FAB Strategies Mindfulness Movement Activities

I wanted to share this video of my FAB Strategies Mindfulness Movement activities to improve student’s behavior  https://www.facebook.com/educationresourcesinc/videos/943257499082558/ It was recorded by ERI at their Therapy in the Schools Conference.  Mindfulness movement activities are simple to do and can improve attention as well as enhance behavior by reducing student’s anxiety and giving them a break from seated work.

Mindfulness movement activities help all students yet are especially helpful for students with developmental disabilities, anxiety, sensory processing challenges, Post Traumatic Stress Disorder, ADHD, and/or other behavioral challenges.  Brief five minute mindfulness movement activities can help students attend better and promote the processing of academic learning when done between academic subjects (e.g., after math before proceeding to language arts).  Mindfulness movement activities can also be done in conjunction with teaching Positive Behavioral Support Interventions and used as a pre-correction before challenging school activities (e.g., lunch, playground, assemblies, and transitions).

In this video I demonstrate Touching the head-shoulders-stomach for sensory body awareness, Belly breathing, Hand opening and stretching to prevent hand cramping from writing (while breathing in) followed by thumb fisting as a mudra for relaxation (while breathing out)


Bird breathing, and Mindful Clock Sitting (righting reactions moving forward-back and laterally).

Mindful clock standing activities can also be used, particularly to help students with sensory irritability gain basic body awareness of the anterior-posterior portions of their body through forward-back balancing movements  


as well as sensory awareness and stability of the bottom (feet) and top (head) of their body through squatting then moving on their toes.


I hope more early childhood and special education teachers as well as occupational, physical, speech/language and mental health therapists will begin using basic sensory mindfulness movement activities with their students.  Mindfulness movement activities offer a great opportunity for teachers and therapists to integrate and co-teach the academic and developmental curriculum areas.  As we continue to integrate the regular and special education curriculums, mindfulness movement activities can benefit students while promoting transdisciplinary interactions between teachers and therapists.


3 Popular Neurologically Based Treatments

Occupational, Physical and Speech/Language therapists often include popular neurologically based approaches in their interventions for students with behavioral and developmental challenges. Brain Gym, Bal-A-Vis-X and Sensory Integration Intervention are three popular neurologically based approaches to promote neurological development for improved functional skills. While many clinicians, parents and families report that these interventions are clinically useful in achieving functional goals, they are criticized for lacking adequate research support.

Given the current emphasis on using evidence-based strategies it is important that therapists using these approaches apply current research to justify their use of these popular neurologically based approaches. A good way to show the efficacy of using these approaches is through goal attainment scaling, which can validate the effectiveness of strategies in achieving the student’s education related goals SIforASDGoal It is also important to consider research related to the components of these methods.

In addition to gathering baseline data and assessing treatment effectiveness through goal attainment scaling, it is important to understand the evidence-based components of these popular neurologically based approaches that can contribute to their effectiveness. First is their emphasis on child motivation through allowing students to choose the treatment activities. Second is their use of cardiovascular and strengthening exercises, and third their implementation of pressure touch strategies.

First, these popular neurologically based approaches facilitate student motivation by involving students in selecting fun and engaging activities. While sometimes criticized for being popular “only because students enjoy them”, the importance of activities that motivate children cannot be over-emphasized.   PRT (Pivotal Response Treatment) is a behavioral intervention that emphasizes the importance of student motivation. PRT was found to be highly effective in improving communication and behavior skills in children with Autism Spectrum Disorder.   The emphasis of PRT on facilitating motivation is a major reason for this success. Client motivation is facilitated in PRT by emphasizing child choice in activity selection and reinforcing attempts. In addition to its developmental efficacy in improving communication and behavior, recent research suggests PRT promotes more normalized neurological functioning.

The second component of these popular neurologically based approaches is their use of aerobic and strengthening exercises. Participation in aerobic exercise has been repeatedly associated in research with improved attention, learning and neurological development. Regular moderate exercise for 30 minutes daily appears to promote neurological development of the hippocampus for learning in both typical students (Cramer et al., 2011) and students with neurological challenges (Ploughman, 2008).

The third evidence based component of these popular neurologically based approaches is their use of pressure touch through massage and brushing. Massage has consistently been found through repeated research to decrease pediatric stress, which can help reduce behavior and learning challenges. More specifically, Asian massage strategies were found to improve behavior and communication skills in preschoolers with Autism Spectrum Disorders (Piravij et al., 2009; Silva & Schalock, 2013) www.qsti.org

While caution should be used in applying these popular neurologically based approaches to school therapy interventions, these techniques can be useful for attaining school goals. It is important to gather baseline data and use progress toward school related goals in judging the effectiveness of these strategies. It is also important to consider research supporting the specific strategies used, as well their research supported components of student motivation, aerobic exercise, strengthening exercise, and touch pressure   Reduce Problematic Reflexes:Hab


Pfeiffer, B. A., Koenig, K., Kinnealey, M., Sheppard, M., Henderson, L. (2011). Effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study. American Journal of Occupational Therapy, 65(1), 76-85.

Piravej, K., Tangtrongchitr, P., Parichawan, C., Paothong, L., Sukprasong, S. (2009). Effects of Thai traditional massage on Autistic children’s behavior. Journal of Alternative and Complementary Medicine, 15(12), 1355-1361.

Ploughman, M. (2008). Exercise is brain food: the effects of physical activity on cognitive function. Developmental Neurorehabilitation, 11 (3), 236-240.

Silva, L., & Schalock, M. (2013). Treatment of Tactile Impairment in Young Children with Autism: Results with Qigong Massage. International Journal of Therapeutic Massage & Bodywork, 6(4), 12-20.


Role of school OT’s, PT’s, SLP’s in Behavior Intervention

School Occupational, Physical and Speech Therapists play a significant role in improving student behavior. While traditionally viewed exclusively as the role of school social workers, psychologists, and behaviorists the complex problems of students with interrelated behavioral and developmental challenges can be helped by the contribution of school therapists.  The relationship between behavioral problems, the occupation of students, communication/language abilities, and gross motor skills supports the role of school occupational, speech/language and physical therapists as members of school teams helping students with behavioral and developmental challenges.

By teaming with occupational, speech/language and physical therapists, teachers and school mental health specialists can enhance their school positive behavioral support programs with expanded use of visual supports, mindfulness, music, exercise, and sensory-motor activities (Patten et al., 2013; Schaaf et al., 2014).  There is emerging evidence that cardiovascular and resistance exercise enhances body awareness, attention, as well as functional strength and endurance for improved participation in school learning tasks http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208137/pdf/nihms297861.pdf

School therapists can utilize evidence based mindfulness strategies as movement breaks that improve attention, and integrate behavioral strategies into their school therapy to enhance student’s school behavior.  Behavior for Therapists Slides The picture below describes the FAB Strategies adaptation of the PATHS PBS Turtle Technique to help students with special needs learn to calm down and avoid aggression.


The AOTA supports the role of school occupational therapy in helping to improve student’s behavior (Cahill & Pagano, 2015).  The following Occupational Therapy article describes clinical school occupational therapy strategies that can be used to reduce student aggression  (Click on highlighted, then double click on lower heading) SchoolOTRedAgg


Cahill, S. M. & Pagano, J. L. (2015). Reducing restraint and seclusion: The benefit and role of occupational therapy. AOTA School Mental Health Toolkit. http://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Reducing-Restraint-and-Seclusion.pdf

Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26(1), 70-95. http://skolenforoverskud.dk/Artikler%20-%20mindfulness/Flook-Effects-of-Mindful-Awareness-Practices-on-Executive-Function-1.pdf

Kazdin, A. E. (2008). The Kazdin Method for parenting the Defiant Child. NY, NY: Mariner Books.

Laugeson, E. A. (2014). The PEERS curriculum for school-based professionals: Social skills training for adolescents with autism spectrum disorder. Routledge.

Mahammadzaheri, F., Koegel, L. K., Rezaee, M., Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavioral analysis (ABA) intervention for children with autism. Journal of autism and developmental disorders, 44(11), 2769-2777.

Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., … & Sendecki, J. (2014). An intervention for sensory difficulties in children with Autism: A randomized trial. Journal of autism and developmental disorders, 44(7), 1493-1506.

Warner, E., Spinazzola, J., Westcott, A., Gunn, C. & Hodon, H. (2014). The body can change the score. Journal of Child & Adolescent Trauma, 7(4), 237-246.


PRT Treatment in SLP, OT, & PT

PRT (Pivotal Response Treatment) is an important frame of reference for Speech/Language Pathologists, Occupational Therapists and Physical Therapists. PRT uses applied behavioral analysis principles as well as child choice, reinforcing attempts, varying activities, alternating familiar with challenging activities, and direct natural reinforcers. PRT’s transdisciplinary family-centered approach makes it particularly appropriate for allied health therapists.


PRT shows significantly greater effectiveness for treating Autism Spectrum Disorder than traditional ABA  https://www.autismspeaks.org/sites/default/files/docs/koegel_prt_rancomized_controlled_trial_of_prt.pdf and facilitates neuroplasticity in young children with Autism Spectrum Disorders PRT NeurogenisisArt.  In addition to its usefulness for addressing language and behavioral challenges related to Autism Spectrum Disorders, PRT is a clinically relevant intervention for addressing other developmental and psychiatric challenges (e..g., fragile x syndrome, cognitive deficits, developmental trauma disorder, oppositional defiant disorder, depression, anxiety). Treatment is done with the family across disciplines in the child’s natural environment, so gains in language and motor skills are generalized to improve functioning.



PRT strategies can be integrated with language, sensory and movement strategies as a component of occupational, speech and physical therapy interventions SensoryBehavior  I have found PRT is a particularly valuable treatment frame of reference for Speech/Language, Occupational and Physical Therapists.


Amaral, D. G., Schumann, C. M., & Nordahl, C. W. (2008). Neuroanatomy of Autism. Trends in Neuroscience, 31(3), 137-145.

Voos, A. C., Pelphrey, K. A., Tirrell, J., Bolling, D. Z., Wyk, B. V., Kaiser, M. D., McPartland, J. C., Volkmar, F. R. (2012). Neural mechanisms of improvements in social motivation after pivotal response treatement: Two case studies. Journal of Autism Dev Disord, 43(1), 1683-1689.


The Importance of Parents

As an occupational therapist working with children and adolescents who have special needs, I am repeatedly impressed by the amazing love and perseverance of their parents.  Supporting and encouraging parents is the most important job of doctors and therapists who are trying to help children and adolescents.  I repeatedly recall my doctoral dissertation on parental perceptions of feeding their young children who had special challenges.

ParChildIntFeeding Pagano Dissertation2000

My study found that half of the parents who had young children with developmental and feeding problems had problematic levels of parental stress.  I further discovered that feeding satisfaction was inversely related to parental stress, with parents who were most satisfied with their feeding experience reporting the least parental stress.  When rating the influence of occupational and speech therapy intervention on their feeding experience 42% reported a positive effect, 23% both a positive and negative effect, and 11% a negative or no effect.

In my current work with adolescents who have psychiatric illness I continue to see the great healing effects of supportive parents.  It is extremely important for therapists and physicians to support these parents through their trials, and help them understand the importance of taking care of themselves.  Parents reported that the most effective component of therapy in reducing parental stress was the experience that the therapist cared about them and their child.  If I do nothing else as a therapist, I hope to always convey to youngsters and their parents how truly valuable and important they are.


Occupational Therapy in Adolescent Mental Health

I was recently honored to present Grand Rounds at Solnit Children’s Center, the adolescent psychiatric hospital where I work. GrandRoundsOT Outline Our dynamic transdisciplinary team over the past 5 years was able to significantly reduce the use of restraint and seclusion.OT role in Restraint Reduction Solnit which was celebrated by making a bench for the hospital grounds from restraint beds (which are no longer used).


Occupational Therapy is a vital intervention for adolescents with mental health, PTSD and developmental challenges.  Occupational therapists address adolescent mental health in schools, outpatient mental health clinics, youth psychiatric hospitals, and juvenile detention facilities. Occupational Therapy (O. T.) focuses on promoting adolescent’s occupations, the things they want or need to do. Adolescent’s occupations typically include school,


activities of daily living (e.g., grooming, keeping their room clean), prevocational activities, sports, exercise, and social activities. For example, intervention on developing occupations is needed by some adolescents recovering from drug addiction, where their primary activities of taking drugs and doing illegal activities (to earn money for drugs) must be replaced by a new lifestyle with more functional occupations.  I am repeatedly impressed by my client’s and their families’ ability to confront the challenges of mental illness, and their unique gifts as individuals http://www.behindthelabel.co.uk

Occupational therapy offers unique contributions to adolescent mental health intervention due to its foundations in neurology, physiology, psychology, development, human occupations, and sensory processing. At Solnit Children’s Center the primary frames of reference used include: mindfulness, sensory processing, sensory massage, trauma informed care, Pivotal Response Training (a research proven form of Applied Behavioral Analysis), exercise, and developmental intervention. Occupational therapy is a vital component of transdisciplinary team intervention for adolescents with mental health challenges.


Neurological Foundations of Sensory Integration

Current neurological research guides therapist’s clinical reasoning for using sensory integration intervention. Recent research proposes that sensory-motor activities help typical youngsters develop internal models of their body and voluntary movements. For example through repeated touch and movement of their thumb as well as learning to ride a bicycle, children develop internal models. With repeated practice these internal models become integrated neurological representations allowing automatic feed-forward control for functional activities. We become able to automatically locate and use our thumb without looking and can ride a bike on a flat road without concentrating on the integrated arm, leg, and balance reactions involved.


Sensory integration challenges appear related to dysfunctional interactions between the neocortex, basal ganglia and cerebellum. These dysfunctional neurological connections cause many children with sensory integration or developmental challenges to experience sensory over-sensitivity, under-sensitivity, body image, and movement planning challenges. For example, individuals with Autism Spectrum disorders and other developmental challenges appear to show significant differences from typical children in representations by the somatosensory cortex of their thumb that may reflect disrupted internal models (Coskun et al. 2009).


Sensory integration intervention appears to promote development of internal models of body image and movement through active exploration that provides naturalistic pressure, touch, movement, visual, and auditory sensory input at an optimal level of challenge.  Sensory integration intervention involves clinical reasoning based on experience and neurological research in gradually guiding active movements involving pressure, touch, movement, visual and auditory sensory input to improve functional skills.  An understanding of this current neurological research regarding development of internal models can be useful to therapists for clinical reasoning during sensory integration intervention.


Koziol, L. F., Budding, D. E., & Chidekel, D. (2011). Sensory integration, sensory processing, and sensory modulation disorders: Putative functional neuroanatomic underpinnings. Cerebellum, 10, 770-792.


Marco, E. J., Hinkley, L. B., Hill, S. S. & Nagarajan, S. S. (2011). Sensory processing in Autism: A review of neurophysiologic findings. Pediatric Research, 69, 48R-54R.