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difficulties

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).

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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Price: £199.99
“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.





 


List Price: £23.99
Price: £18.46

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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Price: £29.99

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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Price: £59.99

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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Price: £12.37

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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Price: £1.05

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.

Vestibular sensory system

THE VESTIBULAR SYSTEM

Definition:

¨       The vestibular system is the most sensitive and one of the most important sense organs. It is stimulated by movement of fluid in the structures of the inner ear, in response to movement by the head.

¨       The vestibular system provides us with information about where our body is in space and whether the movement is up, down, fast, slow or angular.

¨       Even when our eyes are closed we know the position of our head. The vestibular system also allows us to keep our balance with our eyes closed.

 

Why is the processing of vestibular information important?

¨       Input to the vestibular system is important for regulating muscle tone, joint stability, bilateral integration, spatial awareness, eye movements and balance and equilibrium mechanisms. These all affect our ability to maintain good sitting posture i.e. at a desk.

¨       Good postural stability serves as a basis for fine motor control (i.e. handwriting).

¨       The vestibular system sends information to the part of the brain that regulates attention and arousal levels. It also provides a calming effect (i.e. gentle rocking)

¨       The vestibular system ‘talks’ to every other system and is closely linked to the proprioceptive system.

 

Functional Implications:

Over-responsive vestibular system: (i.e. The child who perceives too much movement information)

¨       Gravitational insecurity: excessive fear of falling / of heights / and of feet leaving the ground

¨       Overly frightened by movement / dislikes playground activities

¨       Difficulty mastering environmental obstacles such as stairs or uneven terrain

¨       Intolerance or adverse reactions to movement, motion sickness, nausea, giddiness

Under-responsive vestibular system: (i.e. The child who is not processing enough movement information)

¨       Craves movement, swinging, rocking

¨       Moves excessively, using momentum to compensate for poor balance reactions

¨       Does not get dizzy until they have had an enormous amount of movement

¨       Poor bilateral integration and co-ordination

 

Activity suggestions to Help Improve Vestibular Processing:

1.     Swinging / rolling / rocking / swaying (the best effects are gained when these activities are self activated, i.e. let the child swing / spin him/herself)

2.     Jumping on a trampoline (with supervision)

3.     Balancing on a balance beam or line on the ground

4.     Rolling across the floor, over a variety of textures and objects / in a blanket or towel. Then try with eyes closed

5.     Sledding or rolling down a hill

6.     Spinning around a post / in a chair

7.     Sit ‘n’ spin / pogo stick

8.     Playground activities: see saws, swings, slides, merry go rounds

9.     Bilateral activities: jump rope, swimming, skipping, riding a bike, star jumps, stilts etc.

10.   Movement activities: e.g. Exercises, keep fit, martial arts, dancing

11.   Walking over uneven surfaces

 

WARNING: Encourage the child to choose spinning activities to do independently. Too much swinging / spinning can have a negative effect on the child. Watch carefully for signs of dizziness, nausea, changes in breathing etc. Stop when the child asks to stop the activity. Never swing / spin the child excessively.

 

Reactive Attachment Disorder

Reactive Attachment Disorder (RAD) arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child’s communicative efforts.

Not all, or even a majority of such experiences, result in this disorder.

Attachment disorders can be treated using an innovative new type of working with children and their carers called Sensory Attachment Intervention “SAI”. I have had specialist training with the founder of this whole practice called Eadiaone Breathnach who is truly inspiring and has given me a different way of approaching difficulties.

I am able to offer Sensory attachment intervention for children and parents and the usual course would be anything from 6 weeks to 12 weeks. Working with the child from a sensory perspective is fascinating and can help address many difficult behaviours through sensory strategies applied at home.

Please call for more information if you are a parent, adoptive parent, foster parent and require support in this matter.

 

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Sensory Processing Disorder

Sensory processing disorder or SPD is a neurological disorder causing difficulties with taking in, processing and responding to sensory information about the environment and from within the own body (visual, auditory, tactile, olfaction, gustatory, vestibular and proprioception).

For those with SPD, sensory information may be sensed and perceived in a way that is different from most other people. Unlike blindness or deafness, sensory information can be received by people with SPD, the difference is that information is often registered, interpreted and processed differently by the brain. The result can be unusual ways of responding or behaving and finding things harder to do.

Difficulties may typically present as difficulties planning and organising, problems with doing the activities of everyday life (self care, work and leisure activities including work and play), and for some with extreme sensitivity to sensory input, sensory input may result in extreme avoidance of activities, agitation, distress, fear or confusion.

Difficulty taking in or interpreting this input can lead to devastating consequences in:

daily functioning
social and family relationships
behavioral challenges
regulating emotions
self-esteem
learning

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ADHD

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.

Attention deficit disorder (ADD) is a type of ADHD.

Common symptoms of ADHD include: a short attention span, restlessness, being easily distracted and constant fidgeting. Many people with ADHD also have additional problems, such as sleep disorders or learning difficulties. However, ADHD has no effect on intelligence.They often have sensory processing problems and modulation difficulties (hence behaviour can be out of control).

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Asperger Syndrome

Children with Asperger syndrome have milder symptoms that affect social interaction and behaviour. Their language development is usually unaffected, although they often have problems in certain areas of language. For example, understanding humour or figures of speech, such as ‘she’s got a chip on her shoulder’ or ‘it’s raining cats and dogs.’

Children with Asperger syndrome usually have above-average intelligence. Some children are skilled in fields requiring logic, memory and creativity, such as maths, computer science and music. (But only 1 in 200 children are exceptionally skilled, so-called ‘autistic savants.’)

Children with AS are often severely affected by sensory processing and this is often overlooked during typical health assessments. Behaviour therefore is a big problem for these children who fear change and are often oversensitive by nature.

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Autistic Spectrum Disorders

Autistic spectrum disorders (ASD) are a range of related developmental disorders that begin in childhood and persist throughout adulthood. ASD can cause a wide range of symptoms, which are grouped into three broad categories:

Problems and difficulties with social interaction such as a lack of understanding and awareness of other people’s emotions and feelings.

Impaired language and communication skills such as delayed language development and an inability to start conversations or take part in them properly.

Unusual patterns of thought and physical behaviour. This includes making repetitive physical movements, such as hand tapping or twisting. The child develops set routines of behaviour, which can upset the child if the routines are broken.

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Dyslexia

Dyslexia is a common type of learning difficulty that primarily affects the skills involved in the reading and spelling of words. Dyslexia should be recognised as a spectrum disorder, with symptoms ranging from very mild to very severe. In particular, people with dyslexia have difficulties with: phonological awareness, verbal memory, verbal processing speed.

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