Building Blocks

As an occupational therapist at Child and Family Development in Charlotte, I have encountered many families who are at their wit's end dealing with their child's seemingly inexplicable behaviors that greatly impact the way they function within their family unit, at school, and in the community.  I recently discovered an article on sensory-processing-disorder.com that I want to share with these families to help them better understand their children.  I also want to encourage families to visit this website as it provides some wonderful educational information as well as stories from other families that offer support and encouragement to others.

Despite what you may have already heard, your child's behaviors may not be the result of spoiling, bad parenting, lack of discipline, neglect, ADHD, a learning disability, conduct disorder, anxiety, depression, shyness, a need for attention, power, revenge, or a feeling of inadequacy.

Though these are true for some behavior problems in children, they aren't the only explanation.  These behaviors may occur due to Sensory Processing Disorder or Sensory Integration Dysfunction. 

Some red flags of children with sensory processing disorders include:

• Excessive Energy And Activity Level: A child may be unable to sit still, constantly on the run, or engage in risky behaviors.
  
• Remarkably Low Energy And Activity Level: A child may appear lethargic, uninterested in engaging in the world or activities, or be sedentary most of the day.
  
• Frequent Impulsiveness: A child may be unable to control impulses to jump out of his seat, control his behavior, may be aggressive, and/or frequently "blurt" things out without thinking first.
  
• Short Attention Span And Distractibility: A child may have difficulty concentrating on one activity or task for any length of time and be distracted by every sight, sound, smell, and/or movement he sees.
  
• Motor Coordination Difficulties And Problems With Muscle Tone: A child may appear clumsy, or like a "wet noodle", slouch or rest his head on his hands/arm during desk work, exhibit awkward movements, and/or have frequent accidents or injuries.
  
• Motor Planning Difficulties: A child may have difficulty with sports, handwriting, balance, using eating utensils, riding a bike, doing jumping jacks, clapping, or getting dressed.
  
• Frequent Switching Of Hands During "Tool" Use And Manipulation: A child may not have a dominant hand for writing by age 5, may switch hands often while cutting, writing etc, or may throw a ball with both hands at different times.
  
• Poor Eye-Hand Coordination: A child may have sloppy handwriting, difficulty cutting/drawing a straight line, catching a ball, or tying his shoes.
  
• Significant Resistance To The Unfamiliar: A child may experience anxiety or refuse to try new foods, meet new people, participate in new activities or sleep in a different environment.
  
• Difficulty Making Transitions From One Activity Or Situation To Another: A child may throw a tantrum, be uncooperative, or experience severe anxiety when stopping one activity and starting another. He may have a difficult time leaving a particular place or going to the next task of the day (ie, bath, bedtime, dinner)
  
• Low Frustration Tolerance: A child may become upset, yell or throw a tantrum at the slightest thing that does not go his way or that he is having difficulty learning. He will give up on tasks easily if they are difficult for him.
  
• Difficulties With Self-Regulation: A child may have difficulty with mood stability and maintaining an optimal level of arousal. He may be unable to calm himself down after an activity or get himself going for an activity. His arousal level may fluctuate minute to minute or day to day, which can be one of the most challenging behavior problems of all!
  
• "Academic" Difficulties: A child may have mild to severe learning disabilities as he has a difficult time learning and generalizing new concepts and skills.
  
• Significant Social Skill Behavior Problems: A child may have a difficult time relating to other children and sharing. He may isolate, be overpowering, aggressive, or bossy to help him regulate and control his sensory environment.
  
• Emotional Behavior Problems: A child may have significant self-esteem issues (one of THE BIGGEST indicators of sensory processing dysfunction), be overly sensitive to criticism, transitions, and stressful situations. He may have difficulty relating to others or understanding his own actions, motivation, and behaviors.
  
• Significantly Irritated By And Uncooperative With Activities Of Daily Living: A child may have difficulty getting dressed, going to bed, brushing his teeth, eating, participating in certain activities, or taking a shower.

• Climbing and Hanging (heavy work) - monkey bars, ziplines, stairs, ladders, rockwalls, and slides provide children with an opportunity to climb and hang.  This gives them great input to their joints and muscles (especially in their arms) and is very organizing.  When children participate in these activities they are strengthening their core/postural muscles as well as the muscles in their shoulders, wrists, and hands.  This provides them with a great foundation for writing activities.
• Movement - swings, slides, fire poles, and spinning equipment provide children with the movement opportunities they crave. 
• Sand and water play - sandboxes and water tables give children an opportunity to experience textures and manipulate toys with their hands.  Our hands are the part of our bodies that most interact with the world around us throughout our lives.  These activities encourage children to explore with their hands and learn how to interact with their environment.
• Cozy Spots - Child-sized spaces on the playground support independent discovery and give children a place of their own to explore novel concepts.  These places also serve as a quiet area where a child can regroup from over-stimulation and provide a safe retreat before resuming play.
• Gathering Spots - Children need places to gather together. These areas in the playground are where they plan their play and learn about social interactions. 
• Circuits - Children engaged in looping behavior appear to complete the same activity over and over.   As they do, they are gathering sensory information, gaining valuable experience and beginning to experience the concept of cause & effect.  Planning and practicing ways to move helps them develop a system for mastering new skills.

• Feedback: Proprioceptive (awareness of our muscles and joints) and tactile (touch) sensory processing give us feedback on what our hands are doing.  This feedback helps us identify what we are touching, use and hold tools (pencil, scissors, fork, spoon) correctly, and regulate the force we are using (pencil pressure). 

• Intellectual: Our mind helps us focus on, gain knowledge about, and remember/recall what we are doing.  This helps us acquire and build upon our fine motor skills.

• eNdurance: We need strong muscles in our hands and fingers as well as in our back and tummy (core and postural muscles).  In order to coordinate our hands and fingers, we need to be stable and comfortable sitting in our chair or standing.  That is, we need to be able to focus on what our hands are doing and not worry about holding ourselves upright.  This is referred to as "proximal stability for distal mobility".  

• Eyes: We also need our vision.  The eyes "drive" the hands.  When we combine what we see with what we feel, we learn about what is around us and are then able to figure out how things work.

What is Sensory Integration?

Sensory integration (or processing) is the neurological process of organizing the information we get from our bodies and from the world around us for use in daily life. When our brain efficiently processes sensory information, we respond appropriately and automatically. We do this because our brain is equipped to modulate sensory messages.

What is Sensory Modulation?

Sensory modulation refers to the ability of a person's nervous system to respond to various kinds and amounts of sensory information while overall maintaining an optimal state of arousal. When people are at an optimal level of arousal, they are calm, alert, and ready to learn. Children with modulation difficulties may be under-sensitive or over-sensitive to sensory information and may have problems regulating their attention and arousal, as well as organizing their behavior for participation in age-appropriate activities. Often children that experience sensory modulation difficulties have disorganized behavior, increased anxiety, negative emotional responses, or fluctuating arousal levels. 

What is Sensory Discrimination?

Sensory discrimination is the ability of the nervous system to identify the type of and quality of sensory input-such as the size and shape of an object, the direction of a noise, and the position of our body as we move through space- and then interpret the information for the development of motor skills. When a child experiences difficulty with discrimination of sensory information, they may experience gross and fine motor delays, difficulties with motor planning and coordination, and problems with social interaction.

In sum, adequate sensory processing is necessary to provide a foundation or building block for the development of skills including gross and fine motor skills, visual/spatial abilities, motor planning, and one's ability to move safely within their surroundings. Often difficulties with sensory processing manifest as difficulties in behavior, social skills, and motor responses. For more information on sensory integration, please talk to your Child and Family Development occupational therapist!

Recommended Reading:

·        The Out of Sync Child by Carol Stock Kranowitz, M.A.

·        Sensational Kids by Lucy Jane Miller, Ph.D., OTR

Does your child accidentally break things often, appear clumsy and uncoordinated, and/or have an excessive need to crash and bump into objects, walls, and people. Is your child disruptive, full of excess energy, or even unsafe? Is your child a crasher, jumper, mover, and shaker?  
 

If the above describes your child, he/she is likely seeking out excessive proprioceptive input to calm and organize his/her nervous system.

Proprioception is a form of sensory input to the muscles and joints which makes us aware of our “position in space” (i.e. where we are in relation to other objects or people). Children who have difficulty interpreting proprioceptive input have trouble grading and planning their movements and regulating their level of arousal. Proprioceptive input is the performance of tasks that involves heavy resistance and input to the muscles and joints, and is essential in helping our bodies assimilate and process both movement (vestibular) and touch (tactile) information

BIG Question: How Does Occupational Therapy Help My Child?

BIG Answer: Heavy Work

Heavy work activities (i.e. proprioceptive input) are used for children with sensory processing difficulties to help increase attention, improve muscle tone, decrease defensiveness, and modulate arousal.

Heavy work activities your child can do at home include:

ü       Whole body actions involving pushing, pulling, lifting, playing, and moving

o        Carrying objects such as groceries, animal backpacks, watering can; stacking moving chairs/books

o        Pushing/Pulling toy shopping cart, wagon; tug of war, mopping, vacuuming, sweeping, raking,

o        Jumping and bouncing on trampoline, pogo stick, hippity-hop ball; horseback riding, jump rope, hopscotch, gymnastics

o        Crabwalk relays, Crab soccer/volleyball

o        Climbing/Hanging on jungle gyms, monkey bars, zipline, rock wall, ladder, rope

o        “Sandwich” or squishing activities; bear hugs

o        Wheelbarrow walking, animal walks

o        Working at vertical surfaces such as easel, chalkboard; washing windows; paint with water on side of house

ü       Use of hands for squeezing, pinching, or “fidgeting”

o        Resistive tools/toys such as clothespins, spray bottles, cutting thick paper, play doh presses and molds, paper punchers

o        Fidget or play with stretchy/squish items such as theraputty, play doh, silly putty, rubber bands, stress relief balls

o        Resistive surfaces such as sidewalk chalk on driveway, dig and play in sand

o        Cooking activities such as stirring, pressing, kneading, pouring, scooping

ü       Oral actions such as chewing, sucking, and blowing

o        Chewy foods such as dried fruit, gummi bears/worms, licorice, bagels, cheese, granola bars, gum, raisins, taffy, soft pretzels, popcorn, etc.

o        Resistive sucking using krazy straws, lollipops, popsicles, drink milkshake with straw, hard candies, peanut butter, etc.

o        Blowing activities such as wind instruments, bubbles, balloons, whistles, kazoos, etc.

For additional activities and to answer any questions, please consult with you Child and Family Development Occupational Therapist!

As school days are approaching, pencils are gearing up for a full time job!  Below are activities often used by pediatric occupational therapists that you can also use at home to help your child gain the strength and skills necessary for efficient pencil use in school.

Activities to Improve Wrist and Shoulder Stability/Strength

• Animal walks, wheelbarrow walks, scooter board pulls, play games in hands/knees position
• Using a hammer
• Fishing with large diameter stick attached to string with a magnet at the end.  Cut out fish from posterboard or construction paper and attach paper clips to them.  Fish by using to hands to wind and unwind the string.
• Climbing activities, tug of war, hanging from playground suspended bars
• Drawing/writing on chalk board or another surface that is above eye level
• Work in a vertical orientation (easel, slantboard, inclined surface) whenever possible to do small manipulative tasks - pegboards, Lite Brite, Magna Doodle, coloring, painting
• Use a rolling pin to flatten Playdoh, cracker crumbs, cookie dough, etc. and make sure that the hands are open rather than closed around the handles

Activities to Improve Hand/Finger Strength

• Spray bottles - fill an empty spray bottle with water.  Spray target or take outside and let your child "paint" the sidewalks, walls, and other objects with the water.
• Clothespins - clip clothespins to large coffee can or bucket
• Playdoh, clay, putty - hide/find objects; form shapes, letters, food; use small cookie cutters
• Play with interlocking beads or legos
• Play tug-of-war with small objects (i.e. coffee stirrers, drinking straws, popsicle sticks, etc.) using only fingertips
• Hole punching, stamps
• Place pennies or marbles in a plastic container or tennis ball with a slot cut in it.  Try increasing the number the child is able to pick up and hold within one hand and place them one at a time in the slotted container/ball without help from the other hand.
• Pop bubble wrap between "pincher fingers" (index & thumb)
• zip up ziploc bags with "pincher fingers" (index & thumb)

Activities to Improve Pencil Grasp

• Tongs/tweezers - let your child use kitchen tongs to pick up small objects such as cut up sponges, ice, small blocks, golf tees, packing peanuts, etc.
• Eyedroppers - pinch to transfer colored water into ice cube trays or to make a tie dye picture
• String beads, cheerios, fruit loops, etc.  Could even make a bird feeder with cheerios on a string!
• use a pencil grip

Activities to Improve Pencil Control

• mazes
• dot-to-dots
• tracing activities
• color by number activities

These are just a few activities that are frequently used in pediatric occupational therapy to help children prepare and practice for efficient pencil use in school.  If you have questions about these or additional activities, please ask your Child and Family Development Occupational Therapist.  You can also visit www.skillbuildersonline.com for a free handout on pencil grasp activities.