Early Intervention.

Workshop Notes 

Workshop Notes 

Practical & Effective Strategies for Integrating Sensory & Motor Learning

Developing a Framework to Improve Somatosensory, Vestibular-Motor, Vision & Auditory Systems in Childhood Development

I. Understanding Typical Vestibular-Motor, Vision and Auditory Childhood Development

a. Motor development b. Reflex integration c. Vision d. Communication e. Attachment, social engagement, and interaction

II. Strategies for Improving Upon the Development of the Sensory and Motor Systems

a. Proprioceptive system and strategies b. Vestibular system and strategies c. Tactile system and strategies d. Auditory system and strategies e. Visual system and strategies f. Olfactory system and strategies g. Gustatory system and strategies h. Understanding the integration of sensory systems: somatosensory-visual-vestibular/motor-auditory

III. Executive Functions and Self-Regulation and Their Role in Bettering Academics

a. School-based therapy b. Handwriting c. Participation and engagement

IV. Linking Play and Behavior to Improve Function

a. Play b. Leisure – Relaxation and mindfulness c. Behavior management

V. Address the Impact of Screen-time and Technology in Childhood Development

a. Current statistics and guidelines b. Identify different kinds of media and how to choose best media c. The “C”s of technology d. Implications of technology on child development

VI. The Continuum of Care: Finding the Optimal Balance Within the Home, School, and Community

a. Family dynamics b. Way to support teams and family with follow through c. Provider and caregiver support d. Discussion, questions, etc.

 

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nisha@integratedpediatrics.com

Practical & Effective Strategies for

Integrating Sensory & Motor Learning

Developing a Framework to Improve Somatosensory, Vestibular-Motor, Vision & Auditory Systems in

Childhood Development

Nisha S. Sanghvi, OTR/L1

WELCOME �Online Supplements

https://blog.summit-education.com/Sanghvi/wifi Network: promo code:

8:00am Course Begins 9:30am Break

12:00pm Lunch 2:15pm Break 3:30pm Adjourn

�Restrooms�Cell Phones

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Growth of the Brain �Brain grow ~80% of adult size by age 3 & ~90% by the

age of 5�The brain grows over time and is built bottom up�Architecture of the brain depends on the mutual influences

of genetics, environment and experiences�Early learning lays the appropriate foundation for later

learning and is essential for the development of optimalbrain architecture

�Different mental capacities mature at different stages –children’s ability to interpret what they see changes overtime as their brain circuitry is built

Age appropriate verse developmentally appropriate4

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Growth of the Body �Change in body proportion & size �Change in motor control, balance & dexterity

• rolling�sitting�crawling�standing�walking� • grasp�release�pincer�utensil use�• discriminating sounds�vocalization�one word�sentences�

We as a society attribute these changes to maturation, but we should be mindful that experiences and the environment are crucial to achieve these changes

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Growth of the Mind �Thinking & Learning - newborns integrate knowledge

from different senses provides foundation for amazing growth and development in concepts, causation, memory and problem solving in the early years

�Language - early childhood establishes foundation for complex human reasoning skills and communication (eye contact to word(s) to phrases to sentences)

�Learning and Relationships - daily routines and activities (includes play) help children understand anticipation, representation and build memory

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Growth of the Person�Attachments - provide a foundation for relationships, self-concept

and emotional & moral understanding �Self-Regulation & Social Understanding - throughout early

childhood caregivers have expectations for our children’s cooperation and consideration for others

�Self- Awareness infants – self & others2nd year – visual recognition (mirror) & verbal self-reference (“Mike so big”)3rd year – competence & autonomy (“do it myself”)preschool – monitoring & motivation to succeed with everyday tasks such as dressing, coloring, self-feeding, etc.

�Temperament & Emotional Growth - as infants grow, they learn strategies to manage their emotions impacting social interactions, self-confidence and feelings of well-being 7 8

Brain Structure

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Brain Structure Cerebellum

• located at the back of the brain• small portion of your brain sitting just above and

behind the brainstem • best known for its role in motor control – coordinating

body movements – balance and posture • balance, coordination, attention, rhythm,

proprioception & vestibular

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Brain Structure Cerebrum• the largest part of the brain • Cerebral cortex – outer surface of cerebrum,

composed of gray matter • two cerebral hemispheres, referred to as the “right

brain” and “left brain”, connected by the corpus callosum � superhighway for learning, connecting the emotional and logical

• responsible for all voluntary functions, such as movement, memory, sensory processing and language

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Cerebrum � divided into four lobes

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Temporal Lobe - speech, auditory processing, hearing, behavior, emotions, short-term & long-term memoryParietal Lobe - sensory information Occipital Lobe - visual system & visual information

Frontal Lobe - abstract thinking, problem solving, reasoning, executive functioning, organizing, motor functions, regulates emotions & expressive language

Lowerworking

Higher working

Brain Structure Limbic System – control emotions, memories & arousal � Amygdala

• Storing and classifying emotionally charged memories

• Large role in producing our emotions • Trigger to sweaty palms, freezing, increased hear-

beat and respiration & stress hormone release � Thalamus

• located in the center of the brain and sends sensory and motor information to the brain

• “relay station” 12

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Brain Structure Limbic System � Hypothalamus

• controls sleep wake cycles • maintains homeostasis – thirst, hunger, body

urges • anatomic functions, emotions and motor

functions � Hippocampus

• found underneath the cerebral cortex and processes information from long- and short-term memory

• part of the brain that controls spatial reasoning13

Growth of the Brain�Vulnerability of the developing Brain

•rapid and broad growth takes place in the early brain – pruning & blooming

•Immature, vulnerable organ - awareness of exposure to toxins & stress

�Importance of Environment • Environment: Biological (internal) vs. Physical

environment (external)• Relationships and Attachment: Nurture the child

and offer challenges and help the child discover their potential through everyday experiences

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Motor Development • Development of the child’s bones, muscles & ability to move

around and manipulate his/her environment • Motor development impacts social, emotional and cognitive

skills• Developmental Direction�Cephalocaudal - develop from top of the head to feet� Proximodistal - develop from points close to the center of

the body to points close to the periphery� Differentiation - progress from gross, immature movement

to precise, well-controlled, intended movement� Integration - become more capable of integrating various

systems, especially the muscular system, to produce well-controlled, intended movements

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Motor Development •Body awareness – understanding about the different parts of the body, how they move, what they can do, and how to make movements more efficient

•Spatial awareness - understanding about how the body and objects occupy space and how to move them within that space

•Directional awareness - understanding about the location and direction of the body and objects in space

•Temporal awareness - understanding about the relationship between movement and time (i.e. rhythm, sequencing)

Perceptual-motor development helps children become aware of their own bodies and the relationship of their bodies to others and the world around them

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Motor Development Motor Assessments:

Test of Infant-Motor Performance birth-4 months Motor Skills Acquisition Checklist birth-12 months Bayley Scales of Infant Development 1-42 months Alberta Infant Motor Scales birth-18 months Peabody Developmental Motor Scales birth-72 months Clinical Observations of Motor & Postural Skills 5-15 years Bruininks Oseretsky Test of Motor Proficiency 4.5-21 yearsAssessment of Motor and Process Skills 3 years+

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RED FLAGS - high or low tone, asymmetry, strength, endurance, vision, toe walking, retained reflexes, etc. 18

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CDC�Publications�

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Primitive Reflexes • automatic, instinctual movements directed from the

brainstem that assist in the development, growth & survival � balance, mobility, vision, hearing, speaking, learning and communicating

• needed for survival in the womb, help in birthing process & early months of life that should become inactive with 12 months, merge into higher quality movements � become integrated

• some key primitive reflexes: moro reflex, rooting reflex, palmar reflex, asymmetrical tonic neck reflex (ATNR), tonic labyrinthine reflex (TLR), spinal galant, symmetrical tonic neck reflex (STNR)

• causes of retained reflexes: C-section, trauma, toxic exposure, insufficient tummy time, lack of or insufficient creeping and crawling, head injuries, chronic ear infections

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Importance of Integrating Reflexes “Integrating reflexes is key for the ability to learn, easily manage our emotions and impulses, and meet life’s challenges with greater ease. Incomplete integration of childhood reflexes can be mild to severe, and contributes to anxiety, depression, ADD, ADHD, autism, learning disorders, developmental delay, sensory integration disorders, vision & hearing problems, behavioral challenges, extreme shyness, lack of confidence, addiction, insufficient effortful work and constantly feeling overwhelmed.”

Sonia Story at www.moveplaythrive

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Postural Reflexes: Righting Reflexes

posture balance & fluidity of movementcoordination

� roll � sit � crawl � stand �walk � run 24

automatic movements that control the equilibration we require once upright and moving and having to combat the effects of gravity

•develop after birth and remain for life•help the body to respond to rapid loss of balance & assist with integrated movements of the head on the trunk

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Postural Reflexes: Equilibrium Reactions • reactions appear at about six months of age and remain

for life • subconscious but, their movement response is event

specific and unique to each situation• work by affecting either the position of the center of gravity

of the body or by altering the position or size of the base

�Moving the base – the reaction makes you move to maintain balance

�Keeping the center of gravity over the base - by weight shifting or by moving arms, legs, with twisting movements of the spine to maintain balance within the base

�Widening the base and lowering the center of gravity - by using the arms in protective extension 25

Immature Postural Reflexes • Poor postural control, body alignment and postural tone• Poor coordination, bilateral integration and motor control of

fine movements• Weak head control and/or associated head movement• Compromised gaze control• Reduced visual-motor/hand eye integration and fixation• Difficulties with reading and writing• Inadequate sensory integration• Gravitational insecurity and increased anxiety• Problems with adaptation, sequencing, multi-processing,

information overload• Retained or partially integrated primitive reflexes

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SAMPLE INTERVENTION ACTIVITIES AND POSITIONING

www.toolstogrowot.com/blog/2016/01/11/primitive-motor-reflexes-their-impact-on-a-childs-function

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Vision DevelopmentOphthalmologist

• Medical doctor (residency & fellowship 3-8 years of training)

• Stress is on the disease • Treatment emphasizes medication and surgery

Developmental Optometrists •Evaluate visual conditions that may be interfering

with performance •Visual system is directly related to the

environment and how individual use his/her eyes •Use of lenses, prism, low vision devices and vision

therapy29

Vision Development: Integrity Visual acuity

• the distance at which the subject recognizes the stimulus (Snellen test)

• first 6 months of life are crucial in development of acuity – 20/20 by 6 months of age Refraction

• evaluation of the optical system • refractive error - any disorder of refraction • myopic or nearsighted, hyperopic or farsighted or

astigmatic (lens is elliptical, not sphere therefore individual has difficulty with far & near vision)

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Vision Development: Integrity Ocular health Low vision – 20/70 or worse with best correction; caused by eye disease•Anterior segment: ptosis (drooping lid), inflammations (pink eye), corneal scar

•Lenticular (lens): cataract - blurry vision, streaks of light, shading, fading•Posterior segment: glaucoma, diabetic retinopathy, age related macular degeneration

•Visual Pathway: optic nerve damage, optic radiations or visual cortex � Visual field deficit – lesion in visual pathway (can be aware of

neglect)� Visual neglect – diminished awareness of one side (no awareness)

•Cortical visual impairment: lesion in posterior pathways; some residual vision � Short attention span, attracted to bright & bold colors, close working distance, use of peripheral vision is common

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Vision Development: Efficiency Defined as the effectiveness of the visual system to clearly, efficiently & comfortably allow an individual to gather visual information in all environments

Accommodation disorders – interfere with any activity that requires concentration on small objects or print at a close distance

• accommodation insufficiency: blurred vision, fatigue, movement of print, pulling sensation around the eye, reading difficulties

• accommodation excess: headaches, eye strain, difficulty focusing near to far, sensitivity to light

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Vision Development: Efficiency Binocular Visions disorders – ability to fuse right & left eyes to form one image; can be a cosmetic problem (eye look cross-eyed), constant or intermittent double vision or eye strain

Classification blurred vision, headaches, • Esotropia: eyes turn in eye strain, fatigue, pulling• Exotropia: eyes turn out sensation around eyes, • Hypertropia: eyes turn up movement of print,

avoidance of reading or loss of comprehension

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Vision Development: Efficiency Eye Movement disorders – interfere with individual’s ability to process visual information; be mindful that eye movement development is slow, continuous processing that develops through the elementary school years Classification• Fixation disorder (fixation-ability to keep eyes still, maintain visual

gaze on a single location)• Saccadic Dysfunction (saccade–eye’s ability to quickly & accurately

shift from one target to another)• Pursuit Dysfunction (pursuit-visual ability to accurately & smoothly

follow moving object that enable clear vision of moving objects) • Nystagmus (nystagmus-involuntary, rhythmic oscillations of one or

both eyes) 34

Vision Development: Vision Information Processing Defined as visual cognitive skills used for extracting & organizing visual information from the environment, integrating this information & making a motor response

Visual Spatial Skills – understanding of spatial concepts, allow interaction with environment, body awareness concepts, important for development of body coordination, balance & direction sense

•Bilateral integration: ability to use both sides of body separately & simultaneously

•Laterality: ability to internally be aware of & identify right verse left sides of body

•Directionality: application of laterality to external world 35

Vision Development: Vision Information Processing Visual Analysis Skills – ability to analyze & discriminate visual information

•Visual Discrimination: ability to be aware of features including shape, orientation, size and color

•Visual Figure Ground: ability to perceive the foreground from the background; ability to pick out an object within a busy background

•Visual Closure: ability to visualize a complete whole when given incomplete information or a partial picture

•Visual Memory: ability to remember for immediate recall the characteristics of a given object or form

Dysfunction�trouble learning the alphabet, recognizing words, learning basic math concepts; inability to recognize simple forms or words; difficulty recognizing the main idea from insignificant details; mistakes words with similar beginnings

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Vision Development: Vision Information Processing

Visual Motor Integration Skills – ability to integrate visual information processing skills with motor movement, fine motor coordination & visual motor integration

Dysfunction�difficulty copying from board/screen; messy handwriting; poor spacing & inability to stay in lines; difficulty producing answers in writing; difficulty finishing work on time; poor performance on tests; difficulty with math problems

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Vision Resources • http://www.infantsee.org/• http://www.covd.org/page/symptoms• http://eyecanlearn.com/eyeslearn/symptoms/• http://www.minnesotavisiontherapy.com/symptom_ch

ecklist

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Attachment

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“Attachment is one specific and circumscribed aspect of the relationship between a child and caregiver that is involved with making the child safe, secure and protected.”

“Attachment is where the child uses the primary caregiver as a secure base from which to explore and, when necessary, as a haven of safety and a source of comfort.”

Quality of the infant-parent attachment is a powerful predictor of a child’s latter social & emotional outcome

Normally developing children will develop an attachment with any caregiver who provides consistent care, regardless on the quality of care – we as providers needs to look at the quality and how it impacts the child’s development

There is a hierarchy of attachment with the various caregivers (mom, dad, nanny, grandparents, etc.)

Benoit, Diane. (2004). Infant-Parent attachment: Definition, types, antecedents, measurement and outcome. Paediatric Child Health, 9 (8), 541-545.

TYPE OF ATTACHMENT

Quality of caregiving Strategy to deal with distress

Secure Sensitive – loving Caregiver: sensitive, quick & consistentChild: secure, exploring & happy

Organized strategyBelieves & trust that needs will be met

Insecure –resistantAmbivalent

Insensitive – inconsistent Caregiver: inconsistent, sometimes sensitive & sometimes neglectful Child: anxious, insecure & angry

Organized strategy Cannot rely on needs being met

Insecure-avoidant

Insensitive – rejecting Caregiver: distant & disengaged Child: not explorative, emotionally distant

Organized strategySubconsciously believes that needs won’t be met

Insecure –disorganized

Atypical – Atypical Caregiver: extreme, frightened, frightening & passive Child: depressed, passive, angry or nonresponsive

Disorganized strategy Severely confused with no strategy to have needs met

40Benoit, Diane. (2004). Infant-Parent attachment: Definition, types, antecedents, measurement and outcome. Paediatric Child Health, 9 (8), 541-545. www.attachfromscratch.com

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Attachment through Developmental Stages �Infancy

• Developing relationship with parent/caregiver • Develop expectations of how parent/caregiver responds when

infant is distressed• Develop a preference for primary caregiver

�Toddlerhood • Use parent/caregiver as a security base as child explores his/her

environment come back to when frightened or alarmed �Preschool

• Balance independence, self-discipline and exploration with an increased tolerance for separation and an ability to cooperate with others

�School-Age• Attachment effects self-esteem, autonomy, management of

impulses & feelings, friendships, positive relationship with family, effective coping skills, trust & affection, positive & hopeful belief system and academic success 41www.healthofchildren.com

Communication, Social Engagement & Interaction Joint Attention - shared focus of two individuals on an objectEye Contact - two people look at each other's eyes at the same timeDirecting attention - using eye gaze or a gesture to direct another person’s attention to an object or eventFollowing attention - following another person’s eye gaze or gestureGaze following - looking at what another person is looking atSocial Referencing - process where the infant takes cues from other people in the environment, about which emotions and actions are appropriate in a certain context or situation

� Institute for Learning & Brain Sciences University of Washington: Sharing Attention During Early Childhood module

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Strategies� Focus on faces - developing eye contact (don’t force,

can be hard for kids to look & listen together)• Be at child’s level • Bringing objects to your face • Changing your voice tone, animation and volume• Change position and distances• Mirror activities• Sticker, hats, sunglasses, binoculars

� Focus on play & turn-taking • Objects – cars, trucks, dolls, crayons, play-doh, etc.• Activities of daily routine – mealtimes, bathing &

grooming, balls, bubble, etc. • Rough-house play 43

Strategies�Matching

• Join the child in their play – making same movements and sounds

• Use gesture, sounds and words – narrate, self-talk �Focus on pointing

• Model pointing and shape child’s finger to point • Use word “look” and point • Point, touch and grasping activities• Finger isolation activities – button toys• Cause & effect toys and musical toys • Flash- light games • Books – Cheerio book, look and see flap book,

sliding books, sound books• Choice-making paired with pointing 44

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Strategies�Focus on encouraging the child to shift attention

• Providing an additional toy • Including another individual

�Focus on creating situations where the child can initiate a request for adult to look at something the interests the child

• Rearrange environment • Placement of high-interest toys and objects

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Red Flags Impairment in Social Interaction�Lack of appropriate eye gaze�Lack of warm, joyful expressions�Lack of sharing interest or enjoyment�Lack of response to name

Impairment in Communication�Lack of showing gestures�Lack of coordination of nonverbal communication

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Ideas to Develop Communication Skills • Respond to your child’s gestures, looks and sounds• Talk with and listen to your child• Help children build on their language skills• Teach your child about non-verbal communication• Respect and recognize your child’s feelings• Help your child develop a “feelings” vocabulary• Read together• Narrate what you do as you go through your daily routines• Encourage pretend play• Make your requests clear, simple, and appropriate for your

child’s age and ability• Be a good role model

47https://www.zerotothree.org/resources/302�how�to�support�your�child�s�communication�skills

Development of the Sensory and Motor Systems, Strategies

& Integration

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Neuroscience

Background for understanding how sensory receptors receive & transmit

stimuli

How the CNS codes & interprets the information

How the information gets used to design motor output as well as the importance of modulation of all input as part of optimal CNS

49Dunn, W. (1997). The Impact of Sensory Processing Abilities on the Daily Lives of Young Children and Their Families: A Conceptual Model. Infants and Young Children 9 (4), 23-35.

Neurological Processes Related to Modulation

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• Considered simplest form of learning in the CNS • Happens when the nerve cells & CNS systems recognize

the stimulus as familiar -- decreased transmission among cells because there is not a perceived need to continue to respond to the stimulus

• Enables young children to screen out the familiar sensations to be able to attend to peers, toys/objects & play themes

1. Habituation

• the CNS recognizes the stimulus as important or potentially harmful & generates a heightened response

• Involves the enhancement of cells • Sometimes associated with anatomical changes – an increase

in neuron connections

2. Sensitization

Dunn, W. (1997). The Impact of Sensory Processing Abilities on the Daily Lives of Young Children and Their Families: A Conceptual Model. Infants and Young Children 9 (4), 23-35.

Neuroscience is complex

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continuous interchange between habituation &

sensitization =THRESHOLDS (thresholds are established by

experiences & genetics)

Habituationpatterns

Sensitizationpatterns

Modulation

Poor Modulation Mal-adaptive Behaviors

• Overly Excitable / Hyperactive• Overly Lethargic / Inattentive

Dunn, W. (1997). The Impact of Sensory Processing Abilities on the Daily Lives of Young Children and Their Families: A Conceptual Model. Infants and Young Children 9 (4), 23-35.

Modulation isdefined as the ability to regulate information in the interest of generating an appropriateresponse to particular stimuli

Behavioral Science

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Young Child

Interests

Motivation

Skills

Behavioral Patterns

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53http://www.thebenderbunch.com/2016/05/creating-behavior-intervention-plan-bip.html

Behavioral Science

Ability to be successful

selection of tasks based on his/her need to complete tasks correctly

Expectancy about performance

understand & believe the performance of a particular task will lead to the goal

Incentive to perform

need to value the goal

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Neuroscience vs. Behavioral Science

Neuroscience knowledge provides a means of interpreting behavioral observations

Sensory profile is used to collect formal data about child’s performance from parents, teachers, the child & therapist observation � provides information on how

particular sensory processing problems affect performance on daily life

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Observe & Document �ask all caregivers & look at all settings

• Self-direction vs. adult direction• Eye contact• Joint attention • Engagement • Peer interaction vs. adult interaction • Transitions • Play skills• Emotional regulation

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• Sleep • Food/Nutrition – awareness of food intolerance,

sensitivities & allergies • Safety

Basic Needs

• Consistency with providing activities to help CNS function more typically to prevent sensory overload & panic response

• Sensory smart activities – calming & organizing activities become part of everyday life – CANNOT rely on weekly therapy sessions

Sensory Diet

•Teach strategies•Facilitate as needed

Coping Strategies

• Visual & auditory supports

• EnvironmentalSensory Accommodations

Key Elements

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Physiologic,Medical & Motor

Sensory Environmental & Social

Comorbidity of Diagnoses

• Respiratory distress

• Feeding & Nutrition - GI issues

• Visual challenges

• Auditory –hearing loss?

• Motor challenges

• Sensory Processing Disorder

• Components of hypo or hyper sensitivity

• Family dynamic –loss, divorce, siblings, etc.

• Friendships, acceptance, etc.

• Many times other diagnoses are present

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Causes of the Challenge/Breakdown

Medical – examine components

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Medical

Vision

Auditory

GI &Nutrition

SleepSeizures

Genetics

Medication

Symptom Recognition

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Primary caregiver is

usually the first to recognize

that something is “off”

Sometimes difficult for others (spouse,

grandparents, friends, etc.) to acknowledge &

accept

“normal of a boy”, “lazy”, “bad” – why

label him? This is challenging for primary caregiver –

question himself/herself….

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ADHD vs. Sensory Processing Difficulties

• Cannot stop impulsive behavior regardless of sensory input• Craves novelty and activity that is not necessarily related to

specific sensation • Does not become more organized after receiving intense

sensory input

Be mindful that young children don’t have the framework to control impulses, toddlers can be hyperactive – children are generally not diagnosed with ADHD until 7-8 years of age because of this

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MedicationMedication or not – an individual family choice

Children with ADHD may at some point need medication to help balance the chemicals in their brain to allow them to comfortably function. It is generally accepted that only children with ADHD or ADD will respond to the medication. A child with strictly sensory issues will not respond to the meds…

� Dosage� Growth� Consistency

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Sensory processing disorder & diagnosis • Sensory processing disorder is NOT recognized as a

diagnosis but families often hear SPD when their child has a developmental delay

• DSM-5 now lists sensory problems as a criteria for Autism Spectrum Disorder

• Challenge is that many children who experience sensory processing challenges are NOT on the autism spectrum and these children are often later diagnosed with ADHD or anxiety

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Winnie Dunn explains the 4 basic patterns of response to everyday sensory events

64http://classes.kumc.edu/sah/resources/sensory_processing/learning_opportunities/concepts/sp_concepts_main.htm

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Winnie Dunn explains the 4 basic patterns of response to everyday sensory events

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Sensation Seeking is the combination of high

neurological thresholds and a active self regulation

strategy. SEEKERS

Low Registration is the combination of high

neurological threshold an d a passive self regulation

strategy. BYSTANDERS

Sensation Avoiding is the combination of low

neurological thresholds and an active self regulation

strategy.AVOIDERS

Sensory Sensitivity is the combination of low

neurological thresholds and a passive self regulation

strategy.SENSORS

http://classes.kumc.edu/sah/resources/sensory_processing/learning_opportunities/concepts/sp_concepts_main.htm

Sensation Seeking “Seekers”

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Pattern of sensory processing characterized by high sensory thresholds and active self-regulation strategy (Dunn, 1997)

• Typically enjoy & generate extra sensory input for themselves

• Very active, continuously engaging & excitable • Constantly generating new ideas

Becomes a challenge when seeking behaviors keep the individual from continuing in a desired activity

INTERVENTION/GOAL – more intensity in daily sensory experiences so the child does not have to stop engaging in daily life to get the extra sensory input they desire

http://classes.kumc.edu/sah/resources/sensory_processing/learning_opportunities/concepts/sp_concepts_main.htm

Low Registration “Bystanders”

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Pattern of sensory processing characterized by high sensory thresholds and a passive self-regulation strategy (Dunn, 1997)

• Miss sensory cues that others • Appear uninterested, self-absorbed and sometimes dull in

affect • Described as “easy-going”

Becomes a challenge when the child does not notice things happening in their environment & miss cues that might guide their behaviors

INTERVENTION/GOAL – Increasing the intensity of sensory input to improve the chance for noticing and responding to environmental cues; with more sensory input, the child can continue to pay attention during daily life activities and maintain them for a longer time period

http://classes.kumc.edu/sah/resources/sensory_processing/learning_opportunities/concepts/sp_concepts_main.htm

Sensation Avoiding “Avoiders”

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Pattern of sensory processing characterized by low sensory thresholds and an active self regulation strategy (Dunn, 1997)

• Often Bothered by input more than others • Often are rule-bound, ritual driven & uncooperative • Create routine and order to have “sameness” to reduce

unanticipated sensory input

Becomes a challenge when the child engage in behaviors that limit the sensory input they must deal with because the sensory input is difficult to understand & organize, or might even be “threatening” to the nervous system

INTERVENTION/GOAL – Make input less available, so that the person does not become overwhelmed and want to withdraw from participation in everyday life; when the environment is quiet, the child is able to continue daily life activities for longer time

http://classes.kumc.edu/sah/resources/sensory_processing/learning_opportunities/concepts/sp_concepts_sensation_avoiding.htm

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Sensory Sensitivity “Sensors”

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Pattern of sensory processing characterized by low sensory thresholds and a passive self regulations strategy (Dunn, 1997)

• Usually detect more input than others• Appear distractible, hyperactive and can be complainers • Very discerning and detect errors/patterns that others miss

Becomes a challenge when the child notices more sensory events than others do and comment about them with regularity – allow things to happen and comment rather than removing themselves

INTERVENTION/GOAL – Provide more structured input, so that the individual does not become overwhelmed in everyday life; with more structured sensory input, the child can continue to pay attention during daily life activities & maintain them for longer time

http://classes.kumc.edu/sah/resources/sensory_processing/learning_opportunities/concepts/sp_concepts_main.htm

Sensory System, Dysfunction & Strategies/Tools

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ProprioceptiveInput &

Supports

Vestibular Input & Supports

Tactile Input & Supports

AuditoryInput &

Supports

Visual Input & Supports

Olfactory & Gustatory Input & Supports

RelaxationTechniques

Proprioceptive System • The unconscious awareness of body position – receptors in

muscles and joints tell us about the position of our body parts, their relation to each other and their relation to other people & objects

• Communicates how much force is necessary for the muscles to exert and allows us to grade our movements

• Works closely with the vestibular system

• Helps develop motor planning skills & screen out uncomfortable sensations

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Proprioceptive Dysfunction�Child who is hyposensitive -- bumps & crashes in objects

and people, risky who movements that provide intense sensory input

�Child who is hypersensitive -- appears weak & is resistant to participating in heavy work activities

�Child who has poor body awareness and motor planning skills – difficulty playing with a ball, riding a bicycle, messy handwriting, etc.

�Child who is described as being clumsy 72

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Proprioceptive Strategies • Pushing hands and counting• Pulling or pushing wagon• Theraband Activities • Sandwich Games with pillows • Rolling in blankets or lycra

material • Body Socks • Weighted lap band, vest, hat • Compression garments (i.e.

SPIO)• Lycra Fitted Sheets

• Duvet cover stuffed with blankets and pillows

• Steppin Stones • Weights • Child BackPack with items

inside and strap across chest• Handee Band • Bouncy Bands • Build A Bear – weighted pellets • Accordion Chair• Mushroom Chair

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Vestibular System • Provides information about movement, gravity and changing

positions through receptors within our ears ��� fluid moves in our semi-circular canals, the utricle & the saccule, as fluid moves the hair cells detect changes in gravity & different types of movement in our environment

• Moving or still, speed & direction (with or without vision we still know where we are in space)

• Strong relationship to auditory system and visual system

• Protective function – react to a fall

• Discriminative function – deciphers the different types of movement – up, down, slow, fast, rocking, rhythmic, circular, angular, etc. 74

Vestibular Dysfunction �Child who is hypersensitive – over-reacts to movement and is

fearful with any change in position, often times “gravitationally insecure”� difficulty with stairs, riding bikes, playground activities, etc. � appears anxious, insecure, anti-social, prefers sedentary

play�Child who is hyposensitive - craves movement, always on the

go and unable to sit still� difficulty with registering the movement (need more to stay

alert and aware)� appear to always be climbing, jumping, falling, tumbling, etc. � appear to have short attention span, makes quick transitions � often poor safety awareness� frequently described to be a risk-taker or dare-devil 75

Vestibular Strategies

• Swings – rotary vs.. linear • Sit-n-Spin • Dizzy Disc • Bilibo • Spin Disc • Scooter board • Rocking Horse • Ikea egg chair • Gymnastics • Tumbling Class

• Rolling activities • Animal Walks • Music and Movement Songs • Therapy Ball Activities • Rotational discs• Hippity Hop

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Tactile System • Receives information about touch from receptor cells

throughout our body in the skin – protective & discriminative abilities

� Protective: alerts us when there is danger or potential harm� Discriminative: enables us to identify the quality of the object we are touching

• Provides information about qualities of objects (hard, soft, dull, rough, smooth, etc.) and the quality of touch we are receiving (light touch, pressure, vibration, temperature, pain, etc.) ��� and helps us decide how to respond & react

• Helps develop body awareness & motor planning

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Tactile Dysfunction

�Child who is hypersensitive � excessively registers tactile input and is hesitant to touch objects necessary for task completion

�Child who is hyposensitive � requires intense tactile input/touch; may also have delayed response to tactile input

**Safety is a real concern with tactile dysfunction**

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Tactile Strategies • Sand – kinetic, colored, etc. • Use Play-doh, Gak, Floam,• Sculpey, Silly Putty, clay• Sensory bins (rice, beans, etc.)• Help with gardening• Vibrating toys - pens, balls,• Use hand fidgets• Stuffed animals & pets • Make mudpies• Arts & crafts – finger paints,

glitter glue

• Use foamy soap/shaving cream

• Play with whipped cream• Mix cookie dough, cake batter• Warm bath• Scrub with washcloth/scrubby• Water play• Wear certain fabrics• Explore various textures• Tagless Clothing • Wilbarger Protocol:

therapeutic brushing 79

Auditory System

• receptors are located in the inner ear and are stimulated by air waves

• send information about sounds in the environment to the brain for interpretation

• helps change an individual’s arousal level�alerting - loud, quick, unpredictable sounds�calming – slow, rhythmic sounds

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Auditory Dysfunction

�Child who is hypersensitive � hears everything and is not able to filter out the unnecessary sounds; appears easily distractible

�Child who is hyposensitive �doesn’t respond to auditory input; appears to ignore; delayed reaction

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Auditory Strategies • Background music • Verbal cues to prepare • Use earplugs or sound-canceling

headphones• Changing sound, tone, beat of

auditory input • Varying intonation • Auditory feedback with toys,

computer, iPad, etc. • Listen to favorite music• Discover calming vs. arousing

music• Bang on pots and pans• Play musical instruments• Listen to sounds of nature

outdoors• Singing, Humming or Whispering• Blow whistles• White noise machine or CD• Observe silence• Identify and label sounds• Explore the stereo volume

control knob• “Safe space” with quiet and low

light• Listening programs

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iLs trains the neurological pathways needed for daily functioning. The combined activities have a global effect on the brain and central nervous system, influencing the following systems and their function: auditory, visual, vestibular, motor, cognitive and emotional. As a result, it is successfully applied to a wide variety of conditions. http://integratedlistening.com

What is Therapeutic Listening®? Developed by Vital Links, Therapeutic Listening is research based tool for treating people of all ages who have difficulty with processing sensory information, listening, attention, and communication.(www.vitallinks.net)

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The Listening Program®(TLP) is a music listening method, personalized to improve brain fitness at any age or level of ability. Each evidence-based therapeutic program is used in the individual’s home to aid in a better quality of living. Using The Listening Program (TLP) method of music listening therapy to support clinical treatments will provide a solid foundation for long-lasting rehabilitation and intervention outcomes.

www.advancedbrain.com

Visual System • receptors are located in the retina of the eye and are

stimulated by light

• send information to the brain about objects or people in the environment, help us know boundaries, tell us where we are in our environment and how to navigate in our environment

• variations in light, color and visual distractions� alerting effect – bright & bold colors, bright lighting � calming effect – soft, natural colors, pastel colors, dim

lighting 84

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Visual Strategies • Contrast, bold colors• Limit visual distractions• Look at mobiles, lava lamps,

bubble lamps• Colored light bulbs• Avoid fluorescent bulbs (visual

flicker, & noise)• “Safe space” with minimal visuals• Respect color preference in

clothing, objects, and interior decorating

• Reconsider complicated prints and patterns on clothing, walls, and floors

• Toys in opaque containers

• Leave out 5-10 toys at a time to avoid visual overload

• Look at photos & picture books• Look at nature - fish tanks, farm,

zoo, ocean• Watch cartoons and movies• High-quality sunglasses outdoors• Tinted lenses indoors if sensitive

to glare• Wide brim hat or visor outdoors• Games and activities that

develop visual skills mazes, dot-to-dots, I Spy, drawing, flashlight tag, etc.

• www.zennioptical.com85

Olfactory System • Receptors are located in the nasal structure -- important

for awareness of environment and basic survival • Be mindful that olfactory is not the same for all

individuals • Closely associated with gustatory system - play a role in

feeding • Olfactory input can

� evoke memories� make a situation pleasant � draw child in to

participate in an activity � make a situation uncomfortable � child may

withdraw and refuse to participate in activity 86

Olfactory Strategies

• Essential oils and scented candles� invigorating (typically lemon and peppermint) �calming (typically vanilla, rose, and sweet

orange)• Smell flowers• Sniff spices and herbs • Blindfold smelling game

**history of trauma**

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Gustatory System & Oral Input • Receptors are located on the tongue and are

important for awareness of the environment & basic survival

• Closely associated with olfactory system • Oral motor sensory input plays a crucial role in

arousal levels �alerting effect�calming effect

• Can play a huge role in for the kids we see/treat with feeding & mealtimes

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Gustatory System & Oral Input Strategies• Explore different textures of foods

�Chewy: dried fruit, gummy bears/worms, licorice, beef jerky, bagels, cheese, granola bars, gum, raisins, taffy, soft pretzels

�Crunchy: popcorn, Veggies sticks

• Explore different temperatures of food: hot, cold, room temperature, frozen

• Explore strong flavored foods: sour, salty, sweet, spicy, bitter

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Gustatory System & Oral Input Strategies• Oral Motor Objects: chewy tubes, animal jigglers, teething

vibrators, knobby teething ball, tooth brushes (regular, musical, vibrating, etc.), chewy pencil toppers

• Blowing Activities: wind instruments, bubbles, balloons, whistles, blower party favors, blopens, kazoos, whizzers or other noise makers

• Resistive sucking: through thin straws or krazy straws, smoothies or milkshake through wide straws, sports bottle with straw, lollipops or suckers, popsicles, hard candies

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InteroceptionThe sense of understanding and feeling what is going on inside of our body

• Hunger • Thirst • Pain • Energy level • Toileting needs • Temperature • Emotional regulation & mood

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Internal sensations that help develop self-regulation

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Visual

Somatosensory

VestibularMotor

Auditory INTEGRATION

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http://www.sensationalbrain.com/

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How Does Your Engine Run?® A Leader's Guide to the Alert Program® for Self-Regulation

The book, How Does Your Engine Run?® A Leader's Guide to the Alert Program® for Self-Regulation (Williams & Shellenberger, 1996), describes an innovative program that supports children, teachers, parents, and therapists to choose appropriate strategies to change or maintain states of alertness. Students learn what they can do before a spelling test or homework time to attain an optimal state of alertness for their tasks. Teachers learn what they can do after lunch, when their adult nervous systems are in a low alert state and their students are in a high alert state. Parents learn what they can do to help their child's nervous system change from a high alert state to a more appropriate low state at bedtime

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95http://www.stickids.com/

Formal Planners and Trackers:•Weekly - select 12 pictures to use throughout the week at home or school.•Summary - attaches to reports or use as an overview of pictures to learn. •Monthly - allows 6 activities to be tracked for a month.•Group - select the pictures / activities for a small group.

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Drive Thru Menus by Tere Bowen Irish, OTR/L

Each of the exercises are designed to help children get the sensory input or muscular work they need to accomplish their daily tasks in the classroom in an fun and easy way.

www. allthepossibilitiesinc.com

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systematic, cognitive behavior approach used to teach provides strategies to teach students to become more aware of, and independent in controlling their emotions and impulses, managing their sensory needs, and improving their ability to problem solve conflicts

Red Zone describes extremely heightened states of alertness and intense emotions: anger, rage, explosive behavior, devastation, or terrorYellow Zone describes a heightened state of alertness and elevated emotions; however, one has some control: stress, frustration, anxiety, excitement, silliness, the wiggles, or nervousnessGreen Zone describes a calm state of alertness: happy, focused, content, or ready to learn. This is the zone where optimal learning occurs. Blue Zone describes low states of alertness and down feelings: sad, tired, sick, or bored.

The Zones of Regulation• Brain Gym® International is committed to the principle that moving with

intention leads to optimal learning. The organization was founded in 1987 under the name of the Educational Kinesiology Foundation and in 2000 began doing business as Brain Gym® International. The Brain Gym® work is being used in over 87 countries and has been translated into more than 40 languages.

• Brain Gym® movements, exercises, or activities refer to the original 26 Brain Gym movements, sometimes abbreviated as the 26. These activities recall the movements naturally done during the first years of life when learning to coordinate the eyes, ears, hands, and whole body. The 26 activities, along with a program for “learning through movement” were developed by educator and reading specialist Paul E. Dennison and his wife and colleague, Gail E. Dennison who say that the interdependence of movement, cognition, and applied learning is the basis of their work. Even though it is not clear yet "why" these movements work so well, they often bring about dramatic improvements in areas such as: • Concentration and Focus • Memory• Academics: reading, writing, math, test taking • Physical coordination• Relationships • Self-responsibility• Organization skills • Attitude 98

99http://constanttherapy.com/blog/wp-content/uploads/2017/03/brainrightleft.jpg

“Use Mind-Body Balance to learn faster, work smarter and move more easily through life”

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Kathy Brown, author of Educate Your Brain, discusses how we need our children to have physical movement to have an effective brain bridge, both sides of the brain must work together, to enable whole brain function

Flight or Fright � Brainstem is active & Executive Function is turned off � Frontal Lobe is off/decreased activity

“Survival mode limits our ability to focus, comprehend and make rational choices”35

Brain Gym Movements �Midline Movements – support coordination of left & right side

of body for physical action and left & right hemispheres of the brain for cognitive processing � Cross crawl, Lazy 8s & Double Doodle

�Energy Exercises – help resolve stress-related disturbances that affect physical balance & emotional equilibrium � Brain Buttons, Sipping Water, Thinking Cap & Balance Buttons

�Lengthening Activities – release the “freeze response” that affect posture & physical balance � The Owl, The Calf Pump & Arm Activation

�Deepening Attitudes – diminish the “Fight or Flight” response � Hook-ups & Positive Points

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• Bal-A-Vis-X is a series of some 300 exercises, most of which are done with sand-filled bags and/or racquetballs, often while standing on a Bal-A-Vis-X balance board. Requiring multiple thousands of mid-line crossings in three dimensions, these exercises are steadily rhythmic, with a pronounced auditory foundation, executed at a pace that naturally results from proper physical techniques. Bal-A-Vis-X enables the whole mind-body system to experience the symmetrical flow of a pendulum.

• This carefully modulated system of exercises can become increasingly complex OR increasingly simplified/modified for those with severe special needs. In group (school) settings the program demands cooperation, promotes self-challenge, fosters peer teaching. 102

Astronaut Training: A Sound Activated Vestibular-Visual Protocol for Moving, Looking & Listening• a sensory integrative protocol that is specifically designed to stimulate &

integrate the vestibular, auditory and visual systems• should only be implemented by a trained clinician with fundamental

understanding in sensory integration � then be carried out by a parent/caregiver or member of the classroom staff, once trained

• "The vestibular system teams up with the auditory and visual systems to perform many important tasks by helping us understand the three-dimensional space, or spatial envelope, that surrounds us wherever we go

• the vestibular system provides a perception of orientation in space that must be activated by the musculo-skeletal system - our internal guidance instrument working to tie the body’s senses

• the dynamic interaction between the members of the vestibular-auditory-visual triad provides the backdrop for virtually everything we do, and thus determines much about the quality of our lives." 103 www.understood.org/en/school-learning/your-childs-rights/basics-about-childs-rights/how-idea-protects-you-and-your-

child?utm_source=bing&utm_medium=cpc&utm_campaign=*EN%20-%20Legal%20Rights&utm_term=individuals%20with%20disabilities%20education%20act

The Individuals with Disabilities Education ActIDEA has been amended several times since Congress first passed it in 1975, known as Education for All Handicapped Children Act. Its primary goals are:�To protect the rights of children with disabilities. IDEA ensures

students with disabilities have access to a free and appropriate public education, just like all other children. Schools are required to provide special education in the least restrictive environment. That means schools must teach students with disabilities in general education classroom whenever possible.

�To give parents a voice in their child’s education. Under IDEA, you have a say in the educational decisions the school makes about your child. At every point of the process, the law gives you specific rights and protections. These are called procedural safeguards.

�IDEA covers kids from infancy through high school graduation or age 21

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Handwriting: Print verse cursive???

• Supports creativity• Cognitive skills & critical

thinking • Increases literacy • Educational benefit &

academic success • Self-confidence

• Right – left • Top – bottom • Formation• Spacing • Orientation• Kinesthetic

awareness • Shoulder strength

and stability • Grasping • Proprioceptive

awareness105

Age Performance Milestone Skills to Help Child

10-15 Months Scribbles on Paper Offer crayons and paper frequently to your child for consistent exposure to handwriting tools.

2 Years Can initiate a horizontal, vertical, circular or curved line

Building muscle strength in the hands and fingers is the goal during this age. Give the toddler a spray bottle with water. The gripping and squeezing of the bottle builds their hand and finger muscles necessary for writing.

3 Years Can copy different types of lines, straight and curved on a piece of paper

Continue to provide opportunities for writing and coloring, but with many different options to spark creativity and interest. For example, help your child use chalk, markers, dry erase board markers, crayons, colored pencils, and other options. Also encourage picking up small objects with tweezers, which contributes to an increase of intricate muscle use.

4-5 Years Can copy a cross, right directional line, left directional line and diagonal line, some letters and numbers and may begin to copy their own name

Use tracing sheets with numbers and letters. Create different shaped objects and then ask your child to draw the same shape. Continue to build hand and finger strength by playing and building with play dough. In addition, playing dot-to-dot games or connecting dots on a whiteboard or chalkboard are very helpful. See all activities.

5-6 Years Copy a triangle shape, prints own name, copies upper and lowercase letters

Practice with scissors and cut lots of shapes and lines on paper. To help your child use the tripod fingers on a pencil, take a small ball and have the child use their three fingers (thumb, index and middle) and move the ball up and down their legs to their hips by “walking” with those fingers.

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Treatment related to sensory processing & modulation

Carolyn Dalgliesh, author of The Sensory Child gets Organized states… Sensory Parenting is about Proactive parenting verse Reactive parenting ��� the hard work is in the preparation before the eventIt works because1. Supports the inherent challenges – proactive parenting allows the

parent to generalize each experience for the child 2. Allows you to set the stage – proactive parenting allows the parent to

give your sensory child a plan of attack, a map of what might happen and rules of how to handle different situations Reactive parenting does NOT work for sensory kids because

Emotionally overwhelmed = SHUT DOWN The teaching opportunity is gone…

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Identify the Triggers and Stressors

•Look at typical day

•Parent triggers and child triggers

•Social Interaction Classroom Triggers

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What is happening Where is it happening?

How is it being handled?

Look at typical day

Parent triggers &

child triggersSocial

Interaction &Classroom

Executive Functioning

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“Executive functioning is a term used to describe the many different cognitive processes

that individuals use to control their behavior and to get ready to respond to different

situations.”

Working definition - Executive functioning is at work behind the scenes to help

accomplish the desired goal

Executive Functioning

111

Executive Function: Key Skills • Impulse control: child’s ability to stop and think before acting; may do

unsafe things without thinking it through; likely to rush through homework without checking it; may quit a chore halfway through to go hang out with friends; have trouble following rules consistently.

• Emotional control: child’s ability to manage her feelings by focusing on the end result or goal; often have trouble accepting negative feedback; may overreact to little injustices; may struggle to finish a task when something upsets them.

• Flexibility: child’s ability to roll with the punches and come up with new approaches when a plan fails; think in very concrete ways; don’t see other options or solutions; find it difficult to change course; get panicky and frustrated

• Working memory: child’s ability to hold information in her mind and use it to complete a task; may have trouble with multi-step tasks; hard time remembering directions, taking notes or understanding something you’ve just explained to them; you frequently may hear, “I forgot what I was going to say.”

112https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/key-symptoms-signs-adhd

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Executive Function: Key Skills • Self-monitoring: child’s ability to keep track of and evaluate her

performance on regular tasks; lack self-awareness; can’t tell if their strategies are working; may not even realize they have strategies; often don’t know how to check their work.

• Planning and prioritizing: child’s ability come up with the steps needed to reach a goal and to decide their order of importance; may not know how to start planning a project; may be easily overwhelmed trying to break tasks into smaller, more manageable chunks; may have trouble seeing the main idea.

• Task initiation: child’s ability to get started on something; often have issues with planning and prioritizing for a task, it’s hard to know how to start; can come across as lazy or as simply procrastinating; often so overwhelmed they freeze and do nothing.

• Organization: child’s ability to keep track of information and things; constantly losing or misplacing things; can’t find a way to get organized even when there are negative consequences to being disorganized

113https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/key-symptoms-signs-adhd

Executive Functioning

114

We all have it

Allows us to

• Processes seem to happen in a seamless & automatic way

• Processes seem to not happen quickly enough or at all & the child gets stuck � doesn’t know what went wrong & has a hard time discerning what to do next = MALADPATIVE BEHAVIORS

• Be mentally & behaviorally flexible to all sorts of task demands

• Adjust our thinking to accomplish our goals (even with changing conditions along the way)

• Adapt our reflexes & responses in ways that result in coherence & smoothness of responses

115http://developingchild.harvard.edu/wp-content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf

The Center on the Developing Child at Harvard University has developed an activities guide:Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence

• 6-18 months • 18-36 months • 3-5 years • 5-7 years• 7-12 years • Adolescents

RESET BUTTON - Help Child Identify

116

Body FeelsFunnyJumpy Sleepy Silly Angry

Body NeedsSensory diet

activities Calming strategies Body Movement Activities

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The ProcessHelp child understand how the body works & provide tools to help handle the challenging

situations

Improve safety awareness

Let them know they are not alone – other children experience the same thing, other

families experience same thing

Create a safe-nonjudgmental environment for child to try

strategies

117

The Process

118

1. Identify what soothes & triggers anxious/sensory disregulation behavior

2. Increase awareness in what the body feels like when anxiety levels are increasing

3. Use an scale to rate feeling before explosive moment

Teach child organizing tasks �

help child understand how it makes them feel

“FUN & GOOD”

Children with anxiety don’t often achieve this feeling,

because they are usually on high alert �

help them enjoy it

Emotions

119

mirror

pictures in books &

magazines

take photos

practice with sibling and/or

friends

videos

cartoons Ways to

identify & label

emotions

Emotional RegulationHow would you feel? Internal Emotion

How would you act? External Execution

What does your body

do?Physiological Body Reaction

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What is Emotional Regulation?

121

• Emotional regulation is defined as the processes by which individuals influence which emotions they have; when they have them and how they experience & express these emotions

• Emotional regulation develops throughout childhood as a child learns to express & experience emotion

• Emotional regulation is important because it impacts the person’s ability to be productive, self-confidence & positive social relationships

• Maladaptive patterns of emotional regulation lead to anxiety

Child’s Emotional Response vs. Physical Behavior

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1. • Be aware of safety

2. • Remain Calm

3. • Simple Commands (1-2 word phrases)

4. • Make amends if possible – apology

5. • Once calm – process � need executive functioning skills

We must remember, kids are kids….sometimes they are having a childhood meltdown, but it is important to be aware that sensory issues may raise irritability & anxiety higherlevel of impatience & lack of impulse control

Emotion Scales

123

To help children identify where their body is with a visual support

Once level of emotion identified –work on coping strategies

Can use language in conjunction with emotion level – practice, so in the moment it is familiar

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http://radathome.blogspot.com/2013/11/m-feelings-activity.html?m=1

http://www.themagiccrayons.com/blog/?post_id=21&title=behavior-management---cool-down-cubes

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Behavior Management 1. Create effective routines 2. Teach and practice procedures often3. Review expectations like crazy4. Reflect on expectations often5. Build in simple incentives6. Make environments engaging7. Focus on positive behavior8. Determine the real cause of the behavior9. Use logical consequences.

125http://www.teachertrap.com/2016/06/classroommanagement.html/

Social Behavior Mapping©Social Behavior Mapping© is a strategy, connecting behavior, emotions & consequences across the day• developed by Michelle Garcia Winner • purpose of a Social Behavior Map is to help students learn how each behavior they do has an emotional impact on those around them, & that how a person feels contributes strongly to how he/she reacts to another person's behavior

•individuals learn about the thoughts–feelings–behavior connection

•ultimately that how we feel about ourselves is related to how other people treat us

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Yoga

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Breathing, Yoga, Imagery & Guided Visualization• Relaxation technique in which words & sounds are used to

evoke positive mental images, feelings & thoughts • THE MIND–BODY CONNECTION: uses the whole body, the

emotions & all the senses • Benefits for children

� Balance stress� Helps improve sleep� Help focus and concentration� Reduce physical and mental tension� Reduce anxiety� Helps children through transition� Self esteem 129

GoZen! Anxiety Relief Programs• GoZen! offers an innovative, simple

way for kids to learn how to understand and control their worry. With our animation-based approach, kids come to understand their anxiety in a new way and have fun doing it. Best of all, we use research-based skills and techniques to help them become confident, happy and secure.

• GoZen! provides online and homestudy programs for parentsand practitioners and schools, as well as supporting products. If you’re just starting with GoZen!, our flagship programs are the most popular, comprehensive programs which kids love! You can get immediate access to either program below. 130http://www.gozen.com

Everyone is wired differently… everyone battles a different dragon. Whether it is asthma, shyness, or fear they will not be accepted by their peers, all children have the amazing ability to be a conquer their dragon, just like Joshua. Joshua, a courageous boy who has autism, teaches others that if he can take on the dragon of his disability, they too have the strength within to overcome theirs. Stacey will use Joshua as a bridge to discuss common, everyday dragons like food allergies, shyness, and even clumsiness in a way that generates enthusiasm and is unforgettable.Becoming a dragon slayer is no small feat. Stacey will encourage participants to reflect upon their own personal stumbling blocks to come up with realistic strategies to conquer their dragon and to never use the words, I Can't Do It. Children will learn the four basic rules to becoming a true dragon slayer:

1.) Come up with a plan of attack2.) Always try 100%3.) Never give up4.) Never make fun of someone for having a dragon

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Well Rounded Balance

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Balance in Life

school/work

activities of daily living

therapiesrecreational activities

leisure activities –

independent & family

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A Child’s Life 2019

Television, computers, handheld devices,

smartphones, video games, etc.

Busy lifestyle – activities

Both parents working to support family

Less free and independent play

Today’s�World

133

Digital Native, Digital ImmigrantsIn an article called "On the Horizon" from 2001, author Marc Presky is acknowledged to have coined the terms digital native and digital immigrant. Digital Natives - those people that have grown up with digital technologies including home computers, the Internet, MP3s and mobile phones. Typically these people are 27 years of age or less and have pretty much always been exposed to these digital technologies vs....

Digital Immigrants - those people that grew up before the digital age where items such as home computers, the Internet and mobile phones were either non-existent or not as widely available. The general rule of thumb is that these people are 28 years of age or older. They are those people who adapt with these digital technologies.

Digital Intermediate - those people who grew up prior to the digital age but adopted digital technology as a teenager or young adult. Typically those people who are 28-40 years of age or were born in between 1970-1980. 134

Mindful usage of Screen Time teach our children balance in a world where technology is abundant

Zina at Lasso the Moon shares that often time restriction for children makes the forbidden activity more appealing. She uses the concept of mindful usage1. Set self-imposed usage guidelines. Chat with your children about what

they think is a reasonable amount of screen time. The depth of the conversation will depend on the age of your child. Toddlers to teens will all have their own thoughts; both will likely start with an absurdly high number. Rather than knocking their suggestion, use questions to bring usage time down to a range where you feel comfortable. Your kiddos need to know your family’s general stance towards screen time.

2. Realize that sometimes it rains. When we create strict limits with anything (dieting, exercise routines, meal planning), life tends to get in the way. Instead of providing your child strict limits, teach your kids to asses situations and to be flexible accordingly. So if it’s a rainy day, your kiddo might play an extra 30 minutes on PBS Kids. No biggie.

135http://letslassothemoon.com/2015/08/26/limit-screen-time/

3. Rise above, "Do as I say, not as I do.” Think about how you use YOUR phone or tablet. Are you sneaking a “quick peek” at your phone because your kiddo’s story about a friend seems like it’s going on forever? Flip the scenario and think forward. Imagine you’re trying to talk to your teen daughter and she starts fiddling with her phone mid-conversation. Can you imagine your response? “Are you even listening to me?!?”

4. Recognize that not all screen time is equal. It’s important for your kids to understand this and be mindful of their choices. Following along with a drawing tutorial on Art Hub for Kids, doing a lesson on Khan Academy, or playing Math vs.. Zombie is different than playing Subway Surfers. Talk with your kids about enriching ways they can use their screen time. (Of course, this is an ongoing lesson that will happen over the course of many discussions.)

5. Inspire your child to live offline. When you see your child on a screen, entice him or her with an offline adventure, project, or idea. So often parents (including myself, at times) default to a screen as a quick fix during the witching hour. Keep your eyes open for alternative solutions and BOOKMARK or pin them for later.

**parental control apps**

136http://letslassothemoon.com/2015/08/26/limit-screen-time/

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• For children younger than 18 months, avoid use of screen media other than video-chatting. Parents of children 18 to 24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they're seeing.

• For children ages 2 to 5 years, limit screen use to 1 hour per day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.

• For children ages 6 and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health.

• Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.

• Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.

• Family Media Use Plan tool 137

American Academy of Pediatrics

138

• When used intentionally and appropriately, technology and interactive media are effective tools to support learning and development.

• Intentional use requires early childhood teachers & administrators to have information & resources regarding the nature of these tools & the implications of their use with children.

• Limitations on the use of technology & media are important. • Special considerations must be given to the use of technology with

infants & toddlers. • Attention to digital citizenship & equitable access is essential. • Ongoing research & professional development are needed.

Key Messages of the NAEYC/Fred Rogers Center Position Statement on Technology &Interactive Media in Early Childhood Programs

http://www.naeyc.org/content/technology-and-young-children

The�C’s�of�Technology�

• Creativity• Consumption• Curation • Connection • Collaboration • Communication • Critical Thinking

Technology should facilitate & enhance the learning process

Access to so much more than ever before

139

Technology• Digital citizenship – interactive games and activities to empower

students to use technology responsibly, safely & effectively • TECHNOLOGY is NOT the reward, needs to be integrated into

learning � help the child find his voice, process what he is experiencing � support social emotional development � support independence

• Considerations � compatibility with devices child is using & modifications � independent use and success � fine-motor & visual processing abilities � goals??

• Team collaboration & communication 140

45

Technology – RED FLAG**child gets “stuck” on the screen and is not connecting

with people during screen time -- PASSIVE USE **

• Decrease screen time • Print out schedules, social stories, pictures from the screen • Structure the screen time, add turn-taking • Encourage co-viewing � watch together, narrate – provide

language • Use to make social stories, photos, movies, etc. – use as a

tool • Meal time

141 142http://www.joanganzcooneycenter.org/publication/family-time-with-apps/

� think about goals �talking with children�consider the situation �look at the content

143

Our DIG Checklist was designed to help you identify and recognize high-quality, inclusive children's digital media. Reviewers, researchers, parents, librarians, educators teachers: Use the checklist as a rubric for evaluating or rating children's media. Producers and creators: Use the checklist as a guide to help you produce high-quality children's media that is inclusive, equitable, and accessible.

https://www.joinkidmap.org/digchecklist/ 144

�enhancing the technology skills, experience, and digital media fluency

� increasing the intentional, appropriate, and effective use of technology and interactive media with young children

�promoting the use of technology tools for effective, engaging and empowering teacher preparation and professional development http://teccenter.erikson.edu/about-the-tec-center/

46

145

Common Sense is the leading independent nonprofit organization dedicated to helping kids thrive in a world of media and technology

• Common Sense Media helps families make smart media choices

• Common Sense Education provides high-quality digital literacy and citizenship programs to educators and school communities

• Common Sense Kids Action works with policy makers, business leaders, and other advocates across the nation to ensure that every child has the opportunity to succeed

https://www.commonsensemedia.org/

Media Manager, Mediator, Mentor & Maker • Technology advances at a fast pace, need to provide support

families, educators & providers• roles for educators – media Manager, Mediator, Mentor and

Maker – that can help early childhood educators, informal educators, parents and families establish a healthy media diet for young children, and create a positive media ecology in the classroom and at home to support digital age “wellness” for young children

• “blending and balancing of interactive technology and interactions” Chip Donohue

• all of us who work with children need to become more comfortable and capable of evaluating and integrating these new tools into the daily lives of young children in the most healthy way possible 146http://teccenter.erikson.edu

147

Preventing Eye Strain with Technology• place the screen between 20 to 28 inches away from your child's eyes;

align the top of the screen at eye level so that children look down at the screen while they work

• use low-watt bulbs in lighting fixtures as well as drapes or blinds to reduce glare from windows.

• comfortable, supportive chair positioned so child's feet are flat on floor• encourage children to move around and change positions while working• suggest that they limit leisure screen time to two hours or less a day

(watching TV, playing video games & using mobile phones)• Teach kids to rest their eyes: every 20 minutes, tell them to look at least

20 feet away for 20 seconds; remind children to blink regularly to prevent dry, irritated eyes

• Take notice if children are squinting, frowning at the screen, or rubbing their eyes - signs of eyestrain; make sure their prescription wear is up to date

148http://www.webmd.com/eye�health/features/vision�classroom�technology#1

47

Team Approach

Communication

family

school staff

daycare/nanny

therapists

recreational activities

149

� Communication notebook

� Email � Phone calls/text

Mindfulness�Practice & Model Strategies – be present & ready to

support our clients �Strength-Based Approach for Families

• Focus on the therapist approach to parent & child verse the actual technique

• Be aware of therapist statement to parents • Help families conceptualize their child’s behavior in a

positive manner • We know families with children with special needs have

higher stress level – financial, emotional, time management family dynamics & grief

150

Trust• At any stage of journey for a child and family, we as

therapists need to build and develop a trusting relationship • Open communication – most parents know their child best • We haven’t walked the path with families – don’t know how

doctor communicated information to them, don’t know what other therapist said, don’t know if they had someone in family with challenges – WE DON’T KNOW and cannot assume or judge….

• Support parents be advocates for their children and support children to be their own best advocates at a young age and then build upon that

151

Learning Principles: Strategies for Success

1. Making Intervention Immediately Relevant 2. Linking New Learning to Prior Knowledge 3. Active Practice and Participation are Key 4. Practicing Intervention Strategies in Real-Time5. Feedback is How we Grow

152http://veipd.org/earlyintervention/category/adult-learning-2/

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“Facilitating Attuned INteractions”Feeling, Calming, Thinking, Doing& Reflecting

153http://www.erikson.edu/news/fan-tool-developed-by-eriksons-fussy-baby-network-has-become-a-national-model/

• communication tool for professionals working with families

• originally developed by Erikson professor Linda Gilkerson and her Fussy Baby Network team

• each process is centered on parents’ urgent concern & is designed to support them in the moment.

• what the parent needs most at the time & providers can be mindful of their own responses

Goals

• Target the functional behavior NOT the sensory most of the time

• Often time the sensory activities are the strategies and interventions

• Sensory based goals can be difficult because they need to objective and measurable

• Goal should be a functional activity or task

154

Sample Goal Starters• Improve body awareness so that….• Increase regulation so that….• Improve attention so that….• Increase tolerance for a non-preferred activity…• Decrease outbursts or other undesirable actions…• Demonstrate the ability to self-regulate by identifying personal

alertness level….• Demonstrate the ability to select appropriate sensory break so that

he/she can complete…• Increase attention and participation in daily activities• Increase self-regulation so that he/she can interact with family and

peers • Increase body awareness so that he/she can be safe navigating in

new environments • Increase motor planning skills so that….

155

Home Strategies & Carry-over• Need to get the “buy in” – use simple language to help it

make sense ��� to help make a daily struggle a little easier, something meaningful to the child and parent

• Be aware that strategies are simple, easy and doable and link them to the child & family’s everyday needs

• Be a coach • Provide simple written direction or visual that parent can

refer to and share with others

156

49

Encouragement for continued progress

157

Progress & Goals

Motivators/Rewardsmotivators to use

appropriate strategies, NOT to

stop sensory behaviors

Sticker chart, coupons, “ good” jar,

working towards visual

CelebrationPraise,

acknowledgment & positive

reinforcement take some time to

celebrate goal achievement – it is

important

Self-reflectiondiscussion,

model & problem-solve

for future

Hard Work & Thought Before the Activity Enables Success�Set the task for success

• Time • Environment • Transitions • Supports

�Just Right Challenge • Make sure it is not too hard & not too easy

�Prioritize Needs & Goals • Is this important and how important at this time

158

Community Outings • AMC Sensory Friendly Films • Sky Zone & Pump It Up • Children’s Museums • Baseball Games • Disney on Ice, Circus, Sesame Street Live, etc.• Social Skills Groups: 123 Play with Me • Holidays & Summer Vacations • Airport Rehearsal Programs – Wings for Autism®

Adventures with Autism: The Airport Experience! -Autism Speaks

159

Strategies to offer support

160

Supports

Social stories Photos

Visual strips

First–thenstatementModeling

& Imitation

Turn-taking

Choice-making

Books

50

Success

161

Sometimes we overdo it and that’s ok. Identify what went wrong and move on � use it as a learning experience

51

Therapist-Parent Sensory Smart Worksheet

KEY EVENTS BREAKDOWN/CHALLENGE/BEHAVIOR SENSORY SMART ACTIVITIES

Wake-Up

Breakfast

Mid-Morning Play-time Break

Before Lunch

Lunch

Quiet time

Snack

Play time

Dinner

Bedtime

52

Therapist Problem Solving Worksheet

Challenge: Observations What system is

effected? (dysfunction) Strategy to

Implement Parent Supports

Physiological Signs:

Internal Factors:

External Factors:

Environmental Factors:

Additional Information:

53

Communication Worksheet for Families

Treatment

Activity

Goal – Intent Observations of child

performance Strategy (what worked &

what did not work Home Suggestions

54

Learning through Play – A Developmental Guide* When choosing a toy for a child. It is most important to observe what a child is now capable of doing and what he/she is beginning to master rather than using strict age appropriate guidelines. This chart is intended for use as a guide for choosing an appropriate play activity according to each child’s level of development.

When a child is able to: Provide: To Encourage:

0-3 months Follow objects with eyes Respond to sound by turning head or by general body movements Grasp objects when put in hand

Mobiles (musical or silent), mirror Musical mobiles, radio, rattles Small handled rattles

Eye movements/attention to movements Listening, following sounds Grasping/body awareness

4-5 months Lift head when on stomach, propping on arms Smile when looking at self Place objects in mouth Kick legs Reach out to objects

Mobiles placed within view on stomach, radio, movable windups Mirrors Brightly colored rattles with small grasp Soft balls, foam bricks Hanging toys, rattles, crib gyms

Strength of neck & back muscles Social behaviors Oral stimulation, hand-to-mouth motions, body awareness Awareness of body Aiming and grasping, visual, auditory, kinesthetic awareness

6 months Prop self on arms when on stomach/reaching with one hand Sit supported Squeeze objects Bang toys in play

Toys that move when touched Activity centers, balls Squeeze toys Blocks

Movement (rolling, weight shifting, pre-crawling) Exploration using two hands Gross grasp, association of movement with effect (sound producing) Play at midline, eye-hand coordination

7-8 months Push up onto hands and knees Sit momentarily unsupported Transfer hand-hand Pull string adaptively Manipulate bells, play with noisemaking toys

Push toys that move easily Toys that move easily, toys with suction base Blocks, rattles Hanging toys Bells, noisy toys

Ability to move self/pre-crawling skills Balance sitting, eye-hand coordination Practice grasping and releasing, midline play Realization of effect of grasping movement Auditory discrimination, provide stimulation

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Makes sounds Baby mirror, telephone, radios Simple imitation in social context

9 months Sit unsupported Begin crawling Pull to standing Poke and Probe Pull peg out of pegboard

Swings, supported rocking horse, activity centers, balls, toys using two hands Push toys Furniture in environment Pop-up toys, objects that will produce a response when poked Pegboards, peg men toys, blocks

Balance sitting, protective responses Locomotion, increase mobility Coordination of gross motor movement. Confidence and independence Increased isolated use of index finger Use of opposed grasp

10 months Hit objects with something else Put objects in/out of container Oppose thumb-finger Look for objects upon visual/auditory stimulation

Drums, first xylophone, pots & pans Pails, sorting boxes, cups blocks Pegboards, peg men toys, blocks Pop-up toys

Increased eye-hand coordination Beginning space perception skills, eye-hand coordination Increase higher level hand coordination Search for objects even when hidden

11 months Cruise (take steps while supporting self, moving to side) Imitate scribble on paper

Furniture, large immovable toys Large crayons, paper

Balance standing, lateral movement, confidence Lateral pincer grasp, refinement of eye-hand coordination

1 year Walk with support Walk without support momentarily Release ball/push ball Remove lids off objects Remove stacking discs Put in large pegs Enjoy rhythms

Baby walkers, push toys on wheels Large balls Large jars/containers Donut shaped stacking toys Pegboard/toys using pegman Musical toys

Refinement of balance skills, coordination of large body movements Coordination of two sides of body, coordination of grasp release Coordination of two hands Eye-hand coordination development Eye-hand coordination, space perception Simple imitation of sounds, body movements to music

15 months Walk independently Throw objects Make tower of two Put objects in/out of container in a related manner

Baby walkers, push toys, pull toys Balls Blocks, stacking toy Cups, blocks, posting boxes, cardboard boxes

Better standing balance and independence walking Bilateral coordination Refined release of grasp, space perception Shape discrimination (simple), eye-hand coordination

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Place circle in formboard Maintain sitting balance with movement in different directions

Simple formboards Large rocking toys

Shape discrimination trial and error Refined equilibrium

18 months Walk fast, seldom falling Standing balance good Sit self in chair Carry objects while walking Stack several blocks into a tower Imitate a stroke on paper Play with smaller pegs (1 ½”) Enjoy simple books and pictures Put two forms in board Handle large beads Enjoy sounds, whistles, rhythms

Large climbing toys, toys to challenge balance Child size chair Boxes, pails Blocks, stacking toys Fat crayons, paper Pegboard, pegman toys First books, simple lift out puzzles, inset puzzles Simple formboards Pop-beads, large wood beads Records, radios, music boxes, soundmakers

Refine standing balance Independence, climbing Coordination of body while maintaining balance Eye-hand coordination, simple constructional activity Pre-writing and copying skills, improved hand coordination Refinement of pincer grasp Language development Shape discrimination, form & space perception Eye-hand coordination, space perception Coordination of body movements to rhythms, language stimulation

2 years Move self on wheeled toy Kick ball Turn pages one at a time Make circular motions on paper String 1” beads Know main body parts

Large toys/trucks with wheels Large ball Books Crayons and paper Beads Dolls, mirrors, pictures, puzzles

Coordination of legs to move self Balance while standing on one foot momentarily Finer hand coordination, tactile Awareness Improve copying skills Eye-hand coordination, space perception skills Body awareness

2 ½ - 3 years Push and pull large items, negotiating obstacles Catch a ball Assemble a screw toy

Large trucks, play equipment Balls Toys with screwing action

Awareness of own body in space and relation to another object Coordinating the two sides of the body to midline More advanced coordination of 2 sides of body for more difficult construction activity

57

Begin to imitate lines, simple figures Manipulate clay Snip with scissors String ½” beads Match pictures Match primary colors Name 1 or 2 Know simple shapes Begin to do simple jigsaws Know “big-little” Lace simple cards Enjoy stories Enjoy water play

Chubby crayons, paper Playdough, clay kits Safety scissors Smaller beads Books, lotto, dominoes Formboards, color puzzles, matching games Formboards, sorting box, matching pictures Simple interlocking puzzles Stacking cubes, pegs, stacking disc, objects in environment of all sizes Lacing cards, shoes Books read to child Water toys, sponges

Copying, form perception, can later introduce tracing activities Isolated motions of fingers, strength of hands Strength and coordination of hands Hand coordination, space perception skills Learn concepts of same and different Learning concepts of same & different colors Shape discrimination Problem solving, shape and color discrimination Size perception and discrimination Eye-hand coordination Language development, attention to details, memory Tactile stimulation, body awareness

3-4 years Hop on one foot Throw, catch and kick ball Show agility climbing Trace and copies shapes Build higher level block structures/uses constructive materials Name colors Play in groups of 2 or 3 Sort/compare materials and pictures Complete more complex jigsaws Show awareness of numbers Engage in imaginative play

Climbing equipment, ropes swings, balls, etc. Templates, tracing activities Blocks, simple construction sets form and space perception skills Dominoes, games using color naming/discrimination Simple first games Lotto games, sorting materials Increasingly difficult puzzles Number dominoes, simple games with dice Small representational objects, or larger props for domestic play

Gains in agility and balance, muscular strength Refinement of pre-writing skills Eye-hand coordination, increased form and space perception skills Knowledge of colors Cooperative play, social behaviors Fine eye-hand skills, spatial discrimination, concept development Problem solving & language development, shape and color discrimination Recognition of quantity, simple games with rules Language development, social skills

4-5 years Plan and build constructively

Layout and creative kits

Practice in planning construction using verbal skills

58

Copy shapes and letters Color inside lines Do more difficult jigsaw puzzles Understand rules of simple games Lace shoes

Magnetic letters, letter shapes, chalk blackboard Coloring books, pictures Puzzles of scenes, stories Simple competitive games Shoe lacing toys, lacing cards, large shoes

Simple spelling and letter recognition Space perception skills that are needed for academics Completion of puzzle using figures as clues rather than shape of pieces Practice “winning and losing”, strategies, problem solving, attention span Fine motor coordination, independence in personal care activities

5-6 years Enjoy balance activities Bounce a ball Cut, paste, use drawing tools Use large needle, making large Stitches Complete 2-3 step models Print letters Define simple words, composition of objects Discriminate between fine sounds

Large play/climbing equipment, skateboard, roller skates, etc. Various sized balls Scissors, glue paint brushes, etc. Lacing toys, sewing kits Construction kits Pencils, paper, blackboard, letter writing toys Simple word games Toys/games requiring using hearing alone

Coordination of 2 sides of body, increased balance Coordinated use of preferred arm, coordination of 2 sides of body Fine coordination of hands, finger opposition Coordination of dominant hand, finger opposition Motor planning, problem solving Copying/writing skills Language development Auditory discrimination

7 years Bat a ball Tap rhythms Use greater fine hand control/finger opposition

Balls, bats Records, instruments Craft kits, construction kits with small pieces

Coordinated use of two sides of body, motor planning skills Motor planning, body awareness Increased coordination of dominant hand

8 years Perform rhythmic body movements Draw in perspective Complete more difficult design and construction kits

Records musical instruments Paints, crayons, pencils paper Construction kits with instruction, design copying games

Motor planning skills, increased body awareness Imagination, form and space perception skills Space perception, problem solving

* Originally published by The Able Child, Inc. 154 Chambers St., New York, NY 10007

59

Suggested Books: Therapists, Related Service Providers, Teachers,

Parents & Caregivers

60

61

62

Suggested Books: Children, Siblings & Peers

63

www.juliacookonline.com

64

Suggested Websites

Information & Blogs

www.balancepointpublishing.com

www.childhoodanxietynetwork.org

www.covd.org

www.drannezachry.com

www.eyecanlearn.com

www.henryot.com

www.ilslearningcorner.com

www.infantsee.com

www.lwtears.com

www.lynnekenney.com

www.lynnhellerstein.com

www.mamaot.com

www.moveplaythrive.com

www.out-of-sync-child.com

www.theottoolbox.com

www.pyramidofpotential.com

www.sensationalbrain.com

www.sensationalkid.com

www.sensory-processing-disorder.com

www.sensorysmarts.com

www.sensorystreet.com

www.sensorystreet.com

www.sifocus.com

www.spdfoundation.net

www.special-ism.com

www.theinspiredtreehouse.com

www.thespiralfoundation.org

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www.toolstogrow.com

Products & Programs

www.advancedbrain.com

www.alertprogram.com

www.beyondplay.com

www.braingym.org

www.chewytubes.com

www.chubuddy.com

www.funandfunction.com

www.gozen.com

www.pfot.com

www.sensorygoods.com

www.specialneedstoys.com

www.spioworks.com

www.therapro.com

www.therapyshoppe.com

www.vitallinks.net

www.yourtherapysource.com

www.zennioptical.com

Screen Time Resources

www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx

www.commonsensemedia.org

www.fredrogerscenter.org

www.joanganzcooneycenter.org

www.joinkidmap.org

www.naeyc.org/

www.tech.ed.gov

www.techcenter.erikson.edu

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REFERENCES Alexander, R., Boehme, R. and Cupps, B. (1993). Normal Development of Functional Motor Skills. Tuscon,

AZ: Therapy Skill Builders.

Ayres, A.J. (1998). Sensory Integration and the Child. Los Angeles, CA: Western Psychological Services.

Benoit, Diane. (2004). Infant-Parent attachment: Definition, types, antecedents, measurement and

outcome. Paediatric Child Health, 9 (8), 541-545.

Biel, L. and Peske, N. (2009) Raising a Sensory Smart Child. New York, NY: Penguin Books. Brown, Kathy. (2012). Educate Your Brain. Phoenix, AZ: Balance Point Publishing. Cisler, J. M. and Olatunji, B. (2012). Emotion Regulation and Anxiety Disorders. Current Psychiatry

Reports, 14 (3), 182-187.

Conyers, M. and Wilson, D. (2015) Smart Moves Powering up the Brain with Physical Activity. Kappan, 96

(8), 38-42.

Cosbey, J., Johnston, S.S., Dunn, M.L., and Bauman M. (2012). Playground Behaviors of Children With and Without Sensory Processing Disorders. OTJR: Occupation, Participation and Health, 32, 39–47. Donohue, C. (2015). Technology and Digital Media in the Early Years Tools for Teaching and Learning. New York: Taylor and Francis. Dunn, W. (1997). The Impact of Sensory Processing Abilities on the Daily Lives of Young Children and

Their Families: A Conceptual Model. Infants and Young Children 9 (4), 23-35.

Gilkerson, Linda. (2015). Facilitating Attuned Interactions: Using the FAN Approach to Family Engagement. Zero to Three, 46-48. Green, S. and Ben-Sasson, A. (2010) Anxiety Disorders and Sensory Over-Responsitivity in Children with

Autism Spectrum Disorders: Is there a Causal Relationship? Journal of Autism & Developmental Disorders.

40 (12), 1495-1504.

Greenspan, Stanley and Weider, Serena. (1998) The Child with Special Needs. Reading, MA: Adison-

Wesley.

Jarret, M., Black, A., Rapport, H., Grills-Taquechel, A. and Ollendick, T. (2015). Generalized Anxiety

Disorder in Younger and Older Children: Implications for Learning and School Functioning. Journal of

Child and Family Studies. 24, 992-1003.

Kaliuzhna, M., Ferrè, E. R., Herbelin, B., Blanke, O., & Haggard, P. (2016). Multisensory effects on somatosensation: a trimodal visuo-vestibular-tactile interaction. Scientific Reports, 6, 26301. http://doi.org/10.1038/srep26301 Klass, Perri and Costello, Eileen. (2003) Quirky Kids. New York, NY: The Random House.

67

Kranowitz, Carol Stock. (2005) The Out-of-Sync Child. New York, NY: Penguin Group.

Kranowitz, Carol Stock. (2003) The Out-of-Sync Child Has Fun. New York, NY: Penguin Group.

Kranowitz, Carol Stock and Newman, Joye. (2010) Growing an In-Sync Child. New York, NY: Penguin

Group.

Mahler, K. (2015). Interoception: The Eight Sensory System. Kansas: AAPC Publishing.

Media and Young Minds. COUNCIL ON COMMUNICATIONS AND MEDIA Pediatrics 2016;138. DOI: 10.1542/peds.2016-2591. Media Use in School Aged Children and Adolescents COUNCIL ON COMMUNICATIONS AND MEDIA Pediatrics 2016;138. DOI: 10.1542/peds.2016-2592

Miller, L., Anzalone, M., Lane, S., Cermak, S. and Osten, E. (2007). Concept Evolution in Sensory

Integration: A Proposed Nosology for Diagnosis. The American Journal of Occupational Therapy, 61 (2),

135-140.

Ozonoff, S. and Cathcart, K. (1998). Effectiveness of a Home Program Intervention for Young Children

with Autism. Journal of Autism and Developmental Disorders, 28, 25-32.

Pensky, M. (2001). Digital Natives, Digital Immigrants. On the Horizon MCB University Press, 9 (5).

Reynolds, S. and Lane, S.J. (2009) Sensory overresponsivity and anxiety in children with ADHD. American

Journal of Occupational Therapy, 63, 433-440.

Rigoli, D., Piek, P., Kane, R. and Oosterlaan, J. (2012). An examination of the relationship between motor

coordination and executive functioning in adolescents. Developmental Medicine and Child Neurology, 54

105-1031.

Scanlon, C. (2010). Emotional Regulation in Children: A Guide for Teachers. University of Pittsburgh

Master’s Project.

Silverman, F. and Tyszka, A.C. (2017). Supporting Participation for Children With Sensory Processing Needs and Their Families: Community-Based Action Research. American Journal of Occupational Therapy. 71, 7104100010p1-7104100010p9. doi:10.5014/ajot.2017.025544 Snel, E. (2013). Sitting Still Like A Frog, Boston: Shambhala Productions.

Steiner, A. (2010). A Strength Based Approach to Parent Education for Children with Autism. Journal of

Positive Behavioral Interventions, 13 (3) 178-190.

The Science of Early Childhood Development. National Scientific Council on the Developing Child, Center

on the Developing Child, Harvard University, 2007. Retrieved February 24 2014 from:

http://developingchild.harvard.edu/resources/reports_and_working_papers/science_of_early_childhood_de

velopment

Thompson, Ross A. (2001) Development in the First Years of Life. Caring for Infants and Toddlers. (11)

21-33.

68

Watts, T., Stagnitti, K. and Brown, T. (2014). Relationship Between Play and Sensory Processing. American Journal of Occupational Therapy, 68: e37-e46. Whitcomb, D. A., Carrasco, R. C., Neuman, A., and Kloos H. (2015). Correlational Research to Examine the Relation Between Attachment and Sensory Modulation in Young Children. American Journal of Occupational Therapy, 69, 6904220020p1-6904220020p8. doi:10.5014/ajot.2015.015503.

Wilson, B., Manangan, C., Dauterman, H. and Davis, H. ADHD Symptoms Moderate the Relation Between ASD Status and Internalizing Symptoms in 3-6 Year Old Children. Journal of Autism & Developmental Disorders. 44 (6) 1347-1356.

Yack, E., Aquilla, P., and Sutton S. (2002) Building Bridges through Sensory Integration 2nd ed Arlington, TX: Future Horizons.

Zimmer, M. and Desch, L. (2012). Sensory Integration Therapies for Children with Developmental and Behavioral Disorders. Pediatrics. 129 (6) 1186-1189.

Additional supplements are available at the below link:

https://blog.summit-education.com/sanghvi/

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