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Using Sensory Strategies to Improve Behavior

Sensory strategies have a significant impact on the behavior of children and adolescents with developmental, mental health, Post Traumatic Stress Disorder and sensory processing challenges. Deep pressure touch provided by pediatric occupational therapists through massage, brushing, weighted blankets, mat sandwiches and other sensory strategies are described as extremely positive experiences for children and adolescents with developmental, mental health, Post Traumatic Stress Disorder and sensory processing challenges. Finding preferred activities is helpful because motivation can be a significant problem when treating these youngsters.

MatSandwichPropLayondog

A significant relationship was found between sensory and behavioral problems in children with developmental disorders. Research indicated that deep pressure sensory input functioned as positive reinforcement while matched sensory activities reduced repetitive non-purposeful behaviors in children with Autism Spectrum Disorder. Offering opportunities to use sensory strategies for self-regulation significantly reduced behavioral problems as well as the need for restraint and seclusion in adolescent and adult residential treatment centers for psychiatric and trauma challenges.

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The usefulness of offering clients deep pressure sensory strategies as an alternative to aggression and restraint makes sense, as it can replace the use of restraint as reinforcement for aggression with sensory activities to reinforce avoiding physical aggression. School occupational and physical therapists have begun using sensory activities as reinforcement for avoiding aggression to reduce student restraint and seclusion. SchoolOTRedAgg  The functioning of sensory strategies as positive reinforcement makes it important for therapists to avoid using sensory strategies immediately following aggressive or inappropriate behavior. Despite bitter conflicts between behaviorists, pediatricians and therapists clients would greatly benefit from their collaboration.

References

Canfield, J. M. (2008). Sensory dysfunction and problem behavior in children with autism spectrum and  other developmental disorders.

McGinnis, A. A., Blakely, E. Q., Harvey, A. C., & Rickards, J. B. (2013). The behavioral effects of a procedure used by pediatric occupational therapists. Behavioral Interventions, 28(1), 48-57.

O’Hagen, M., Divis, M., & Long, J. (2008). Best practice in the reduction and and elimination of seclusion and restraint; Seclusion: time for change. Aukland: Te Pou Te Whakaaro Nui: The National Center of Mental Health Research, Information and Workforce Development.

Rapp, J. T. (2006). Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: A preliminary investigation. Journal of Applied Behavioral Analysis, 39(1), 137-140.

Sutton, D., Wilson, M., Van Kessel, K., & Vanderpyl, J. (2013). Optimizing arousal to manage aggression: A pilot study of sensory modulation. International Journal of Mental Health Nursing, 22, 500-511.

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.

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Light touch and Holding Interventions

Light touch and holding strategies promote body awareness and social-emotional skills in children and adolescents with behavioral challenges. Deep pressure touch is a more common therapeutic intervention. However, light touch and holding are valuable therapeutic options for promoting attention, body awareness and social-emotional skills.

KONICA MINOLTA DIGITAL CAMERA

KONICA MINOLTA DIGITAL CAMERA

Body awareness, stress and somatic pain challenges negatively impact behavior in many children and adolescents with developmental, sensory processing, Post-Traumatic Stress Disorder, internalizing behavioral concerns and other psychiatric disorders.  Attention, body awareness, stress and somatic pain problems can be addressed through the use of light touch and holding strategies.  Light touch and holding strategies are particularly useful for improving and directing functional attention, and provide a valuable option for reducing stress, somatic pain, and social-emotional problems when deep pressure massage is contraindicated.  Particularly for young people experiencing acute pain, edema, taking analgesic medications (e.g., which can decrease pain perception) or taking antidepressant medications (e.g., which can cause light headedness and dizziness) light touch and holding are preferred.

Recent research indicates that positively perceived slow, light touch specifically activates CT afferent fibers connecting to the Insular Cortex that convey social-emotional interactions and our internal sense of self.  FAB Strategies utilizing light touch and holding include: Vibration to the Back, Arms, & Body as well as the Rolling the arm, Back X, Spine crawl, Head crown, and Foot input.  These light touch and holding techniques which are components of FAB Strategies will be described below.

It can be clinically useful to provide extremely irritable children and adolescents who have significant body awareness challenges repeated sensory experiences of the front, back, top and bottom of their bodies. FAB Strategies light touch and holding techniques were developed to provide sensory experiences of the front, back, top and bottom of the body as a foundation for improved body awareness and social-emotional skills.  In addition to the light touch and holding strategies the awareness of the front, back, top and bottom of the body is practiced through several FAB Strategies deep pressure touch and mindful movement activities.

Vibration to the Back, Arms, & Body provide light touch input.  Vibration can also be applied to various body parts with eyes open and closed, to increase body awareness by having clients identify each body part as it is touched (e.g., arm, left ankle).  Light touch can also be provided through the Rolling the arm strategy.  The therapist rolls the arm in a palm open, thumb lateral direction providing relaxation.

Trager and me Original

The Back X involves drawing an X across the back with your fist, while the Spine crawl involves moving up the spine to give awareness of the back. The Back X and Spine Crawl can be done as part of the X Marks the spot light touch game

XMarkstheSpot

The Head Crown involves 10 second holding on the head, first on both sides then on the front and back of the head.

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Foot input involves massage and holding of the feet to provide improved sensory awareness of the feet as the foundation and bottom of the body.  Foot input can be followed by stretching exercises to help decrease the likelihood of habitual toe walking.  Light touch and holding strategies are a valuable intervention to improve attention, body orientation and social-emotional skills through interpersonal touch.  Light touch and holding can also decrease stress, pain, and provide comfort when more intense massage is contraindicated.

References:

Beider, S., Mahrer, N. E., Gold, J. I. (2007). Pediatric massage therapy: An overview for clinicians. Pediatric Clinics of North America, 54(6), 1025-1041.

Bjornsdotter, M., Loken, L., Olausson, H.., Valbo, A., & Wessberg, J. (2009). Somatotopic organization of gentle touch processing in the posterior insular cortex. The Journal of Neuroscience, 29(29) 9314-9320.

Koester, C. (2012). Movement based learning for children of all abilities. Reno, NV: Movement Based Learning Inc.

McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective touch: Sensing and feeling. Neuron, 82(4), 737-755.

Perini, I., & Olausson, H. (2015). Seeking pleasant touch: Neural correlates of behavioral preferences for skin stroking. Frontiers in Behavioral Neuroscience, 9.

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Transdisciplinary School Strategies Enhance Inclusion

It is common for early education classes to include undiagnosed special needs students.  While the students often eventually qualify for special education services their teachers need strategies to meet the immediate needs of these students within the regular classroom.  This is important for both the special needs students and the ability of all the other students to learn.  Fortunately, transdisciplinary use of positive behavioral support strategies improve behavior and learning in regular and special education students in a variety of settings.

Teachers are becoming overwhelmed with the demands of increasing academic standards and students with developmental, behavioral, and mental health challenges.  Meanwhile, related services personnel are recognizing the importance of working in conjunction with classroom teachers to best serve students.  There has been much hostile criticism of related services staff by some early childhood faculty and organizations.  Despite this teachers, parents, and students have increasingly recognized the contribution of related services staff including occupational, speech/language, physical, and mental health therapists (social workers, school psychologists, guidance counselors). Teachers and related services staff have particularly found value in teaming together in implementing evidence-based positive behavioral support interventions.

ElemSchWalPush Wallpushups

Teachers and related services staff learn from working together to more effectively educate students using positive behavioral support interventions.  In my over thirty years working as a school occupational therapist with regular and special education students I have learned from teachers and other special services school staff many strategies to improve student learning and behavior.  Particularly using positive behavioral support strategies we have effectively integrated special and regular education students in activities to improve their behavior and learning.  My attached list of Evidence-BasedClassBehaviorStrategies has resulted from this collaboration.

References:

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.

Simonsen, B., Fairbanks, S., Briesch, A., Myers, D., & Sugai, G. (2008).  Evidence-based practices in classroom management: Considerations for research to practice.  Education and Treatment of Children, 31(3), 351-380.

Simonsen, B., Britton, L. & Young, D. (2010).  School-wide positive behavior support in an alternative school setting.  Journal of Positive Behavioral Intervention, 12(3), 180-191.

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Classroom Exercise Improves Transitions and Learning

As greater educational demands are made on students and teachers, often beginning in preschool or kindergarten, it is increasingly important to embed brief exercise strategies into the elementary school curriculum.  Movement activities done before transitions enable students to integrate their learning and behave more appropriately.  Increasing time spent in seated teaching and testing along with the integration of special needs students into regular classrooms makes the inclusion of movement strategies increasingly important.

Transition strategies include signals, music and exercise activities that integrate and improve learning while preparing students for new tasks.  Some children require extra time to process information, especially developmentally immature children and those with developmental challenges. While thought by some administrators to take away from learning, twenty minutes of added daily physical activities embedded into the classroom curriculum significantly improves behavior, attention, fitness as well as math and reading achievement compared to classes given equivalent time to seated learning tasks.

Several FAB Strategies can be implemented in under five minutes in regular classrooms to promote student’s behavior and learning.

ClassExercise

FAB classroom exercise strategies integrate mindfulness, stretching and movement activities Transition Strategies  Students are taught to move vigorously then transition back to academic learning.

MindfulClock2 MindfulClock1

Additional activities can be found for various grade levels at <www.pecentral.org>

References:

Donnelly, J. E. & Lambourne, K. (2011).  Classroom-based physical activity, cognition, and academic achievement.  Preventive Medicine, 52, S36-S42.

Erwin, H., Fedewa, A., & Ahn, S.(2012).  Student academic performance outcomes of a classroom physical activity intervention: A pilot study.  International Electronic Journal of Elementary Education, 4(3), 473-487.

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Movement Enhances Learning Behaviors

Appropriate behavior for learning is enhanced by engaging sensory activities that teach rule based inhibitory movement control.  Behavioral problems frequently involve inadequate inhibitory control of movement involving the arms (e.g., punching, slapping, scratching), legs (kicking) or mouth (e.g., spitting, biting, threatening, screaming, swearing).  Teachers can collaborate with occupational, physical, speech/language, and mental health therapists to enhance self-control using developmentally appropriate movement activities with children and adolescents who have behavioral, mental health, sensory processing, and/or developmental challenges. 

A major obstacle in teaching youngsters with behavioral challenges is motivating them to participate in challenging activities to enhance their development.  Children and adolescents find movement activities engaging and fun.  Involving students in brief developmentally appropriate movement brake activities enhances academic transitions, self-control and learning. Helpful activities include: playground tasks, parachute games, Simon says, red light, giant steps freeze dance, freeze shake, play plan, play review, obstacle courses, and movement to music (10 little hotdogs, Hokey-pokey, If your happy and you know it, Hot cross buns, We all need somebody to lean on).

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Additionally, basic yoga and mindfulness activities provide sensory movement that is useful as a pre-correction technique (e.g., activity used before problematic situations like school assemblies or lunch time).  Pre-school and elementary classes benefit from mindfulness and basic yoga tasks such as the: wall pressing, tensing then relaxing their muscles, mindful clock, body scan, feel your feet, feel your palms, stretching activities, and isometric exercises.

MindfulClock1MindfulClock2

Children with behavioral and sensory processing problems often show improved behavior following movement activities involving slow linear movement and deep pressure (e.g., pushups, wall pushups, desk pressing, rocking onto their hands on their stomachs over a therapy ball).  Helpful activities for students with behavioral and sensory processing challenges who are integrated into a regular education program include: setting the table, moving mats, moving tables, moving chairs, passing out books, and delivering notes or packages to teachers through out the school.

WallPushupProneTherapyballfar

Finally, special accommodations can sometimes be made for children who are academically bright but have difficulty maintaining a sustained seated position.  Sitting on therapy balls, sitting on disk-o-sit cushions, standing in a masking taped area, or using a sensory area in the back of the class where they can do there work without disturbing or being disturbed by others.  Rolling to read and rolling to math are useful activities for children who can’t remain seated but are capable of academically advanced work.  During resource room, occupational and speech/language therapy, and home work sessions they roll across the floor then read a chapter in a book or complete several math flash cards.  After completing the reading or math they are reinforced then roll again and do the next chapter or flash cards.

Particularly for preschool, kindergarten, and all students who have behavioral, psychiatric, developmental, sensory processing, and/or trauma history challenges it helps to include movement activities in the classroom.  Students are initially taught the cardinal rules for movement tasks: “Don’t touch any body or anything with out permission, and resume good learning after so we can do this activity tomorrow (if not we will skip this activity tomorrow then try it again the next day and I’m sure you will do much better”).  Teachers and principles understand that students benefit from movement engaging the bodily-kinesthetic, interpersonal, and musical intelligences.  While the teachers I work with and I am accused of “coddling students” and “wasting time” by using movement activities in the class room, no one can dispute our data showing this method results in increased academic goal achievement and decreased behavioral problems.

References:

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

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, 70-95.

Koester, C. (2012).  Movement based learning for children of all abilities.  Reno, NV: Movement Based Learning Inc.

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.

Warner, E., Koomar, J., Lary, B . & Cook, A. (2013).  Can the body change the score?  Application of sensory modulation principles in the treatment of traumatized adolescents in residential treatment settings.  Journal of Family Violence, 28(7), 729-738.

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Implementing Sensory Strategies in Preschools & Kindergartens

Many excellent discussions debate the best ways to responsibly integrate sensory strategies that help young children. While I don’t have a conclusive answer for this dilemma I have been struggling with this question all of my professional life. The attachments presented in this post describe my FAB Strategies for integrating environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation strategies in preschool and kindergarten classes.

My hope is to offer an approach for teachers and therapists in the schools to help children both who have and who have not yet been diagnosed with special needs and are having difficulty learning.  The FAB “Functionally Alert Behavior” Preschool & Kindergarten Strategies form can be used by teachers and therapists for children both with and without identified special needs.  It guides home programs, serves as a check list for teachers and therapists of strategies that help children with behavioral and developmental challenges learn, and can be used to guide goal-directed interdisciplinary interventions for children receiving special education services FABPre&KStrategies

I offer small two-day workshops for occupational, speech, physical, and mental health therapists that include direct practice for developing, implementing, and consulting with parents and teachers implementing FAB Strategies (see Schedule of FAB Strategies Workshops Page of this blog). I will be releasing an additional schedule of my 10 larger, one-day workshops in January and March 2014 for teachers, parents, and school therapists.

I have included for teachers, therapists, consultants, and researchers my recently published paper describing my research supported theory of FAB Strategies for preschoolers and kindergarteners.  I am currently conducting research regarding the relationship between children’s behavioral and sensory processing challenges.

FAB STRATEGIES Preschools & K