Sensory Diet

May 29, 2013

Once a parent understands Sensory Processing (see this post for a full explanation), the next question is often “what do I do with my or my child’s sensory needs?” An OT will usually answer, “it depends on the individual.” Every person explores, feels and senses their environment differently.  For example, when I am unable to focus on my work, often times I will play calming music in the background and that helps me become more focused. For others any type of noise in the background can be very distracting.

To help figure out what is calming/alerting for you or your child, your occupational therapist will usually establish a sensory diet.  A sensory diet is something that can be embedded in your daily routine and help the individual get through tasks/transitions that can be very difficult. For example; if a child has difficulty getting dressed in the morning and complains about the feeling of the material or doesn’t like certain textures on their skin, the therapist might suggest an activity that would help the individual transition into the non-preferred activity (such as getting dressed). An example of one of the activities might include wrapping the child up in a blanket like a burrito and giving deep squishes to help desensitize the skin before putting clothes on. It could also help decrease the child’s anxiety about getting dressed as being wrapped up tightly can give a calm and safe feeling (again, every individual is different). Occupational therapists work with the family to help establish a diet that works for the child and family. Below is a list of tools, most of them are divided into calming, alerting or organizing activities. Please take note that these are suggested activities and may not be calming/alerting for your child; as I mentioned before every person processes information differently.

Activities that may be found in a Sensory Diet:

 

 Alerting Activities: Alerting activities help the undersensitive child to increase hypo-responsiveness to sensory stimulation. Stimulation activities include:

§  Applying lotion with stimulating scents (peppermint, citrus scent).

§  Jumping activities (jumping jacks, jumping on trampoline, hop scotch, jumping on bed/furniture).

§  Bouncing activities (therapy ball, beach ball, peanut ball).

§  Eating crunchy food (raw vegetables and fruits, nuts, crunchy cereal, toast).

 

 

 Calming Activities:

Calming activities should be used to help the oversensitive child decrease hyper-responsiveness to sensory stimulation. These activities are characterized by slow, linear movement or comfort. They include:

§  Deep pressure activities (being sandwiched in between 2 pillows; being rolled in a blanket pretend to become a burrito; pushing against the wall with hands, back, and head; clamping hands in each other and squeeze; pushing down on a hard surface with extended arms and flat hands…).

§  Slow rocking (in the arms of an adult, in rocking chair, placed in a blanket held by 2 adults, in a hammock).

§  Taking a warm bath/shower.

§  Applying lotion with calming scent (lavender, chamomile, vanilla).

§  Sucking on hard candy, lollipops, or pacifier.

§  Holding a cuddle toy (stuffed animal, favorite blanket).

§  Manipulating a fidget toy.

 

 

 

 Organizing Activities: These activities help regulate the child’s responses. Organizing activities use resistance and/or rotational, upside down movement. They include:

 

§  Eating chewy foods (chewing gum, eating peanut butter, chewy fruit bars, dried fruits, fresh bagels).

§  Hanging activities (hanging arms of monkey bar, or chinning bar, hanging of adult’s elevated arms).

§  Pushing activities (pushing furniture, heavy grocery and/or laundry bags).

§  Climbing (on play structures, furniture, trees).

§  Bouncing activities.

§  Digging in resistive mass (theraputty, sand, mud, rice).

§  Sitting on an air cushion, peanut ball.

§  Participating in rough play (tug of war, roughhousing).

§  Upside down movement (somersault, cartwheel, hanging off trapeze).

 

By: Laura Anderson MS, OTR/L


Social-Pragmatic Skills and Autism Spectrum Disorders

December 17, 2012

Social pragmatic skills help individuals engage in social interaction with others. Many of us grasped the unwritten rules that govern our behavior in the social environment early on in our lives. However, individuals with Autism Spectrum Disorder (ASD) have difficulties learning these rules. In fact, social-pragmatics is often considered a core challenge for these children. The “hidden” social expectations can make social interaction a confusing experience. Therefore, many professionals and parents may want to help children with ASD develop a variety of skills that fall within the social-pragmatic realm. Nonetheless, before we start, we need to first sort out important conversational skills and find ways to assess children’s performance.

Social pragmatic skills involve not only one’s ability to communicate intent, but also knowledge of discourse management, register variation, presupposition, and other social skills. Discourse Management involves managing the conversation to keep it flowing and effective. Conversation partners need to agree on turn allocation, which involves identifying turn-taking opportunities and limiting one’s talking to one’s turn. They stay on the topic unless there is a signal by a communication partner that he/she is going to change the topic. Knowledge of topic maintenance includes knowing how to smoothly switch to a new topic. When conversation breakdown occurs, one needs to recognize it and use subsequent repair strategies such as repeat, rephrase, or adding information to aid communication. Register variation includes politeness/social role recognition, as people change their word choices, sentence forms, vocal tone and gestures/body posture to adjust to social roles in various discourse patterns. Presupposition, or perspective-taking, involves making assumptions about what other people know. People learn to understand everyone has different thoughts, feelings, and experiences, and take this into account during the conversation. Paralinguistics refers to the use of prosody, gaze, gestures, and physical proximity to show interest in the interaction, convey different layers of meanings and monitor the nonverbal communication of the partner. Social behaviors involve use of facial expressions, conventional gestures, and social actions that are expected in one’s culture, such as dressing appropriately for an occasion, offering to share something, assisting someone who needs help, patiently waiting for a turn in a game, etc.

Children with ASD may be able to fluently express their intention, but they often face difficulties in their social interaction with lack of proficiency of more than one skill listed above.

Assessing pragmatic skills can be a challenge since conversations are dynamic, and there is no easy way to measure one’s performance via standard tests. Formal assessment which involves static, often pictured situations can be used to establish a starting point, but information collected through observation, interview, and check lists helps us to detect if the individual lacks the knowledge to manage such conversations or is merely experiencing a performance issue. If needed, specific situations can be created to probe particular skills. Information from more than one source is necessary to establish goals and priorities for intervention.

Several key components need to be considered as we develop an individualized treatment program for children with ASD. These include the child’s knowledge about social communication, his/her ability to apply social knowledge in various situations, the cognitive/emotional cost to the child, the need to find right strategies to specific challenges, the co-occurring elements in the planning/implementation stages of social interaction, plans to generalize learned skills, self-monitoring skills that promote independence and flexibility, etc. Interventionists should also consider what skills are easiest/most important to teach, which skills can be paired together, and which skills will make the biggest impact in terms of improving social interaction. Many tools and programs have been developed for improving social interaction in this population. For example, social groups and social stories help children with ASD to experience different social roles and social situations, expand their knowledge of social skills, give them examples of strategies they can use, and offer them opportunities to practice social-pragmatic skills in a low-stress environment. While the SLP may lead intervention, family members and school teachers can also provide additional learning opportunities throughout the day to help children monitor their newly learned skills.

Information taken from:

http://www.autismsupportnetwork.com/news/meeting-challenge-social-pragmatics-students-autism-spectrum-887512

– Chloe Chenjie Gu, MA., Speech-Language Pathology Intern

– Kristina Elliott, MA, CCC-SLP


Sensory Strategies to Alert or to Calm Yourself or Your Child

December 3, 2012

Did you know that you can use sensory strategies to alert or to calm yourself or your child?

You may have heard of relaxation techniques to calm oneself by using soothing music or deep breathing. What about techniques to alert oneself when experiencing low energy? When addressing sensory strategies we often think of the sense of smell, sight, hearing, touch, and taste. From a sensory integration perspective, we also have the vestibular (balance) and proprioceptive (body awareness) systems. Based on personal responses and preferences, we can change or “regulate” the level of arousal through the use of these sensory systems.

There are some activities that tend to be calming in nature and some activities that tend to be alerting. You may notice that you have already used these strategies without realizing. For example, you may have used calming strategies with a young baby by dimming lights, playing soft music, swaddling and gently rocking him/her. These strategies address the vestibular, tactile, visual, and auditory input. Or you may have used alerting strategies when staying up late working or studying by removing clutter from your desk beforehand to prevent distractions, talking to yourself or reading aloud, fidgeting with your pencil, tapping your foot and eating a crunchy snack. These strategies address the visual, auditory, tactile, vestibular, and oral motor input.

Think about what you do or what your child does in a small subtle manner in order to maintain appropriate levels of arousal. This may help you select appropriate types of sensory input. Remember that each individual responds differently to different types of sensory input. Individuals need to reflect on their response to different types of input.

If you have any questions, please contact an occupational therapist who can assist you with using environmental/sensory strategies to support you or your child.

 

-Felicia M. Hashimoto, M.A.T., M.S., OTR/L

 

TYPE of INPUT ALERTING QUALITIES CALMING QUALITIES
VESTIBULAR (movement of head through space =>   contributes to balance) fast, jerky, changes directions, moving in suspended   equipment slow, rhythmic, movement in one direction,  using grounded equipment
PROPRIOCEPTIVE (on joints => contributes to body   awareness and coordination) fast paced, quick changes, jarring, jerking, starts or   stops abruptly joint compression, slow stretch, heavy resistance, (e.g.   push ups, heavy work, weighted blankets, backpacks, vests, or lap pad)
TACTILE light touch, unexpected touch, cold, rough, cool   environment pressure touch, tight wrap, firm stroking over large area,   predicted touch, warm environment
VISUAL bright colors, unexpected visual stimuli, bright lights,   red-yellow shades, changing/moving stimulus dark colors, predictable rhythmic pattern, dim lights, blue-green   shades, stimulus remaining constant
AUDITORY unexpected, loud, complex or mixed, pronounced expected, quiet, gentle rhythm, simple, melodic or   sing-song
OLFACTORY all odors tend to be alerting familiar odors associated with pleasurable & comforting   experiences, interactions or people
ORAL MOTOR Crunchy textures (e.g. pretzels, chips, raw veggies), cold   temperatures (ice chips, ice-cold drinks)) Deep breathing, resistive biting and chewing (e.g. fruit   leather, non-food items like Chewelry or Chewy tubes), sucking on hard candy,   thumb, or pacifier)

 

 

ALERT program from Therapy Works, Inc.: www.alertprogram.com

Ayres, J. (2005). Sensory Integration and the Child. Western Psychological Services.

Biel, L. & Peske, N. (2009). Raising a sensory smart child. London, England: Penguin Books.

Cohn, E., Miller, L. J., & Tickle-Degnen, L. (2000). Parental hopes for therapy outcomes: Children with sensory modulation disorders. American Journal of Occupational Therapy, 54, 36–43.

Kranowitz, C. (2006). The out of sync child: Recognizing and coping with sensory processing disorder. New York, NY: Perigree Trade.

Sensational Brain: www.sensationalbrain.com


How can parents help their children to develop good social skills? The 4 P’s!

November 16, 2012

As children get older, they become part of a larger social world. They begin to form relationships with other children and adults in school as well as outside of school. Being sociable helps us with resilience (the ability to withstand hard times). Children who are constantly rejected by peers are lonely and have lower self-esteem. Parents can help their children learn social skills so they are not constantly rejected or begin to bully and reject others.

Parents can act as coaches for their children to develop these social skills. Children learn a lot from how parents treat them and when they observe how parents interact with others. The American Academy of Pediatrics recommends that parents use a 4-part strategy when helping their children develop social skills; Practice, Praise, Point out, and Prompt. These four steps can be used when parents notice that a child needs to work on a particular social skill. Before using them, however, the parent should point out the problem area sensitively and privately (not in front of others) to the child.

Practice: You can help your child substitute a specific appropriate response for a specific inappropriate one. This might mean brainstorming with the child about different alternative responses and then practicing one or more with the child. Practicing can involve mapping out actual words to say or behaviors to use, role-playing, and using the newly learned skills in real situations.

Praise: Reward your child with praise when the new skills are practiced as a way of helping the skills become habits. This might be a specific verbal statement (“You did an awesome job of X instead of Y when you got angry at the store”), a nonverbal sign such as a thumbs up, or even a treat (10 minutes extra play time before bed).

Point Out: Parents can use opportunities to point out when others are using the desired skill. It might be a specific behavior of the parent, another adult, a child, or even a character in a book or on TV. The idea is to give children examples and role models of people engaging in the appropriate social skill.

Prompt:  Without nagging, parents can gently remind their child to use a new skill when the opportunity arises. This might be verbal (“Now might be a good time to count to ten in your head”) or nonverbal (a nonverbal cue such as zipping the lips when a child is about to interrupt).

Good coaches know that patience is important because learning new skills takes time and practice. It is important to remember that the ability to have good social relationships is not simply about personality or in-born traits. People who get along with others have learned skills to do so, and they practice these regularly.

 

Information gathered from Angela Wiley, Ph.D., “Importance of Teaching Social Skills to Children” and AmericanAcademy of Pediatrics

Sarah Peters, M.A., CCC-SLP


Social-Pragmatic Skills and Autism Spectrum Disorders

November 10, 2012

Social-Pragmatic skills help individuals engage in social interaction with others. Many of us grasped the unwritten rules that govern our behavior in the social environment early on in our lives. However, individuals with Autism Spectrum Disorder (ASD) have difficulties learning these rules. In fact, social-pragmatics is often considered a core challenge for these children. The “hidden” social expectations can make social interaction a confusing experience. Therefore, many professionals and parents may want to help children with ASD develop a variety of skills that fall within the social-pragmatic realm. Nonetheless, before we start, we need to first sort out important conversational skills and find ways to assess children’s performance.

Social-Pragmatic skills involve not only one’s ability to communicate intent, but also knowledge of discourse management, register variation, presupposition, and other social skills. Discourse Management involves managing the conversation to keep it flowing and effective. Conversation partners need to agree on turn allocation, which involves identifying turn-taking opportunities and limiting one’s talking to one’s turn. They stay on the topic unless there is a signal by a communication partner that he/she is going to change the topic. Knowledge of topic maintenance includes knowing how to smoothly switch to a new topic. When conversation breakdown occurs, one needs to recognize it and use subsequent repair strategies such as repeat, rephrase, or adding information to aid communication. Register variation includes politeness/social role recognition, as people change their word choices, sentence forms, vocal tone and gestures/body posture to adjust to social roles in various discourse patterns. Presupposition, or perspective-taking,involves making assumptions about what other people know. People learn to understand everyone has different thoughts, feelings, and experiences, and take this into account during the conversation. Paralinguistics refers to the use of prosody, gaze, gestures, and physical proximity to show interest in the interaction, convey different layers of meanings and monitor the nonverbal communication of the partner. Social behaviors involve use of facial expressions, conventional gestures, and social actions that are expected in one’s culture, such as dressing appropriately for an occasion, offering to share something, assisting someone who needs help, patiently waiting for a turn in a game, etc.

Children with ASD may be able to fluently express their intention, but they often face difficulties in their social interaction with lack of proficiency of more than one skill listed above.

Assessing pragmatic skills can be a challenge since conversations are dynamic, and there is no easy way to measure one’s performance via standard tests. Formal assessment which involves static, often pictured situations can be used to establish a starting point, but information collected through observation, interview, and check lists helps us to detect if the individual lacks the knowledge to manage such conversations or is merely experiencing a performance issue. If needed, specific situations can be created to probe particular skills. Information from more than one source is necessary to establish goals and priorities for intervention.

Several key components need to be considered as we develop an individualized treatment program for children with ASD. These include the child’s knowledge about social communication, his/her ability to apply social knowledge in various situations, the cognitive/emotional cost to the child, the need to find right strategies to specific challenges, the co-occurring elements in the planning/implementation stages of social interaction, plans to generalize learned skills, self-monitoring skills that promote independence and flexibility, etc. Interventionists should also consider what skills are easiest/most important to teach, which skills can be paired together, and which skills will make the biggest impact in terms of improving social interaction. Many tools and programs have been developed for improving social interaction in this population. For example, social groups and social stories help children with ASD to experience different social roles and social situations, expand their knowledge of social skills, give them examples of strategies they can use, and offer them opportunities to practice social-pragmatic skills in a low-stress environment. While the SLP may lead intervention, family members and school teachers can also provide additional learning opportunities throughout the day to help children monitor their newly learned skills.

 

Information taken from:

http://www.autismsupportnetwork.com/news/meeting-challenge-social-pragmatics-students-autism-spectrum-887512

 

Chloe Chenjie Gu, MA., Speech-Language Pathology Intern

Kristina Elliott, MA, CCC-SLP


Use of Social Stories for Children with Autism

November 2, 2012

Many children with autism have difficulty knowing what to do in various social situations.  Carol Gray, Director of the Gray Center for Social Learning and Understanding, created social stories.  Social stories are short stories used as a teaching tool for children with autism that describe a potentially challenging situation, skill, or concept in terms of relevant social cues, perspectives, and common responses.  They are written or tailored to an autistic individual to help them understand and behave appropriately in social situations. The stories have a specifically defined style and format.

They describe a situation in terms of relevant social cues, the perspective of others, and often suggest an appropriate response. They may also be used to applaud accomplishments.  It breaks down a challenging social situation into understandable steps by omitting irrelevant information and by being highly descriptive to help an individual with an ASD understand the entirety of a situation. It includes answers to questions such as who, what, when, where, and why in social situations through the use of visuals and written text. Social Stories are used to teach particular social skills, such as identifying important cues in a given situation; taking another’s point of view; understanding rules, routines, situations, upcoming events or abstract concepts; and understanding expectations.  Social Stories can provide information in an accurate but supportive manner, describe an unfamiliar or uncomfortable situation, prepare an individual for an upcoming event, or help an individual understand what is going on around them and the expectations of the situation.

The goal of a social story is to reveal accurate social information in a clear and reassuring manner that is easily understood by the individual with an ASD. The improved understanding of the events and expectations may lead to a change in behavior, although it is suggested that the goal of a social story should not be to change individual behavior.

Examples of situations when a social story would be appropriate are: “Going to the grocery store,”  “Going to school,” “Going to the doctor,” or “Riding the bus.”

Prewritten social story examples can be found on: http://www.child-behavior-guide.com/free-social-stories.html.

It is also beneficial to create your own stories with real pictures to help the child relate better.

Information taken from:

http://en.wikipedia.org/wiki/Social_Stories

http://www.autism-community.com/social-stories/

Michelle Morgado, M.S., CCC-SLP


Joint Attention

June 6, 2012

Learning to communicate using speech and language is a primary developmental task for young children. Significant progress in research related to language intervention is available to improve the delivery of Early Intervention services. According to the most recent research, social attention and prelinguistic communicative behaviors are fundamental to language learning and use.  According to Adamson et al., 2009, “the process of joint engagement between children and their partners is foundational to emerging communication.” In CSLOT’s parent handout, Making a Joint Effort to Communicate, joint engagement is initiated by the child’s communication partner through observation. By becoming a thoughtful observer, one can learn what the child enjoys, desires, feels – even what they want to communicate. Yoder & Warren, 2004 indicated that “coordinated joint attention is an important early indicator of social communication abilities and predicts the onset of spoken language in typical children with disabilities.” How can a parent, caretaker or therapist initiate coordinated joint attention? According to Making a Joint Effort to Communicate, one way is to become more physically involved in the same activity as the child. This works best when it is an activity of the child’s choosing. During the joint action, try imitating the child’s play- then try adding or expanding on their play.

Adamson et al., 2009 also found that the use of symbols (gestures, words) within the context of joint attention marks the transition from prelinguistic to linguistic communication. One way of using language during a joint activity is by providing joint referencing for the child. According to the handout, once the communication partner (i.e., parent, caretaker, therapist) is engaged in joint action with the child and they have established joint attention (i.e., both attending to the same thing), the communication partner can introduce the language component by talking about the object/action that the child is attending to. For example, if the child is playing with a car, then the communication partner will guide their attention to the car, talk about what it is, what it looks like, what it is doing, etc. The car is important to him right now so one can make that a “teachable moment.” Additional methods for teaching joint attention and prelinguistic communication skills (point, show, give, turn taking) have included environmental arrangement, modeling, prompting, and reinforcing child responses in naturalistic and direct teaching paradigms. Please speak with a speech-language pathologist for additional information on these techniques.

-Sarah Peters, MS, CCC-SLP

Information gathered from www.cslot.com and “Advances in Early Communication and Language Intervention,” (Kaiser & Roberts, 2011).