SLP Mommy of Apraxia

Tag: Sensory Integration

  • September Speciality Series with Mama OT: Sensory Processing DisorderPart II

    September Speciality Series with Mama OT: Sensory Processing DisorderPart II



    Today I welcome back Christie from MamaOT for Part II in our Q & A about sensory processing disorder!  If you missed Part I, you can read about it here.  


    Hi Christie!  So now that we know WHAT it is, let’s talk about what we can DO about it.  My first question is what should parents do if they suspect their child has any warning signs? 
    If you are a parent and you suspect your child may be demonstrating sensory processing difficulties, mention it to your child’s primary care provider (usually the pediatrician) and be an advocate for your child. It is not uncommon for pediatricians to brush off parental concerns regarding sensory processing difficulties. I have heard many examples from parents where the pediatrician either disregarded the concern altogether (saying something to the effect of, “He’ll grow out it, he’s just active because he’s a boy”, or, “She’ll grow out of it, all toddlers and preschoolers are picky eaters.”), or completely overlooked the sensory issues and labeled them as something else entirely (such as Oppositional Defiance Disorder or ADHD). So, as both a parent and a professional, I strongly feel that parents need to be advocates for their kids. I’m not saying you need to be hostile toward your child’s doctor. But you know your child best. You know how they have been since the day they were born (and before), and you know how significantly their daily life is impacted by their difficulties.
    If you do talk to the pediatrician about your concerns, emphasize how these sensory processing difficulties are impacting your child’s ability to perform activities of daily livingsuch as bathing, grooming, dressing, eating, self-feeding, sleeping, or playing. You can also emphasize any safety concerns you have, such as your 4-year-old unsafely seeking movement by climbing onto countertops or fences and then jumping off, or becoming so overstimulated in noisy environments that she begins crashing her body into walls or banging her head. Once you have shared your concerns with the pediatrician, he or she can then put in a referral for an occupational therapy evaluation and, depending on the results, OT treatment sessions can then begin in order to address the areas of concern and goals that are written as part of the evaluation process.  
    Sensory bins and activities seem to bombard social media, but from a professional perspective, why are they important? 
    Sensory bins and “messy play” activities allow children to learn and explore through the sense of touch. For children with typically functioning tactile systems, this is good because it provides sensory information to the tactile system that actually helps develop a more refined sense of touch (discrimination) and, subsequently, supports the development of fine motor skills such as using eating utensils, writing implements, scissors, and handheld sports equipment such as a basketball, baseball bat, or tennis racquet. For kiddos who demonstrate any of the three previously mentioned patterns of disordered sensory processing, sensory bins and activities are even MORE important and helpful. For those with over-responsive tactile sensory systems, sensory bins and messy play activities give kids the chance to explore tactile materials in a gradual, non-threatening, fun way. This can help them become more comfortable engaging with textures and substances their body perceives as threatening and can even help decrease picky eating. For kids with under-responsive tactile systems, sensory bins and activities provide the additional sensory input needed to sort of “wake up” their tactile system and give it the extra input it has been missing, which is so important for the development of those fine motor skills. And kids who seek/crave tactile input? They have more fun than anyone! For these kiddos – the touchers, the fidgeters, the grabbers – sensory bins and messy play activities are like a breath of fresh air to their tactile system! It gives them a chance to stimulate that sensory system in a fun, creative, safe, and age-appropriate way. Learn tons of fun ideas for sensory bins, plus find out lots of different ways to play with sensory bins HERE.
    What are some easy ways to incorporate sensory activities in the home?
    First of all, don’t go crazy trying to do every creative and crazy sensory activity you find on the internet! There are many ways to incorporate and embed sensory activities into your child’s daily routine. Here are a few ideas:
       If you have a baby or toddler, let them get messy when they eat. Read more about why this is good HERE.
       Allow kids to eat with their hands (when appropriate) so they can be exposed to a variety of textures during meal time.
       Give your kids the chance to help with meal preparation and “play” with their food at the end of their meal. Your Kids Table has a great post HERE about why and how to do this.
       Use a water table to promote outdoor sensory play and exploration. Learn more about how to use a water table for sensory play HERE.
       Many household chores provide natural opportunities for movement and “heavy work”, which is great for all kids but especially those who seek out proprioceptive input (to the joints and muscles). Some examples include taking out the trash, sweeping, mopping, vacuuming, raking leaves, loading or emptying the dishwasher, loading the washing machine with wet clothes, washing mirrors or windows, or mowing the lawn. So if it’s chores time, give your sensory seeker the choice of “heavy work” chores that are appropriate for their age and level of responsibility.
       Let your child push the shopping cart at the grocery store.
       Start a habit of taking your child (or the whole family) on a walk after dinner. It can be a walk to the park, around the block, or down a favorite path. Your kiddo can push their sibling’s stroller, pull a wagon, or even ride their trike or bike.
       Challenge your child to “animal walk” to different parts of the house during their routine activities, such as getting dressed in the morning or getting ready for bed at night. Some good animal walks include walking like a bear (hands and feet on floor, booty in the air), walking like a crab (hands and feet on floor, belly up to the ceiling, booty up off the floor), and crawling like a snake or lizard (belly crawling with arms and legs pulling the body along).
    Surviving and navigating Sensory Processing Disorder is no small task. It can be frustrating, confusing, and downright maddening. But remember that there is a community of occupational therapists who are trained to help, intervene, listen, and celebrate successes with you and your child as they work to develop the skills needed to more fully participate in and enjoy life!
    Thanks so much Christie!  Tell us a little about your blog, MamaOT.com.
    MamaOT.com is a place where I share tips and tricks for those who care for children, particularly babies, toddlers, and school-age kids. I started Mama OT in 2012 and love that I am able to use my experience as both a mom and an OT to help other parents, caregivers, therapists, and teachers as they support the development of the children in their lives.
    There are many ways you can follow and connect with me!
  • September Specialty Series with Mama OT: All about Sensory ProcessingDisorder Part I

    September Specialty Series with Mama OT: All about Sensory ProcessingDisorder Part I

    Today I’m thrilled to introduce Christie from MamaOT!  Hi Christie!  I’m a faithful follower of your blog and find your activities so easy, fun and practical to do at home!  For my readers who don’t know you though, tell us a little bit about yourself, your background as an OT, and your family.

    I’m a pediatric occupational therapist who works with children and their families to help improve their ability to participate in daily living activities (known as “occupations”) such as eating, sleeping, self-care, playing, socializing, and learning. This is done by addressing underlying difficulties such as fine motor, hand-eye coordination, problem solving, attention, and sensory processing skills (to name a few), while also taking into account the effect of a task’s difficulty on the child’s performance, as well as the impact the physical and social environment has on their ability to participate. OT’s get to do such amazing work! I have worked as a pediatric OT in a variety of settings, including in-home early intervention, clinic-based therapy, and school-based therapy. I have loved working with kids ever since I myself was a kid and, once I discovered the field of occupational therapy after I graduated college, I realized I was born to be an OT.

    I am a wife and a mom to two sweet boys, currently ages 3 and 1. The thing I love about being both a mama and an OT is that nearly everything I learn in one role teaches me how to do a better job in the other. The things I learn from being an OT make me a better parent. And the things I learn from being a parent make me a better pediatric therapist. It’s awesome!

    So today I wanted to talk about Sensory Processing Processing Disorder.  SPD gets a lot of buzz lately, but was is it really?

    In order to talk about Sensory Processing Disorder, we need to first understand what typical sensory processing is.
    “Sensory processing” refers to the nervous system’s ability to take in sensory input from all the different sensory systems, organize it in the brain for functional use, and then send out signals to activate the appropriate motor, behavior, or emotional responses (known as an “adaptive response”). In individuals with intact sensory processing, this happens automatically, unconsciously, and nearly instantaneously.
    When occupational therapists talk about sensory processing (also referred to as “sensory integration”), we are typically referencing seven sensory systems. 
    Most people have heard of the classic five senses but never knew there are two additional “hidden” sensory systems that play a powerful role in our body’s ability to function on a day-to-day basis. Without going into too much detail (I don’t want to bore you!), the seven sensory systems OT’s typically refer to are:
     Vestibular: Sense of balance and motion, located in the middle ear, tells us where we are in space.
     Proprioception: Sense of body awareness, located in sensory receptors in our muscles and joints, activated any time we push or pull on objects, as well as any time the joints are compressed together or stretched apart (such as jumping up and down or hanging on monkey bars). Proprioceptive input tends to have a calming and organizing effect on the body. 
      Tactile: Sense of touch, located in sensory receptors in our skin and mouth. Tells us when we’ve touched something (sensation) and what it is we’ve touched (discrimination, such as texture, size, temperature).
       Visual: Sense of vision, but it’s more than just about being able to see clearly. Our visual system also helps us see what we need to see and filter out what we don’t need to focus on.
       Auditory: Sense of hearing but, again, it’s more than just able to hear accurately. When we process auditory information, our brain has to be able to determine what sounds are important and what sounds can be “tuned out”.
       Olfactory: Sense of smell, influences sense of taste, and is the only sense that is directly tied to the part of the brain responsible for emotional memories (think of the emotions you feel when you smell a familiar smell, whether a positive one like grandma’s cookies baking in the oven, or a negative one like the smell of cologne/perfume that a previous boyfriend/girlfriend used to wear).
       Gustatory: Sense of taste, responsible for detecting all the different flavors that come in the mouth.  
    Sensory Processing Disorder occurs when the nervous system struggles to adequately process the incoming sensory information and organize it (or “integrate” it) in order to produce the expected motor, behavioral, or emotional responses. 
    While all of us struggle with processing certain types of sensory input to some degree on occasion, disorderedsensory processing occurs in approximately 1 out of every 20 individuals, and it significantly impacts individuals’ ability to participate and succeed in the important tasks, activities, and roles of daily life (aka – “occupations”). I want to be clear that SPD is more than just being sensitive to certain types of textures, scents, movements, or sounds. As occupational therapist Dr. Lucy Jane Miller describes in her book “Sensational Kids”, the difficulties resulting from Sensory Processing Disorder are chronic and they disrupt everyday life. It doesn’t matter how hard you try to positively reinforce good behavior, or how firmly you set your behavioral expectations for wearing certain clothing textures, eating certain foods, not wiggling or fidgeting while seated, or keeping hands to self. It just doesn’t work, because those kiddos’ brains are just wired differently than those without SPD.
    Thinking of the brain as a “traffic cop” for sensory input can be helpful when trying to understand SPD. In those with intact sensory processing, the brain acts as a traffic cop and is able to take the incoming sensory information from all the senses, process it, and then send it to the appropriate location in an orderly and accurate fashion; this allows people to respond to all of the information in an accurate, efficient, and functional manner. In individuals with SPD, however, the sensory information is not processed and sent off to the appropriate location in that expected orderly fashion, causing what you could say is a “neurological traffic jam” (a term pioneered by OT, educational psychologist, and neuroscientist Dr. A. Jean Ayres). This means certain parts of the brain do not receive the correct information needed in order to interpret and respond to the sensory input, making it difficult to process and act upon the information received from the senses in an accurate, efficient, and functional manner.
    Sensory Processing Disorder can (and often does) occur in relation to more than one sensory system. So a child (or grown-up) with SPD may be over-responsivein one or more senses while simultaneously being under-responsive or sensory seeking in other senses. Additionally, a person’s ability to process and respond to particular types of sensory input can vary from day to day, hour to hour, even minute to minute. This can be extremely frustrating for parents, teachers, therapists, medical professionals, and even the children themselves. One day (or one minute) they may be fine with the hum of the air conditioning or the fluorescent lights in the room, and then the next…it is unbearable to them. One day they may be okay eating a food of a certain texture or wearing a particular pair of socks, and then the next…the sight or thought of them makes them scream and cry. The body is constantly working to filter out what is unnecessary and focus on what is important, and then trying to respond to all of that input in a functional way. For a person with disordered sensory processing, the brain and body need extra help to be able to balance all of this incoming sensory input and appropriately respond to it (often referred to as “modulation”).
    As you can probably tell, Sensory Processing Disorder is very complex, and very tricky! 

    So do we know what causes Sensory Processing Disorder?
    At this point in time, the exact cause of Sensory Processing Disorder is unknown. But we do know from research that SPD is neurologically based; the brains of individuals with SPD are actually different than those of individuals who do not have SPD. In Chapter 13 of  “Sensational Kids”, Dr. Lucy Jane Miller notes that current research suggests three “leading contenders” that contribute to Sensory Processing Disorder – heredity, prenatal and birth complications (such as prematurity or labor and delivery difficulties), and environmental factors (such as sensory deprivation, trauma, or abuse). However, like many conditions, more research is needed to in order to truly be able to identify the causes of SPD.
    Who diagnoses Sensory Processing Disorder?
    At this point in time, Sensory Processing Disorder is not an “official” medical diagnosis. That is, it is not listed as its own category in the most current version of the handbook used for diagnosing neurologically-based disorders such as Autism, ADHD, OCD, and Depression. However, as any parent of a child with SPD will tell you, this does not mean Sensory Processing Disorder is not real. It just means there is still millions of dollars of research that needs to be done in order to demonstrate that SPD is a condition that is separate from the other neurological disorders.
    As pediatric occupational therapists, we do not treat the diagnosis; we treat the whole child. So, to be honest, it doesn’t really matter what “diagnosis” a child has when they are referred to OT. We look at what the child’s strengths are, what occupations they are struggling with, what skills or abilities are needed to be able to perform those occupations, and then we set goals and create a treatment plan to help them be able to more fully engage, participate in, and enjoy life. This can include addressing sensory processing difficulties and their impact on daily life.
    Can SPD occur in isolation or only with other disorders? What other disorders does it occur with?
    Research has already shown that the brains of children with SPD are different (and respond differently to sensory input) than those diagnosed with disorders such as Autism and ADHD. Yes, Sensory Processing Disorder can and does absolutely occur on its own, but it also can and does occur alongside many other diagnoses such as Autism (over half of individuals with Autism also have SPD), ADHD (approximately half of those with ADHD also have SPD),CAS (Childhood Apraxia of Speech),  OCD, Depression, PTSD, Prematurity, Developmental Delays, Learning Disorders, and more.
    How early can SPD be diagnosed, and what are some early warning signs? 
    Sensory processing difficulties can be identified from birth, though it is not usually until later in the child’s first year or beyond that parents or medical professionals suspect that a child’s behavioral or developmental difficulties might be related to sensory processing.
    As I mentioned previously, kids may either over-respond, under-respond, or seek/crave certain types of sensory input. Dr. Lucy Jane Miller’s book, “Sensational Kids”, has some great checklists in Chapter 2 to help parents identify whether their child might be exhibiting signs of SPD. Below are some examples from those checklists, all of which are commonly known to OTs who are trained to work with children with SPD.
    Some red flags related to over-responsive sensory systems can include avoiding or being extremely bothered by or avoidant of certain textures, fabrics, messy substances on hands or face, grooming tasks (tooth or hair brushing, nail clipping), smells, sounds, lights, or movements (particularly not wanting to be laid down for diaper changes as a baby or not wanting to be out of an upright position as a child). Children with over-responsive sensory systems may appear to be irritable (babies often express an over-responsive tactile system by arching), aggressive, impulsive, overly cautious, or overly rigid in their desire for structure and predictability.
    Some red flags related to under-responsive sensory systems can include appearing to not “register” the sensation or pain caused by minor injuries (such as splinters or sprains), seeming to not sense typical body sensations such as hunger/temperature/full bladder or bowel, preferring sedentary activities over physical play, seeming oblivious to what’s going on in the environment, and generally demonstrating a lack of body and spatial awareness. Children with under-responsive sensory systems may appear passive, lethargic, slow, unmotivated, uncoordinated, or disinterested in social interactions.
    Some red flags related to sensory seeking/cravingcan include excessive movement, fidgeting, wiggling, spinning/jumping/rolling/climbing, touching everything, non-stop talking, seeking out vibration (such as washing machine, dishwasher, vibrating toothbrush or toys), licking/mouthing/chewing non-food objects, consistently smelling objects, seeking out certain noises, seeking out visual input, and preferring strong foods and textures (lemons, hot sauce, pickles, ice cubes, crunchy foods, etc.). This can cause children to behave as if they are impulsive, angry, difficult to calm down, disobedient, or difficult to control.
    Wow Christie!  Thank you so much!  

    Stay tuned for Part II when Christie discusses treatments, what parents can do, and why sensory play isn’t just a Pinterest trend!  

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