Sensory Processing Disorders

Pinterest.com/FABStrategies/fab-sensory-processing-interventions

2. Sensory Discrimination Disorders 3. Sensory Based Motor Disorders

1. Sensory Modulation Disorders

Reference: (Schaaf & Miller, 2005)

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Integrating Behavioral & Sensory Tx © Copyright 2016 by John Pagano, Ph.D., OTR/L

★Sensory input as Reinforcement-★Deep pressure mat sandwich functioned as reinforcement of

behaviors that immediately followed it for ASD students (McGinnis et al., 2013)

★Sensory match for problematic self-stimulation-★Non-contingent reinforcement NCR (Machalicek et al., 2007; Mays et

al., 2011; VanRie et al., 2010) with matched sensory stimulation and reinforcing on task (Richman, 2008) reduces problematic self-stimulation for improved school learning in students with ASD (Murray et al., 2009).

★Combine systematic desensitization (Koegel & LaZebnik, 2009) with preparatory sensory modulation (Pfeiffer et al., 2007).

★Conditioning Calm Recall-For severe developmental disabilities pair therapy activity (unconditional stimulus) thats consistently relaxing with a conditioned stimulus (e.g., smell, song). Pre-correction provide the conditioned stimulus and reinforce the child for not acting aggressively (Lieberman, 2010)

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Sticker Charts, Conditioning Calm Recall & Bully Proof © Copyright 2015 by John Pagano, Ph.D., OTR/L

• Points (Visual Sticker Point Chart)-Award points & give specific praise for positive opposite behavior and practice sessions graded points and prizes (Kazdin, 2008)

Prompts: Specific statement, Calm, Close. Praise: Specific, enthusiastic, touch. Refuse: Calmly describe why no reward, will have more chances to earn. • For severe developmental disabilities pair therapy activity (unconditional stimulus)

that consistently relaxes the child with a conditioned stimulus (e.g., smell, song). When child starts becoming upset or for Pre-Correction provide the conditioned stimulus and reinforce the child for not acting aggressively (Lieberman, 2010)

• Sensory systematic desensitization- Progressive exposure to anxiety producing situations paired with mindfulness, game or snack. Can use sensory match, if skill missing address that first

• Embed reward- Jump with student• Bully proof “Teach Physical”-Practice differentiating. Avoid the bully, Don’t: Police

the bully, Call attention to yourself around him, befriend him, use teasing comebacks. Do: Hang out with other people, stay near an adult when the bully is around, only if people are in danger tell an adult privately.

• Bully proof “Teach Verbal”-“Whatever” no emotion; Anyway; Yeah and; So what; who cares” short practiced teasing come backs, then walk away.

(Ref: UCLA Peers Clinic www.semel.ucla.edu/peers)17

Improved School Behavior Goals © copyright 2013 by John Pagano, Ph.D., OTR/L

• Identify and utilize sensory adaptive equipment and techniques to maintain attention/seated attention and a quiet alert state for 30 minutes.

• Increase attention span for individual classroom learning tasks to an average of 5 consecutive minutes.

• Increase to ten the variety of foods he will taste with out resistance.

• Increase use of safe hands and a safe mouth by demonstrating less than 2 incidences of hitting or biting others daily.

• Increased self-control with less than 3 incidences of self-injurious/repetitive non-purposeful behavior hourly.

• Increase frustration tolerance by waiting for four minutes for individual teacher attention without yelling. (Seifert, 2011) www.DrKathySeifert.com

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Evidence-Based Class Behavior Strategies Sensory Behavior Class Strategies Integrating Special Needs Adaptations

© Copyright 2015 by John Pagano, Ph.D., OTR/L

♣ A structured classroom environment with maximal open space, dividers, and minimal distractions. Cut out foot prints, stop signs, and masking tape can help students remember physical boundaries. Study carols and optimally stable sitting (symmetrical,

neutral pelvis against seat back, ninety degree angle of thighs, calves, and supported feet) can promote attention.Children with good balance but difficulty remaining seated can benefit from Theraband tied on the legs or arms of their chair, disk-o-sit cushions therapyball seats, or standing.

♣ Maximizing students opportunities to respond in class with small erasable boards they hold up to answer questions, computer assignments, and peer tutoring.

♣ Teach, review, and post a few major classroom procedures and expectations. Strategically place visual schedules, social stories, choices, self-control reminders; prepare before transitions; directions to choose 1 activity for a set period before cleaning up and choosing another task; and a designated sensory quiet area in the class room can promote direction following.

♣ Teach feelings and social skills using positive behavioral support strategies. Basic positive behavioral support strategies (Turtle technique, Character comics; Play plan and review; Stretching exercises, Favorites toss, Focus on feet, Tense & relax muscles; Freeze dance) can be co- led with school related services mental health, occupational, speech-language and physical therapists. For challenging groups it is especially helpful to use co-leaders, one leads the group while the other supports students with direction following.

♣ Sticker chart system rewarding specific desired behavior. Differential reinforcement can reward students for avoiding inappropriate, self-injurious, or aggressive behavior. Children who work with multiple staff can construct and use a Coping card- a laminated index card listing their behavior goal, reinforcement plan, and pictures of their preferred character and coping strategies.

♣ Group reinforcement opportunities for the class to earn special privileges through appropriate behavior. Additional positive behavioral support activities, mindfulness games, exercise, movement, and music breaks (e.g., Giant steps, Simon says, Mindful clock, Lean on me song & dance, Hot cross buns activity, Pushups) can be earned by the class for safe behaviors during break activities and returning to class work immediately after breaks.

Reference: Simonsen, B., Fairbanks, S., Briesch, A., Myers, D., & Sugai, G. (2008). Evidence-based practices in classroom management: Considerations for research to practice. Education and Treatment of Children, 31(3), 351-3.

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Back X, Spine Crawl, Egg Head & Foot Input © Copyright 2013 by John Pagano, Ph.D., OTR/L

X MARKS THE SPOT X on entire back WITH A DOT DOT DOT 3 dots with your fist AND A LINE LINE LINE 3 horizontal lines AND A QUESTION MARK ? on entire back“CRACK AN EGG ON YOUR HEAD fist eggLET THE YOKE RUN DOWN” finger yoke (2 X)CREEPY CRAWLIES UP YOUR SPINE spine crawl with knuckles both sides spineCREEPY CRAWLIES DOWN palms down both sides spine

★Back X/Spine Crawl-★Egg head/Foot input-

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Deep Pressure Improves Attention for Learning © Copyright 2016 by John Pagano, Ph.D., OTR/L

• Proprioceptive sensations (from muscles, joints, & tendons) contribute to body awareness, body scheme and behaviral organizational for learning (Schaaf & Mailloux, 2015)

• 5 Little Hot dogs-• Pushups/Weight lifting-• Pull ups/Pull hands apart-• Stretch: Front/Side/Down/Up/Lateral/Twist-• Climbing toys-• Swings-• Isometrics: Up & down/Center-• Move tables/mats-• Press Wall/Desk-• Therapy ball: Bounce/Hands rock/Wheelbarrow walk• Theraband/Theraplast-

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Movement to Improve Self-Control © Copyright 2016 by John Pagano, Ph.D., OTR/L

• Freeze dance-• Freeze shake-• Giant steps/Simon says/Red light-• Set table-• Deliver messages/book/box-• Rolling to Read/Math-• Playground swing-• Sliding board-• Scooter/Scooterboard- 9

Antecedent Strategies P. 10© Copyright 2016 by John Pagano, Ph.D., OTR/L

• Antecedent strategy movement/music breaks,pre-correction, trigger recognition, and coping strategies more effective than reinforcement for students with ODD, brain injury related, and persistent severe behavior concerns (Ylvisaker et al., 2007)

• Schedule story- • Visual Environmental triggers- • Visual Body triggers- • Visual Coping strategies-

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PAGANO FAB TRIGGER&COPING FORMS Copyright © 2011 John Pagano, Ph.D., OTR/L www.fabstrategies.com

Color/Circle 3 Major Body Triggers for Misbehaving

Crying Red/hot face Laughing/Silly Threatening

Act mean/rude Swearing Whining Breathe hard

Clench fists Shake/Tics Yelling/Screaming

Rocking Acting Hyper Scrunch Face Run Away Reference: Mass. Dept. of Mental Health Safety Tool, 2006 12

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PAGANO FAB TRIGGER&COPING FORMS Copyright © 2011 John Pagano, Ph.D., OTR/L www.fabstrategies.com

Color/Circle 3 Best Coping Strategies for Behaving

Writing Games/Toys Drawing/Art Tense & Relax Muscles

Warm Bath Being Left Alone Computer Slow Deep Breaths

Reading Watching TV Count to 10 Focus bottom of feet

Rocking chair Swings Dancing Sports Swimming Reference: Mass. Dept. of Mental Health Safety Tool, 2006 13

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PAGANO FAB TRIGGER & COPING FORMS Copyright © 2011 John Pagano, Ph.D., OTR/L www.fabstrategies.com

Color/Circle 3 Best Coping Strategies for Behaving

Talk on Phone Listen to Music Singing/Humming Theraband Exercises

Hug Stuffed Animal Get a Hug Pressure Touch Fidget

Bean Bag chair Weighted Blanket Sit Moved on Ball Wall pushups

Play on Playground Theraputty Playdoh Exercrcise Chewey Reference: Mass. Dept. of Mental Health Safety Tool, 2006

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PAGANO FAB TRIGGER & COPING FORMS Copyright © 2011 John Pagano, Ph.D., OTR/L www.fabstrategies.com Color/Circle 3 Best Coping Strategies for Behaving

Noise Cancelling Headphones Mini-trampoline Jumping Brushing

Pressure/Weighted Vest Rock over Therapy Ball

Body Sock Quiet Area Reference: Mass. Dept. of Mental Health Safety Tool, 2006 15

ENERGY LEVEL

HighMediumLowOKNOT OK

fabstrategies.org

Emerging Evidence for Coordination Exercises

• Corpus callosum communication between the right and left cerebral hemisphere is required for emotional regulation of negative emotions through reappraisal and problem solving (Shobe, 2014)

• Brain gym midline crossing exercise was equivalent to the effect of same side movements on improving attention; but significantly better learning retention in the same side exercise group and intermanual transfer in the midline crossing group (Thomas, 2012)

• Bilateral sport stacking exercises significantly improved reading comprehension in typical fifth graders (Uhrich & Swalm, 2007)

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Coordination Exercises © Copyright 2016 by John Pagano, Ph.D., OTR/L

★ HAND TO KNEE Hand same side knee Hand opposite side knee Hand same side knee- eyes down right Hand opposite side knee- eyes up left ★ DRAW AND WATCH Draw a diagonal Draw an opposite direction diagonal Draw an X Draw an Infinity sign Draw an Infinity sign-following it with your eye balls Draw an infinity sign-each hand doing half the work Twist, Elbow infinity signs, then twist again

★Flex & Extend Shoulder & Ankle Same side: Right shoulder & right ankle simultaneously Opposite: Right shoulder & left ankle simultaneously Same Half: Right shoulder & left ankle simultaneously; Add left shoulder beginning with the left for half way up, then returning the final way down

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FAB Pressure Touch Research © Copyright 2016 by John Pagano, Ph.D., OTR/L

• Pressure touch and weight bearing increase vagal activity and calming through stimulating pressure receptors (Field, 2010), while resistance exercises enhanced proprioception and motor planning skills (Kaufman & Schilling, 2007)

• Preschoolers with ASD (Autism Spectrum Disorder) given sensory massage showed improved behavior and language regardless if initially hyper-responsive, hypo-responsive, or both sensory modulation challenges (Silva et al., 2011; Silva et al., 2012)

• Preschoolers with Mild ASD symptoms showed significantly greater improvement with parent’s giving them sensory massage, while those with severe ASD symptoms showed significant improvement given therapist and parent massage (Silva, Schlock & Gabrielsson, 2011)

• Children with PDD given massage in addition to sensory processing intervention showed significantly greater behavioral improvement in addition to the benefits from Sensory Processing Intervention (Piravej et al., 2009)

• Massage in Preschoolers with ASD (Autism Spectrum Disorders) significantly improved behavior and communication skills and hypo as well as hyper-responsivity (Silva & Schlock, 2013)

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FAB Pressure Touch Strategies© Copyright 2016 by John Pagano, Ph.D., OTR/L

• Head crown- • Shoulders squeeze- • Shoulders press- • Arm roll- • Spine roll- • Brush back- • Brush arm- • Self-brushing- • Vibration-Back/Arm/Body- • Tap-Press self: (Up dorsal arm from finger tips then) Ear to

palm • Tap-Press self: Head to sides • Back tech: Tap-Press

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Sticker Chart & Bully Proof Groups © Copyright 2015 by John Pagano, Ph.D., OTR/L

• Point (Visual Sticker) Chart-Award points & give specific praise for positive opposite behavior and practice sessions graded points and prizes

• Prompts: Specific statement, Calm, Close. Praise: Specific, enthusiastic, touch. Refuse: Calmly describe why no reward, will have more chances to earn. (Kazdin, 2008) • Provide higher functioning children with a sensory anchor (feel your feet/

palms) and gradually train them to use this anchor for calming when trigger physical reactions or situations begin, then reinforce them.

• Physical bully proof-Practice differentiating. Avoid the bully, Don’t: Police the bully, Call attention to yourself around him, befriend him, use teasing comebacks. Do: Hang out with other people, stay near an adult when the bully is around, only if people are in danger tell an adult privately.

• Verbal bully proof-Teasing only. With no emotion say, “Whatever”; Anyway; Yeah and; So what; who cares”, short practiced teasing come backs, then walk away (Laugeson, 2008 www.semel.ucla.edu/peers)

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Roll the Ball Movement Song to Develop Interactive Skills

• I ROLL THE BALL TO MARY Mom rolls ball • SHE ROLLS THE BALL TO ME Help roll back • I ROLL THE BALL TO MARY Mom rolls ball • SHE ROLLS THE BALL TO ME • ROLL THE BALL (REPEAT 3 MORE X) • I ROLL THE BALL TO MARY Mom rolls ball • SHE ROLLS THE BALL TO ME Help roll back

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Questions in Problem Solving1. How do I feel?

2.What is the problem?

3.What can I do and I won’t get in trouble?

<www.cfchildren.org> problem solving song