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FAB Strategies Mindfulness Movement Activities

I wanted to share this video of my FAB Strategies Mindfulness Movement activities to improve student’s behavior  https://www.facebook.com/educationresourcesinc/videos/943257499082558/ It was recorded by ERI at their Therapy in the Schools Conference.  Mindfulness movement activities are simple to do and can improve attention as well as enhance behavior by reducing student’s anxiety and giving them a break from seated work.

Mindfulness movement activities help all students yet are especially helpful for students with developmental disabilities, anxiety, sensory processing challenges, Post Traumatic Stress Disorder, ADHD, and/or other behavioral challenges.  Brief five minute mindfulness movement activities can help students attend better and promote the processing of academic learning when done between academic subjects (e.g., after math before proceeding to language arts).  Mindfulness movement activities can also be done in conjunction with teaching Positive Behavioral Support Interventions and used as a pre-correction before challenging school activities (e.g., lunch, playground, assemblies, and transitions).

In this video I demonstrate Touching the head-shoulders-stomach for sensory body awareness, Belly breathing, Hand opening and stretching to prevent hand cramping from writing (while breathing in) followed by thumb fisting as a mudra for relaxation (while breathing out)

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Bird breathing, and Mindful Clock Sitting (righting reactions moving forward-back and laterally).

Mindful clock standing activities can also be used, particularly to help students with sensory irritability gain basic body awareness of the anterior-posterior portions of their body through forward-back balancing movements  

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as well as sensory awareness and stability of the bottom (feet) and top (head) of their body through squatting then moving on their toes.

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I hope more early childhood and special education teachers as well as occupational, physical, speech/language and mental health therapists will begin using basic sensory mindfulness movement activities with their students.  Mindfulness movement activities offer a great opportunity for teachers and therapists to integrate and co-teach the academic and developmental curriculum areas.  As we continue to integrate the regular and special education curriculums, mindfulness movement activities can benefit students while promoting transdisciplinary interactions between teachers and therapists.

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Role of school OT’s, PT’s, SLP’s in Behavior Intervention

School Occupational, Physical and Speech Therapists play a significant role in improving student behavior. While traditionally viewed exclusively as the role of school social workers, psychologists, and behaviorists the complex problems of students with interrelated behavioral and developmental challenges can be helped by the contribution of school therapists.  The relationship between behavioral problems, the occupation of students, communication/language abilities, and gross motor skills supports the role of school occupational, speech/language and physical therapists as members of school teams helping students with behavioral and developmental challenges.

By teaming with occupational, speech/language and physical therapists, teachers and school mental health specialists can enhance their school positive behavioral support programs with expanded use of visual supports, mindfulness, music, exercise, and sensory-motor activities (Patten et al., 2013; Schaaf et al., 2014).  There is emerging evidence that cardiovascular and resistance exercise enhances body awareness, attention, as well as functional strength and endurance for improved participation in school learning tasks http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208137/pdf/nihms297861.pdf

School therapists can utilize evidence based mindfulness strategies as movement breaks that improve attention, and integrate behavioral strategies into their school therapy to enhance student’s school behavior.  Behavior for Therapists Slides The picture below describes the FAB Strategies adaptation of the PATHS PBS Turtle Technique to help students with special needs learn to calm down and avoid aggression.

FABModifiedTurtleTech

The AOTA supports the role of school occupational therapy in helping to improve student’s behavior (Cahill & Pagano, 2015).  The following Occupational Therapy article describes clinical school occupational therapy strategies that can be used to reduce student aggression  (Click on highlighted, then double click on lower heading) SchoolOTRedAgg

References

Cahill, S. M. & Pagano, J. L. (2015). Reducing restraint and seclusion: The benefit and role of occupational therapy. AOTA School Mental Health Toolkit. http://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Reducing-Restraint-and-Seclusion.pdf

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(1), 70-95. http://skolenforoverskud.dk/Artikler%20-%20mindfulness/Flook-Effects-of-Mindful-Awareness-Practices-on-Executive-Function-1.pdf

Kazdin, A. E. (2008). The Kazdin Method for parenting the Defiant Child. NY, NY: Mariner Books.

Laugeson, E. A. (2014). The PEERS curriculum for school-based professionals: Social skills training for adolescents with autism spectrum disorder. Routledge.

Mahammadzaheri, F., Koegel, L. K., Rezaee, M., Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavioral analysis (ABA) intervention for children with autism. Journal of autism and developmental disorders, 44(11), 2769-2777.

Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., … & Sendecki, J. (2014). An intervention for sensory difficulties in children with Autism: A randomized trial. Journal of autism and developmental disorders, 44(7), 1493-1506.

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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PRT Treatment in SLP, OT, & PT

PRT (Pivotal Response Treatment) is an important frame of reference for Speech/Language Pathologists, Occupational Therapists and Physical Therapists. PRT uses applied behavioral analysis principles as well as child choice, reinforcing attempts, varying activities, alternating familiar with challenging activities, and direct natural reinforcers. PRT’s transdisciplinary family-centered approach makes it particularly appropriate for allied health therapists.

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PRT shows significantly greater effectiveness for treating Autism Spectrum Disorder than traditional ABA  https://www.autismspeaks.org/sites/default/files/docs/koegel_prt_rancomized_controlled_trial_of_prt.pdf and facilitates neuroplasticity in young children with Autism Spectrum Disorders PRT NeurogenisisArt.  In addition to its usefulness for addressing language and behavioral challenges related to Autism Spectrum Disorders, PRT is a clinically relevant intervention for addressing other developmental and psychiatric challenges (e..g., fragile x syndrome, cognitive deficits, developmental trauma disorder, oppositional defiant disorder, depression, anxiety). Treatment is done with the family across disciplines in the child’s natural environment, so gains in language and motor skills are generalized to improve functioning.

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PRT strategies can be integrated with language, sensory and movement strategies as a component of occupational, speech and physical therapy interventions SensoryBehavior  I have found PRT is a particularly valuable treatment frame of reference for Speech/Language, Occupational and Physical Therapists.

References

Amaral, D. G., Schumann, C. M., & Nordahl, C. W. (2008). Neuroanatomy of Autism. Trends in Neuroscience, 31(3), 137-145.

Voos, A. C., Pelphrey, K. A., Tirrell, J., Bolling, D. Z., Wyk, B. V., Kaiser, M. D., McPartland, J. C., Volkmar, F. R. (2012). Neural mechanisms of improvements in social motivation after pivotal response treatement: Two case studies. Journal of Autism Dev Disord, 43(1), 1683-1689.

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FAB Rainbow Goal Strategy

The FAB Rainbow goal strategy is useful for developing goals and reinforcers that motivate students, while involving staff in supporting the goal and its achievement.  Like the FAB Coping card strategy, the rainbow goal allows clients to visually plan and review their behavioral goals and reinforcement schedule. The student begins by drawing a star at the top of the rainbow representing what they would choose if they could earn anything in the world.  It is presented as the positive opposite of what they say they want to avoid (e.g., being kicked out of their home or school).

Next, the student draws five separately colored rainbows beneath the star describing the steps needed to achieve their goal.  The five rainbows are the specific steps they need to take to achieve their goal, described positively as what they need to do rather than what they need to avoid doing.  The final rainbow is what they need to do immediately upon returning to class, and is linked to a sticker chart and tangible reinforcer.

The rainbow goal pictured below was done by a sixth grader with Pervasive Developmental Disorder and Oppositional Defiant Disorder, who hit classmates approximately every ten minutes.  He was initially unable to identify any goals for the future or prizes he wanted. The student reported that his goal was to stay at home, rather than again being sent to a group home or juvenile detention facility.  Using the FAB Rainbow Goal Strategy the therapist guided him in visually representating his goal and the steps for achieving it.

His sequential rainbow steps were organized into positive opposites of his current behaviors: “I can talk to Mom when upset (stop hitting Mom), Stay in control (not hit peers), and Do what Mom asks” (not misbehave).  His final rainbow step was that he would now go back and “Today work hard in school”.  The therapist also learned from his mother that the most effective way to increase his behaviors was to give him items related to toy cars.

Rainbow Goal Strategy

After observing the student and collecting data the student’s greatest current problem was found to be hitting other students, so the positive opposite of keeping safe hands was used to behaviorally describe his current goal: “Today work hard in school”. Since the student was found to hit others on average once every ten minutes the reinforcement schedule was developed that 15 minutes of safe hands (not hitting peers) earned one car sticker.

The student’s rainbow goal picture was laminated to his desk, and he received one car sticker whenever he kept safe hands for fifteen minutes.  If he hit another student before10 minutes the teacher pointed to his rainbow goal and explained she still liked him but could not award him a sticker yet because he was not showing his goal of working hard in class by keeping safe hands for fifteen minutes.  At the end of the day he would cash in all his car stickers for a reward. One sticker earned a racing car card and stick of gum, while six stickers bought a toy race car and an hour with an adult who would help him assemble it.

The FAB Rainbow Goal Strategy is useful for motivating students, staff and families to set a behavioral goal, action plan for achieving it, and follow a reinforcement schedule.  It promotes goal directed positive behaviors such as safe hands, which research shows can decrease the development of long term aggressive behavior.  The FAB Rainbow Goal Strategy empowers students, teachers, therapists and families to develop and visually represent behavioral goals, so they are motivated to achieve them.  It is helpful to pair the students most immediate goal with an observeable behavior and tangible reinforcer.

References:

Kazdin, A. E. (2008).  The Kazdin Method for parenting the Defiant Child.  NY, NY: Mariner Books. http://childconductclinic.yale.edu/

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

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FAB Turtle Teaches Self-Control

The FAB Turtle Technique is a practical evidence-based method of teaching self-control to pre-school and kindergarten students. The turtle technique is a component of the PATHS positive behavioral support program using classroom routines, rewards, stories, puppets, crafts, and activities. The turtle technique is based on Tucker Turtle, who learns to control his aggression when he feels angry so he doesn’t upset his friends. Preschool and kindergarten teachers around the world use this technique to promote self-control, with free resources available at http://www.challengingbehavior.org/do/resources/teaching_tools/ttyc_toc.htm#turtle .

In addition to its usefulness with typical preschool and kindergarten students, the turtle technique can be modified to teach self-control to pre-school through fifth grade students with special needs (e.g., emotional, trauma history, developmental, and/or sensory processing challenges). Free resources for students with special needs are offered using the FAB Turtle Strategy.

FAB Turtle Technique

The FAB turtle strategy modifies the turtle technique as: 1) Stop immediately after noticing your environmental and body triggers 2) Go to the classroom sensory calming area 3) Do your individualized coping strategies in the sensory calming area 4) When you are sure you will not act aggressively return to your seat 5) Later the teacher will guide you in problem solving and reward you for doing the turtle strategy to avoid aggression.

The FAB turtle strategy modifies the turtle technique going into your shell by putting your shirt over your head when angry to going to the sensory calming area (e.g., designated area in the back of the classroom that other students can not enter). The turtle technique 3 deep breaths to calm down are substituted with the student’s individualized coping strategy (e.g., pushups, mindfulness activities). Emphasis is placed on the student not leaving the sensory calming area until they are certain they won’t act aggressively, and delaying as long as necessary before problem solving as students with special needs may need longer periods of time to calm down. While the student might need to be reminded of the initial conflict, this additional time provides the calmness needed for problem solving.

The FAB turtle strategy individualizes the turtle technique for students with special needs by building on the original turtle technique curriculum and resources.

TurtleTriggers&CopingTurtleCoping

TurtleRewardSafeTuckerCalmNecklaceTuckerSupportPeople

TurtlePuppetPATHS Conference 2014

The FAB turtle strategy can be used to individualize the turtle technique for children with special needs in inclusive classrooms. Teachers can also begin by using the FAB turtle strategy for students with special needs, then transition them to the turtle technique and other positive behavioral support strategies.

References:
Domitrovich, C. E., Cortes, R. C., & Greenberg, M. T. (2007). Improving young children’s social and emotional competence: A randomized trial of the preschool “PATHS” curriculum. The Journal of Primary Prevention, 28(2), 67-91.
Pagano, J. L. (2005). Functionally approached body strategies for young children who have behavioral and sensory processing challenges. Available online at http://www.eric.ed.gov search by ERIC # ED490718 http://eric.ed.gov/?q=John+Pagano+2005&id=ED490718
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.

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Classroom Sensory Integration Equipment

This post describes the FAB Procedure for using sensory integration informed adaptive equipment and techniques in the classroom to improve behavior and learning.  Strategies are individualized for regular and special education students with behavioral, developmental, and sensory processing challenges.  The procedure is described sequentially, followed by an example provided in italics.

  1. Choose one goal involving adaptive equipment or techniques to improve the student’s behavior, learning and future.  Collect base line data regarding the frequency of this behavior. 

Sam is an intelligent kindergartener who can not stay seated more than five minutes in December.  He needs to stay seated for fifteen minutes next year to succeed in first grade.  His goal is: Sam will maintain seated attention for fifteen consecutive minutes. 

2. Consider the student’s need for sensory input using the Sensory Profile, an activity analysis, and the FAB Trigger & Coping Forms.

Sam’s scores on the Short Sensory Profile showed definite difference in Underresponsive/Seeks Sensation and Tactile Sensitivity.  Sam’s most effective coping strategies on the FAB Trigger & Coping Forms included theraband exercises.  His activity analysis found Sam kicked his legs and wrapped his feet around the desk while seated.   

  1. Select adaptive equipment or techniques to help achieve the student’s goal.

ChairlegsTherabandTheraband chairarm rotation

Sam was found to enjoy and sit longer given theraband (an exercise band) tied around the legs of his chair.  This allowed Sam to move and provide himself with deep pressure input through his legs while seated.

     4. After getting parent permission, introduce adaptive equipment as well as the rules and expectations for continued use.

Parental permission was obtained and the adaptation was introduced. Sam was told he could use the theraband on his chair if it helped him pay attention while seated as long as he did not untie it or disturb others.  

     5. Reward and monitor progress toward the student’s goal, and modify the plan as needed.

Sam was rewarded with a sticker he could cash in for a prize whenever he sat and paid attention for over fifteen minutes.  Progress was recorded showing increased seated attention, so use of  the adaptation was continued.

The FAB procedure guides the use of sensory processing adaptive equipment and techniques in school, assuring that any adaptations used assist with goal achievement.

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

Stahmer, A., Suhrheinrich, J., Reed, S., Schreibman, L., Bolduc, C. (2011).  Classroom Pivotal Response Teaching for children with Autism.  New York, NY: Guilford Press.