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>
5 thoughts on “Sensory Strategies for Childhood Trauma”
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Can you explain this a little more: “Hypervigilent PTSD
Behavioral Response
SIB-Automatic negative
reinforcement” ?
I’m not sure how this is negative reinforcement. What kind of negative outcome is someone trying to avoid with SIB?
I’m curious because I work in acute inpatient psych and we see a good bit of this behavior and I would like to know more about how to help and there is certainly not much in the literature for it.
Good questions Cindy,
I didn’t explain this well. Research suggests that one reason adolescents engage in self-injurious behavior “SIB” is for automatic (sensory) negative reinforcement. I remember negative reinforcement by thinking of the annoying sound that goes off when you don’t fasten your seatbelt. Fastening your seatbelt goes up (is reinforced) because it makes that annoying sound (negative) stop. Adolescents told researchers when they are remembering great trauma, guilt, or other negative feelings they cut themselves because the pain distracts them, making the negative trauma memories, guilt or other feelings stop and get replaced by pain. What I as an OT am trying is giving them an alternative sensory strategy, like using a vibrating bath brush or getting massage on their arms, to serve as the replacement distractor instead of cutting. This seems to work best on children with sensory style differences, and I’m doing research on this question now. Regardless, I also reinforce (praise, give prizes) kids for using the massage and brushing to succeed in cutting themselves less, because they tell me brushing while it is better in that it doesn’t cause visible scars, is not as “effective” a distractor as cutting themselves, so I add reinforcement for not cutting.
Hypervigilent PTSD is when kids with PTSD trauma response are always looking around in class and can’t concentrate on their class work.
I appreciate your questions because as an occupational therapist who uses sensory integration in psychiatry and also use a lot of jargon, I sometimes am hard for mental health therapists, teachers, parents, and adolescents to understand and want to be clearer in my language. Thanks again, John
Thanks so much for your clarification on this! I was aware of negative reinforcement, but was having a hard time determining what someone with SIB would be avoiding.
I am also an OT and work in acute pediatric inpatient psych. We have had quite a few difficult cases of SIB in adolescents lately and it seems like not much is helpful since some of them keep coming back. We are somewhat limited in what we can provide for the kids and still keep them safe. We try to use sensory strategies and relaxation techniques combined, but as you stated, it is not as “effective” as cutting. One of our recent cases spoke of an endorphin rush that came along with the cutting behaviors and we are considering recommending other ways to get that…maybe coupling exercise with sensory strategies? Just a thought…The only things that have even helped a little bit so far are model magic, snapping a rubber band on the wrist, or squeezing ice.
I find exercise works real well, especially wheelbarrow walking and aerobics. A key of replacement is the reinforcers, my teens like to earn a vibrating bath brush for 10 days of reducing self-injurious behaviors. My children although they hurt themselves badly really dislike the ice and rubber band snapping and refuse to try it. What is model magic? As an OT you may want to try QST, although researched for Autism I’ve had a lot of success with it for kids with trauma histories and self-injurious behavior. It is a long process but really works over time. An example link is at my latest blog post JLP96007.wordpress.com The web site for traditional qst is Thanks for your e-mail, John
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Model Magic is like play-doh, but softer and will dry out and retain its shape after a few hours. Our teens like to use it as a manipulative or like a stress ball, but it is also neat because you can color on it and make things with it.
http://www.crayola.com/things-to-do/how-to-landing/model-magic.aspx
QST definitely seems interesting, but our kids are usually only in the hospital 3-5 days, though some of our more difficult SIB cases have stayed 30 days or more. We are starting an outpatient program and it could potentially be useful for that population. Thanks for the information!
I am enjoying reading your blog and your ideas are interesting, so please keep them coming!