0

FAB Strategies Workshops

I’ve been getting several enquiries from therapists, parents, and teachers interested in taking my FAB (Functionally Alert Body) Strategies workshops.  FAB Strategies offer evidence based transdisciplinary mindfulness, sensory processing, handling, behavioral, art, music, and activity strategies for children with behavioral, developmental, and sensory challenges. I would enjoy discussing setting up workshops with you and can be reached at JLP96007@yahoo.com I am currently conducting efficacy research and working on a FAB Strategies Book.

Through ERI (Education Resources Inc.) I am currently offering small high quality trainings for occupational, physical, speech, and mental health therapists.  The number of participants is strictly limited so I can give individualized activity and handling instructions to each participant through laboratory sessions, where participants can learn to immediately use FAB Strategies in their clinical practice.  Professionally produced handbooks are provided for each participant with research references and unlimited ability to use my copyrighted FAB Strategies activity and handling forms.  My currently scheduled FAB Strategy Workshops are October 18 & 19, 2013 in Cedar Knoll, NJ and November 8 & 9, 2013 in Hollywood, Florida.  More information and registration informationis available at 

http://www.educationresourcesinc.com/course-details?courseid=38

2

FAB Sensory Calming Area Strategy Improves Self-Control

FAB Sensory Quiet Area Log
The FAB sensory calming area strategy improves self-control in individuals with behavioral, sensory, and developmental challenges. The FAB sensory calming area strategy integrates best practice sensory processing intervention and behavior modification theory by encouraging clients to use a designated area to modulate their arousal to a calm alert state when they begin experiencing stress related to environmental and body triggers. The FAB sensory calming area strategy encourages self-control and reduces the need for punishment or physical restraint.

Sensory calming areas are becoming increasingly popular and may be referred to as peace corners, quiet areas, coping areas, sensory rooms or safe spaces. Based on the Massachusetts Department of Mental Health Safety Tool, the FAB sensory calming area strategy uses the concepts of environmental and body triggers as well as coping strategies including the sensory calming area. The sensory calming areas can be adapted for use in school, home, clinic, and psychiatric hospital settings. Therapists can individualize each sensory calming area to the specific needs of their clients. Sensory calming areas vary from a designated seat in the back of a regular classroom where children are not to be disturbed, a pup tent in a child’s home, or a specially equipped sensory room in a clinic or hospital. It is important to clearly distinguish sensory calming areas from spaces used for punishment, seclusion, or restraint.

I developed the FAB Sensory Calming Area Log to assess the effectiveness of the sensory quiet area in helping clients behave more appropriately. It objectively tracks the degree to which the room helps each individual calm down, frequency and duration of quiet area use, and whether the client or a staff member suggests the need for its use. In schools space is often extremely limited, and the use of break areas may be discouraged for fear they will be use to avoid school activities. The Log tracks the effectiveness of the FAB sensory calming area strategy, and specifies the environmental adaptations and activities that best help calm each individual. In schools I have two folders in the sensory calming area, one with blank logs and the other for completed logs. The staff member who accompanies the client to the sensory calming area fills out the log, and the staff member who completes the most forms each month can be awarded a gift certificate for coffee by the occupational therapist.

I developed the FAB sensory calming area strategy to assure goal directed individualization and safe use of sensory calming areas. A crucial component for success is supervision of the sensory calming area by an occupational therapist in consultation with parents, teachers/instructors, as well as physical, speech, and mental health therapists. Further, use of the FAB Sensory Calming Area Log facilitates this process, and allows modifications in use to be made as needed. Supervision is important to enable the sensory calming area to safely achieve specific functional goals to improve the children’s lives. Coordination among parents and staff sometimes result in offering the sensory calming area proactively following environmental triggers, such as difficult class lessons or trauma processing by mental health clinicians. I hope that you will find use of the FAB sensory calming area and the FAB Sensory Calming Area Log helpful.

References
Ayres, A. J. (2005). Sensory integration and the child: 25th Anniversary Edition. Los
Angeles, CA: Western Psychological Services.
Dunn, W. (2007). Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants & Young Children, 20(2), 84-101.
Mass. Dept. of Mental Health Safety Tool. (2006). MacLachlan, J. & Stromberg, N. Safety Tools.

0

Pediatricians on Sensory Integration for Developmental and Behavioral Disorders

As a pediatric occupational therapist for 30 years, reading the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders (American Academy of Pediatrics, 2012) impacted me deeply.  My reaction is bests summarized by the movie title The Good, the Bad, and the Ugly. 

The Good is the best practice directive for implementing sensory integration interventions strategies (also called sensory processing, sensory-motor, and sensory strategies) for developmental and behavioral disorders.  I agree with the policy that best practice is the use of sensory integration intervention to achieve sensory related functional goals as one component of a comprehensive treatment strategy. I also agree with the pediatrician statement that in certain specific situations behavioral strategies can be more affective than sensory integration for children with severe Autism who do not respond to people.  It is helpful to be reminded of these best practice guidelines.

The Bad of the pediatrician’s policy are several deceptive omissions that may harm children and confuse parents.  First, while the policy mentions that sensory integration is used by occupational therapists, they do not mention that it is one of several approaches that occupational therapists comprehensively use with children who have developmental and behavioral challenges.  My occupational therapy interventions for children with developmental and behavioral challenges often includes sensory integration in purposeful play activities but equally utilizes the behavioral, cognitive behavioral, mindfulness, massage, and developmental frames of reference. Second, the policy statement omits that OT uses sensory integration interventions because there is evidence they provide effective activities (Smith et al., 2005) and environmental modifications (Dunn et al., 2012).  Sensory activities can frequently initially be the only intrinsically motivating interactions with children who have developmental and behavioral challenges (Parham et al., 2011; Pfeiffer et al., 2011), and can be clinically effective in reducing the need for or amounts of medications with potential side effects prescribed to manage behaviors.  

 Given the recent seated academic emphasis beginning in pre-school, sensory strategies provide a needed active multiple intelligence approach to learning that involves bodily-kinesthetic and visual-spatial experiences enabling learning in students with developmental and behavioral challenges (Brand, 2006).  In my work over the past 30 years treating children with severe developmental and behavioral challenges I’ve found sensory strategies are an important frame of reference that integrates extremely well with the behavioral (Pivotal Response Training) and developmental models.  I  obtained a Master’s Degree in Special Education and a Ph.D. in Marriage & Family Studies but chose not to pursue certification as a special education teacher or Marriage & Family Therapist.  While I team extensively with and greatly respect Special Education teachers and Marriage & Family Therapists, I stayed only an OT because I‘ve found great value in occupational therapy including use of a sensory integration intervention model.

The ugly is the confusion the omissions mentioned above in the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders bring to parents and medical doctors and the lack of respect they convey to the occupational therapy profession.  Which leads me to the reason that while I hate conflict with doctors, I wrote this response to the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders

Many years ago I worked with a child who had severe developmental and behavioral problems and was being expelled from preschool. His mother had me work with the preschool using a combined sensory integration and behavioral frame of reference.  The teachers implemented my consultation suggestions and were pleased with his behavioral improvement, when suddenly the mother stopped the OT at the urging of her pediatrician who said “I hate the OT sensory stuff”.   The child’s behavior deteriorated and he was eventually heavily medicated for his behavior so he would not be expelled.

I work extensively with pediatricians (mostly developmental pediatricians) and continue to respect pediatricians. While I appreciate their best practice reminders I worry that the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders will prejudice pediatricians against occupational therapists, and hurt pediatrician’s relationships with parents who appreciate what we do to help their children.

References:

American Academy of Pediatrics. (2012).  Policy Statement:  Sensory Integration therapies for children with developmental and behavioral disorders.  Pediatrics, 129; 1186-1189.   

Brand, S.T. (2006).  Facilitating emergent literacy skills: A literature-based, multiple intelligence approach.  Journal of Research in Childhood Education, 21(2), 133-148. 

Dunn, W., Cox, J., Foster, L., Mische-Lawson, L. & Tanquary, J. (2012).  Impact of a contextual intervention on child participation and parent competence among children with autism spectrum disorders: A pretest-posttest repeated-measure design.  American Journal of Occupational Therapy, 66, 520-528. 

Smith, S.A., Press, B., Koenig, K.P., Kinnealey, M. (2005).  Effects of sensory integration intervention on self-stimulating and self-injurious behaviours.  American Journal of Occupational Therapy, 59, 418-425. 

0

A FAB Sensory Behavioral Strategy for Kids with Autism

FAB (Functionally Alert Behavior) STRATEGIES

A clinically affective strategy for children with Autism who engage in repetitive self-injurious behavior is the FAB Reinforce Sensory Match Strategy.  The FAB Reinforce Sensory Match Strategy involves replacing the automatic sensory reinforcement that encourages repetitive self-injurious behaviors with matched sensory activities, while also reinforcing the child for refraining from the self-injurious behavior.  The Sensory Profile and a sensory functional behavioral analysis assessment can help direct the intervention.  The Sensory Profile alerts the therapist to definite difference in the child’s sensory processing that only occur in 1 out of 100 kids.  The Sensory Functional Behavioral Analysis establishes base line data, determines the function served by the problematic behavior, and helps direct intervention. The Reinforce Sensory Match strategy is most effective with children who have significantly different sensory modulation styles and engage in self-injurious behavior only to obtain sensory input.

The therapist hypothesizes the automatic sensory reinforcement the child is getting from the problematic behavior then offers adaptive equipment and sensory techniques that match it.  For example, when the Sensory Profile and Sensory Functional Behavioral Analysis show that a child repetitively mouths his hand for sensory reinforcement the therapist analyzes whether the sensory reinforcement is oral input, touch on his fingers, or both.  The client is then offered various mouth and hand touch activities, and a super chew toy is found to be his favorite.  The child is offered the chewey to use whenever he wants, and is praised for not mouthing his hands for progressively longer periods of time. For particularly problematic behavior the FAB Reinforce Sensory Match Strategy can be one component of a functional behavior plan written jointly by a Certified Behavior Analyst and Licensed Occupational Therapist.

References:

Dunn, W. (2007).  Supporting children to participate successfully in everyday life by using sensory processing knowledge.  Infants & Young Children, 20(2), 84-101.

Higbee, T.S., Chang, S., Endicott, K. (2005).  Noncontingent access to preferred sensory stimuli as a treatment for automatically reinforced stereotypy.  Behavioral Interventions, 20, 177-184.

Mays, N.M., Beal-Alvarez, J., Jolivette, K. (2011).  Using movement-based sensory interventions to address self-stimulatory behaviors in students with Autism.  Teaching Exceptional Children, 43(6), 46-52.

Rapp, T.R. (2006).  Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: A preliminary investigation.  Journal of Applied Behavioral Analysis, 39, 137-140.