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What survival looks like in school – a resource for understanding children with trauma

As children and young people go back to school here is a reminder of a fantastic resource from Inner World Work.

This parent and carer online resource and support site, explains how children with trauma might respond and react in difficult situations.

Beautifully illustrated and easy to read it is a great way to help teachers and other adults, who come into contact with children living with trauma, to understand a little more about what might be going on inside when children are in the protective survival states of fight, flight, freeze or submit.

Download the full pdf here


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Research Update: Bone, not adrenaline, drives fight or flight response [? could this be why proprioception helps reduce anxiety?]

Fascinating research adds to and challenges our existing knowledge. This recently published research is suggesting that the fight and flight response in vertebrates may in part be triggered by osteocalcin release via bones. This research raises so many questions regarding the evidence about why sensory integration may help support self regulation. It makes me wonder about the role of the heavy muscle work we all use as part of therapy and the sensory strategies we recommend to support self regulation at home and school.

Does activating proprioception sensors found in the muscles and tendons around our bones have a role in inhibiting release of osteocalcin? Does proprioception andvdeep pressure touch signalling via DCML alter or impact on osteocalcin release? And what’s the impact on GABA ?

planking is one of those heavy work proprioception rich activities that can aid self regulation for clients across the lifespan

A layman’s article about this interesting research can be found here:

Read the original research:

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Research Update: All about how one hospital is meeting the sensory needs of acutely unwell young people.

Meeting the needs of children with sensory integration and processing difficulties when they need cate for acute illness can be challenging for parents and medical teams. This study explores the development of a sensory care pathway to address this need.

“Objective: To identify pediatric patients with sensory sensitivities during a hospital visit, and to implement a clinical pathway that can meet their sensory needs. The goal is to remove barriers to care delivery that is related to the sensory need for pediatric patients who present with an acute medical illness.
Methods: The clinical pathway (identified as ‘Sensory Pathway’) was developed as a joint effort between key stakeholders within the community and medical providers. The pathway was conducted in a tertiary pediatric hospital from September 2016-April 2019. The main components of this pathway included- 1. Staff training; 2. Provision of sensory toolkits and story board; 3. Early collaboration with allied professionals; and 4. Early and continuous parental involvement. The Sensory Pathway was implemented first in the emergency department, followed by inpatient units. Patients triggered the pathway through caregiver or staff identification. Demographic of patients who triggered the pathway was extracted. A detailed qualitative analysis of any parents’ feedback received was performed.
Results: A cohort of patients with sensory needs was identified amongst pediatric patients who presented to the hospital with an acute illness. The most common comorbidity associated with sensory sensitivity/need was Autism Spectrum Disorder (48%), followed by cerebral palsy (22.8%) and Attention-Deficit/Hyperactivity Disorder (16%). 1337 patients (51.8%) had a single comorbidity while 45.9% patients had more than one comorbidity. Only 1.3% patients had a known diagnosis of sensory processing disorder. The pathway was triggered in 2,580 patient visits with 1643 patients and 937 repeat visits. The vast majority of patients who triggered the pathway had a medical presenting complaint (vs. behavioral). The following themes emerged from the parents’ feedback: 1. Additional help received specific to the child’s sensory needs; 2. Feeling of comfort; and 3. Improved overall experience.
Conclusion: The Sensory Pathway identified a unique profile of pediatric patients who have sensory needs during their hospital stay. The pathway was successfully implemented for children with sensory need in our hospital across a wide range of demographic and with varied medical illness.”

Read more about this exciting initiative here.

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Research Update: Sensory Modulation Disorder (SMD) and Pain: A New Perspective

Pain and sensory integration difficulties including sensory sensitivity are thought to be features in many disorders including CFS/ME and hyper mobility. Recent research and evidence is exploring the links.

Abstract “Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.”

Read more here: Sensory Modulation Disorder (SMD) and Pain: A New Perspective

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Research Update: Sensory Over-Responsivity as an Added Dimension in ADHD

Anecdotally many Occupational Therapists who use Ayres’ Sensory Integration to inform assessment and practice report the close links between ADHD and sensory integration challenges. This article by expert Sensory Integration researchers Shelley Lane and Stacey Reynolds offers research evidence and neuroscience in strong support of the links between differences in processing and integrating sensory input for those who meet criteria for a diagnosis of ADHD.

Abstract “Years of research have added to our understanding of Attention Deficit Hyperactivity Disorder (ADHD). None-the-less there is still much that is poorly understood. There is a need for, and ongoing interest in, developing a deeper understanding of this disorder to optimally identify risk and better inform treatment. Here, we present a compilation of findings examining ADHD both behaviorally and using neurophysiologic markers. Drawing on early work of McIntosh and co-investigators, we examined response to sensory challenge in children with ADHD, measuring HPA activity and electrodermal response (EDR) secondary to sensory stressors. In addition, we have examined the relationship between these physiologic measures, and reports of behavioral sensory over-responsivity and anxiety. Findings suggest that sensory responsivity differentiates among children with ADHD and warrants consideration. We link these findings with research conducted both prior to and after our own work and emphasize that there a growing knowledge supporting a relationship between ADHD and sensory over-responsivity, but more research is needed. Given the call from the National Institute of Health to move toward a more dimensional diagnostic process for mental health concerns, and away from the more routine categorical diagnostic process, we suggest sensory over-responsivity as a dimension in the diagnostic process for children with ADHD”.

Read the full article here: Sensory Over-Responsivity as an Added Dimension in ADHD

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Research Update: Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A School-Based Practice Case Example

From AOTA May 2019

“Evidence Connection articles provide case examples of how practice decisions may be informed by findings of systematic reviews sponsored by the American Occupational Therapy Association Evidence-Based Practice Project. This Evidence Connection article is the second article in a two-part series. The first article described a case report of occupational therapy provided to a child with a diagnosis of autism spectrum disorder and challenges in sensory integration in a clinic setting (Parham et al., 2019). This article describes the same child’s occupational therapy service delivery by the occupational therapist working in the school setting.”

Read more here: Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A School-Based Practice Case Example

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CPD Update: Neurodevelopmental Soft Signs: Implications for Sensory Processing and Praxis Assessment—Part One

An interesting read, this AOTA CE Article links sensory integration and processing difficulties and higher functions linked to occupation and participation. 
A table in the article links types of neurodevelopmental soft signs (NSS) in Occupational Therapy evaluation and underlying brain areas implicated in the literature, commenting that
“Integrating clinical observations of NSS with advanced brain-based research expands our understanding of the sensorimotor scaffolding that leads to higher functions of behavior organization, communication, and cognition.”
To access/buy a copy you can find out more here:
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Research Update: Sensory sensitivity and its relationship with adult attachment and parenting styles

“I was reflecting on the original ASI in MH case study I used when teaching about SI application in MH at a DBT Conference.

Convincing others SI was relevant beyond childhood and to my DBT colleagues in psychiatry in 2002 was a very tricky thing then. Wish I’d known then I’d be reading this today! How times have changed. “

Parenting styles vary in levels of both warmth and control, with evidence that type of parenting behavior is linked with social-emotional and other developmental outcomes for children. There are well-established associations between adult attachment and parenting styles. Given emerging evidence that people with different attachment patterns vary in how they receive and modulate sensory information, there are potential implications for parenting which have rarely received research attention. This cross-sectional study investigates the links between parenting style and parental sensory sensitivity, and the possible mediating role of parental sensory sensitivity in the relationship between adult attachment and parenting styles. A convenience sample of 155 parents of children aged 4–12 years old completed an online survey measuring: adult attachment (Experiences in Close Relationships-Modified 16-item Scale), sensory sensitivity (Highly Sensitive Persons Scale-Shortened Version), and parenting styles (Parenting Styles and Dimensions Questionnaire). Correlation, regression and mediation analyses were conducted. Analyses revealed that parents who reported more attachment insecurity also reported higher levels of parental sensory sensitivity, and more authoritarian and/or permissive (non-optimal) parenting styles. Parental sensory sensitivity was found to fully mediate the relationship between attachment avoidance and permissive parenting, and to partially mediate the relationship between attachment anxiety and both authoritarian and permissive parenting. This study represents the first quantitative evidence for associations between parental sensory sensitivity and parenting styles, and the mediating effect of parental sensory sensitivity on the known relationship between attachment insecurity and parenting. Awareness of a parent’s level of sensory sensitivity, in addition to his/her attachment style, may assist in developing effective strategies to meet both the parent’s and child’s needs and support the parent-child relationship.

Read more here:

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Research Update : Decoding Touch Sensitivity in Autism

“The inability to tolerate light touch is a telltale feature of autism and one of the disorder’s many perplexing symptoms. It has defied treatment and its precise origins have remained somewhat of a mystery.

Now, a study led by investigators at Harvard Medical School’s Blavatnik Institute has not only identified the molecular aberrations that give rise to heightened touch sensitivity in autism spectrum disorders but also points to a possible treatment for the condition.”

Read more here

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Keeping little ones barefoot can encourage a strong foundation for optimal development of the brain and nervous system.

Rather than buying expensive baby shoes, keeping little ones barefoot whenever safe and possible will encourage the development of their nervous systems. Read more in this article by Kacie Flegal, D.C.  here

toddler climbing on wall