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Sensory Strategies Improve Learning

Classroom environmental adaptations can enhance behavior and learning.  However, effectively using adaptive equipment and techniques involves more than handing out adaptive equipment.  To improve learning and avoid causing additional classroom management problems it is important to specifically consider how sensory strategies can improve an individual student’s behavior for enhanced learning.SensoryRoom

Sensory Integration and Positive Behavioral Support strategies can be combined to develop effective coping strategies.  The first step is to choose one specific goal involving adaptive equipment and techniques that improves the student’s behavior, learning and future.  Select a goal that is most important for improving behavior and is attainable within six months.  The goal is worded positively and is incompatible with the inappropriate behavior that interferes with learning.

For students who have multiple needs research suggests prioritizing goals that can reduce future school aggression such as: safe hands (no hitting), polite voice (no yelling), as well as increased attention and seated attention.  After the goal is chosen collect base line data on how often the desired behavior occurs.  Use the base line data to refine the goal before choosing adaptive equipment.

Next consideration is given to the student’s specific need for sensory input.  The Sensory Profile and an activity analysis are useful tools for finding effective adaptive equipment and techniques.  The Sensory Profile is a reliable, valid assessment that identifies significantly different sensory behaviors.  If a student’s scores show a definite difference in Sensory Seeking/Low Registration (e.g. a significant difference found in only 2 out of 100 students their age) this provides clues about the sensory input needed.  Sensory processing disorders are complicated, and each student’s individual sensory needs must be addressed.

Next an activity analysis is done to explore the sensory input the student may be getting through the inappropriate behavior, sensory strategies that have helped him in the past, and his favorite activities.  Begin the activity analysis by considering the sensory input the student receives from the problematic behavior (e.g. wiggling his fingers in front of his eyes so frequently that it interferes with learning).  Determine if he is doing this for attention, sensory input, or both.  If he is doing the behavior for sensory input, go where no one will see you and imitate the student’s behavior to determine the sensory input it provides (e.g., finger movement, visual stimulation, or both).

Further assessment for developing coping strategies can be gathered using the FABTriggerCopingForms filled out by the student or parent, who choose on each page the three most frequent situations and body reactions that precede the inappropriate behavior and the most helpful coping strategies for avoiding inappropriate behavior.  This provides greater information regarding the role served by the behavior and possible alternative activities that provide the needed input. INSERT  Choose the adaptive equipment or techniques that will help achieve the student’s goal using information from the SensoryProfile, activity analysis, and FAB Trigger & Coping forms.

 

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Once adaptive equipment or techniques are chosen introduce them in a way that maximizes success.  Given current school inclusion practices many classrooms include students with diverse developmental levels.  It is helpful for teachers and therapists to initially explain to the class that they have different needs and abilities, and will be treated fairly but not equally.  Students will be given different rules, equipment and expectations based on their individual needs.  Adaptive equipment is then tried with individual students “for the day as an experiment that will be continued only if used appropriately to help reach their goal”

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Specifying rules for continued use of adaptive equipment or techniques before introducing them avoids potential problems.  Many teachers forbid adaptive strategies because they interfere with classroom management (e.g., forbid gum chewing because gum is stuck on seats; don’t allow fidget toys because students throw or make loud noises with them).  Setting clear limits that adaptive equipment will no longer be used if students break the rules or don’t progress toward their goal make teachers and parents more willing to try them.

It is also important and challenging to be sure parents/guardians approve of adaptive equipment before it is used.  The best way to do this is by discussing it at a parent conference.  When this is not possible write a note describing the goal and reason for the adaptations.  Then ask the parent to sign permission for the goal and specific adaptive equipment to be tried on the bottom of the form.

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Finally, additional reinforcement with a sticker chart or other reward is given to the student for making progress towards their goal.  By keeping track of goal progress from the base line, it is easy to show that the plan is working or modify it if it is ineffective.  While this process of combining sensory and behavioral strategies is criticized because it does not show whether the plan worked for sensory or behavioral reasons, it affectively improves student behavior and learning.

References:

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

Seifert, K. (2011).  CARE-2 Assessment: Chronic Violent Behavior and Treatment Needs.  Boston, MA: Acanthus Publishing.  www.drkathyseifert.com

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Behavioral & Occupational Therapists Working Together

Combining sensory processing and behavioral strategies is useful for students with complex behavior, developmental and sensory processing challenges.  Integrating sensory processing and behavioral strategies is underutilized because of the theoretical rigidity of many behavioral and occupational therapists.  However, I was lucky enough to work with a behavioral therapist who respected occupational therapists, and by working together we helped improve student behavior more easily than either of us could have working alone.   

An effective strategy for helping students who engage in repetitive behavior that interferes with their functioning or is self-injurious is the FAB Sensory Match Strategy.  The FAB Sensory Match Strategy combines offering specific sensory input and reinforcement for decreasing the repetitive behavior. The specific sensory input is developed by first considering the sensory function provided by the repetitive behavior.  If a child repeatedly bangs his hand on a desk, I go where no one will see me and do the behavior myself, considering the sensory input it provides.  Sensory processing knowledge helps in finding activities that will meet the child’s sensory needs so they don’t have to continue engaging in repetitive self-injurious behavior.

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Considering the child’s class setting, favorite activities, developmental level, and Sensory Profile I find several activities the student enjoys that provide the sensory input he’s seeking in a more appropriate way (e.g., hand drumming, pounding playdoh). Finally, the behavioral therapist helps me determine how often the child bangs his hand on the desk and the most effective reinforcement strategies.

The child is then offered the sensory activities to do whenever he chooses and is reinforced for going progressively longer periods with out banging his hand on the desk.  Behavioral therapists are trained in gathering and analyzing data to find the best reinforcement and the schedule for using it.  Occupational therapists are taught to use the Sensory Profile and a task analysis to find appropriate activities that provide the sensory input the child is getting from the repetitive behavior.  The behavioral therapist and I would assess the data on the child’s progress to determine if the reinforcement, schedule for providing it, or sensory activities needed to be adjusted.  By combining their forces behavioral and occupational therapists can integrate behavioral and sensory processing strategies to improve student’s behavior and learning.

 References:

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

  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.

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Individualizing Coping Strategies to Improve Behavior

The use of coping strategies is an evidence-based intervention that improves behavior.  It is commonly used in school positive behavioral support programs and mental health interventions to improve functional skills.  Coping strategies enable individuals to manage their strong feelings of sadness, anger, or anxiety with out violence or other functional difficulties.  Coping strategies are a proven component of school Positive Behavioral Support programs (Second Step, PATHS, DECA), Dialectic Behavior Therapy (DBT) and CBT (Cognitive Behavior Therapy).

Learning to use coping strategies to manage depression, anxiety, and aggression can be particularly challenging for individuals with behavioral, mental health, developmental, trauma history, and/or sensory processing challenges.   Learning to consistently implement coping strategies is a long process that can be facilitated by teachers, family members, as well as occupational, speech/language, physical, and mental health therapists.  It is important when evaluating coping strategies with clients to assess their efficacy in facilitating short-term and long-term frustration tolerance and functioning.  For example, some client attempts to cope with strong feelings provide short-term relief (e.g., self-injurious behaviors, risky sex, drug and alcohol abuse) but worsen long-term coping and functioning.  It is often necessary to exert considerable effort to help clients find the best fit of coping strategies to improve their functioning across settings.

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Careful consideration of client’s interests, developmental level, sensory processing, as well as success and challenges in implementing coping strategies is a good place to start.  Coping strategies involving physical movement are usually most successful when teaching new coping strategies to clients.  Inclusion of physical exercise, music, sensory equipment and adaptive techniques, mindfulness strategies, yoga, and touch strategies can be particularly helpful for individuals with special needs.

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A helpful tool is having clients select 3 items from each page of triggers and coping strategies on the FABTriggerCopingForms

An understanding of the client’s unique environmental triggers (situations such as “being told no”) and body triggers (e.g., “breathing fast; crying”) that precede disabling anxiety or aggression are helpful in teaching coping strategies.  When evaluating the effectiveness of coping strategies those that show the greatest effectiveness with slight environmental and body triggers can be expanded on.  Repeatedly practice and reinforce clients for successfully using coping strategies in controlled settings, while gradually increasing their stress levels.  Once strong feelings can be consistently managed with coping strategies in controlled settings, begin practicing and reinforcing them in supported naturalistic settings.  While coping strategies are difficult to learn they are worth the effort, as they are extremely helpful in increasing client’s functioning.

References:

Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007).  Dialectical behavior therapy with suicidal adolescents.  NY, NY: The Guilford Press.

Kovacs, M. & Lopez-Duran, N. (2012).  Contextual emotion regulation therapy: A developmentally-based intervention for pediatric depression.  Child and adolescent psychiatric clinics of North America, 21(2), 327.

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Strategies to Improve Body Awareness & Mental Health

Intervention strategies promoting body awareness can improve behavior in children and adolescents with sensory processing, trauma history, developmental, and mental health challenges.  Improving youngster’s body awareness is particularly important for children and adolescents because it impacts development and provides the foundation for functional motor planning skills.  Many children with internalizing behavioral challenges including depression and repeated complaints of pain can be helped through enhancing their body and emotional awareness skills.

Although body and emotional awareness difficulties are commonly described in children and adolescents with trauma histories and psychiatric disorders, limited attention is given to body scheme and emotional awareness by mental health therapists. The sensory integration, massage, mindfulness, and yoga frames of reference offer effective body awareness assessment and intervention strategies. FAB Sensory Modulation Strategies that promote body awareness include: Touch vibration on the Back and Arms, FAB Pressure Touch, arm traction, Back X, Spine crawl, Wall pushups, Nose breathe, Mindful clock, Bird, Tense & relax, Focus on feet, Focus on palms, and the Body scan.

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Light touch to reduce somatic pain and improve body awareness can be provided using the FAB Back X and Spine crawl strategies in the BackX & SpineCrawlGame

 References:

Beider, S., & Moyer, C. (2007).  Randomized controlled trials of pediatric massage: A review.  Evidence-based Complementary and Alternative Medicine, 4(1), 23-34.

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.

Intervention strategies promoting body awareness can improve behavior in children and adolescents with sensory processing, trauma history, developmental, and mental health challenges.  Improving youngster’s body awareness is particularly important for children and adolescents because it impacts development and provides the foundation for functional motor planning skills.  Many children with internalizing behavioral challenges including depression and repeated complaints of pain can be helped through enhancing their body and emotional awareness skills.

Although body and emotional awareness difficulties are commonly described in children and adolescents with trauma histories and psychiatric disorders, limited attention is given to body scheme and emotional awareness by mental health therapists. The sensory integration, massage, mindfulness, and yoga frames of reference offer effective body awareness assessment and intervention strategies. FAB Sensory Modulation Strategies that promote body awareness include: Touch vibration on the Back and Arms, FAB Pressure Touch, Back X, Spine crawl, Wall pushups, Nose breathe, Mindful clock, Bird, Tense & relax, Focus on feet, Focus on palms, and the Body scan.  Light touch to reduce somatic pain and improve body awareness can be provided using the FAB Back X and Spine crawl strategies in the Back X & Spine Crawl Game.

 

References:

Beider, S., & Moyer, C. (2007).  Randomized controlled trials of pediatric massage: A review.  Evidence-based Complementary and Alternative Medicine, 4(1), 23-34.

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.

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Possible implications of New DSM-5 PDD Diagnosis for OT, PT, and ST

Given the DSM-5 diagnosis of Autism Spectrum Disorder “ASD” as a single diagnosis with differing degrees of severity and a subcategory of restricted repetitive behaviors occupational, speech-language, and physical therapists are uniquely qualified to offer important diagnostic input. ASD is categorized as Level 1 requiring support, Level 2 requiring substantial support, and Level 3 requiring very substantial support. Particularly given their respective expertise regarding functional sensory activities, speech/communication, and movement development occupational, physical, and speech therapist assessments can uniquely inform the diagnosis of PDD.

Occupational, physical, and speech/language therapists offer unique expertise in the areas of functional sensory, speech, and motor development. Their expertise regarding functional sensory, speech/communication, and movement development can enhance comprehensive intervention plans to enhance social skills as well as address repetitive behaviors. For example occupational therapy expertise regarding the development of functional sensory skills can enhance the abilities of children with PDD to learn to play catch, brush their teeth, and engage in many functional sensory tasks that normalize social development in a family context. Occupational, speech-language, and physical therapists are potentially valuable allies for pediatricians, psychiatrists, and mental health therapists in the assessment, treatment, and research of individuals with Pervasive Developmental Disorders.

References
Dunn, W. (2007). Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants & Young Children, 20(2), 84-101.
Silva, L.M. Schalock, M., Gabrielsen, C. (2011). Early intervention for Autism with a parent-delivered qigong massage program: A randomized controlled trial. American Journal of Occupational Therapy, 65(5), 550-559.
Whitney, R.V. & Miller-Kuhaneck, H. (2012). Diagnostic Statistical Manual 5 changes to the autism spectrum criteria: A critical moment for occupational Therapists. The Open Journal of Occupational Therapy, 1(1), article 7.