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Friday, March 30, 2018

Types of Sensory Processing Disorders

The following information is excerpted and condensed from my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills.

Types of Sensory Processing Disorders 

It has been my experience that most if not all children who have an autism spectrum disorder (ASD) also show one or more symptoms of  a Sensory Process Disorder (SPD). However, many children who have  SPD do not demonstrate the social  and communication challenges associated with autism.
Understanding SPD is complex because there are three primary diagnostic groups, and children may have more than one type. These three primary types are:
1) sensory modulation disorders (see 3 subtypes below)
2) sensory-based motor disorders and; (see 2 subtypes below)
3) sensory discrimination disorders 

In addition, there are the following subtypes, resulting in a total of six recognized sub-types of SPD. 

 1) Sensory Modulation Disorders 
  • Sensory over-responding: These children are extra-sensitive to sensations, often picky eaters, and easily over-stimulated by sensations. They are sometimes called hyper-reactive or avoiders.
  • Sensory under-responding: These children need a lot of stimulation to respond; for example, they can spin intensely without getting dizzy. They are sometimes called hypo-responsive, under-reactive, or seekers

  • Sensory craving: These children never seem to get enough stimulation, touching and chewing on everything. They may also be called seekers.
2) Sensory-Based Motor Disorders
  • Postural disorders: These children show poor body awareness and low muscle tone; for example, they might slip out of a chair or lean their head on an arm while writing.
  • Dyspraxia: These children have difficulty with motor control needed to perform tasks accurately (such as folding paper on a line).
3) Sensory Discrimination disorders: These children have difficulty interpreting sensations; for example, a child may keep stuffing more popcorn in her mouth, even though it is already full. 

 The Impact of Sensory Modulation Disorders on Individuals with Autism

Let’s look more closely at the first type of SPD called sensory modulation disorders and how it impacts individuals with autism. 
Many children with autism have challenges with sensory modulation. These children may be  described as having difficulty with self-regulation. Self-regulation is the ability to control one’s behavior, emotions, or thoughts and adapt to the demands of a situation. Children with a sensory modulation disorder may be impulsive, overly and easily stressed, difficult to soothe, or highly distractible. On the other extreme, they may seem lethargic, apathetic, or day-dreamy. Some children have behaviors associated with both seekers and avoiders! Most children with ASD have signs of sensory modulation disorders. Let’s take a closer look at the three subtypes of sensory modulation disorders.
  • Sensory over-responding, or super-sensitive: Four-year-old George is easily overwhelmed by sounds, smells, movements, and things he sees, to the point where he frequently “shuts down” and cries. He hates to touch food, bubble bath, or fur, and often strips naked at home. George’s favorite “toys” are rocks and blocks of wood, which he lines up in the basement. Repetitive body movements—such as rocking, flapping his arms, or flicking objects—seem to calm him. George will give familiar people a “high five”—but it had better be a firm one. His mom calls him “the Naked Curious Avoider.” 
  • Sensory under-responding: Ten-year-old Dorothy frequently daydreams and slumps in her chair at school. She finds it easier to do her homework while bouncing on a ball seat, listening to  music, and chewing gum. Even with all this sensory stimulation, Dorothy’s hand gets tired after writing a couple of sentences and she struggles to organize her sentences into a paragraph. 
  • Sensory craving: Twelve-year-old twins, James and Errol, are home-schooled. They both love to make funny sounds, stand on their heads, and have pillow fights. Their parents converted the basement into a small gym with a suspended swing, trampoline, and crash pad made out of pillows on a mattress. James and Errol follow a schedule that includes weight lifting, jogging, cooking—the spicier the better, according to the boys—making bread, and creating pottery between their academic lessons and weekly visits to volunteer at a farm. These boys never seem to get enough stimulation.
Researchers have documented that sensory modulation disorders interfere with developing functional skills. Some of these children may have difficulty developing hand skills because they just don’t sit still long enough to learn and then practice them. For other children it takes extra effort just to sit upright and still long enough to connect two pop-it beads or insert a straw into a juice box. Both sensory “seekers” and “avoiders” frequently have fine motor delays because they lack experience and practice in common childhood activities, such as building with construction toys or cutting out paper dolls. 
Researchers disagree on which of the three types of sensory modulation disorders are most associated with autism. In fact, many children appear to fluctuate between hypersensitivity and hyposensitivity. 
Occupational therapists often use sensory-based strategies with children on the autism spectrum with the goal of  promoting engagement and self-regulation and decreasing what is called sensory defensiveness.  Sensory defensiveness describes strong sensitivities to touch, movement, or other sensations. Children who have sensory defensiveness are often described as “avoiders” because they try to escape from sensations that seem neutral or pleasant to most people, such as a kiss on the cheek. To them, the sensation seems unpleasant, perhaps even painful!

Strategies for Sensory Modulation Disorders
Occupational therapists often create sensory diets that may explore:

1)      Seating and positioning options 

2)      Use of weighted, vests, collars, lap bags or wrist weights

3)      Use of fidget tools

4)      Activities that provide deep pressure and movement sensory stimulation

Source: How Vibration Helps Children with Autism or Sensory Processing Disorders by RecyclingOT

The Impact of Sensory-Based Motor Disorders
Many children with autism have  one or both of the following type of SPD called a sensory-based motor disorder. 
1) Postural disorder
2) Dyspraxia 
These children often have low muscle tone so that it takes a lot of work to control their posture and movement. They  may  have decreased body awareness and appear clumsy. A child with poor body awareness might sit on top of, instead of next to, another child, have difficulty fitting his arm into a sleeve, or use so much force on a spoon that he splatters food on his clothing when scooping. Children with dyspraxia often do not stabilize (hold steady) materials when working (such as steadying the paper while writing). They may have delays in developing a hand preference or not develop one at all.  Also, they often avoid reaching from one side of the body to the other. 

 Strategies for Sensory-Based Motor Disorders 
Toy manufacturers know that children love multisensory games and products that engage all their senses. That is why some ring stackers and puzzles play music, baby toys may vibrate, markers may be scented, and some balls make giggly sounds when thrown. Multisensory like these appeal to more than one sense, and may help children better understand where objects are in relation to their bodies and how objects such as shapes relate to other objects such as shape sorters.  Many children find that multisensory and resistive activities help them to tolerate touch better so that they can engage in hand activities. Children with dyspraxia may also benefit from using

1)      Resistive activities that involve squeezing, pushing or pulling. This provides deep pressure sensory stimulation. Examples are- pushing Lego bricks together,  using a hole puncher or stapler, coloring over sandpaper squeezing a Hungry Harry ball.    

2)      Activities adapted to vibrate

3)      Activities with extra large, easy to manipulate parts such as stringing rings instead of beads.

4)      Simplified materials such as a shape sorter with only one or two shapes

5)       Repetitive activities that promote practice

      6)       “success only” activities

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT

Sensory Discrimination Disorder
Sensory discrimination is the last of the SPD subtypes I describe in my book. It refers to abilities to differentiate various sensory stimuli such as temperatures, textures, and colors. 
Sensory discrimination disorders

·         Visual: Sense of sight

·         Auditory: Sense of hearing

·         Gustatory: Sense of taste

·         Olfactory: Sense of smell

·         Tactile: Sense of touch

·         Proprioception: Sense of position in space

·         Vestibular: Sense of balance

·         Interoception: sense of internal regulation

Children with sensory discrimination disorders often overreact to sensations they see, hear, taste, or feel. You have learned that this is called sensory defensiveness. Sensory defensiveness can impact any of the senses. However, it is the tactile sense that is most important for learning to grasp and manipulate objects. Children with tactile defensiveness (an overreaction to touch sensations) who have avoided early touch experiences, such as grasping a rattle, may be slow to learn about how objects differ in texture, size, weight, shape, or other attributes. These children may manipulate objects in an awkward and inefficient manner. 
Many of the same strategies that help children with sensory modulation challenges and/or sensory-based motor disorders also help children who are sensitive to touch and movement. These strategies include tummy positioning early in infancy, deep pressure and resistive activities, alternative seating, positioning, alternatives to messy play, and use of multisensory activities. 

Saturday, March 17, 2018

Simple Sensory Motor Activities that Help Individuals with Autism Spectrum Disorders

Children and adults on the autism spectrum frequently seek deep pressure and movement sensory stimulation. We see this when they are running, jumping, twirling, rocking, swaying, crashing into things and burying themselves under  blankets and cushions.  These are the individuals who are "sensory seeking" and they are attempting to self-regulate or soothe themselves, decrease anxiety or agitation or in other words, make their brains function at a more comfortable state for optimal focus and learning.  Some therapists describe the brain as an engine that may be running too high or too low.  Sensory diets are designed to help make "engines" run- just right.

Parents with young children may see these types of sensory seeking behaviors, but it does not necessarily mean that their children have an autism spectrum disorder. Many children with a sensory processing disorder (SPD) have atypical responses to sensory stimuli (what they see, hear, taste, feel, smell,  feel and how they move), yet do not manifest the social/communication impairments associated with the autism diagnosis. In my book From Flapping to function; A Parent's Guide to Autism and Hand Skills, I describe in great detail the types of SPD, the impact on children on the autism spectrum and strategies that help promote attention, learning and hand skills.

In this post, I share a few strategies that help bring the person with a very active brain or "engine" to an optimal state for learning. These strategies may help decrease the anxiety that leads to agitation and the agitation that contributes to maladaptive  behaviors such as biting ones hand or having a meltdown.

Lets start by exploring a variety of seating options that allow movement  (such as ball chairs and seat cushions) and use of weighted lap pads, vests, shoulder pads, etc.  My client shown in the photo is sitting on a large canvass bag I found, stuffed with foam, fabric, squeaky dog toys, bubble wrap and other items. He likes to stand and sit in order to make the squeaky toys, squeak. He also likes the weighted collar.

Its not expensive to explore strategies. Try filling a large sock with plastic bags of sand. If you use them outside you can omit the plastic bags, but the socks will leak. In any case, these feel great around the shoulders, lap or just to hold in the hands.
Now let's get moving! The young lady in this photo is enjoying the tight squeeze of my old life jacket. You can also try commercial weighted or pressure vests or fill an old vest with pockets with little bags of sand. Young children may enjoy the tight swimming garments or shirts that are so small they squeeze the body. Many children love layers of clothing in order to get that tight feeling and some prefer no clothing at all! So of course, use lots of trial and error and your experience to design adaptations....

The woman wearing the red vest is pushing a heavy cart loaded with bottles filled with sand. She is walking down the hallway at her program removing one at a time to place on the floor along the walls. Moving up and down or high/low provides vestibular stimulation, as does pushing the cart across the room. This vestibular stimulation is not as powerful as swinging or spinning but it is safe in this environment and does not take any special skill on the part of the staff to implement these strategies throughout the day.

I took the socks filled with sand and sewed the ends together to make weighted rings. I placed a pile of the rings on a tall cart so that the client shown in the picture needs to  reaching high into it. The rings may be placed on the floor or across the room to provide other types of movement as the client retrieves them and adds to a ring stack.

Parents with children at home may try hiding these rings under cushions or other heavy objects so that they use lots of muscle power to find them. Perhaps you can set up a large cardboard box to throw heavy bags or the rings into. The child can gather rings from inside the house or yard and place them on their arms or around their waist  if they fit before bringing them over to toss into the box.

This will be even more fun if you place a big vibrating massager inside the box so that it shakes. After your child inserts the weighted bags, it might be a great time to take advantage of the calm and focus and show them how to form shapes, letters, numbers or words on the cardboard box or just scribble if your child is at that level.

In the following video you will see my high energy clients travelling across the room to take an object and then use it in a different part of the room. Here are a few ideas...
1) place rings on one side of the room, or hide under cushions or inside containers to open and bring them one at a time to stack on a tall ring stack on the other side of the room.
2) Place a container of golf balls on top of a vibrating cushion so that the child takes one ball at a time and brings it across the room to push into a small opening in a lid. I have taught clients to take the objects one at a time so that the activity lasts longer. Pushing the balls through a tight lid is very sensory in itself because it takes force to push them.
3) Set up a large number of heavy bean bags or socks filled with sand on one side of the room to bring to a large container on the other side. Try using a very large container with a small opening so that they need to push the bags inside. Then when the activity is finished your child might enjoy having the bags dropped on them while sprawled on the couch or floor.
4) Create an obstacle course with trampolines, boxes to step in and out of or bolsters to crawl over as they move the weighted objects.
5) Set up so that objects are moved back and forth from the floor to higher surfaces in order to provide that high/low vestibular stimulation.
6) Provide a shoulder bag or backpack to help gather the objects and bring back to the container for insertion. You can see in the video that that can be quite challenging in and of itself!
6) Try counting the weighted objects or attach pictures, letters numbers or words  on them to identify or read.  Sensory motor activities are a great time to teach academic concepts!

Source: Sensory-Motor Activities for Individuals with Autism by RecyclingOT

Remember: It does not require a lot of space or money to create a fun sensory environment! Learn more at

Wednesday, March 14, 2018

"Success-Only Activities" Help Develop Hand Skills

I describe in my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills, a teaching strategy that I call "Success-Only Activities".  This means that the activity will work only when done correctly. Many years ago, I started a position at a day program training adults with developmental disabilities and noticed that some of the clients had goals such as naming or matching colors.... for years if not decades!!!! I immediately set about creating realistic goals given the client's cognitive level and sensory motor skills.
I designed the ring stacks shown above so that the red rectangular shapes only fit over the red rectangular stack and the blue triangular shapes only fit over the blue triangular stack. This is a 'success only activity" because the shapes will only fit and go down when the shapes are matched AND the colors will automatically be correct. The user may or may not learn color matching, but this is a great way to introduce the concept.  This illustration and a more detailed description is found in my book: The Recycling Occupational Therapist. 

Here are a few more example of easy to make shape sorters and ring stacks that require the child or adult to correctly orient the pieces to fit. Notice that the little boy is only working at orienting the blocks rather than using a traditional baby shape sorter. He has visual-perceptual delays and the shape sorters sold for babies have too many shapes and openings to match up. It was challenging enough to work on only the square shape.  Next he worked on fitting dominoes into a rectangular opening. This was a bit more challenging than inserting a cube shape.

The little boy in the photo below must orient the rectangular rings to fit over the sword. I cut the rings out of detergent bottles. I bought the sword at the dollar store. Notice how he has such nice visual attention while using his hands together to stabilize the sword.

The ring stack with the triangular shape was made by using triangular shaped cardboard packaging and covering it with contact paper. I cut out lots of red circular and blue square shaped rings but only the yellow triangular rings will fit on the stack. Therefore, children will be automatically correctly matching yellow if they are able to push the yellow rings down the yellow stack.

The coin insertion bottle shown below is designed to teach coin discrimination. I provided a pile of quarters, pennies and nickels. The slot in the bottle is large enough for the pennies to fit inside. The quarters and nickels are too large to fit and there are no dimes since they are  small enough to fit. This is a great way to teach children to think about the size of the coin before attempting to fit them into the slot and to discriminate pennies- the only coins that are a coppery color. After children learn to select and hopefully identify pennies, try providing only nickels and quarters with an opening just large enough for the nickels to fit through.

I have used this "success only" adaptation with a woman with developmental disabilities who rapidly pushes objects into openings without considering size, shape or color.

The picture at the bottom of this post shows a pile of pennies and little green plastic rings. I punched holes in the rings. The green rings can be strung onto the cord and are too large to fit inside the slit in the bottle. The pennies obviously cannot be strung!

I used this "success only task" to teach the client to slow down and think about whether to push the round object into the container slot or string it onto the cord.

 I provided enough assistance with point cues so that she would not get frustrated during the learning process. then she was able to work on this independently, allowing the activity rather than me to give feedback on what works and what needs to be tried a different way. This nonverbal aspect of using success only activities is often very appealing to individuals on the autism spectrum who perhaps prefer visual cues.  

We can also set up situations to teach cognitive concepts. For example,  provide an egg carton with 12 egg sections. Provide a large bowl of plastic Easter eggs or other objects. Then ask the child to count out 12 objects while placing each in a section. The child may have difficulty counting correctly to 12 but after filling each section, will automatically be successful at counting out 12 objects.  Provide lots of praise for this success!

Now its video time! The children in the video must position the cones correctly in order to succeed in stacking them......

Source: Occupational Therapy Cone Activities * by RecyclingOT

Source: Occupational Therapy Cone Activities * by RecyclingOT              

The child must choose the correct shape opening in order for the shapes to fit. Notice how effect it is to use with a motor inside!

Source: Velcro Bottles for Individuals with Developmental Disabilities by RecyclingOT

After unscrewing the covers, the individual must match the sizes correctly in order to insert them in the round and oblong slots.

Source: Matching Lids Sensory Activity by RecyclingOT

Source: Matching Lids Sensory Activity by RecyclingOT

The clients are matching pictures, but they also have the physical cues to help them. The pictures will only fit inside the matching rectangular, round or square form board openings. This is a fun way to teach picture matching.

Source: Form Board Picture Activity for Individuals with Developmental Disabilities by RecyclingOT