Submitted by guest blogger Ruth OT
Our daughter recently appeared on a UK Kids TV show called Something Special. I was ridiculously excited about it and told lots of people who never usually watch CBeebies, the BBC children’s channel, that they just had to see her.
Filming was brief but exciting. We got to meet Justin briefly (one child was very disappointed Mr Tumble wasn’t there too) and the team were genuinely very lovely.
Some of the people who would never normally watch CBeebies were surprised there is a programme which exclusively features children with special needs and/or disabilities, they felt that pointing out the difference wasn’t kind and the kids should be encouraged to blend into a typically developing world. This was a good opportunity to explain how the show “Something Special” had helped other children to understand the way our girl supports her speech with signing and to not be phased by her difference. We’ve often heard comments like…“oh look! She signs like Mr Tumble does!”.
Then a friend asked what I thought of “Pablo”, another CBeebies programme about a little autistic boy and the imaginary world he creates to navigate the confusing things around him. Of course, I had to investigate. I watched a little video of the autistic boy who plays Pablo explaining that he thought it was important for other children to understand autistic children so that they would want to play with them and that Pablo helped that, and I was ready to investigate.
So, I sat down with four kids to watch. The 8 and 10-year-old exclaimed in unison “Oh, I love Pablo!” so of course, I asked them what the show is about “a little boy with a really good imagination who draws stories about things”. Fair enough. And so we all sat and watched the show together…
In the episode, Pablo and his mum are going about really everyday things (cleaning a bin in the first one we watched) and Pablo’s mum uses a phrase he doesn’t really understand to explain what she’s doing. He knows he mustn’t touch the “smell gobbler” but doesn’t understand why. Pablo draws his fears, in this case, he is concerned that the “smell gobbler” might eat his own familiar safe smell which he likes and then what would he do? He and the cartoon characters that represent aspects of him, problem solve it and trap the “smell gobbler” under the laundry basket. Mum comes back and is amused to find her air freshener trapped.
I actually loved the show. The kids who told me they loved Pablo hadn’t spotted that he’s autistic (the 8-year-old is usually quite a diagnostician) and yet they loved that he has such a really good imagination. watching the show together opens up a way to talk about autism with her and how her autistic sibling and friends might see the world a bit differently. It touched on the sensory differences that can come with autism and the importance of sameness for people with autism and modelled a useful way for children with autism to reason through problems and confusions they encounter.
I have a speech therapist friend who is very keen on creating comic strips with children as a method of problem-solving and reasoning through situations before they happen. I could do that or I could just let my kids carry on enjoying a funny cartoon about “what if we really meant exactly what we say?”.
It’s my job to watch what my kids are watching and use it to start those conversations with them. I’m so glad these programmes give us a platform to start that.
Submitted by guest blogger Ruth OT
I meet so many parents who are concerned about their children’s motor or sensory processing skills who tell me their child never 4-point crawled, or did so only briefly. They proudly tell me how their child was ahead of their motor milestones and walked early, and never realise how important crawling is.
What is so special about crawling?
In crawling, the baby supports their weight on their hands and arms, this works wonders for developing shoulder girdle stability and proprioceptive awareness of the hands and arms which is foundational for fine motor skills like handwriting, fastening clothing, threading, sewing, crafting etc. Crawling also requires the baby to hold their core flat and stable off the ground, developing core stability against gravity. It also puts the baby’s neck into extension (ie bent back so that the baby is looking forwards not at the ground), this activates areas of the brain stem and supports baby’s developing understanding of their relationship with gravity and thus vestibular processing.
But what good is telling you all this now if your baby wasn’t a crawler? My youngest child was a very proficient bum shuffler, he could get anywhere over any surface (but not steps!) very quickly shuffling along on his bum. If I put him into the tummy time position, he just laid there and cried until I sat him up. I knew crawling was important for his development and that bum shufflers are late to walk, but I couldn’t make him do it once he’d learned a really efficient way to get where he was going!
So now that he’s a confident walker, we’re going back to crawling activities, and I thought I’d share some of the activities we do without any extra equipment at home to get those crawling benefits…
Going back to crawling…
- Climbing! There’s a lot of motor planning and problem-solving in this as well, depending on where you climb. Over rocks, up muddy hills, up slides (you will get looks from other mums), in soft play, anywhere where they need to use their hands to support their movement is good by me
- Cars and small world toys- some kids I know will squat down on their feet and use their hands to play, if this is your kid try setting up a small world where the kid has to reach far enough that they have to support their weight with their hands to reach the middle.
- Big floor art, floor puzzles etc. We love messy art at the best of times, but if you can get a roll of lining paper on the floor to do your art on, you can work on shoulder girdle stability, prone extension and motor planning while you do it.
- Tunnels, those pop up tunnels you can get for kids are great for encouraging crawling (you can’t bum shuffle through one, we speak from experience!)
- Ball pools, he loves falling face first in them and then crawling back to standing up.
Ditch the train tables, lego tables and tuff tray stands. I know they make tidying up easier and are more comfy for parents, but playing on the floor is about so much more than the game.
Chocolate as therapy? Two small studies may provide more evidence for dark chocolate’s health benefits. And at reasonable doses.
— Read on www.forbes.com/sites
Submitted by Guest authour Jane OT
As I read the recent article “14 Phrases Kids Said That Were Code Words for ‘I’m Anxious“ from The Mighty, It felt familiar – like I had met every one of these responses to anxiety and not just from children.
“What’s wrong with me?”… “I’m tired.” … “Can’t we stay home?”
“I don’t feel well.”
Anxiety affects so many people and they are not all confident naming and talking about it. Some may know they are anxious but be embarrassed about telling people, for others, it may be that long-term anxiety is new to them and they haven’t really grasped that the physical symptoms are related to their anxiety.
So how does anxiety play out in real life and how can we help?
The elderly lady who has had a reduction in her mobility now feels sick when she goes in the car (but her doctors can’t find anything physically that would cause this), may not understand that her body and brain has become accustomed to less movement and so is less able to integrate vestibular stimulation with other sensory stimulation hence she feels sick now avoids leaving her chair for fear of some as yet unidentified illness but is embarrassed to say she feels scared. Her fears about illness then generate yet more anxiety symptoms e.g. Feeling sick racing heart and more, confirming that she really has got some mystery illness that the doctors are missing, so she avoids leaving her chair whenever she can. This leads to a further loss of integration between her senses as she is not moving much (vestibular) and she is not using her muscles much (proprioception) and will eventually lead to loss of function.
Or that friend who is always tired or busy when you want to go out (there might be other reasons) and cancels at the last minute. But to be honest, as a mother to a lovely but anxious young lady it is the young people who concern me most
My concern for young people is driven by the knowledge that the young brain is primed to learn (Jenson 2015)… And learn it will – either good things or less good things, so if like the elderly lady the young teen avoids activities there is a good chance that these coping strategies will become an ingrained life pattern.
So what can we do to help?
- First get to know the symptoms of anxiety there are numerous self-help books and Web pages e.g. The NHS Web site, Web MD, mind etc.
- Second help the young person to choose activities that are likely to reduce anxiety… From a sensory integration perspective, these are likely to be ones that involve heavy muscle work and muscle stretch (proprioception) and ones that make the young person think like Martial arts, dance, rock climbing gymnastics etc. Will be better than just proprioception alone. We do dance and acrobatics.
- Consider 1 to 1 tuition if they need to gain skills to catch up with their peers… But if you do this it’s good to plan to reintegrate the young person into group lessons… So that they can deal with social anxieties. We went to a group lesson and it was clear my daughter had a lot to learn so we had a year of individual lessons (and still supplement the group lessons with the occasional individual lesson). But then we went to group lessons, it took half a term but now she is enjoying doing acrobatics duets which brings me to my next point.
- Make sure the young person attends regularly and on time for a good chunk of time…..
Be prepared for ongoing anxiety and be firm that they go… My daughter frequently tells me on the way home “oh sensory mum you’re right I do feel better.“
- Try to avoid surprises… We have a wall planner for the term and all activities are written on it… And I have noticed my daughter (and I am) much calmer knowing what needs to be done and when.
- Discuss and consider professional help… Some Ayres’ Sensory Integration trained occupational therapists use other techniques in conjunction with their sensory integrative therapy, others will work alongside mental health professionals and for some people, Ayres’ Sensory Integration therapy will be enough on its own.
- You may also decide to work through a self-help book and this can be a good option… But if in doubt always consult with your GP or/and any other health professional who is working the young person.
So what about those adults… Its a little different to the young people but listening and understanding or trying to understand is a good first step. Giving them information about sensory integration and mental health issues can also be helpful. Then asking them what they want you to do and staying in touch with them even if it’s difficult. And always remember it’s never too late for someone to get help.
Reference The teenage brain by Frances Evans Jenson. L
This article by Clinical Psychologists Christopher Robinson and Alicia Madeleine Brown in the Scottish Journal of Residential Child Care includes a lovely environmental checklist (adapted from Simpson 2009) used in considering the physical environment in three children’s residential homes.
Abstract: Sensory processing issues are generally considered to be clinically significant in children who have suffered abuse and trauma and much has been written about the possible neurological correlates of such sensitivities (De Bellis and Thomas, 2003; van der Kolk, 2014). Comparatively little focus has been given to the functional aspects of these sensitivities, and particularly how these might interact, in context, with a child’s underlying neurological vulnerabilities. In this respect, the environment surrounding the child is a neglected area of significant, perhaps critical, importance. In terms of potential hypersensitivity to environmental stimuli, children with Autistic Spectrum Conditions (ASC), although with different aetiological correlates to trauma affected children, are known to face profound environmental challenges. Children with ASCs have received a wealth of attention in the literature with regard to these sensory challenges, whereas, in contrast, trauma affected children have received very little direct attention at all. It is the aim of this paper to focus on the environmental aspects of sensory processing in trauma affected children, specifically in relation to the physical environment of children’s residential homes.
from the Scottish Journal of Residential Child Care 2016 – Vol.15, No.1 Scottish Journal of Residential Child Care ISSN 1478 – 1840 6
Read the full article free here.
Occupational Therapists across the globe are increasingly using Ayres’ Sensory Integration in combination with other approaches to address trauma in both paediatric and adult clinical populations.
Jane Koomar’s work with children in this field is exemplary, developing the SAFE PLACE programme. The SAFE PLACE programme is a multi-disciplinary intervention approach to treating sensory integration, trauma and attachment concerns in children with sensory processing difficulties and complex trauma.
Read more here on OTAWatertown’s website about the programme.
In 2016 Teresa May-Benson summarised Dr Jane Koomar’s work and the SAFE PLACE programme in more detail in a white paper.
“Dr. Jane Koomar, an occupational therapist, in conjunction with psychologist Dr. Daniel Hughes, proposed a transdisciplinary model of collaboration among psychotherapist, occupational therapist, parent or caregiver and child to maximally meet the needs of children with sensory integration problems and complex trauma concerns including disrupted attachment. This model provides care across and within disciplines that is focused on the child-parent relationship. It is particularly concerned with the influence of the sensory, physical and emotional environment on that relationship. This ecological framework involves cross-training of professionals, through consultation, co-treatments, and education to provide each member with resources to facilitate sensory processing and self-regulation, trauma- healing and promote attachment within the boundaries of their skills and profession. The role of the mental health professional, occupational therapist or parent, level of collaboration and team coordination varies depending on the needs of the individual child.”
Teresa May Benson 20 May 2016 in a white paper “A Sensory Integration-Based Perspective to Trauma-Informed Care for Children”.
You can read the white paper here free here
Influence of Trauma & Attachment on Praxis in Children from ATTACh on Vimeo.
“It is so important not to be defined by tragedy, to be shaped by it but never defined by it” Amanda Holden – Britains got Talent
How can meaningful occupation and occupational therapy be useful in healing and recovery from trauma? and why should occupational therapists be trauma-informed?
This morning I was sent this video by a friend, I found it really powerful because not only is the story in itself one of beauty and empowerment but also because it ties together everything I have learnt this year about the use of meaningful occupation in both physical and emotional healing.
This incredibly moving dance routine was choreographed to pay tribute to the victims of the Manchester bombing.
The video tells the story of Holly whose aunt was killed in the attack. Like so many of the children who were at the Manchester arena that night, Holly has experienced both physical and emotional trauma. Physically, Holly broke her right knee, he left leg and foot was broken, she suffers from nerve damage and must use a splint to be able to walk. Holly has already had eleven operations to help her recover physically.
An occupation that had been meaningful to Holly before the attack came to play a central role in her recovery. Only a couple of days after it happened Holly was asking the medical staff…”When can I go back to dancing?” Dancing is meaningful to Holly, her mum describes it as being “everything to her”.
Because of the damage to her legs, returning to dancing may have seemed like an impossible goal for Holly. Through returning to dancing Holly has been empowered to shine, to show incredible bravery facing what, I can only imagine, are her worst fears in returning to a venue similar to the one where the attack happened. Social isolation is a real risk for survivors of trauma and those with physical disabilities, however, through grading and adapting the occupation and a desire to keep Holly dancing as part of the team the choreographer has done an incredible work in valuing Holly’s presence and contribution. It is a beautiful example of the importance of meaningful occupation and social inclusion in both physical and emotional healing.
For me, this video summarised the answer to a task I was given this year by my lecturer Sarah Bodell (OT)…
“Find a way to explain how occupation links to health and wellbeing, I want you to tell them this…What you do affects how you feel...”
After lots of thinking and hard work this superb horse themed Sensory Ladder was created to help make talking about being in the right space for learning at school easier. #sensoryladder #sensoryintegration
Reasonably priced and available from the Spiral Foundation
who ship this quickly to the UK and Ireland, the complete resource Adult/Adolescent Sensory History
- self-report questionnaire
caregiver questionnaire for parents/ caregivers of those unable to self-report
- shortened/abridged self-report for those not be able to complete the full self-report questionnaire
- a medical and developmental history form
- excel based scoring program that generates standardised scores of the full self-report and caregiver questionnaire to assist in identifying discrete patterns of sensory challenges in processing and integrating sensory information
The tool assists therapist clinical reasoning, goal setting and intervention planning.
While filing our journal articles for our course resources for participants files, I got distracted reading this article, which includes a lovely summery of evidence making links between sensory integration difficulties, motor co-ordination and articulation difficulties. A great article supporting possible links between motor praxis and oral praxis difficulties we commonly see in clinical practice. It reminded me of this phrase I learnt when being taught child development, sensory integration and NDT when I was a student OT a long time ago.
“What you see in the mouth you often see in the body.” Anon.
Read the full article free here.