August 02, 2007
These recommendations and modifications come from Anita Bundy, ScD, OTR/L, FAOTA. This list of modifications and recommendations were generated by OT's, for OT's, but could and should be used by parents, caregivers, teachers and other professionals or family members who interact with our SPD children on a frequent basis.
The list is quite extensive, so I am breaking it down into a three part series (one part per month). The first half will be this month... solving problems at home using a Sensory Integrative therapeutic approach. Next month will be the same idea, but will discuss specific problems they may have at school and what you or teachers can do to help them academically, personally, developmentally, and socially. Then I will personally add a third part to the “Insider Secrets Series” the following month in which I will specifically talk about using SI theory to problem solve for adults. This third part was not part of Anita Bundy's original “list”, but I feel it is very critical information that must be put out there. I do hope you enjoy and learn from all three parts! You will learn tips and secrets of what therapists suggest, what they do, and what they want you to do for your child.
Since these lists are lengthy, I feel confident that each of you will find something that will specifically address a particular issue you or your children face. Also, know that, although the first two parts of the three part series will be geared towards children, many of the same ideas or concepts can be modified or used for adults as well. Just think of the “bigger picture”. What is the “problem” or symptom, what is causing it (based on SI/SPD theories), and how can it be resolved. If you understand the theories, you will understand the recommendations.
(Note: I have also personally added some of my own ideas to this list. What I have added will be in italics, so as not to be mistaken for Anita Bundy's work. My personal thanks as well to Anita, the parents and OT's who contributed to this discussion!)
USING SENSORY INTEGRATION THEORY TO SOLVE PROBLEMS AT HOME AND AT SCHOOL
Below is a list of the ideas generated by the small group problem solving sessions during this workshop. The ideas are not presented in any order, but rather they represent the order in which they were taken off the group recorder sheets. Our thanks to the parent who assisted Dr. Bundy by sharing some of the ideas she learned in working with her own child and to the OT's who were also willing to share ideas with the group. All of these are included below.
Child has trouble sitting through entire mealtime, fidgets, squirms, changes position frequently.
1. Kneel or stand while eating.
2. Do not have child come to the table until dinner is served.
3. Allow for “run-around” (or deep pressure/heavy work) break between main meal and dessert.
4. Use a “Tripp Trapp” chair, or put something under the child's feet for good support.
5. Have the child jump on a trampoline prior to meals.
6. Use a Disc 'o Sit cushion on the chair for added sensory feedback.
7. Sit on an exercise ball or ball chair for a dynamic seating position.
8. Tie Theraband around chair and ankles to do “heavy work” while eating.
9. Use a weighted vest, weighted hat, wrist weights, or a weighted lap pad while eating.
10. Use weighted silverware for extra input.
Child dawdles and doesn't eat during meals. Child may also talk and not eat.
1. Use a timer.
2. Use breaks for “talking” after a bite or several bites.
3. Cut down on distractions.
4. Discuss with teacher the possibility of having a snack later on in the day if the child is unable to finish lunch.
Child frequently knocks over glass when eating.
1. Put the glass in a soft, foam drink holder to provide extra cues when holding the glass or picking it up.
2. Provide the child with a place mat that has the top marked for the glass. By only saying “top”, the parent can remind the child to put the glass where it will not be knocked down. This minimizes the child's embarrassment at being reminded in front of others.
3. Use a weighted cup.
4. Use a bright colored cup the child can easily see.
Low tone child with feeding problems.
1. One therapist found that spicy foods helped the child get better lip control. As an example, she used Cheetos or similar type foods to stimulate the sides of the tongue for better tongue movements and to prepare the mouth for other foods.
2. A low tone child who eats slowly might take a “fast” lunch with him on field trips or days when lunch must be finished early. This might include Carnation Instant Breakfast or yogurt.
Child crumbles food, or puts hands in mouth, plays with food from mouth and/or stuffs mouth with food.
1. Reduce the quantity of food; use smaller pieces or bite size pieces such as Teddy Grahams. Cut sandwiches with cookie cutters so they are smaller.
2. Use smaller utensils.
3. Provide another tactile activity on the table while the child is eating so his/her hands have something to do other than play with food. (For example, fidget toys, stress balls, or strips of textured material).
4. Use a behavior modification approach with a “sensory” reward for appropriate eating.
5. Use a “sensory” program before meals or snack to reduce the need for the child to seek additional sensory input in inappropriate ways (including proprioceptive input to mouth and whole body).
6. Provide the child with a fork with a uniquely textured handle so he/she holds the utensil rather than playing with their food.
Child who is having trouble using utensils.
1. Instead of doing hand over hand, press up on the utensil from the bottom as you help the child to increase the proprioceptive/tactile input.
2. For the child who is having difficulty learning to use utensils because of a developmental delay and/or refusal to hold the spoon, try tying/strapping the utensil to the child's hand so he/she only has to practice hand to mouth movement. Grasp will come automatically once this pattern is learned. (or use a utensil with a loop on it so they can grasp it easier)
If the child does not like the feel of the spoon in his/her hand, the therapist might pad the spoon. Also the therapist might want to tie the spoon so the child can not shake or pull the spoon out of his/her hand. As you are assisting the child, do not hold the child's hand, rather hold the protruding tip of the utensil and if necessary assist at the child's elbow- use as little sensory input of your hands on the child's hands or arm as possible. For example, once the spoon is on the way to the mouth, reduce/take away your cues.
It was also suggested that the therapist/family use a large bowl filled with foods with a consistency that will stick to the spoon (i.e., pudding, yogurt, mashed potatoes). The bowl is filled with more food than the child will eat so he/she continues to have the feel of the spoon leaving the bowl and does not yet have to learn to scoop. The therapist let's the spoon “sink” into the food and then encourages the child to lift the spoon to the mouth (often by tapping up on the child's hand or arm). The change in resistance when the spoon leaves the food provides feedback to the child. As the arm returns naturally to the table after leaving the mouth, the therapist moves the bowl to meet the spoon. Do as little hands on as possible, and make sure the child is doing at least the hand to mouth part by him/her self.
Children who are having difficulty learning to use utensils often rely on outside sensory input; it becomes part of the child's motor plan and can markedly delay acquisition of self feeding.
3. Use a plate with lip or plate guard to it to decrease spills.
4. Put Dycem or “sticky”, rubbery, foam-like shelf liner under the plate to keep it still, so they can fully concentrate on the use of their utensils.
Child drools (past the teething stage).
1. Chew bubble gum or a “chewy”(rubber tubing), the “Grabber”, or “chewelry” which offers lots of resistance. (Children who drool often have low tone and/or poor modulation of sensory input).
2. Have a small mirror mirror on the child's desk as a visual cue to swallow.
3. If child drools when he/she sits to work, try placing work on a vertical surface so the child's head remains up and it is easier for him/her to control the flow of saliva.
4. Use terry cloth wrist bands to dab/wipe drool throughout the day (fairly stylish, yet not so obvious... and completely washable!)
Caregiver tends to over-react to spills causing the child stress.
1. Emphasize that it is not the spill that counts, it is what you do about it. Do not assume the child can figure out how to clean up. Also, explain that they do not assume it was the child's “fault”... remember motor planning and motor coordination can truly be difficult!) Help the child acknowledge the spill and learn the steps/sequencing of the task for taking care of it.
First, clean up with the child (verbalizing the steps). Second, talk the child through the process, decreasing the amount of instruction as the child takes over. Third, encourage the child to clean up independently; praise liberally but honestly.
Child takes too long to get dressed in the morning.
1. Provide sensory input first thing in the morning. (The hypothesis is that some children seem to need increased sensory input to get up and “organized” in the morning). Suggestions include:
* brushing and joint compressions
* use of vibrator on limbs
* hot or cold shower (whichever seems to be most effective with that child.)... then dry off with a brisk towel rub
2. Lay out the child's clothes at night in the order they are to go on. One therapist even suggested putting pegs on the wall and hanging each article of clothing on a peg in the order the clothes would be put on.
3. Have the child make a dressing board which shows the pictorial sequence for dressing.
4. Buy fastener free clothes.
5. Put on a timer. The child earns a reward if he/she gets dressed at or before the timer goes off.
Child can not tie shoes.
1. Take two different colored shoe laces and tie them together. The therapist can then use the two different colors to cue the child.
2. Have the child practice tying on his/her thigh so he/she can see the process better.
3. Practice dressing and tying skills with learn to dress dolls, cubes, and/or boards and puzzles.
Child is bothered by the feel of some clothes.
1. Use a body suit under clothes.
2. Provide socks that are tight around the ankle.
3. Wear silk/lycra underclothes.
4. Seamless socks.
5. Tagless pants, shirts, and underwear.
6. Get used clothes at a second hand store... they are usually well broken in and softer.
7. Use plenty of fabric softener when washing clothes.
Child has difficulty with hair washing.
1. Wash hair with a washcloth.
2. Have the child hold a wash cloth over his/her face as the head is tilted back and water poured over their hair.
3. If the child is gravitationally insecure, they may be fearful of tilting their head back. Have them lean forward and use a head cuff with a visor to keep water from their face.
4. Some children who have very poor balance or children/adults that are gravitationally insecure may find it very difficult to stand in a shower with their eyes closed. If this is felt to be true, the child can use a hand held shower spray and sit or kneel (may want to kneel on a wash rag or small towel). For older children or adults, a bath chair can provide the stability they want or need.
5. Have the child hold the hand held shower spray or wash his/her own hair so he/she has some control over the hair washing process.
6. Some children do better having their hair washed when standing over a sink (or kneeling on a chair with head hanging over the sink... don't forget to give them a washcloth to cover their eyes. If your counter top in the kitchen is big enough you can have them lay on their back or belly on the counter with a rolled towel under their neck for support while you wash their hair over the sink).
7. Many children are very uncomfortable with the feeling of wet hair on their face, or water dripping down their face from the hair. If the child is leaning over, it is easier to place a towel around the wet hair to keep it off the face once it has been washed.
Child hates showers.
1. Stand outside the shower (or in the tub with the water running from the faucet only, not the shower head) and wash with soap and wash cloth.
2. Every other day, skip the shower, but have the child wash all parts with baby wipes. There are also no rinse shampoos if you are really desperate.
3. Attach a hand held shower spray (with a variety of pressure and water flow settings) to the shower head. Let the child hold this and control when and where the water is sprayed.
Child will not use the toilet at school (or other public places).
1. Have the child start by using the teacher's bathroom or the bathroom in the nurse's office.
2. Have the child wear head phones or ear plugs when going to the bathroom, particularly if the child is sensitive to the noise in the children's bathroom at school. (Public bathrooms often magnify sound).
3. If the child is bothered by the smell of the bathroom, have the child carry a fresh fabric softener/dryer sheet in their pocket to hold close to their nose when in the stall. Or, they can have a vile of essential oil in their pocket to smell while in there, or to dab under their nose before they go in.
4. If the child is having difficulty with the fasteners on his clothes and this is felt to be one of the problems, talk with the parents about alternative pants or slacks that push off and on.
Child does not seem to relax when sitting on the toilet.
1. Provide toys, books to read, or headphones with relaxing music to promote relaxation.
2. Provide a foam cushion for the child to lean back against to minimize the need to contract muscles to stabilize themselves.
3. Put a foot stool under the child's feet to help with stabilization.
4. Put a mirror on the door to help remind the child to relax.
5. Run water or have the child drink water.
6. Use a soft toilet seat cover.
7. Relaxation activities.
8. Check the child's diet to make sure there are no dietary causes or if a change in diet would be helpful.
Brushing teeth is a problem.
1. Use a vibrating toothbrush.
2. Experiment with different toothpastes.
3. Try to break down the aversion to the toothbrush by having the child brush with peanut butter, Kool-Aid, pudding,or other preferred foods as a game.
4. Use ice or pressure to the mouth before brushing to reduce the hypersensitivity.
5. Place a mirror at sink level so the child can watch him/her self and/or the caregiver brush their teeth.
6. Wear a weighted vest, hat, or neck wrap for 15-20 minutes before and during brushing their teeth.
Child will not wash their hands.
1. Try Crazy Foam, scribble sticks, or small guest size soaps of interesting shapes. Give the child fun shaped sponges to use.
2. If the hands are sensitive, try pretend hand washing or play in a rice box.
3. Try a loofah sponge.
4. Have the child begin washing objects instead of their hands directly.
5. Use antibacterial gel for times when hand washing with soap and water is too much.
6. Use baby wash cloths.
Child performs ADL tasks at school, but not at home.
1. Videotape the child for the parents so they can see how the task is done at school.
2. Ask the parents to fill out a checklist to find out how the child is performing at home.
3. Find out the parent's priorities and expectations.
Child does not like/refuses to have hair brushed.
1. Use a hair pick instead of a hair brush.
2. Have the child brush his/her own hair and firmly place your hand on the place on the child's head he/she is to brush next.
3. Wear a weighted hat prior to brushing hair.
4. Use extra conditioner, leave in conditioner, or detangling sprays to decrease the chances of knots (and do NOT go to bed with wet hair as it will surely increase the knots!)
5. Do compressions on head (show parents proper technique) before brushing hair.
6. Keep hair short and layered.
Motor planning problems seem to be making hair brushing difficult.
1. Teach the child to turn his/her head to brush the sides (child may not do this automatically).
2. Use a double mirror so the child can see the back of his/her head.
3. Practice on large doll's head facing the doll AWAY from the child
4. Use baby brush and/or bristle brush; do not use a vent brush
Child does not like/refuses hair cutting.
1. Try cutting the child's hair while they are asleep.
2. Recite nursery rhymes or silly poems with the child, clipping once after every line... i.e., “Jack and Jill went up the hill” (clip). That way the child can anticipate each clip.
3. Cut hair while child is in bath or shower for immediate rinsing off of any hair that falls on them.
4. Cut hair when it is wet so the child doesn't feel pieces of itchy hair falling on them. Brush away any hair that does fall on them with powder and a towel. Rinse whole body off immediately after in bath or shower.
5. Explain preferences to a receptive hairdresser (if child is old enough have THEM tell the hairdresser what they like/don't like and need from them). “Shop around” until you find one they are comfortable with, or take them to YOUR hairdresser whom you have talked to ahead of time about the child's needs.
6. Have the child watch you/sit on your lap while you get your hair cut and explain steps and feelings as they cut your hair.
7. Find out which sensation is more comfortable for the child... leaning back over the hairdresser's sink or having a spray bottle to get their hair wet for cutting.
8. Avoid hairdressers with long fingernails.
9. Use “no tear” shampoos such as baby shampoo.
10. If the child has difficulty sitting still try a Disc 'o Sit cushion and/or fidget toys. Also give them heavy work/deep pressure input before sitting for the haircut.
Child does not like/refuses to have his/her nails cut.
1. Recite nursery rhymes, then clip as stated in #2 in above hair cutting tips.
2. Try clipping the child's nails while he/she is asleep.
3. Continue to use baby nail cutters even when older, they tend to prevent cutting too far, and are much gentler.
4. Clip nails during or immediately after bath while nails are softest
Child is bothered by sounds of household appliances.
1. Alert the child and let him/her see what you are doing so the child can prepare him/her self for the sound.
2. Give the child some control and let him/her press the button (even if with earplugs in).
3. Use items on lower speeds first since this is often a less irritating sound.
4. Use of ear molds (or plugs) found in drug stores. The therapist who offered this suggestion said the child she worked with, had to accommodate to the ear plugs since she was also tactile defensive, but eventually was able to wear them.
5. Introduce the child to these sounds through play (i.e., a play vacuum cleaner, blender, vibrating toys such as a play chainsaw, etc.)
6. Give the child some sound canceling headphones for those times when he/she just can't handle the sound.
7. Use cotton balls to block the ear from the sound (we would use ½ of a cotton ball per ear).
Child's room is always messy.
1. Richard LaVole suggests that some children may not remember what their room looks like when it is clean. Take a picture of the room from several angles and hang them on the wall for a comparison. If the child needs additional assistance try asking, for example, “What is different about your bed and the pictures?”
2. Montessori suggested placing several small baskets on low shelves for the storage of toys.
3. Rotate toys not presently in use out of circulation to reduce the potential amount of mess.
4. Establish the “one toy” rule. The child can play with only one toy at a time and must put it back before selecting another one. This may be better as a periodic, rather than a permanent solution.
Child continually pesters parents about "how long" before a particular show comes on.
1. Some children have a poor perception of the passage of time. “In ten minutes” may not have meaning for them. Provide the child with a timer, preferably one where the child can see how much time is left, and set it for the length of time before the television show is to come on.
Child has difficulty sleeping at night.
1. Have the child sleep on lambs wool or a down comforter. (This “neutral” warmth may be relaxing.)
2. Establish a bed time routine that includes relaxing activities such as a warm bath and/or rocking (“glider” rockers, platform swings, bassinets and gliding baby rockers are all great... anything that glides/swings in one plane).
3. Use flannel sheets.
4. Try sleeping with a weighted or heavy blanket. One therapist said she had a child that slept with a blanket rolled up and placed over the child's shoulders. Firm pressure can also be calming and relaxing.
5. Try a water bed or memory foam mattress topper (use either of these two IF child is old enough without a risk of “suffocation”).
5. Use bed rails for the child who is gravitationally insecure and may fear falling.
6. Use of a sleeping bag that gives the child a confined space. Put some stuffed toys/animals in the sleeping bag. This may be good for the child who is having trouble organizing getting to sleep (often these children will also be tactile defensive) or for the child who feels he is “floating” when he begins to fall asleep.
7. Have the child sleep on a velour towel.
8. Sleep in tights, lycra/spandex, or “Long John's” that are tight and give touch pressure. (But NEVER the deep pressure hug vests, which should only be used for short intervals.)
9. One therapist mentioned sleep problems need to be kept in perspective since they are common for all children at certain developmental ages. Do not over intervene since the child may not learn to get to sleep by him/her self. Help parents stick to a schedule and not pick up the child when he/she cries, but just go in to let the child know you are there. One therapist/parent indicated that even with a “normal” child, if you have been up with them several nights in a row when they are sick, they begin to develop a routine where they want you to come in when they wake up at night.
10. Providing the child with something to suck on. (BEFORE they go to sleep, not something that would fit inside their mouth that they could potentially choke on.)
11. Children's Hospitals usually have a clinic for children's sleep disorders if the problem is a serious one and parents and/or therapists need help.
12. The child may have trouble organizing him/her self to go to sleep. Provide pre-requisites such as a routine.
13. A CD player and CD's provide a pleasant way to go to sleep.
14. Bedtime is a good time for cuddling, story telling, processing days activities, and resolving issues. Try talking about one or two things the child accomplished that day (“You were a great helper. You made a great painting", etc.).
15. Create a “cuddle corner” in the bed by lining up or surrounding them with stuffed animals.
16. Give the child and Epsom Salt bath.
17. Give the child a lotion massage after their bath and before bed.
18. An aromatherapy machine, white noise machine, or nature sound machine can help drown out other sounds and help them fall asleep.
19. Use room darkening shades if they wake up too early or if it is still light out when they go to bed (i.e., summertime).
20. Sleeping in a special themed/character toddler bed or bed tent.
21. Sleeping on an air mattress that is lower to the ground may help the gravitationally insecure and the “softness” may help the tactile defensive.
22. Use an aromatherapy bear, “log”, or neck wrap that you can heat up in the microwave for the child to hold/snuggle with (also provides them with some weight/deep pressure input).
23. Use a vibrating mattress or bassinet.
24. If old enough (no suffocation risk), push one side of the bed against the wall, place a body pillow against that wall and then sandwich them between that one and another on on the other side of them. You can use stuffed animals to keep the pillows in place too.
Child fears bad dreams.
1. Offer the child some wonderful things to dream about. “Tonight you can dream about your room filled with balloons... of riding your bike as fast as the wind... or building a sand castle bigger than Daddy”. Offer possibilities that extend what the child can actually do.
Child gets up in the morning very slowly.
1. Allow extra time for the child to wake up slowly and give them some extra snuggle time when they get out of bed and go sit on the couch, for example.
2. Do arousal techniques such as bouncing on the bed, place child on a towel and “roll” the child, and/or push and pull for heavy input.
3. Get the room warm and/or have the child begin dressing under the covers. Some children with poor regulation of the autonomic nervous system may get cold at night.
4. Have a favorite candle lit (supervise if needed based on age), and soft soothing music playing when they awaken.
Some other suggestions for a variety of struggles you may face at home can be found throughout my website (check out the site map to find what you need). Additionally, many of the products mentioned throughout this list are on my site ( www.sensory-processing-disorder.com ) or at my store ( www.sensoryprocessingdisorders.com ). So, if you haven't already taken the time to look around, go take a peek! And, even if you have, I have updated all the product pages and store pages within the past month or two, so there may be some new things you haven't seen before!
Anyway, that's it for the tip of the iceberg. Just a few suggestions to help you with a some of the problems that you or your child may be struggling with.
The point is... you will have to make accommodations and modifications for their over or under responsive sensory systems. They need to be comfortable in their own home, in their own space. Home should be where they feel best. Please help them feel that way.
Traditional parenting methods, or strict behavioral approaches do not usually work for our kiddos. We need Occupational Therapy to help them reorganize their nervous systems, a sensory diet and home programs, and changes in their environment if you want them to be comfortable in their own skin. We can do that for them, can't we? We must!
I do hope this has helped get you “thinking sensory”. Think about the actual sensory system that may be affected, then make changes and adjustments around that. Give your children this gift! Now THAT is love!
Thanks for joining me. I look forward to being with you again next month for PART II of the “Insider Secrets” Series!