Q&A with Gwen

QUESTION: How to Address Visual Over- and Under-Responsiveness?

QUESTION:

If a child is over- or under-responsive to visual stimuli, how does a therapist use a sensory diet to help?

GWEN’S ANSWER:

For visual over-responsiveness, try these suggestions:

  • Implement a sensory diet with primarily calming strategies (BrainWorks yellow or red arrow activities). Whole-body calming helps visual over-responsiveness.
  • Allow access to visually calming strategies. These differ from person to person, but most people find things like lava lamps and bubble tubes to be visually calming.
  • Recommend modifications and adaptations to minimize visual over-stimulation. Some examples include study carrel, sunglasses, cozy shades for lights, full-spectrum lighting rather than fluorescent, minimizing visual clutter, and allowing a student to wear a cap to limit the visual field.

For visual under-responsiveness, try these suggestions:

  • Implement a sensory diet with primarily alerting strategies (BrainWorks green arrow activities). Whole-body alerting strategies usually helps with visual under-responsiveness.
  • Recommend modifications and adaptations such as seating the student close and directly in front of the teacher, keeping lights on directly above the teacher but dimming the lights elsewhere in the classroom, and encouraging the teacher to stand in front of black background as much as possible when speaking. You could use black roll paper on a wall to create this effect.
  • Assess visual-perception and oculomotor skills and treat accordingly since deficits in these areas can present as visual under-responsiveness.

Our view-on-demand webinar titled “Visual Perception” has lots of great tips and tricks for addressing visual issues as well:

https://www.sensationalbrain.com/shop/the-visual-system-webinar/

I hope that helps! Please let me know if I can be of further assistance.

Best Wishes,
Gwen

QUESTION: What to Do for Aggressive Behavior Toward Adults?

QUESTION:

I have a student who will forcefully charge at adults by scratching and/or trying to bite for 15 minutes at a time during escalations. We see him seeking bodily input during escalations in the form of climbing, jumping, hitting his own face, and kneeing wall. He also seeks input from others, such as taking off his pants and peeing or directly going at adults by lunging at them to engage in physically aggressive behavior. Our hypothesis is that he wants an adult to intervene, which then amps him up more.

Two-arm holds were used in the past, but those never helped de-escalate the situation and put adults at risk of getting bitten or headbutted. Now we use mats to confine the student to a smaller area of the room away from objects, other kids, or hard walls, but then all we can do is keep him in there till he rides it out.

The student responds very well to sensory things like squish balls, sand hour glass, and kids song videos. But those are only effective when the student is in a lower level state. When escalated, they are just things to throw.

What sensory input can teachers provide in the middle of an escalation? Or is the only thing we can really do is ride it out?

GWEN’S ANSWER:

Sounds like a tough kid! I know it’s easier said than done, but the best approach is to make every attempt to avoid the escalations in the first place. To that end, here are some suggestions:

  • Implement a sensory diet to meet his needs proactively. I recommend using the Sensory Symptoms Checklist available in our FORMS sections to find out what he is over-responsive to and what he is under-responsive to, so you can design a sensory program to meet his needs. If you are new to all of this, you may want to take our webinar titled “Sensory Diets 101.”
  • Use the Antecedent-Behavior-Consequences (ABC) method of behavior analysis to determine antecedents for his escalations and develop a plan to minimize or eliminate them as much as possible. This is discussed in our “Sensory AND Behavior” courses, either the 2-hour or the 6-hour version, both available in view-on-demand format.
  • Implement rewards for increments of time in which he uses sensory strategies to stay in the “just right” zone. You may want to use the BrainWorks tachometer or Zones of Regulation to help him understand the “just right” zone.
  • In spite of your best proactive efforts, he may continue to escalate from time to time. Once that occurs, I think letting him ride it out behind the mats is probably the safest bet for everyone.

Please keep me posted if you find success in addressing this child’s needs.

Best Wishes,
Gwen

QUESTION: How to Address Startling at Loud Noises?

QUESTION:

I’m looking for information about working with a 5-year-old Asperger student who struggles with auditory filtering and startles at loud noises. He doesn’t like to wear headphones. The only other idea I’ve ever heard is to use an FM system, but our district hasn’t been willing to let OT use them. Do you have any ideas for me?

GWEN’S ANSWER:

Here are a few suggestions:

  • The easy startle response is an indicator that he is in fight-or-flight mode. I recommend implementing a sensory diet to keep him calm and modulated.
  • You may try offering incentives for wearing noise-reduction headphones during times of teacher instruction, such as circle time. Once he gets used to them, you can probably discontinue the incentives.
  • Preferential seating close to the teacher is typically helpful for kids with auditory issues.
  • If you have the option of being trained in Vital Links Therapeutic Listening Program or iLS (Integrated Listening Systems), the implementation of one of these programs would most likely be beneficial for this student.

Please let me know if I can be of further assistance.

Best Wishes,
Gwen

QUESTION: Lighting for Those on the Spectrum?

QUESTION:

Is there a company, brand, or style of lights that work best for folks on the spectrum? The usual answer I get to this question is to mute the lighting. If you know of any resources or have any other good thoughts I would appreciate the input.

GWEN’S ANSWER:

Most research shows that full-spectrum incandescent lighting is best for most of us, but especially for people with autism. Here is an article that gives a nice overview on this subject:

https://www.psychologytoday.com/blog/mental-wealth/201409/why-cfls-arent-such-bright-idea

I hope that helps!

Best Wishes,
Gwen

QUESTION: How Much Weight and Time for Hats and Blankets?

QUESTION:

Would you lease provide weight information or recommendations for weighted hats and blankets? I generally use 7 to 10% of total body weight for vests but wasn’t sure about the others. Also, are recommended wearing times the same as vest of 30 minute maximum on and off?

GWEN’S ANSWER:

Here is a link to my recommendations for weighted vests:

https://www.sensationalbrain.com/uncategorized/question-new-protocol-for-weighted-vests/

There isn’t enough research available for protocols on weighted hats or blankets, but through research on the adult population and experiential data with kids, we feel we can go higher in weight for blankets−typically up to 15% of the child’s body weight. The reason is that they are sedentary during use and the weight is distributed across the whole body. For hats, I typically start with about a one-half poind of weight and let the child provide feedback on whether more is desired. For hats, I would adhere to a wear-schedule similar to that for vests. With blankets, I feel comfortable having kids sleep under them all night as long as they meet these three criteria: The child

  1. can remove or get out from under the blanket independently.
  2. are over the age of 3 and are able to use quilts and comforters safely.
  3. show appropriate responses to physiological variables like over-heating.

I do feel strongly that weighted garments should only be used by kids with normal muscle tone. Unweighted compression garments are probably a better option for kids with high or low tone.

I hope that helps!

Best Wishes,
Gwen

QUESTION: Picky Eating Resources?

QUESTION:

I am a BrainWorks member. I was wondering if you have any suggestions, resources, or printable forms with suggestions for parents of picky eaters or kids who still mouth everything. Presumable seeking oral input. Can’t find anything on website.

Thanks!

GWEN’S ANSWER:

Here are a couple relevant Q&As from our website:

https://www.sensationalbrain.com/?s=oral+seeking

https://www.sensationalbrain.com/?s=picky

By using the sensory symptoms checklist, you may be able to find out what’s causing the picky eating and then select activity cards to create a visual routine to support feeding times.

Additionally, we do have a couple of good webinars about feeding:

https://www.sensationalbrain.com/shop/whole-pie/

https://www.sensationalbrain.com/shop/food-progressions/

I hope this helps!

Best Wishes,
Gwen

QUESTION: Any Apps for Emotions?

QUESTION:

Do you know of any good apps for identifying emotions AND learning to respond appropriately to them−maybe with some video modeling? I am working with a junior high student who is on the hi-level autism spectrum. I am looking for an app to help him understand and respond appropriately to his emotions. He continues to throw tantrums when he feels things are not fair for him. Social stories have been used over the years.

Thank you!

GWEN’S ANSWER:

I actually have not used apps in therapy much. I’m working in an outpatient clinic so our approach is a little different than school-based therapy. I am copying Kim Wiggins on this email. She uses apps in therapy a fair amount and has even done a couple of great webinars for us about apps! Thanks in advance for weighing in, Kim.

Here is a link to her most relevant webinar:

 https://www.sensationalbrain.com/shop/ipads-to-enhance-therapy-part-two/

I do use a variety of emotion picture cards in therapy. I have acquired some from the Zones of Regulation curriculum, some from the Self-Regulation Curriculum sold on yourtherapysource.com, and some from sites like Teachers Pay Teachers. I often use these to have kids sort them into the “Zones” or the BrainWorks colors and then have them select sensory strategies that may help them handle each emotion appropriately.

I also have a view-on-demand webinar titled “Facilitating Self-Regulation in Children and Teens.” Here is the link:

https://www.sensationalbrain.com/shop/self-regulation/

Please let me know if I can be of further assistance.

Best Wishes,
Gwen

KIM’S ANSWER:

Tying into Gwen’s response, the first thing that popped into my mind was the Zones of Regulation apps. They have 2 of them. I always start with this one:

https://itunes.apple.com/us/app/the-zones-of-regulation/id610272864?mt=8

It gives the general idea of which zone you are in depending on your emotion.  I’m currently teaching this program with the majority of my students that have sensory issues. Our speech pathologist is also using it, and it’s being reinforced in the classrooms. It’s a wonderful program. If you’re not using the actual ZOR book (18 lessons plans are included) you can use the app above. After you use that app you can then move on to this app:

https://itunes.apple.com/us/app/the-zones-of-regulation-exploring-emotions/id1033751819?mt=8

This one allows you to move your avator into social situations on a playground and deal with situations that arise. It is also wonderful.

I also really love the “I Can Do Apps,” and they have an “emotion” one. I’ve never used it, but I use several others that they make:

https://itunes.apple.com/us/app/emotions-from-i-can-do-apps/id525637590?mt=8 

I hope this helps!  🙂

Best Wishes,
Kim

QUESTION: Setting Up a Sensory Room?

QUESTION:

I attended your wonderful conference through CASE in Champaign, Illinois. I spoke with you briefly but wanted to get your input again on the use of Sensory Rooms in schools. I have a few of them that are used by special as well as general education kids, but I’m having difficulty getting these rooms to work effectively. I was wondering what you might suggest as the easiest way to set them up. When a child is brought into Sensory Room, how would you structure it so that aides could work with kids fairly easily?

You mentioned having a calming corner then a section for vestibular/proprioceptive, so I plan to inservice and follow up with staff. I am also trying to set up visuals so staff are not using rooms in a counterproductive way.

Thanks!

GWEN’S ANSWER:

Here are some helpful (hopefully!) hints:

  • Start with basic instruction for all of the kids who will be using the sensory room. They need an understanding of how to determine their current sensory speed and then how to alter their speed accordingly.
  • I recommend creating three areas in the room: calming, just-right, and alerting. I often call these areas SLOW, JUST-RIGHT, and GO! Ideally, it’s awesome to visually section off the rooms with dividers, rugs, or just colored duct tape on the floor.
  • As kids enter, the aide can ask “who thinks they need to SLOW (relax, calm down, chill out)?” then send those kids to the SLOW area. Continue with the other centers.
  • The aide should be trained to watch for signs that a child chose incorrectly.
  • Have the whole group finish with 3 minutes of slow wall pushups (or other form of proprioceptive input) and belly breathing.

I hope this helps!

Best Wishes,
Gwen

QUESTION: Walk a Mile in My SPD Shoes?

QUESTION:

I have been looking for a way to have demonstrations with parents and staff on what it is like to experience a sensory processing disorder, for example, having the parent wearing gloves when taking out coins from your pocket to demonstrate problems with tactile discrimination. Do you know where I can find more examples in either videos or reading,  reference, or anecdotal materials?

Thank you so much!

GWEN’S ANSWER:

I love your idea of having an experiential learning experience for parents and staff but, unfortunately, I haven’t done anything like that myself, so I don’t have any readily available ideas for you. Here is a link to a good YouTube video about SPD that may be helpful:

https://www.youtube.com/watch?v=6O6Cm0WxEZA

Here are a couple of other ideas:

  • Turn on a strobe light and loud music simultaneously while you read a paragraph. Then turn the light and music off and test their comprehension of what was read. Explain that their experience occurs in the brains of some kids with SPD in response to typical lighting and environmental sounds.
  • Ask them to think back to the last time they were required to stay seated and quiet for a long period of time—maybe a long car trip or a long class. This is how sensory cravers feel when asked to sit even for short periods of time.https://www.youtube.com/watch?v=6O6Cm0WxEZA

There are some great videos on YouTube. I bet you can get some good ideas there, too. I wish I could be of more help!

Best Wishes,
Gwen

QUESTION: What Can Interoception Dysfunction Cause Toilet Training Issues?

QUESTION:

I am a school-based OT working with a 7-year-old, regular education student. I initially began treating her in kindergarten for fine motor, visual motor, and SI deficits. She has a diagnosis of Autism, but she is very high functioning. She is not toilet trained and must wear pull-ups to school. Her parents have taken her to specialists to rule out medical reasons and have not found any answers. She is unaware of when she goes even with underwear. Very recently, her parents shared that she has trouble with constipation and over-eating as well. Her body temperature regulation also seems off. At their most recent appointment in Boston, their doctor brought up the possibility of interoception dysfunction. As a result, her mother contacted me to see if I’ve had experience working with this and if there was anything I could do to improve the functioning of this sense. I’ve been an OT for about 10 years and have not heard of this. I formally tested her primitive reflexes, and she does have a retained ATNR reflex, so I plan to incorporate more integration exercises into my sessions and train the parents to complete them at home. I’ve read that therapeutic listening, Wilbarger brushing protocol, and a consistent sensory diet might also help but I was wondering if you had any insight to share on this topic. Any feedback would be greatly appreciated. Thanks for your time!

GWEN’S ANSWER:

Interoception is now considered to be the eighth sense. This sensory system tells us if we are hungry or thirsty; if we need to go to the bathroom; and if we are hot, cold, ill, or in pain. It does indeed sound like this child has symptoms of interoceptive dysfunction. Unfortunately, we don’t have easy access to this sensory system. But there does seem to be a link between the vestibular system and the interoceptive system. So if I see interoceptive UNDER-responsiveness, I use alerting vestibular input. If I see interoceptive OVER-responsiveness, I use calming vestibular input. Sounds like you are describing interoceptive UNDER-responsiveness so I would incorporate activities like the following into her sensory diet:

  • spinning
  • multi-directional fast swinging
  • bilibo, balance boards, therapy ball activities

I have also had some success with pressure garments as it seems to increase awareness of what’s happening internally. One boy I treat stopped having accidents after starting to wear the Squease Pressure Vest. This one is from the Netherlands, but the Snug vest from the states is very similar. Both are expensive, but it may be worth it to the family. I do use both the iLS and Therapeutic Listening programs in my practice but haven’t looked into the use of either for these types of issues. It makes sense that certain programs/tracts from both could be helpful. There isn’t much research on this issue yet, so we are still at the trial-and-error phase. I hope this gives you a starting point at least. Please let me know if I can be of further assistance.

Best Wishes,
Gwen