Our two day workshop is a “great opportunity to reflect on clinical practice and learn new skills”. Find out more about the application of Ayres’ Sensory Integration beyond childhood to support health and wellbeing.
This fantastic resource from Inner World Work, a 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.
Christmas time in school can be difficult for children with additional needs, changes in routine and new experiences can be hard to manage. Here is some advice from Its a Tink Thing with ideas for helping autistic children to be included in the Christmas play.
Here are some great hand-eye coordination activities for clients across the lifespan – some are especially good for teens! Try these with tweenies and teens with difficulties with sensory-motor coordination, to get them off devices and outdoors over the summer.
“Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination that causes a child to perform less well than expected in daily activities for his or her age, and appear to move clumsily.”
NHS Choices[accessed 1 July 2018]
Sometimes the terms we use as therapists are disputed in EHCP meetings or tribunals. The following quotes have proved useful in defending my own use of the terms in reports, especially when I link the term I use to the specific assessment tool I have used to do my assessment and clinical formulation.
Gibbs and colleagues 2007 described that “the definition of DCD is very similar to dyspraxia. A survey of health and educational professionals showed widespread uncertainty about the definitions of, and distinction between, DCD and dyspraxia. Furthermore, the rationale for using one or the other term in the literature has been unclear. Therefore, DCD and dyspraxia should be regarded as synonymous.”
When I use the Movement ABC-2, I will tend to use the term DCD, as the tool and the research about it are clearly linked. As our local NHS paediatric services use the Movement ABC-2 for diagnostic purposes, despite its limitations.
For some referrals, therefore, this is my tool of choice and the quickest way to ensure the child can access services because their condition is then officially recognised by teachers and the Local Authority. Thie example report is then how I report the results, ensuring I clarify the limitations of the tool, and that additional data and assessment has been undertaken to inform my clinical reasoning.
But when I use the term Dyspraxia, I am usually using it to refer to a pattern of praxis difficulties recognised in the research that we hypothesise interferes with participation in activities at home, school and out and about.
I will also use the COSA, OSA, SCOPE and MOHOST to gather information related to difficulties with participation in daily life and to set goals, and these can then also act as great subjective outcome measures. The impact of DCD/Dyspraxia on daily life is significant. Caçola 2016 described how Dyspraxia/DCD is considered to be “one of the major health problems among school-aged children worldwide, with unique consequences to physical and mental health.”
Poor praxis often means a person with little understanding of where their body is in relation to the world and so what to do next, making the plan and doing it becomes harder than for others. When this happens, our brain is unable to feel safe and secure, and so it is unlikely that the person can remain in a ‘calm and alert’ state.
For those who have poor praxis, a sudden increase in arousal often happens when a new or unfamiliar task is presented, because the previous failures to achieve success on sensory-motor tasks will trigger and raise arousal levels. This often means the person’s body is on ‘red alert’ – reactive to the world and small confusing changes happening within their own body. This may mean they are more likely to make decisions in flight, fight or freeze mode, resulting in behaviours that challenge others. The underlying problem is the praxis deficit not sensory reactivity in response to a perceived threat. This is why thorough assessment is required.
Arousal and alertness, sensory modulation and praxis are interwoven with a complexity that is often missed by others and those new to learning about sensory integration theory and practice. Praxis difficulties that result in behaviours that challenge others are often labelled as sensory modulation difficulties, however digging deeper will often reveal praxis deficits underpin the dysregulated behaviours and attempts to get control. This is very true of our clients who have dyspraxia co-occurring with mental health difficulties. We ignore and disregard praxis at our peril. Left unaddressed, praxis deficits continue to interfere with participation in daily life, skill development and self-esteem unabated.
Watch this young person’s story about living with dyspraxia.
How is a diagnosis made?
For a diagnosis of DCD to be made, your child usually needs to meet all of the following criteria, in some areas of the UK this requires a score below a cut off on the Movement ABC-2 Test.
motor skills are significantly below the level expected for their age and the opportunities they have had to learn and use these skills
the lack of motor skill is significant and persistently affects the child’s day-to-day activities and achievements at home and at school
the child’s symptoms first developed during an early stage of their development
the lack of motor skills isn’t better explained by
a delay in all areas of development (general learning disability)
other medical conditions; such as cerebral palsy or muscular dystrophy
Usually, DCD is only diagnosed in children with a general learning disability if their physical coordination is significantly more impaired than their mental ability.
What about DCD/Dyspraxia and Autism?
In numerous studies, the links between autism and praxis skills have been reported.
In 2016 Cassidy published important findings from a study, showing that
Dyspraxia/DCD is significantly more prevalent in adults with Autism
Motor coordination difficulties commonly co-occur with Autism
Dyspraxia is associated with significantly higher autistic traits and lower empathy in those without Autism.
These results suggest that motor coordination skills are important for effective social skills and empathy. This is clearly seen in children and young people presenting in clinics who struggle to know how to make friends, ask for the help they need and can’t understand others feelings and frustration.
What about DCD/Dyspraxia and Speech and Language Difficulties?
In 2012 Stout and Chaminade stated that “long-standing speculations and more recent hypotheses propose a variety of possible evolutionary connections between language, gesture and tool use. These arguments have received important new support from neuroscientific research on praxis, observational action understanding and vocal language demonstrating substantial functional/anatomical overlap between these behaviours.”
Listen to this Speech and Language therapist describe the links between speech and language concerns and tone, more general praxis and motor coordination difficulties.
“Early trauma is stored in the body via the senses, this is why therapy through the senses is effective.”
Smith, K BPD and SI 2004
Occupational Therapists are ideally placed to work through play and via the senses to promote the development of healthy neurological pathways and structures; impacting the development of sensory motor skills and abilities that underpin our ability to move, learn, play, develop, communicate, think and process emotions.
Sensory integration is integral to the process of healthy development ‘when the functions of the brain are whole and balanced, body movements are highly adaptive, learning is easy and good behaviour is a natural outcome’
They can do this with clients who are very young, or those who are adults with childhood trauma, who often find talking therapies very hard to engage with as the trauma memories are stored before language has developed, so are instead stored in the body and via the senses.
These young people do need trauma-informed schools, but this is not enough! The problem with whole school approaches to trauma is that for these children whole school strategies are not individualised and personalised and as such, are not specifically targeted. Specialist assessment and intervention is needed for these young people to reduce the impact of trauma on their young plastic brains, still in development.
Postgraduate education in Ayres’ Sensory Integration theory and practice alongside undergraduate education in infant and child development means that occupational therapists are ideally placed to address the sensory-motor needs of looked after children who have often been subjected to trauma in utero and early childhood.
Ayres’ Sensory Integration is a theory that suggests that brain “maturation is the process of the unfolding of genetic coding in conjunction with the interaction of the individual with the physical and social environment. As a result of experience, there are changes in the nervous system.”
Spitzer and Roley 1996
Sensory qualities of the environment can positively or negatively interact with function and development.
Schneider et al, 200
Occupational Therapists working in this area are able to use a discreet but comprehensive range of skills and resources within their scope of practice to offer direct one to one sensory integration – based intervention. These may be with the individual child, while also supporting foster and adoptive families, and typically includes parent participation in therapy. Occupational therapists will also offer parent and family education and work alongside schools and other organisations via a consultation model, offering education, in-service training, supervision for staff.
“Adopted children who have suffered traumatic early experiences are “barely surviving” in the current high-pressure school environment and need greater support if they are to have an equal chance of success, a charity has said.
They are falling behind in their studies because they are struggling to cope emotionally with the demands of the current education system which “prizes exam results at the expense of wellbeing”, according to a report from Adoption UK.”
The development of Occupational Therapy care pathways for children, adolescents and adults with trauma is increasing, as the role of Occupational Therapists in this area is increasingly being recognised.
‘Sensory Integration sorts, orders and eventually puts all the sensory inputs together into whole brain function.’
What emerges from this process is increasingly complex behaviour, the adaptive response and occupational engagement.
Allen, Delport and Smith 2011
You can read more about work in this area by following these links:
1. May–Benson, T. A. (2016). A Sensory Integrative Intervention Perspective to
Trauma–Informed Care. OTA The Koomar Center White Paper. Newton,
3. Werner, K. (2016) “Occupational Therapy’s Role in Addressing the Sensory Processing Needs of Young Children with Trauma History” Entry-Level OTD Capstones. 8. http://commons.pacificu.edu/otde/8[accessed Jul 01 2018]
Supporting development is everyone’s business. If you are a therapist practicing Ayres’ Sensory Integration, parent education and support between sessions with sensory rich activities to support development through ploy is likely to be a part of what you do. The resource includes downloadable printable activities guides for different ages, that will make great handouts for parents and teachers. Another great resource from Harvard..
Parents bringing their children to therapy are dedicated – no matter who is funding the therapy. A weekly commitment to therapy sessions while juggling family life will test even the most organised Mum or Dad’s diary and working day. Fun easy to do activities that can support therapy and provide ideas for what to do when the ideas run out are a bonus.
These activities in this resource from Harvard are just so much more. Research has shown that this collection includes age-appropriate activities and games that adults can use to support and strengthen executive function and self-regulation skills in children.
On our courses, we teach staff from CAMHS and adult/older adult mental health services how to use Ayres’ Sensory Integration to inform care including for those who have had early trauma.
On our in-house courses, we regularly teach mixed staff teams including Mental Health Nurses and Healthcare Assistants, CPN’s, OT’s, PT’s, SLT’s and Therapy Support Staff, Complementary Therapists, Psychologists and Psychiatrists. Working with staff teams from forensic, secure, acute and longer stay units, our lecturers help teams to develop and implement sensory informed care pathways. This includes working with sensory providers to develop secure safe sensory rooms for safe self-regulation and sensory-rich movement activities suitable for secure and forensic environments, where ligature risks mean traditional swings and other equipment cannot be used.
The use of Ayres’ Sensory Integration to support health and well-being has grown across the UK and Ireland.
The research and evidence base is expanding across the globe, with more clinical audits and studies being published that report that Ayres’ Sensory Integration is
promoting participation in everyday life
increasing clients ability to engage with others, with therapy
this means that there are significant reductions in
days in secure or acute care
the use of PRN medication
the need for the use of physical support aka TMAV
We’d like to thank Tina Champagne for pointing us in the direction of this resource which fits so neatly alongside the resources and tools we teach on our courses.
Tina is a critical friend of ASI WISE and wrote several chapters in this free online resource about developmental trauma and practical ways to institute trauma-informed care.
Resources for Eliminating Control and Restraint aka Therapeutic Manage of Aggression and Violence
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
The ASI Wise lecture team have been at Abbot’s Lea School in Liverpool this weekend with a fantastic group of committed and enthusiastic occupational therapists, speech and language therapists and teachers exploring the use of sensory strategies and Ayres’ Sensory Integration therapy to support children, young people and adults mental and wellbeing health.
Experiential learning opportunities, embedded into the course, help participants to understand their own sensory systems and to experience the challenges that the people they are working with face on a daily basis.
With a mixture of classroom-based and hands-on practical learning, participants explored how to use the spaces and environment available in both school and clinic to support regulation and praxis. The workshop provided an opportunity to hear about the theory and practice of Ayres’ Sensory Integration, it’s application supporting those with autism, ADHD and dyspraxia, with up to date research and evidence supporting practice.
To find out more about our courses and learning here
We are so grateful to Abbot’s Lea School who have allowed us to use such a beautiful spacious venue. The three lovely well-lit rooms allowed us to create a pop-up sensory clinic, where participants had space to move about; extra room to break into groups supporting learning and the sharing of ideas. The school staff and local therapist volunteer support team have been incredibly welcoming and supportive, helping the workshop to run smoothly. As a bonus, the sun has shone all weekend which has allowed us to use the outdoor spaces, we have spotted a few daffodils and blossom trees around the city – it feels like spring is on its way.
Thank you to our volunteer therapists who helped to make the weekend such a success.