Saturday 20 September 2014

Sensory Processing Disorder. And more on avoiding meltdowns in children.

I will start by saying I am not an expert on sensory processing disorder. This is written from notes taken in response to a recent information session that took place in the Illawarra, reading books, and prior research done. If you have any concerns about your own child after reading this, you can contact an OT (Occupational Therapist) to discuss this further.

Sensory Processing Disorder (SPD) can be defined as "the inability to use information received through the senses in order to function smoothly in daily life. SPD is not one specific disorder…..but rather an umbrella term to cover a variety of neurological disabilities." (p9, Out-of-sync Child, by Carol Stock Kranowitz)

Below is a diagram showing the Categories and Subtypes of SPD (p10, Out-of-sync Child, by Carol Stock Kranowitz)



Chances are, if you are reading this, you are already familiar with SPD. Perhaps you have a child or work with a child that has SPD. There are many people who don't believe it exists, but if you are personally familiar with a child who has it, and have seen results when strategies have been applied, then you are probably well aware that finding out can be an amazing step in the right direction. I was first introduced to SPD when I noticed differences in my middle child. I'm not big on comparisons but it's easy to notice when one child will not sit still easily, puts things in her mouth constantly and finds it really difficult to not touch and feel everything.

SPD in my family

Lucy is a child who craves sensory experiences. Looking back at her first three and a half years provides many answers as to why. Lucy was quite a challenging baby. To say that she cried, would be the understatement of the century. Like three of my other children she had reflux, which she was medicated for until the age of 3 1/2 years. But there was more to it. At 4 weeks old she began to sleep through the night. But this is not a normal or good thing, as she slept through due to the intense screaming through the day and evening. That and it was the only time of day I didn't have to force her to feed. I remember the day I had to give soy formula a trial. It was my worst day as a parent. Lucy drank 65mls all day, did not stop crying, and by evening was covered head to toe in a rash that had previously on been on part of her body. Craig worked a double shift and by 9:30pm all three children were screaming. To cut a long story short, Lucy was prescribed an elemental formula and things improved slightly. Months later, every trial of food led to rashes. She was intolerant to almost everything. At 7 months Lucy could tolerate one brand of rice cereal. But not rice itself. Then by 9 months pureed corn that had been boiled for three hours. By 1 1/2 years she could tolerate five foods, all cooked for such a long time that they were mush, which continued until she was three years. By three years the food challenges began to work and by 3 1/2 she could eat relatively normally. What I was unaware of at the time, was the lasting impact of these years. She missed a huge amount of the necessary sensory experiences that a normal toddler is exposed to.

For us finding out there are ways to help her has greatly reduced the frustration all round. It also changed our expectations in different situations, and gave us ways in which we could help her.

The SPD information session

I have been able to use strategies discovered through research in my work as a teacher as well. But nothing has helped as much as the information session I went to mid this year. It helped with Lucy, parenting in general, and definitely teaching. The presenters were great, but the guest speaker, who felt compelled to attend as she has just moved to our area and is now a local, was AMAZING. I plan to attend her internet inservice in October. As a teacher I feel it will be of great benefit.

I wrote about my big parenting breakthrough as a result of this information session, in How I learnt to be a better parent in one moment. And the results of putting one simple thing into practice. Remembering that children can hear what I think has also been a great help as a teacher. I won't repeat myself here, but this was an amazing lesson for me, and many other parents who have given me feedback since. I am genuinely shocked at the number of people with happy books now!

I touched on my views on tantrums and meltdowns in It's never really about what it's about. The main speaker at the information session helped to crystallise my own views in this area. She said that the question she was asked the most was how to stop tantrums and meltdowns. She said that you can't, which I completely agree with, and wrote about in the post above (there are more specifics later in this post.) I really loved the way she asked all the adults attending to imagine a certain situation, to help them understand exactly what's going on with a child when a meltdown is underway.

Imagine you are in peak hour traffic in the middle of Sydney, and you are lost. All the kids are complaining in the back of the car, you have an important event you are now late for, there is nowhere to pull over and collect your thoughts. Now imagine your partner sitting next to you telling you that you need to calm down, or yelling at you to do something else. Exactly how likely is it that you can do what they are telling you to do? At that moment the chemistry in your brain is such that the higher order thinking required to make a good decision is cut off. This is what it is like for children in that meltdown state.

For people (of any age) with SPD, things that would not even rate a mention for most people, grate on them to the point that they can not concentrate and can reach this meltdown state much sooner or due to things that others may think of as unreasonable. As an example, the presenters had been doing various things while one person spoke. I was completely unaware anything was happening. I did not hear the paper rustling, or the foot tapping of the other presenters. I was able to filter out all the unnecessary sounds and could completely concentrate on the presenter speaking. This would be like most children within a classroom. Someone in the crowd, unexpectantly put her hand up to interrupt, and asked if the tapping could be stopped because she just couldn't hear anything that had been said. A couple of others agreed. I had not even heard it! Others said that seeing the rustling paper out of the corner of their eye led to them not being able to concentrate either. This had been a perfect example of just one of the minor differences between those with SPD and those without. The sensory system just wasn't set up in a way to allow proper filtering, and as such small annoyances became large and the brain had responded allowing chemicals to be released into each persons system that prevented the higher order thinking required to attend to listening and remembering what had been said by the presenter.

As the response to the sensory input is a chemical one, what is needed is a chemical response, that cancels out the first one. The chemicals needed are dopamine and serotonin. These can be increased naturally through VOLUNTARY heavy work and movement. If it is enforced and is not fun it just doesn't produce the right chemistry. So it becomes a regulation issue.

As a society we are big on offering rewards to children to get things done. The problem is that for children with sensory issues, getting the work done, and avoiding meltdowns, is not a defiance issue. It is not that they don't want to work or pay attention, they just struggle to. It is not something that they can do all on their own, so offering all the rewards in the world is not going to help. What they need, is to be prepared to achieve. Their brains need the initial right chemistry to start with. It's all about momentum. If the chemistry is set up for a meltdown, it can easily continue to accumulate, then it can't be stopped: get out of the way. Heavy work and deep pressure, given in a fun way can be very effective at setting up the correct chemistry.

Engine Time/Sensory Gym


This is where we come to 'Engine Time' or a 'Sensory gym' for children with SPD. This is a complete reversal of what generally happens with children. The idea is to set children up for learning at the beginning of the day, rather than as a break partway through learning time. When I later thought about it, I found it amusing that there are so many adults who start their days with a run, a workout, or some kind of physical activity, but this is not really a common thing among children, who are then expected to sit at desks, with minimal activity, for two straight hours.

The presenters explained how it worked within each of their classrooms. This is a general overview.

First fast, more active, activities are set up around the room like a continuous circuit to music (upbeat.) The circuit should aim as much as possible to get the child's feet off the floor (which helps a person use their diaphragm correctly to breathe, aiding the acquisition of the desired brain chemistry), so crawling along or under, or climbing over, activities are great. Examples would be crawling through fabric tunnels, crawling under desks, crawling along air mattresses or quilt covers filled with foam pieces, climbing over air cushions, climbing over low desks, rolling over big balls such as exercise balls, and carrying heavy things such as weight balls, crates with books in them from one place to another, or around a cone, back to the original place.

After about 15 minutes, the idea is to move towards calm with a bubble blowing/balloon blowing time. Their are special tools that can be bought also that have little cars that race along a track as the end is blown. Another idea is to blow a ping pong ball around a container, using a straw. This is a time when the child is stationary, and the music playing in the background is slowing down.

After a few minutes the children lay down on the floor, back facing up, as the music slows once again. An exercise ball is then rolled over the backs of the children. This pressure is the final step, before calmly moving onto learning. For children with SPD this is a great circuit that can be modified and done at home, before school. I personally have begun to think about how I could modify this for home use, using our downstairs playroom, where we have the space available. Lucy loves the weight ball I recently bought at Big W, and she has a large ball that she rolls on often after coming home from school.


Outcomes

The presenters, teachers from four different schools, were so amazed at student outcomes following the implementation of 'Engine Time' that they felt compelled to give this free presentation. They each spoke about the differences they had observed. One that I noted down was a student who was originally being 'rewarded' for each compete sentence, taking 30 minutes of extremely difficult redirection, to being able to sit for 45 minutes happily, writing 5 complete sentences in a row. It was believed that the student in question would never be capable of this. As it turned out, the chemistry that was present was acting as a block and he was unable to access the higher order thinking needed.

They also spoke to improvements in fine motor skills and behaviour. All believed improvements across the board could be seen in about two weeks. Some students how ever reacted poorly to begin with before improving. This was thought to be due to the sensory system having shut down. It needed to be 'woken up' first.

The guest speaker noted that she has seen children start to make speech sounds, where parents were told that their child would never be able to talk at all and other amazing individual outcomes. She has implemented programs through many schools overseas, including large private schools in America, where outcomes have included lower anxiety levels among the student body, where the program has been implemented across the board.

The outcome that I have definitely seen, along with the presenters, is a difference in my own attitudes and responses. One presenter spoke of behaviours like lethargy in class, students saying everything is too hard, and students biting and playing with things etc. are now viewed in an entirely new way. It has helped me personally to see each behaviour as an indicator, in much the same way as I have with my younger children in the past. I now try to see through the behaviours to the core and the cause of the issue, rather than simply feeling I need to fix a behaviour or stop it. There seems to be greater success in this. Not to mention closer relationships, which in themselves produce a more positive environment both in the home and at school.

More on meltdowns

Avoiding meltdowns:

- Aim to always validate and empower children. This is not the same thing as always giving them their own way. It's about acknowledging that the child has a view and empathising that it is difficult when we don't get what we want or can't have everything our own way. This is difficult to deal with even as an adult! It is always nice to be able to talk to someone about things when they are not going well and have someone nod along and say that it is difficult. It's just nice to be heard. Situations don't always need to be fixed. For example: "It's really hard when we want to watch TV but it's not TV time, let's go and check outside to see if there are any birds on the clothesline."

- Offer choice. BUT never offer any choice that can not be followed through with.

- Don't use the word 'but' in a response when a meltdown is brewing. EVER. Use the word 'and' instead, even if it is not grammatically correct. Trust me when I say this is a difficult thing to get used to. I was so very unaware of how often I said 'but' in a day. For example "I know it's really hard to get ready to pick the kids up from school when we are playing, and we are walking out in about two minutes so we need shoes on."

- Waiting. Yep, good old patience. I find this hard, because I want my children to listen and do NOW. But it can take some children a long time to process information, so only a small amount of information needs to be given at once. Say each direction once- quietly- even whisper. Pause and wait. Then give another direction. Repeat. Try not to say things over and over. I am definitely guilty of the adults-who-talk-too-much syndrome! Especially in the last half an hour when my children are getting ready for school. I'm working on this.

- Don't feel the need to get to the bottom of everything. There is no bottom; the brain is like the google search engine. Sometimes it's best to just move on and go with what's working.

- Remember that children hear what you think, not always what you say, and this becomes a self-fulfilling prophesy. Read more on what to do about this here.

- Never ask a question that you can not 100% accept the answer to. For example if I was to ask "can you go and get ready for school?" it can be answered with "no," and I would have to be okay with this as I asked the question. Instead I need to phrase it as a direction.

Too late? A meltdown is underway. What to do next:

- Don't act. Someone else can not stop it. Let it run it's course.

- Scan the environment to make sure the child and other bystanders are safe.

- Take all the words out! In other words: don't speak. Adults often feel compelled to do something, but this only makes meltdowns escalate. This is yet another opportunity I find that helps me to learn patience.

- As the child calms down, come back in with the simple phrase "what is it that you wanted." This is not saying you will give it to the them, just an acknowledgement of their point of view, and an opportunity to move on. "And now it is time to go and find a tissue."

- A great way to move on is start with "It is time…" then offer a choice, but pretend to not want them to pick one of the choices, which of course they then will!

Other ideas for people with SPD

Other ideas mentioned specifically for children with SPD are probably already familiar to those who know about SPD, but I will repeat them just in case.

Activities where children need to hang from their hands, without touching the ground with their feet, are great. Monkey bars are great.

Weighted lap blankets are good for times when a child with SPD needs to be sitting and concentrating. I made one for Lucy from a jumbo cord fabric for school.

Fiddle toys, blu tac and velcro stuck under the table are also options available to help children with SPD concentrate.


For children with SPD struggling to learn sight words etc, rather than just running through the words on card, hide the cards in a container of rice or spiral pasta.

Some children like to listen to music, via an iPod, while they are working. Calm, instrumental, music can sometimes help to drown out distractions. The iPod shuffle is a great option. We are considering this for Lucy.


Make sure that all items used are referred to as 'tools'. They are not toys. Tools are used to help with focus, and avoid meltdowns, and are needed for learning.

Try to integrate tools and activities throughout the day to maintain the right brain chemistry. The 'Engine Time' mentioned above lasts generally for half the school day.


Find some fun sensory activities for around the home. We have a rock and sand pit, that is loved by all 5 of our children. Peeling vegetables or cutting paper provides the 'feedback' that some children with SPD like. Lucy likes the feeling of colouring in, especially with scented pens or pencils. We have both Smiggle scented pens and Smencils (scented pencils) for her. The trampoline can be great, especially straight after school, but a transition activity is needed following, to calm down, such as bubble blowing, blowing up balloons, or rolling on an exercise/large ball. Pillow fights or climbing over a pillow 'track' can be great too.


Core disks or exercise balls can be great to sit on when sitting still is a challenge.


As light touch usually leads to a meltdown about an hour and a half later, this should be avoided with kids with SPD. As should touch that has come as a surprise, like a touch on the shoulder as someone passes from behind the child.

When sleep is an issue, try deep pressure, as in massage. Some children need to be hugged tightly, or will squeeze their own limbs. Many children love 'rumbling' (especially with dads!) before bed. Again, aim for feet off the floor, perhaps using lounge cushions, but at least an hour before bed. The hour before bed should ideally be in bed. I have recently been reading into the importance of this 'slush hour' in 'Nutureshock: why everything we thought about children is wrong' by A. Merryman and P. Bronson. Our bedtime routine is something that I am looking to tweak in our house over the holidays for the coming term.


And lastly, from me

Speaking from my very own point of view, as with many things it comes down to difference. I believe we are all made different on purpose. I don't think it's a mistake that we all have different needs and parents and teachers are challenged to meet all the different needs of children. I have seen in my own life how the challenges that are presented to me have helped me to grow as a person. Compassion. Appreciation. Gentleness. And above all I have continually been humbled and learned to be more patient and understanding. I'm not all the way there yet. I never will be. This life I have been given, is a forever learning experience and I am altogether thankful for the difference that is constantly before me, challenging me to do better. To be better. We aren't all the same. We aren't meant to be. And I wouldn't have it any other way.


For further information:

My Pinterest board on SPD.

I highly recommend the book "Out-of-sync Child" by Carol Stock Kranowitz, MA. I bought it through Amazon and I am currently reading it.



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