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School Sensory Modulation Strategies

Sensory modulation strategies, a component of sensory integration intervention, help improve behavior and reduce the need for harsh discipline in schools. Sensory modulation strategies teach students to be aware of and regulate their arousal levels for appropriate behavior and learning.  Sensory modulation strategies are particularly useful for students with behavioral, mental health, trauma history, developmental, and/or sensory processing challenges.

Sensory modulation strategies help students adjust their arousal level for improved self-control. They learn to notice whether their arousal level is low (they feel numb), medium (just right for learning) or high (too hyper to pay attention) and use coping strategies to adjust their energy level.

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Most students learn best when they’re in a quiet alert state rather than overly relaxed or excited.

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Maintaining appropriate arousal levels also involves social skills, as different levels of arousal are expected during class and at recess.  Occupational and mental health therapists can team with teachers to use sensory modulation strategies with students who have self-control challenges. Clinical research shows that sensory modulation strategies can improve behavior and reduce the need for restraints and other harsh discipline methods.

http://www.traumacenter.org/products/pdf_files/Can%20the%20Body%20Change%20the%20Score_Sensory%20Modulation_SMART_Adolescent%20Residential%20Trauma%20Treatment_Warner.pdf

Sensory modulation strategies are especially affective for students with severe behavioral, mental health, trauma history, developmental, and/or sensory processing challenges.  Students are taught to identify when they begin experiencing environmental and body triggers to use their most affective sensory coping strategies http://www.sensoryconnectionprogram.com/what_helps_poster_activity.pdf

 

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If sensory modulation or behavioral interventions alone are not working, combining both strategies using picture reminders can be helpful.

Busy teachers may sometimes attend to disruptive and ignore appropriate behavior, and reversing this can make a huge difference. For some students, individual sessions with an occupational and/or mental health therapist are used to teach sensory modulation, while others learn sensory modulation strategies by therapists working with the teacher or leading groups. Sensory modulation strategies can include teaching students to do pushups for self calming when they’re hyper or going to a quiet area for a few minutes to calm down so they won’t misbehave and are able to learn. Therapists need to try various strategies with students to find what works best.  Sensory modulation strategies in schools may involve the use of a quiet area in the class room,

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a sensory coping room

 

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adaptive equipment

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or bulletin boards reminding students of class rules  and sensory coping strategies.  Working together therapists and teachers can use sensory modulation strategies to improve their students’ behavior and learning.

Reference:

Chalmers, A., Harrison, S., Mollison, K., Molloy, N., & Gray, K. (2012). Establishing sensory-based approaches in mental health inpatient care: a multidisciplinary approach. Australasian Psychiatry, 20(1), 35-39. www.rompa.com/media/free-resources/establishing_sensory-based_approaches_in_mental_health.pdf

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Self-Injury is a Bad Habit

A lot of occupational therapy referrals at my psychiatric hospital are for adolescents and young adults with mental health, trauma history, developmental, and/or sensory processing challenges who repeatedly injure themselves. Individuals with trauma history and developmental challenges have greater incidences of neurological, sensory processing, and self-injury challenges. Clients with these complex difficulties benefit from integrated intervention addressing their specific triggers, coping strategies, mindfulness activities, and sensory input needs to reduce self-injurious behavior.

Long-standing self-injurious behavior has often become a bad habit. Reducing this “bad habit” can be helped by first recognizing the triggers. Research shows that the brain (Striatum at the center of the subcortical basal ganglia) forms habits by chunking behavior into a single automatic memory package. However, through planning and mindfulness the brain (Neocortex) can interrupt or stop the habit. The habitual aspects of self-injurious behavior can be address by recognizing the triggers, then replacing the bad habit of self-injury with the good habit of coping strategies that include mindfulness and sensory activities.

Recognizing the environmental triggers (e.g., “being told no”) and body triggers (e.g., “crying”) that precede self-injurious behavior empowers clients.  Research shows many adolescents and adults report their motivational triggers for injuring themselves are to: “distract myself from negative thoughts and feelings, feel something when I feel numb, get social attention, and/or get out of unwanted social situations”. An understanding of their early motivational, environmental, and body triggers empowers people who self-injure to discover and use effective coping strategies.

A useful self-assessment I developed for clients with self-injurious behavior is the PaganoFABTriggerCopingForms copyClients choose the three environmental and body triggers that most often precede their self-injurious behavior. Their triggers can serve as early warning signs that they need to use coping strategies. On each of the coping strategies pages the client selects their 3 most effective coping strategies. Their selections remind clients of their most common triggers and effective coping strategies related to self-injury. When introducing the coping forms the therapist demonstrates any unfamiliar mindfulness and sensory coping strategies. behindthelabel.co.uk

It is helpful to review the trigger and coping strategies the client determines are most relevant to their self-injurious behaviors, building on their most effective coping strategies. The most helpful new coping strategies to try are usually physical activities, rather than strategies such as talking to a friend. Commonly effective new physical coping strategies for reducing self-injury include hobbies (e.g., art), mindfulness movement (e.g., opening their hand while breathing in, then closing their hands by breathing out), and sensory strategies (e.g., focusing on the bottom of their feet or palms of their hands).

FAB Basic Mindfulness Movement

For clients who appear to have sensory processing challenges, it is helpful to have them self-assess using the Sensory Profile http://www.sensoryprofile.com  For example, if a client has significantly different tactile sensitivity and self-cuts, using a vibrating bath brush may be useful as a sensory replacement for habitual self-cutting. It is important to be sure that brushing does not cause skin irritation and that clients never brush over open wounds. To interrupt the self-cutting habit the brush can be located where they most frequently engage in self-injury (such as their bedroom) to facilitate the use of self-brushing as replacing the habit of cutting with a less dysfunctional habit (brushing).

Finally, because self-injury may already be established as a habit, reinforcement is helpful (e.g., being given praise and a vibrating bath brush following two weeks of safe behavior). A helpful tool for clients with sensory modulation difficulties is rating their energy level and planning activities to keep a medium energy level and prevent self-harm using the Energy Modulation Wheel.

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A helpful tool for individuals with sensory and developmental challenges is using a laminated index card that reminds clients of their goal, hero, and coping strategies for preventing self-injurious behavior using a COPING CARD

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Reference: Gaybiel, A. M. & Smith, K. S. (2014). Good habits, bad habits. Scientific American, 310(6), 38-43. Nock, M. K., Prinstein, M. J., Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118(4), 816-827. http://dash.harvard.edu/bitstream/handle/1/4134406/Nock_FormFunction.pdf