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Preschool & Kindergarten Strategies for Complex Behavior Challenges

Preschool and kindergarten teachers are extraordinary, under-appreciated professionals who are confronted with helping children develop the foundation for academic achievement, while often simultaneously developing the social skill prerequisites for learning in students with behavioral challenges.  Some preschool and kindergarten students may also demonstrate “complex behavioral challenges” including significant social, developmental, and sensory processing challenges that must be addressed before they can begin learning.  Early childhood educators are confronted with increasing numbers of students with complex behavioral challenges, along with higher academic expectations and testing requirements for all students (that some typical students may lack the developmental readiness for when they enter preschool or kindergarten). 

The FAB Strategies for Preschoolers & Kindergarteners form is helpful in preparing young children to learn these higher academic skills while simultaneously addressing the needs of any students with complex behavioral challenges.  The FAB “Functionally Alert Behavior” Strategies for Preschoolers & Kindergarteners form offers a checklist of activities to promote attention for learning more complex academic tasks and quickly provide home activity suggestions, particularly for children who enter class lacking the maturity to learn.  The FAB Strategies for Preschoolers & Kindergarteners form is also useful in simultaneously developing the social skills needed for learning in children with complex behavioral challenges. 

Complex behavioral challenges are often related to genetic, perinatal, neurological, developmental, early trauma, sensory processing, environmental, and/or parental stress factors.  Many children with complex behavioral challenges in preschool and kindergarten classes have not yet been identified with special needs or given supplemental services to help them learn. When preschool and kindergarten students are provided with supplemental services (e.g., individual teaching assistant and/or occupational, physical, speech/language, or mental health therapist), coordinating goals and intervention can be challenging and is often the responsibility of the classroom teacher.

For children receiving supplemental services the FAB Strategies for Preschoolers & Kindergarteners form helps integrate goals and learning across disciplines.  FAB Strategies are organized in four sections addressing: environmental adaptations, sensory modulation, positive behavioral support, and physical self-control strategies.  The teacher or team lists objective educational goals at the top of the FAB Strategies form, and chooses at least one strategy from each section.  Strategies chosen are checked and underlined for use across disciplines.

A few FAB Strategies options (listed in bold type) are included that can be marked with an X for use by trained occupational, physical, and speech therapists. Two blank lines on the bottom of the form enable teachers and therapists to add strategies not listed on the form.  A line is also included at the bottom of the form for the parent or guardian signature designating that they understand and agree with the strategies used.  The FAB Strategies for Preschoolers & Kindergarteners form is helpful for preschool and kindergarten teachers and therapists in promoting classroom learning.  FABPre&KStrategies

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Sensory-Motor Strategies to Improve Self-Control

Sensory-motor strategies are often motivating for children and adolescents, providing therapists with a useful modality for improving self-control.  DBT www.linehaninstitute.org and CBT intervention http://apt.rcpsych.org/content/7/3/224.full can improve self-control in children and adolescents, but are often ineffective for youngsters who have significant cognitive deficits and/or a very limited attention span. Sensory-motor strategies offer a motivating and effective component of comprehensive mental health treatment to improve self-control in young people with complex behavioral, developmental, and sensory processing challenges.   

Inappropriate behavior involves a lack of functional inhibitory motor control.  Behavioral problems result from inadequate inhibitory control of arm movements (e.g., punching, slapping, scratching) or mouth movements (e.g., spitting, biting, threatening, screaming, swearing). Actively helping children learn motor self-control is an effective intervention for aggressive youngsters with behavior, developmental, and sensory processing challenges. Sensory-motor strategies promote the development of overall inhibitory control, behavior, and social skills. Since inappropriate behavior involves movement, graded activities requiring increasing levels of inhibitory control can be reinforced to improve self-control.  These activities include: Simon says, red light, giant steps freeze dance, freeze shake, play plan, play review, and turn taking during sensory-motor games. www.fabstrategies.com  www.challengingbehavior.org

Self-control can also be facilitated through new learning of developmentally sequenced bilateral movements.  Research suggests that learning new bilateral sequential skills (e.g., drumming and piano) promotes neurological connectivity (e.g., between cortical and midbrain emotional centers as well as across the corpus callosum coordinating the brain hemispheres) involved in self-control skills.  Neurological connectivity impacting self-control can be significantly compromised in youngsters with Pervasive Developmental Disorders and/or an early trauma history.  For this reason sensory-motor activities involving sequential bilateral movement appear clinically useful in promoting inhibitory control and communicating feelings.

Sequential bilateral activities include: ball bouncing activities, bean bag pass, obstacle courses, and mindfulness movement. Sequential bilateral activities can be integrated with the verbal expression of feelings and coping strategies using a game format.  Sequential bilateral movement activities are clinically useful to promote learning and social development in students with behavioral, developmental and sensory processing challenges. www.braingym.org www.movementbasedlearning.com

In addition, clinical experience utilizing the sensory processing frame of reference suggests that slow sequential movement activities involving deep pressure input through the joints help calm children and adolescents with behavioral, developmental, and sensory processing challenges.  While some therapists question the efficacy of sensory-motor intervention the benefits of exercise on the development of physical and mental health has been repeatedly demonstrated.  Further, exercise clearly has less potential contraindications when compared to the alternative of prescription medications to reduce hyperactivity and anxiety.

Sensory-motor activities can be embedded in regular classroom activities through movement brakes, music activities, brakes to get a drink at the water fountain, and school jobs (e.g., moving desks, moving mats, passing out books, delivering supplies around the school).  Children and adolescents can be taught to independently use tasks combining slow linear movement with deep pressure coping strategies (wall pushups, isometric exercises, therapy ball activities, theraband arm exercises, theraplast hand exercises) to maintain a quiet alert state when they initially notice they are becoming anxious.  In addition, children can participate in after school activities involving aerobic exercise (e.g., walks, biking, scooter, swimming, basketball, soccer, dancing and structured playground activities).  Sensory-motor strategies offer an effective component of a comprehensive intervention program to improve self-control and functional behavior.

References:

Bengtsson, S.L., Nagy, Z., Skare, S., Forsman, L., Forssberg, H., Ullen, F. (2005).  Extensive piano practicing has regionally specific effects on white matter development.  Nature Neuroscience, 8, 1148-1150.

Hillman, C. H., Pontifex, M. B., Raine, L. B., Castelli, D. M., Hall, E. E., Kramer, A. F. (2009).  The effect of acute treadmill walking on cognitive control and academic achievement in preadolescent children.  Neuroscience, 159(3), 1044-1054.

Riggs, N.R., Greenberg, M.T., Kusche, C.A., Pentz, M.A. (2006).  The mediational role of neurocognition in the behavioral outcomes of a social-emotional prevention program in elementary school students: Effects of the PATHS curriculum.   Prevention Science, 7(1), 91-102.

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.

Sun, F.T., Miller, L.M., Rao,  A.A., Esposito, M.D. (2007).  Functional connectivity of cortical networks involved in bimanual motor sequence learning.  Cerebral Cortex, 17(5), 1227-1234.

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Combining Sensory Integration with Behavioral Strategies

FAB (Functionally Alert Behavior) Strategies synthesize sensory integration with behavioral strategies to help children and adolescents with behavioral, developmental, and sensory processing challenges.  Some therapists limit themselves to using only sensory integration or behavioral techniques.  However, combining these interventions provides opportunities for structure and child-centered movement that improve behavior in children with complex needs.  Sensory integration is addressed in FAB Strategies through environmental equipment, adaptive techniques, mindfulness, movement, touch, and traditional sensory processing intervention. The two major behavioral methods applied in FAB Strategies are Positive Behavioral Support (PBS) and Pivotal Response Training (PRT).

Positive Behavioral Support (PBS) is used extensively by schools to help children learn about feelings, practice self-regulation, and use environmental modifications to reduce behavior problems.  Sensory integration strategies complement PBS intervention by allowing greater consideration of the sensory environment (such as noise levels and adaptive equipment) for environmental modifications, and utilizing sensory movement activities in teaching self-regulation. <www.challengingbehavior.org> Pivotal Response Training (PRT), developed by a behaviorist and speech & language pathologist, is a research proven intervention that promotes attention, motivation, and communication in children with Pervasive Developmental Disabilities.  Sensory integration complements this approach by expanding the utilization of sensory strategies and equipment as naturalistic reinforcers (e.g., developing motivating sensory activities as naturalistic reinforcers).  http://education.ucsb.edu/autism

FAB Strategies are organized into four sections: environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation. The sensory modulation section emphasizes sensory integration activities while the positive behavioral support section addresses behavioral strategies.  However, both sensory integration and behavioral strategies are included in all sections.  For example, the fourth row of the positive behavioral control section includes reinforce using specific praise (a behavioral strategy) and sensory activities (a sensory integration intervention).  FAB (Functionally Alert Behavior) STRATEGIES

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Sensory Strategies for Childhood Trauma

After 20 years as a pediatric occupational therapist, I got a job as Mental Health Coordinator at Head Start and immediately discovered that children with behavioral problems and an early trauma history respond dramatically to developmental and sensory integration interventions. Many of my children who had childhood trauma and behavioral problems showed sensory discrimination, as well as “numbing”, and “hyper-arousal” sensory modulation challenges.  These children respond well behaviorally to environmental adaptations and intervention strategies addressing their sensory discrimination (body awareness), low registration (lack of sensory responsiveness), sensory sensitivity (over sensitivity), and self-regulation (sensory modulation and self-control) challenges.

Over the next ten years working as an  occupational therapist in pediatric psychiatry I’ve been continuing to develop research based interventions that improve behavior in children and adolescents with an early trauma history.  Research shows significantly more sensory processing problems in children with early trauma histories, and I’m finding a synthesis of developmental, sensory, and behavioral problems is effective in reducing aggression in these youngsters.  The slides below show that early childhood trauma is related to significant neurological challenges (slides 1-3), and sensory challenges (slide 4), that can benefit from an environmental sensory strategy of first decreasing then increasing sensory input (slide 5).

FAB TraumaTxSlides

The final slide above illustrates an effective practical strategy for helping children who are too low or high energy to behave and learn appropriately.  First, decrease all stimulation (noise, touch, movement, visual input) and see if that improves their ability to achieve a calm alert state. If that doesn’t help continue to incrementally increase sensory input in a social acceptable manner until a quiet alert state is achieved.  Regardless of sensory modulation style or cause, if children are too hypo and/or hyper-sensitive to learn (including children who have sensory processing problems affected by trauma), you can initiallty reduce all sensory input, then if needed increase sensory stimulation in a socially acceptable manner until a quiet alert state is reached.  This strategy frequently helps regardless of their current sensory modulation problem.

Strategies to Improve Sensory Discrimination include massage, mindfulness, and movement games (e.g., Put your finger on your nose, Hokey-Pokey, Head, Shoulders, Knees and Toes). To promote self-regulation teachers and therapists can help kids identify their initial state of arousal using energy meters or other tools, then direct them in decreasing or increasing their energy level as needed.  Activities combining linear movement with deep body pressure help promote self-control by enabling children to modulate their arousal state.  This can include taking a walk, biking, scooters, swimming, basketball, soccer, dancing, and structured playground tasks.

These movement and pressure activities can be adapted for the classroom through having children take walks to get drinks or deliver messages, set table, move mats, move tables, and pass out books.  For bright children who are unable to be still, having them roll across the room then read several pages or do a math sheet, then roll back and do more combines movement and pressure with academics.  FAB Strategies that help promote self-regulation include Freeze dance, Freeze shake, Giant steps, Simon says, Red light, Social role playing, and implementing a Plan-Do-Review process.  Resources to improve self-regulation are available at <www.fabstrategies.com>  <www.spdnetwork.org> and <www.challengingbehavior.org>