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Helping Autistic Children Manage the School Christmas Play

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.

https://itsatinkthing.com/how-to-help-an-autistic-child-to-manage-the-school-christmas-play/

Christmas photo 1495318_541193059305224_1470605699_o

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Summer fun ideas for challenging Tweenies and Teens

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.

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Dyspraxia or DCD, what term and recommendatons do you use in your EHCP’s and why?

pexels-photo-1040427“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 word 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.”

art assess communication conceptual

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. 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 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.

DCD Proforma

But when I use the term Dyspraxia, I am usually using it to refer to a pattern of praxis difficulties recognised in the research about Ayres’ Sensory Integration. When we do this, we hypothesise that underlying sensory deficits, usually in the proprioceptive and tactile systems, interfere with active and effective participation in activities of daily life at home, school and out and about.

This pattern is typically identified by gathering a history of development and functional difficulties, Ayres’ Clinical Observations and the Sensory Integration and Praxis Test. I like the history form in Schaaf and Mailloux 2015 and the Sensory Processing Measure or for adults the Adult/Adolescent Sensory History.

people in front of macbook pro

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. These can then also act as significant subjective outcome measures. The impact of DCD/Dyspraxia on everyday life is meaningful. 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 limited body awareness 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.

children riding bicycle

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 usually 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 a 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 responses 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 essential findings from a study, showing that

kid s plating water on grass field during daytime

  • 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 essential 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.

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Early trauma is stored in the body via the senses, this is why therapy through the senses is effective

“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
boy wearing gray hoodieOccupational 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’

Ayres, 1979

girl jeans kid lonelinessThey 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
IMG_2043
created, a sensory ladder key ring with football players, to support a young man with trauma to develop improved self-awareness and how to communicate what he needs and when to others

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.”

from The Guardian 27 June 2018

https://www.theguardian.com/society/2018/jun/27/adopted-children-barely-surviving-in-high-pressure-schools

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.’
Ayres 1979
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. MayBenson, T. A. (2016). A Sensory Integrative Intervention Perspective to
TraumaInformed Care. OTA The Koomar Center White Paper. Newton,
MA: OTA The Koomar Center(PDF) A Sensory Integration-Based Perspective to Trauma-Informed Care for Children. Available from: https://www.researchgate.net/publication/303383214_A_Sensory_Integration-Based_Perspective_to_Trauma-Informed_Care_for_Children [accessed Jul 01 2018]
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]
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CPD on the Sofa: An Activities Guide for Enhancing & Practicing Executive Function Skills

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.

Follow this link for more information and access to these great downloads: developing-child.harvard.edu/resources/activities-guide-enhancing-and-practicing-executive-function-skills-with-children-from-infancy-to-adolescence/