Sensory Processing Disorder

Proprioceptive & Vestibular Systems

As I have talked about before, one child diagnosed with autism does not have the same set of challenges as another child. One part of Ethan's specific diagnosis is Sensory Processing Disorder. The way to help Ethan overcome this disorder is to have him participate in Occupational Therapy. During the first several weeks of OT, we investigated Ethan & his senses in order to develop a personal sensory diet. The first systems that the therapist had us look at were Ethan's Proprioceptive & Vestibular Systems. This was my first experience in the field of OT, and it amazed me! And still does.

The proprioceptive system "tells us about our own movement or body position. The receptors are in the muscles, joints, ligaments, tendon, and connective tissue." For Ethan, this is a weak system. He isn't aware of his own body movement & positions....making him appear to be clumsy. He trips over his own feet, walks into walls, falls out of chairs, and bumps into other children which puts him in the "under-responsive" category. Because of this, Ethan needs activities that will tap into this specific system, or sensory input, in order to help him overcome his "clumsiness". So, for 2 weeks, we tried different activities & recorded Ethan's responses. The therapist gave us a list of 71 activities that may or may not work with Ethan...and I tried them all.

Here is what our research discovered - Ethan & his proprioceptive system responded well to...
1. Jumping & bouncing
2. Pushing & pulling heavy objects
3. Weighted items (lap pads, heavy blankets, medicine balls)
4. Crashing into or being squished by couch cushions
5. Playdoh, stretchy tubing, squeezable fidget toys
6. Being pulled by arms &/or legs
7. Sports, gymnastics, wrestling


Meanwhile, at the same time, we were also testing Ethan's Vestibular System. The vestibular system "tells us where we are in space and how the body is moving. It allow us to maintain our balance and elicit protective reactions." This system seems to be very typical...not overly or under responsive. This is a great thing. People who's system is overly responsive usually self-calm themselves by rocking back & forth. People with under responsive systems usually arouse their levels by spinning. These images are what people usually equate with autism. But this is only one part...and not all children with autism demonstrate these characteristics...and Ethan is one who does not. However, we still tested his system by participating in 48 activities. Yep...we did them all!

Here is what we discovered that Ethan responded well to.....
1. Jumping - trampoline, hip-pity hop ball, bed/cushions
2. Crashing & rough-housing
3. Climbing, pulling & pushing heavy things
4. Running
5. Upside Down activities - somersaults, bending over, laying off the couch

The reason these were tested together is because their activities are very similar. And to bring about the most benefit to Ethan, you need to do a Vestibular activities followed by a Proprioceptive activity. When we realized what Ethan enjoyed doing & responded well to, we began doing this about every 4 hours....we called it a "moving activity following by a heavy activity". It reminded me very much of exercising....do your cardio & then your weights.

When we did this, Ethan was able to focus on tasks longer, sit at the dinner table longer, and was much more manageable....for lack of a better word. However, since Ethan has been in OT for awhile now & his vestibular system is average, we don't have to do a moving activity near as much as we used to in the beginning. However, he still needs the weighted input in order to do everyday activities. When he sits at the dinner table, he has a step-stool under his feet, a chair with arms & a weighted stuffed animal (a caterpillar that I stuffed with panty-hose full of rice). Because of these aids providing input to his proprioceptive system, he can now feed himself with utensils, sit at the table longer (although he is still a toddler....he doesn't sit THAT long!), and is starting to talk to us about his day during mealtime.

This just amazes me that a few little changes have added up to such a big difference for Ethan & us. Occupational Therapy is AMAZING! Stay tuned for the tactile system......finger painting anyone???

Brushing & Tactile

During our first couple of months of occupational therapy, the therapist had us participate in a variety of "experiments" in order to create a specific sensory diet for Ethan. Tapping into Ethan's 6 different senses can either help calm him or help stimulate him.....and we were on a mission to discover his tailored program.Why is this so important? Well....after trying over 100 OT activities in the first 2 weeks, I was asking myself that same thing. Our occupational therapist showed me a graph.


What happens to Ethan is that he tends to sit at the top of the graph.....his senses put him in a state of hyperarousal. This doesn't mean that he is running all over the place with energy. It means that his senses are very heightened, so something (like a hair dryer) that seems like no big deal to me, is a VERY big deal to Ethan....because his senses are heightened. So, let's look at this through Ethan's body.....

He wakes up to the sound of my hair dryer....not all that bad since I am a room away, but it is enough to wake him. He wakes easily to sound. So, right away, he is moving up the graph....he is still in the Optimum Zone, but he is moving up towards the top black line. Then, we go to the bathroom. The light is turned on, the temperature changes because he takes he bottoms off to go to the bathroom on a cold toilet, and we flush the loud toilet in the small echo-ish room....sensory overload. So, now, he is either at the top of the Optimum Zone or he has crossed over into the Hyperarousal state or Sensory Overload. When this happens, Ethan has a very difficult time doing anything. It is like he is paralyzed with fear/anxiety. So, in order to calm him, we must do something from his sensory diet. This is why we are doing the experiments....to see what makes him climb to the top of this graph (triggers) or what helps him fall down the graph (calms). An interesting note....if Ethan is above the optimum range, and he doesn't calm far enough down the graph....he will continue to be paralyzed over & over again. This is why events, such as Vacation Bible School or birthday parties or family functions, are difficult for Ethan. There usually aren't very many opportunities to calm down completely. So, Ethan tends to exclude himself from the main events or from the large group....it helps him stay in the optimum range. (He's so smart!)

Back to our morning routine, we now know that the sound & feel of running water is calming to Ethan. So, washing his hands after going potty isn't only important for sanitation....it's important to his sensory systems. And he usually spends a lot of time playing in the water.....which is fine with me! And, as I'm writing, Ethan brought me his yoga ball & laid down on the floor. He is watching morning cartoons....which tends to make him climb the chart. We know that pressure is calming to Ethan. So we use a yoga ball a lot! He can roll around on it....allowing him to crash, hang upside down, kick/throw, or just lay on it.....all things that involve his muscles & calm his senses. He also likes to lay down while we roll the ball up & down his body with VERY slight pressure. I believe that, even at his young age, Ethan is aware of his needs even though he can't communicate it to us with his words. Just like bringing me the yoga ball & laying down. He knows he needs it, but he can't tell people....but we are working on that too.

So, after working with Ethan's Proprioceptive & Vestibular Systems (cardio & weight...see previous post), our therapist introduced us to a Brushing/Compressions Technique. For the first 2 weeks every 4 hours, we would complete this routine.You literally brush Ethan's skin (using a special brush) in order to wake up his senses. Then you give quick compressions to his joints in order to "reset" his system. It was the weirdest thing I had ever witnessed in my life! Here is a YouTube video of a mom doing this with her child.....and this is what we did with Ethan every 4 hours. It was so strange, but the results were amazing! Ethan was a different kid! He was sitting for longer periods of time, he was making more eye contact, he was following directions better....his senses just seemed more calm overall! It was totally worth doing this weird thing!

We did that for about 6 weeks. Our therapist told us that once Ethan was aware of what calm "felt" like, he wouldn't need to be brushed as much or at all. And she was right. Towards the end of the 6 weeks, we actually saw this technique hype him up! So, we knew that he was done with the brushing. But I'm so glad we did it! Now, we only do the joint compression, and it's only as needed....another tool in our toolbox.

During this time we also explored Ethan's tactile system. This is our sense of touch. After participating in 43 tactile activities (yes...I did them all), here is what we found most helpful to help calm & reset Ethan's system. This pushed the reset button on his senses so he can start anew on the graph.

1. Rice Play - Similar to a sand box, but using rice or beans & can be used inside the house
2. Kid Sandwich - Picture an Oreo cookie. Ethan is the filling & pillows/cushions/Mom&Dad are the cookies
3. Heavy blanket
4. Massage/Bear Hugs
5. Matching & Finding games
6. Deep pressure - Firm tickling, firm hand-holding, firm shoulder touch for guiding, etc. Firm - NOT HARD

Oral Sensory

So far, I have talked about how we were discovering Ethan's Sensory Diet by trying out his different senses. We have explored his proprioceptive system, his vestibular system, and his tactile senses. Next, we started looking at his Oral Sensory Input. This includes tastes & smells. "Oral receptors respond & measure touch and taste stimuli to the mouth. We use our mouths to organize, calm or alert ourselves. Oral input has a range of characteristics including: The Action (what you do...chew, lick, swallow, etc.), The Quality (how it feels or tastes...spicy, bitter, hot, cold, slimy, crunchy), and The Medium (with what...food, bubbles, straw, hands, etc.) When you think about it, what kinds of "mouth" things do we do to help us focus or stay awake when we have been in a long meeting....chew gum, drink coffee, smoke breaks, bite nails, crunch ice, have a snack, chew on our pens, etc. Same thing here!

I was very excited to start in this area because this could help with his feeding. Not only were his fine motor skills under-developed which made feeding himself with silverware a challenge, but he is an EXTREMELY picky eater! He definitely did NOT get that from me! So...I was SUPER excited to learn more about this section.

During our OT session, his therapist did a variety of games with Ethan in order to see his response. She had Ethan blow bubbles, blow craft pompons & styrofoam balls across the table by blowing through a straw, blowing tissues & feathers, and blowing into a plastic tube that was coming out of soapy water...thus making more bubbles with his air. When we did all this, she noticed that Ethan was having difficulty blowing because he lacked the ability to make an "O" with his mouth. She told me to continue with these activities to help develop those particular muscles because it would help with his speech development as well! CRAZY!!!!

After those activities, she pulled out a bunch of food. She laid them all out on the table & wanted to see what he would do or eat. He chose to eat the animal crackers & Twizzlers. She told me that this could indicate that he needs something to "wake up" his senses in his mouth. We talked before about how Ethan's body craves deep pressure in order to be calm. This eating test told us that Ethan's mouth needs to be stimulated. This would also be another avenue to keep Ethan calm when he starts to have a meltdown....chew toys. As a baby, Ethan was a biter, and he will still occasionally chew on some toys. So, this totally made sense to me! This is why he hates to eat oatmeal, mashed potatoes, bananas, mac-n-cheese, lunch meat, cheese, etc.....they are all soft/runny foods. They don't wake up his senses in his mouth. But he LOVES popcorn, chips, cereal, goldfish crackers, fruit snacks, bacon, or anything crunchy/chewy. And these are things that would "wake up" his mouth.

So, now, when I make dinner or snack for Ethan, I am always sure to include a food that is "alerting"....bacon with breakfast, chips at lunch, fruit snacks at dinner, etc. If Ethan has one of these foods, he will eat his other foods....CRAZY! Another trick that would work is to have Ethan brush his teeth BEFORE we eat..because the brushing would wake up his mouth. She also gave us a Nuk brush (therapy aid) that he can chew on before meals or when he is anxious. We use this a lot as well, and he LOVES it! We also have a TON of chewing items that we use in order to keep Ethan calm. Suckers & Twizzlers are a big one, but if he is with other children, they want the candy too so we can't use these all the time. Our therapist gave us an amazing trick. The chewing aids that are available tend to be very expensive when you need several or your child chews through them a lot. So she told us to us aquarium tubing! I know that sounds strange, but Ethan LOVES it! And I have been able to use it to make a variety of things with it. The pictures below are Ethan's Sensory Survival Kit. We keep the tote at home & fill the zipper pouch to take with us when we go somewhere. These are just the oral therapy toys, but you can see some of the things I have been able to make out of the aquarium tubing. Now...don't judge me, but I also bought some pet chew toys, took the squeakers out & washed them. He loves to chew on those too! ANYTHING that I can find that will work for him, I will use!

Ethan's Sensory Survival Kit

All of his portable calming sensory toys

The Oral Toys: Ring Pop, Twizzlers, 2 pet chew toys, vibrating tooth brush, bubbles, sucker, chew necklace & toy.

I used aquarium tubing & beads from a baby teether to make these toys. His favorite are the knots in the tubing.

 So, after doing 19 at home experimental therapy activities which included buying a ton of food from a Oral Motor Grocery List, here is what we learned that Ethan's senses crave in this area.....

1. Chewing & sucking on rubber tubing/pacifier/licorice
2. Sucking on sports bottles/pacifier/sucker
3. Eating certain food - crunchy, sweet, salty or spicy

Isn't this stuff AMAZING! I still think that EVERY child could benefit from discovering their sensory diet with an occupational therapist!

Smell, Sound & Sight

Closely related to taste, is the sense of smell or the Olfactory system. Certain smells can awaken or calm ourselves. I relate this to candle shopping. Have you ever stood in the candle section of a store "testing" all of the different smells in order to find the candle you want to purchase? Why did you pick that particular scent? Or have you said or ever heard anyone say, "I LOVE the smell of_________!" Well, there is a reason that you are drawn to particular smells. More than likely, it is causing your body's senses to either relax or energize. Same thing for people with autism....the only difference is they tend to react stronger than a typical person. Typically, "scents (and tastes) that are generally calming & easier to process include: almond extract, butter, banana, cinnamon, lavender, pine, soap, vanilla, chamomile, rose & sweet foods. Scents (and tastes) that are generally invigorating & harder to process include peppermint, lemon, garlic, mothballs, vinegar, fish, burnt material, coffee, dirt, chocolate, onion, basil, salty or sour foods." (ipmr)

We tested Ethan and found that he was MOSTLY indifferent to smells. However, we did notice that he has a difficult time eating at the table when dinner smells are still high. As I am typing up these notes, I am remembering last night's dinner. I made salad, spaghetti & garlic bread......GARLIC bread. If you see in the notes up above, that is a energizing smell. Spaghetti is one of his favorite foods, but last night, he wouldn't hardly step foot into the kitchen/dining room. We coaxed him into taking 3 bites, and then he was outta there! After awhile, he came back in & asked for waffles.....which would include syrup.....a sweet (calming) food. And, by that time, dinner has turned cold......and cold food has less smell than hot food. This is one of the reasons that Ethan & I can't cook/bake together....the smell is too much for him. Honestly, I often forget about smell because it isn't a BIG trigger for Ethan. But if our kitchen has a strong smell of any kind, he won't come in....too much for him. So, we do have to be careful about buying scented bubble bath, burning candles, wearing perfume, air fresheners, etc. In fact, when I brew my coffee, I immediately pour the whole pot into a large thermos in order to keep the smell to a minimum. So, our conclusion is that Ethan doesn't have a strong response to specific smells.....only overwhelming smells.

Second, is the sense of sound or the Auditory system. This is a MAJOR one for our Ethan. "Individuals can be defensive towards loud noises, have difficulty attending & focusing in noisy environments, &/or be calmed by music. Many children do well with verbal warning of noises. Rhythmical beats, decreased unexpected noises, use of headphones or ear plugs can be calming. Loud irregular beats and unexpected noises (such as toilet flushing or fire alarm) are alerting." ~(ipmr)

We did not need to test Ethan in this area.....this is the reason we knew Ethan needed OT. We already knew what he could & couldn't handle. When he was an infant, he would instantly calm when we would turn on our range hood in the kitchen, but he would cry when I would vacuum. He would fall asleep in his crib to a CD of white noise, but he would cry when I would use the blow dryer. We already knew these things from his infancy. Loud noise, commotion, and transitions are Ethan's BIG triggers....he is easily set off with these things. His big triggers are high frequency noise (electronics, appliances, etc.....another reason he won't cook with me in the kitchen....I think the one time I foolishly used the blender did him in for life.), but he craves the low frequency (car motors, white noise, etc.) In order to help him cope &/or calm himself, we use several things. Ear plugs/Headphones, verbal warnings/cover our ears, social stories or practice prior to an event, white noise machine which includes rainfall, ocean waves & a lullaby song....that is in 4/4 time (calming), quiet time, transition phrases, and quiet silly songs. This is Ethan's most difficult sensory system to overcome, but he is getting better the older he gets......and we are getting better at helping him as well.

Lastly, is the sense of sight or the Visual System. "We use our visual information to alert and calm ourselves and to help with focus and attention. Some children become over-stimulated by visual input such as fast paced TV or watching a ceiling fan. Decreased clutter, dimmer lighting, small enclosed space or slow moving visual stimuli tends to be calming. Fast paced visual input, highly decorated room, fast moving toys/lights tends to be alerting."(ipmr)

This is an area that affects Ethan very little. We experimented with several types of visually calming & alerting activities, and he had no response either way. However, we did find out that Ethan loves watching a fire as well as a fish tank, he enjoys visual cues such as a picture schedule, and he loves visual games like match games or dot-to-dots. However, let me say this......although certain sensory systems do not seem to seem to cause a reaction from Ethan, combined together they can be triggers for a meltdown. For example, in out-of-routine situations, I am always aware of any extra sensory overload. We are already tapping into a trigger due to being out of the ordinary. So, that mixed with a lot of visual stimulation could cause a meltdown. If we go to a new environment, I am trying to be aware of new stimuli......fans, appliances, commotion, etc.....in order to prepare for a possible meltdown. Usually, I can see that Ethan has tolerated all he can, and we remove him from the situation before the meltdown occurs. Lately, he has been doing VERY well at handling new things & tolerating unfamiliar stimuli for longer periods of time. YAHOO!!!!!!!!!

I know this is a long entry, but I wanted to finish up Ethan's Sensory Diet. Now, I can file this paperwork away.......but not too far out of reach. I like to refer to it time & time again in order to refresh my memory as well try new recommended activities with Ethan. And, maybe, someday Ethan will want to cook with me in the kitchen......just maybe without the blender.....maybe rice crispy treats!?

Ethan's Rice Box. Tactile System=Calming. He will bury the toys & dig them out. Nice way to use happy meal toys!

Similar to a sandbox, he can dig in this rice bin. It's messy, but it's worth the 10 min clean up for the 30 min of playtime.

I had looked all over for these, and finally found them at a toy store in St. Louis. These are great to work his "shoulder" muscles....which help with his proprioceptive system.....and will help him with his HANDWRITING!

These are most of Ethan's tactile system toys....or fidget toys. They are great for the car & the dinner table.

Ethan's headphones & ear plugs....great for making loud sounds quieter.

 

Ethan's sound machine. I think I've posted this before, but we use this all night long. This helps him sleep soundly & block out noises that could wake him up. He has started requesting what he wants to listen to...I love it!

This is Ethan in a BOUNCE HOUSE! Less than a year ago, he wouldn't go near one because the air-blowing motor sound was too loud. Late this summer, he played in this bounce house (that was surrounded by 2 other bounce houses) for more than an hour! He started with ear plugs, but they didn't stay in too long before HE took them out! YEA!!!!

Here is Ethan at his school's Halloween parade. He handled it just fine...with a little ear covering action.

Here are a few visually organizing toys that help Ethan in high anxiety situations. We use these when we run errands. Stickers & flashcards that he can organize/line up.

Again, I think I put this on here before, but this lamp includes cars that go around & around. We bought it to help soothe Ethan, but he doesn't seem to be interested in it anymore....but it sure is cool!!!

Here is an example of a visual schedule. These help Ethan know what to do next, and he really likes them. However, once he knows the schedule, he doesn't use/isn't interested in them anymore.

OK! That's the end! This is Ethan's Sensory Diet!