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Sensory Attachment Intervention (SAI) Level 1. Complete package costings.

Sensory Processing, Regulation and attachment from a sensory perspective

An Explanation of Sensory Processing Difficulties Sensory Processing Difficulties are characterised by the inability to accurately process information coming to the brain from the senses. This results in inaccurate judgement of sensory information such as touch, sight, movement, balance, taste, smell and sound. • Our experience of ourselves and the world is unique and we can all experience ‘hiccups’ in our sensory processing. • A person can be under or responsive when processing information coming into the different sensory systems, and this can fluctuate across the day. • This becomes a problem when it is persistent and interferes with daily life and learning. • Three main areas of difficulty are: o Turning messages into behaviour that match the intensity and duration of sensory input (tuning in or out, over or under reacting, or regulation) o movement (planning or stabilising) difficulties (eg dyspraxia or postural problems) o sensing similarities and differences between sensations. Sensory Regulation Our unconscious autonomic nervous system is constantly making minor adjustments to enable our body to match the demands of the environment around us. Eg: when we stand up our heart rate increases and blood pressure rises so that we don’t feint. • Our autonomic nervous system is divided into o the sympathetic (fight or flight/ anxiety/survival response), designed to speed up our bodies ready to cope with a perceived threat o the parasympathic (feed and breed/relaxation response) designed to enable us to sleep, digest food and relax. Although we can influence our unconscious nervous system by our thoughts ( eg thinking about a worry can trigger an anxiety attack for some, or remembering a holiday can make you relax), it responds largely on an unconscious level to sensory input. • Our arousal or ‘alert state’ is governed by a balance between these two unconscious systems: if our sympathetic nervous system is triggered we become anxious or aggressive, if our parasympathetic nervous system is triggered we become lethargic. • If totally overloaded , our parasympathetic nervous system can be triggered and we completely ’shut down’ as a survival behaviour. • Ideally, we should spend most of our time with an even balance between the two. This balance is central to our emotional wellbeing and ability to learn (see Appendix II: Alert States). Emotional Regulation and Attachment Behaviours The sensory processing mechanisms, alarm system that triggers arousal levels, and emotional centres of the brain operate largely unconsciously, are closely linked, and influence each other greatly. • In infancy we develop attachment behaviours to draw caregivers to us so that our physical and emotional needs can be met. • Caregivers in turn respond to our signals for help and meet our needs through comforting and nurturing us primarily through touch, eye contact, movement and meeting our physical needs (hunger, thirst, sleep etc). • Our sensory systems develop through these caring activities (eg bathing, feeding and play) and our caregivers provide the right balance between calming and alerting sensory stimulation. • Through this we begin to develop our capability to regulate our sensory and emotional responses more independently and can separate from our caregivers for increasing lengths of time without undue distress. Trauma in infancy can disrupt this process and set the alarm system to mistakenly interpret sensory and emotional events as dangerous and threatening to our survival. • This can cause the child to over-respond emotionally (Reactive ‘Fight or Flight’) or shut down (Avoidant). These automatic survival behaviours can develop into patterns that interrupt the child’s ability to learn, play and relate to others. • Supporting the child to use sensory strategies to regulate their emotional state can be a useful tool in changing these patterns over time. • Learning to use regulating sensory strategies for themselves can help to change stress patterns and ‘reset’ their alarm system, helping them to feel calmer and ‘just right’ in themselves and begin to learn how to stay more emotionally regulated. • From this position, children are more able to understand their own feelings and then other peoples- this is key for relating to others, developing play skills and learning. • This approach: o Uses environmental enrichment to support the child in finding the sensory input they need to feel regulated in their immediate environment at school and home o Supports key caregivers and the child to link survival behaviours and sensory strategies that calm and organize, or feel ‘just right’. Sensory Attachment Children’s Books: available from Aldertree Press. o ‘The Scared Gang’ by Éadaoin Bhreathnach: http://www.sensoryattachmentintervention.com/scared%20gang.aspx For online information about sensory attachment interventions: o http://www.sensoryattachmentintervention.com/Documents/Just%20Right%20State%20Programme%20Executive%20Summary.pdf (with thanks to my very clever and brilliant colleague, Isabel Ball, for putting it so succinctly).

Other people who work at Therapy Space

My name is Jenny Hagel and I have worked with Children, Parents and Professional colleagues in a private practice for Holistic Therapy (PGL) in Oberursel, Germany for the last 4 years. I have now joined Linda at the Therapy Space bringing additional knowledge and expertise to this great working environment. image of Jenny My aim is to help bring smiles to faces through fun and enjoyable learning and by understanding where each child is in their development journey, recognising the next steps, and moving forward together. - AD(H)D - ASD DIR®/ FLoortime - Social training (building and holding positive relationships, finding a place in a group, bullying) - Behaviour training (Communication strategies,providing opportunities for conflict resolution) - Concentration training (at the table or in the movement room) - Handwriting and handedness (gross or fine motor skills, left or right handed) - Sensory Processing Disorder (vision, audition, tactile, proprioception, vestibular) - Self confidents and self-perception - Attachment Disorder - Teaching learning strategies ‘Psychomotricity is based on the holistic view of a balanced body and mind. It integrates the cognitive, emotional, symbolical and physical interactions in the individual´s capacity to be and to act in a psychosocial context ‘. Psychomotricity´s scientific references are medical, psychological and neuropsychological educational, as well as the social sciences. (More information: http://psychomot.org/documents-inventory/professional_competences_2012.pdf) ‘The DIR®/Floortime™ Model‘ Developmental, Individualised, Relationship-Based (DIR®) Approach (aka FloortimeTM) offers a developmental approach to intervention for children with special needs in partnership with their parents. DIR/Floortime is a way of relating to a child in which we recognise and respect the emotional experience and expressions of the child, shown in their actions, ideas, and intentions, and interact in a way that helps the child use their natural emotions with an even greater sense of purpose, building their capacity to engage and communicate, at increasingly complex levels of functional development. Education University Marburg Master of Arts in Motologie (MA Psychomotricity) University of Applied Sciences Darmstadt Bachelor of Arts Social Worker Contact: Jenny.Hagel@gmx.de Or 07725615804 Hourly therapy £50 (negotiable if child is very young) Membership: BVDM e.V.(http://www.motologie.net/)

Autism Services and Links

Therapy Space offers children with ASD assessments and sensory integration treatment. We are able to provide sensory diets for children to implement into their home and school day. The Just Right State is a course suitable for both children and parents to learn about sensory processing and attachment difficulties classic for children with ASD. links with other services are made regularly. see below for other people/services valuable to children/adults with ASD. Caroline Seyedi is a Freelance Autism Intervention Specialist & Parent Consultant in Bristol offers a variety of services to individuals, parents, carers and professionals. She uses a parent-participative, naturalistic, holistic and individualised approach which is non-intensive and focuses on parents and carers acquiring the skills and techniques to help establish long term gains for their child and create consistency across environments. Caroline has 15 years experience in researching and implementing interventions, treatments and therapies for autism; is trained to use PECS and Portage and experienced in using TEACCH, Makaton, Intensive Interaction and many other interventions. She is currently completing her research for a Masters degree in Autism Spectrum Disorders and training as a practitioner in Neuro-Linguist Programming (NLP). Caroline is a member of the following organisations: ACAMH (Association for Child & Adolescent Mental Health); NHS Foundation Trust; Mentor of the Institute of Enterprise and Entrepreneurs. Caroline Seyedi.SRSH.MIoEE.Dip.Ed.(Autism)

Eye-tracking exercises – reflex integration

Eye Tracking. Children with neurodiverse conditions such as ASD, ADHD, Dyspraxia, DCD often have problems with retention of reflexes (specifically the Asymmetric Tonic Neck Reflex) and find it hard to fix and track effeciently with their eyes. Hence a simple video to try with your kids. I find if parents or staff at school can do this at least 3 times a day there will be a marked improvement in eye tracking, crossing midline and bilateral integration skills. Please try it out. [youtube]http://www.youtube.com/watch?v=pTeVii_JjS8[/youtube] Many children improve quite quickly whereas others find this very challenging and avoid it at all costs. Find a toy of interest to watch (especially if autistic) and try. Fix and look at an object of interest for 5 seconds each in up, down, left and right directions Track a moving object of interest (about 30cms away from eyes) across the midline in both horizontal and vertical directions.(see video) Have fun and enjoy the exercise and if your child starts to blink and rub eyes take a break as probably overloading, return when have had a little rest.

Developmental Delay

Developmental Delay is a diagnosis often given to a child with overall learning difficulties and problems such as low tone, cognitive, sensory and physical delay. Often these children do not fit criteria to be seen in the NHS by OT teams however this does not mean that Occupational Therapy is not a really important therapy for them.In my experience these children can make some of the best progress. Therapy Space offers 1:1 consultations with parents related to children of any age with developmental delay. Often children with developmental delay miss essential milestones due to their physical, emotional and cognitive limitations so Therapy Space offers them the chance to progress through developmental stages which are vital for progress and learning. As Occupational Therapists we treat the child as a whole so we will work on developing head control, balance, rolling, crawling and general coordination. We also work on hand skills and development of play and cognition (thinking skills). We have experience and knowledge about all the relevant stages children should go through. It is vital to go through basic stages otherwise primitive and postural reflexes stay retained instead of being integrated which can affect coordination throughout the child's life. Sensory integration therapy is a fantastic way to encourage children to play and develop skills in a safe nurturing environment. Almost all children with developmental delay have sensory processing difficulties which is exactly what an occupational Therapist can help with. Services offered: Initial telephone consultation free of charge.(up to 30 minutes) Initial assessment to identify strengths and needs. Regular Therapist: Parent:child sessions where play is used to develop skills based on sensory integration intervention. Report writing optional. Conditions frequently seen: Developmental Delay, Downs Syndrome, Cerebral Palsy, genetic conditions, ASD, Dypraxia, DCD, SPD

Useful Equipment


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Therapy Balls Therapy Balls are really useful for balance and strengthening shoulders. They can be used for rolling over and doing push ups, also for being squished. To get the right measurement for your child measure from arm pit to wrist and this should be correct. Many children improve with their handwriting by playing on the balls.




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Weighted blankets Weighted blankets can be perfect for helping children sleep through the night, they provide extra deep pressure which is comforting and stimulates proprioception. Many children will use them as a comfort wrapped them when watching tv and relaxing. They can help calm an overanxious child. Some parents say it is the first good night's sleep they have had ever!!!(both child and parent)




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“Cosy weighted blanket” by Carol Stock Kranowitz Imagine the warmest coziest robe or towel you have ever felt, combined with the soothing hug of a loved one. This weighted blanket provides the input for a child who has poor sleep patterns and who crave and seek proprioception input.



 

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mov'n sit cushion These fidget cushions are fantastic for children who cannot sit still in class or assembly. They can use them sitting on a chair or the floor. It enables the child to move and satisfy their vestibular sense. Especially good for hyperactive children. Some parents have noted how long their active child sits during assessment when using one. Can also be used at home for mealtimes. Allowing the child to move frees up their ability to concentrate better otherwise they have to work hard at not fidgeting.




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Lycra resistance band Resistance bands can be a fantastic way to calm down. Tying them around table or desk legs to pull against while sitting and listening can help. Pulling (tug of war) type games can also be fun. Be careful not to let them spring back in your face though.




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sensory seekers combo kit Quick easy ready made sensory box to meet your child's oral and tactile needs. A brilliant resource to have in all households and classrooms will benefit sensory seeking children. Teachers may sometimes think this may be distracting but infact will have more focused alert pupils.




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looped scissors Easy to use looped scissors for children who find accuracy with normal scissors too difficult. Children achieve success and neatness with these. A must for those who struggle.




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looped scissors Great pencil grips for children who grip their pencils too hard and get sore hands from writing. These allow the child to place fingers in the correct position. Excellent.



Chew'lery from Special.direct.com Chew'lery is a great way to keep kids from chewing on their clothes, while letting them work through their chewing tendencies. It's also great for oral-motor stimulating activities. Use with adult supervision. Non-toxic, colourful, plastic jewellery that 'stretches'. Handwriting Without Tears. HWT.com Go onto this site for some useful downloads about handwriting and information for parents, teachers, therapists. An excellent resource.

organisation skills ideas

Therapy Space Handout. COPING STRATEGIES TO IMPROVE ORGANISATIONAL SKILLS  useful for all neurodiversity conditions FACT SHEET Timers - use an egg timer when working on a piece of homework, and set it every fifteen minutes to remind the child what this 'feels' like.  A timer in the shower or bathroom set for ten minutes will act as a reminder that their time is up. Digital watch - these are often easier to read than a traditional watch and can be set to alarm at certain times to remind the teenager to complete a certain activity. Buzzer key reminders - there are all sorts of reminder key rings and pens available that can remind you at certain times.  There is a pen with a rewinding tape and a key ring that can record about 15 seconds of tape.  They can be useful in just saying " remember the German book" for example, and can be played back at home to check the books back in to the bag to go back to school as well.   Laminated timetable - this can be put in the child's room to remind them to get out the appropriate clothes and sports kit for the following day.  Another copy can be on the inside of their school bag and a third one in their locker acting as a reminder at key points.  If you can get this before the child moves to the school this also acts to prepare them for the change. Key on a chain - losing your locker key is a problem when it happens more than once.  Putting in on a string around the child's neck may be dangerous.  Using a key ring on a plastic 'curly' chain means it is where he will need it.  If the trousers don't have a belt loop, sew a piece of tape inside a pocket for the key ring to be attached. Mentor or buddy - a new school day is very stressful.  A buddy that knows their way around can make all the difference.  They can take them from class to class.  They can also remind them to check their books into their bags at the end of the day and also help them to make sure they have the correct equipment for each class.  This can be a problem if the other children think that the child is having extra help all the time, and it does need to be handled sensitively to make sure the child doesn't n become bullied as a consequence.  An older child as a mentor, perhaps someone in the sixth form, can be very supportive.  The sixth former can talk to the class teacher if there are problems, whereas the child may be reluctant to do so, especially if they are new to the school.   Appropriate clothing - labelled, and in drawers that are labelled -at home make sure the child is well prepared for the day.  Drawers should be ordered and labelled in a way that makes it easier and logical to find clothes.  The child should be part of the process of organising this, as this will reinforce for him, where items are.   Pencil case - use a clear plastic pencil case where the objects can be seen from the outside.  A list of the contents can then be stapled on the inside, but facing the outside of the case.  At the end of the lesson all the items can be checked back into the case.  This reduces the chances of losing items.  The pencil case should contain the bare minimum to get through the school day (less to drop etc.).   Use a ruler with a ridge - or an architects metal ruler with a handle, as this will make it easier to place the ruler on the paper.  Place Dycem on the end of the ruler so it grips to the paper.   A selection of pens - and pencils with and without grips should be tried out to see what suits the child.  There are some pens with a rubber area to grip on to, that can be quite comfortable.  The child with ligamentous laxity may find that a gripper makes it harder not easier.   Make sure there is a spare set - of all equipment at home which stays there, so that the school pencil case can stay in the child's bag ready for the following day.   Use scissors - that are the appropriate size for the child and if they are left handed, get left handed scissors.  If the child cannot use scissors well, think about using artists cutters or dressmakers scissors (Peta roll cut scissors) which may be easier to manipulate or even battery operated scissors.   Have a homework diary/message book - that can be checked in and out with the timetable clearly written on the inside cover.  Have another book for difficult to spell words, tables etc.  Break tables down into small steps.   Money - buy a purse belt or round the neck travel wallet.   Keep work tidy - have plastic folders for work sheets.   Forgetting things - use post it notes or other visual cues.   Homework - have a phone number of a helpful friend for queries.  Agree level of help with school.  Use alternate lines if work will have many errors (white space improves presentation).  Allow 15 minutes to unwind after homework, before giving any instructions (e.g. drink, snack, bath, music or video).   Problem solving - use the 4 point plan - to encourage confidence to think through situations and problem solve independently. -          What is the problem/what am I supposed to do? -          What is my plan/how can I do it? -          Am I using my plan? -          How did I do? Problem solving with help - task analysis - when faced with a situation that cannot be worked through independently, following the task analysis format with another person.  This structures the external help and provides opportunities for independence. -          Name the task. -          Break down the task into small steps. -          Write down the steps onto cue cards. -          Read through the steps aloud. -          Practice the task using the cards as visual prompts. -          Talk through each step as you go. -          Any feedback?  What went well/could have been better? -          Use as form of checklist.   Temper outbursts - work on temper reducing activities, have a selection planned in advance e.g. -          Go swimming, play in the park, provide food, drink, cuddle, T.V. punch bag, drawing, music, time alone to cool down. -          A small favourite toy on string pinned to the inside of pocket can be reassuring and calming.  Count to ten. Traffic light codes -  Aim - -          To help with expression of views at the time of an incident.  Use of the traffic light code can enable him/her to instantly make his/her feelings known regarding a given situation. -          Red - I'm very cross -          Amber - I'm not happy -          Green - Everything is O.K.   Expressing him/her self appropriately - -          Emotional confrontation - use of the DESC script could help order his/her thoughts and feelings in certain situations. -          D - describe the problem -          E - explain why and include your emotions -          S - say what you want to happen -          C - give the consequence and conclusion -          (the script can be quickly rehearsed on the spot and the acronyms used as prompts).   Rewards - Have a system of rewards planned. -          Your attention -          A joint activity. -          Do not underestimate the value of a cuddle.   Communication - Speak in the positive -          "Hold the scissors by the closed blades", rather than "don't hold the scissors like that". -          Say what answer you would have liked to have heard e.g. "Yes Mum I'd love to clear the table". for further information and ideas call Linda Plowden OT 07814 633926    

Tactile sensory system

  THE TACTILE SYSTEM Definition: ¨       We get tactile information through sensory receptors located in the skin. ¨       The tactile system provides us with information about touch sensations: pressure, vibration, movement, temperature and pain. ¨       The tactile sense is made up of two components: the protective (or defensive) system and the discriminative system.   Why is the processing of tactile information important? ¨       The tactile sense or sense of touch is a huge sensory system that gives us information needed for visual perception, motor planning, body awareness, academic learning social skills and emotional security. ¨       The function of the protective / defensive system is to alert us to potentially harmful stimuli. We need it for survival. The receptors for this system are in the skin, particularly the hairy skin on the head and genitals. Light touch is the stimulus that causes the receptors to respond. ¨       The function of the discriminative system is to tell us what we are touching / where on our bodies it is touching us, and the properties of that touch, i.e. size, shape, texture, temperature and whether the touch is light or deep. The receptors for this system are found in the skin, especially of the hands and fingers, soles of the feet and the mouth and tongue. ¨       As an infant develops into childhood, the discriminative system suppresses the protective / defensive system, although not completely. Both systems work together to enable us to interpret tactile information throughout our lives. ¨       Tactile dysfunction is the inefficient processing in the central nervous system of the sensations perceived through the skin.   Functional Implications: Over-responsive to touch: Tactile Defensiveness  /Hypersensitivity: ¨       Child has a tendency to react negatively and emotionally to unexpected, light touch sensations ¨       May dislike having hair washed and brushed and nails cut ¨       May display hostility / or withdraw from situations requiring lots of tactile input: i.e. getting dressed, in the playground ¨       Overreaction to physically painful experiences: make a “big deal” about a minor scrape ¨       Fuss about clothing, such as stiff new clothes, shirt collars, elasticated waists, hats and scarves. May prefer short sleeves and shorts, even in winter to avoid the sensation of clothes rubbing on the skin / OR prefer long sleeves even in summer to avoid having skin exposed ¨       Avoidance of messy play activities i.e. finger painting, clay, sand and water play / fastidious about washing every bit of dirt from hands ¨       Excessive ticklishness / avoidance of kisses preferring hugs ¨       Seeks out deep pressure sensations which are easier to process and can be calming and organising Under-responsive to touch: Hyposensitivity: (i.e. The child who is not processing enough movement information) ¨       Craves extra stimulation and is constantly touching objects and people ¨       May show no reaction to pain from scrapes, bruises, cuts or injections ¨       May be unaware of messiness around the mouth / nose: may not notice a runny nose ¨       May hurt other children or pets during play, seemingly without remorse but actually not understanding the pain that others feel ¨       May drop things without realising

Poor tactile discrimination (i.e. The child’s brain does not register information about how things feel)

¨       Difficulties using tactile sense for complicated purposes like learning at school ¨       Child may be unable to identify which body parts have been touched without looking ¨       May be afraid of the dark ¨       May be a messy dresser i.e. twisted waistbands, shoes untied etc. ¨       May be a messy eater ¨       Difficulties with tool use: i.e. cutlery, scissors, pencils, paintbrush etc. ¨       May avoid initiating tactile experiences i.e. picking up tools / toys N.B Remember: your child may be both HYPERSENSITIVE and HYPOSENSITIVE, i.e. s/he may be extremely sensitive to light touch, moving away from a light tap on the shoulder, but indifferent to the deep pain of an injection. Strategies to Help Improve the processing of Tactile information: 1.     Where possible, avoid surprising your child with unexpected light touch sensations i.e. brushing past them, approaching from behind and touching them. 2.     At school, make sure that your child is not sitting at the end of a the desk next to the main walk way in the classroom, so as to reduce the likelihood of unexpected light touch. 3.     Provide opportunities for your child to experience deep pressure sensations as these help to suppress sensitivity to light touch sensations. Deep pressure can be provided by a bear hug, being rolled up and squashed in a duvet, through rough and tumble play, massage, press-ups etc. Any activity that provides pressure to the joints can be very calming and may help prepare your child for a difficult light touch activity, i.e. hair washing / tooth brushing. 4.     Use sheets on the bed that can be tucked in tightly to make your child feel secure. Some children feel safer sleeping on their beds in a sleeping bag 5.     Brushing with a surgical brush (ask your Occupational Therapist for advice on this technique) can help to reduce your child’s sensitivity.   Activities to reduce Tactile Defensiveness:
  • When directing a movement – use firm touch.  Firm pressure can help reduce tone, calm and organise a child’s movements.
  • Avoid light brushing or intermittent light touches.
  • Give verbal cues to prepare a child.
  • Sometimes activities that emphasise joint compression (e.g.. jumping, dangling, pushing, pulling, weight bearing) may help.  Heavy muscle work often reduces sensory defensiveness.
  • Use a variety of texture experiences on the skin.  Start dry and progress – wet materials, e.g. sand, rice, pasta, packaging foam.
  • Small toys hidden in a bucket full of paper / sawdust / material for the child to find.
  • Activities that involve all over body pressure; pretend the child is being painted with a paint roller or get him/her to roll him/herself up in a rug, sheet, etc.
  • Brushes and scourers (not too rough) are useful to have in and out of the bath e.g. nailbrushes, paint, scrubbing and cosmetic brushes.
  • Playdoh – for rolling, patting, poking and modelling.
  • Outdoor play – encourage swinging on a tyre or swing – try on tummy pushing with legs.
  • Play catch and throw with weighted materials, e.g. Beanbags, heavy padded balls.
  • Wet activities – body painting
  • hand lotion / shaving foam on mirror or tray.  Also include cleaning as part of activity
  • When completing puzzles and activities indoors try getting your child to work on their tummies with elbow support
  • Cooking / baking activities involving handling ingredients and experiencing different textures
  • Gardening activities: planting / watering seeds: handling soil etc.
  • Self care activities: Hand washing – Try using liquid soap and a nailbrush.
  • Bath times – Encourage use of different textured bath mitts to wash parts of body.  Afterwards, firmly rub down with a thick terry towel.
  • Encourage the child to rub hands and body with lotion.