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Research update: Forest design for mental health promotion—Using perceived sensory dimensions to elicit restorative responses

Forest design for mental health promotion—Using perceived sensory dimensions to elicit restorative responses, research into the qualities of the natural environment which promote restoration

forest design for mental health promotion - research update

download full article – open access pdf here  

 

gray bridge and trees

 

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Health and Safety Fears Getting in the Way of Child Development

Ofsted has warned that some early years education providers have “undue concerns” about letting children play outside, climb and run around. These health and safety fears are hindering children’s ability to build up muscular strength and dexterity.

Without taking risks, children’s “natural inquisitiveness” is stifled, Ofsted’s annual report said, “In the early years, a crucial part of preparing children for school is developing their muscular strength and dexterity…

Read more in this article in the Telegraph

Ofsted is the Uk government’s Office for Standards in Education, Children’s Services and Skills. Ofsted inspects and regulates schools, services that care for children and young people, and services providing education and skills for learners of all ages. The full report is available here 

blur boots child childhood
Photo by Lela Johnson on Pexels.com
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News story – UK Government review to improve the lives of autistic children

“The government will collect evidence from autistic children, their families and their carers on how to improve the support they get… Supporting people on the autism spectrum or with learning disabilities is one of the 4 clinical priority areas in the NHS long-term plan…”

Read more on the UK government website gov.uk 

https://www.gov.uk/government/news/government-review-to-improve-the-lives-of-autistic-children

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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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Neuroplasticity Infographic

This beautiful and detailed infographic originally created by Alta Mira, San Francisco, is a great introduction to neuroplasticity you can see the infographic below and read more about it here

Rewiring_the_Brain_Infographic_1

Rewiring_the_Brain_Infographic_2

https://bigthink.com/ideafeed/this-nifty-infographic-is-a-great-introduction-to-neuroplasticity

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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 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.”

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. 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.

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 that we hypothesise interferes with participation in activities 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, 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.

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 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

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 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.

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Trauma and development of the brain.

Watch this amazing TED about trauma…here’s a taster of what Nadine Burke Harris will share with you in her presentation, which explores the underlying neuroscience.

close up photography of grizzly bear

Well, imagine you’re walking in the forest and you see a bear. Immediately, your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal gland that says, “Release stress hormones! Adrenaline! Cortisol!”

And so your heart starts to pound, Your pupils dilate, your airways open up, and you are ready to either fight that bear or run from the bear. And that is wonderful if you’re in a forest and there’s a bear. (Laughter) But the problem is what happens when the bear comes home every night,and this system is activated over and over and over again, and it goes from being adaptive, or life-saving, to maladaptive, or health-damaging.

Children are especially sensitive to this repeated stress activation, because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.”

<div style=”max-width:854px”><div style=”position:relative;height:0;padding-bottom:56.25%”><iframe src=”https://embed.ted.com/talks/lang/en/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime” width=”854″ height=”480″ style=”position:absolute;left:0;top:0;width:100%;height:100%” frameborder=”0″ scrolling=”no” allowfullscreen></iframe></div></div>

 

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About the senses and development.

Our seven senses are critical to early development. Watch this video below to see more.

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Ayres (1972) defined sensory integration as “the neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment”

When they do not work well, or the environment we live in does not allow this to happen, we can’t get the sensory information our bodies and brain need. This interferes with our development, learning and participation in all the activities of our everyday lives.

pexels-photo-1166990“Sensory integration difficulties can influence self-regulation, movement, learning and interaction with others.”

Allen and Smith 2011

 

You can watch more here.

 

 

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Please don’t say… “She seems fine to me…”

Submitted by guest blogger, Ruth OT.

In my time as a special needs parent, I’ve had a variety of responses to telling people my child has special needs. Some responses have been great, others have left me crying all the way home. Literally. Some have opened up conversations, others have shut them down. I know that those people who have not been so helpful have just been looking for the right thing to say and found the wrong one. So here are some cues to think about what you’re saying. Remember when the parent says the “we think (s)he might have….” Or “(s)he’s got…” they are very vulnerable. They will have cried and fretted and lost sleep over the information they are giving you and they will be at some stage of processing that information. If they are giving you that information, they either need you to change the way you are interacting with their child, or they need to talk about it. Choose your words carefully to open up the conversation and hear what they’re trying to tell you.

three-signs-in-male-fists-saying-stop-wait-and-go-isolated-on-a-white-C1ECPD

Please don’t say: “(s)he seems fine to me”. I know you’re trying to be reassuring, but by saying this, you imply that you are more able to identify the child’s developmental needs than the parents and the professionals working with the child. It pretty much shuts the conversation down, but if it continues, you force the parent into the role of pointing out their child’s deficits while you defend them. This is not a natural way of things, the parent spends enough time pointing out their child’s deficits with professionals, you need to enable them to big their child up and point out what a wonderful person they are.

Say instead: “I hadn’t noticed. What’s going on?” By saying “I hadn’t noticed”, you can reassure the parent that it isn’t that obvious, but also put yourself not the parent in the position of the person who needs educating about the child. You open up the conversation, and you give the parent the choice about how much information to give you, they might just tell you a load of assessments and appointments or they might tell you what the child is struggling with. It’s up to them.

Please don’t say “I couldn’t do it” the truth is you could. Of course, you could and a whole lot more, if that was what your child needed. Don’t point out how lucky you are that you don’t have to. The parent might well be wondering whether they can do it, and how long they can keep doing it for, they need you to reassure them that they can keep going.

Say instead “I really admire the way you’re doing it” This way, you’re complimenting the parent, you’re recognising how hard they’re working but you’re not sowing that seed of doubt that they might not be able to keep going.

Also, say “how can I help you do it?” they probably won’t know, but they’ll really appreciate being asked. It might be as simple as “watch my child while I have a pee in peace”. Do that. Then offer to do that again, don’t wait to be asked.

Please don’t say “(s)he’ll catch up” (s)he might well not. People were telling me this when the doctors were telling me she might well steadily regress. It wasn’t reassuring, it was frustrating. Again, it puts you in the position of the expert over the parent and professionals and the parent in the role of pointing out the deficits. Parents do not want to point out their child’s deficits, please don’t make them do it. Please don’t encourage the parent to compare their child to typically developing children, the only person a child needs comparing to, to track their learning is themselves.

Say instead “what does (s)he really love doing?” Give the parent a chance to gush about their kid, what they love, how much fun they are etc. Most parents will leap at this chance, it’s so refreshing after appointment after appointment telling professionals what their child can’t do.

Please don’t say “is there a cure?” The child may well not need a cure, they’re probably not ill. If the child is ill and there is no cure, they really won’t want to keep repeating that and if they know there is a cure, they’ll be doing it. Trust me, they will have researched treatment options very thoroughly.

Say instead “what are you thinking about for the future?” Again, keep it open. The parent might be trying really hard not to think about the future, they might well be taking one day at a time or they might be able to think of nothing else. They can choose how to interpret “the future” in your question and might tell you about getting them to eat just one more type of food or school support options, or they might be racing ahead to adulthood prospects.

Please don’t say “have you tried…?” again, you’re putting yourself in the role of expert with this one and the parent in the role of person to be taught how to raise their child. Unless you’re really actually a professional expert in what you’re suggesting, and you’ve spent time really interacting with the child, please just don’t.

Say instead “what do you think might help?” A parent who thinks their child has some additional needs will have done very thorough research, trust me. Give them time to talk about what they’ve learned. They might say “nothing” and then you’ll feel really awkward. Live with that, they feel awkward a lot of the time. They’ll probably tell you things that have been suggested and why they think/ don’t think that’s any good. Listen.

Please don’t say “you won’t want to come” Don’t presume, parenting a child with additional needs is isolating and exhausting. They might say no. Don’t be offended if they do but give them that option.

Say instead “I know (s)he finds this difficult, but I wanted to invite you in case you think they’d like it” Invite the child, acknowledge that it might be hard for them and they might want to say “no” and that’s OK, but make sure they know you want them there and you value time with them.

Please don’t say too much in front of the child. Remember they may well understand more than they can say and for any child seeing their parent upset is confusing and frightening.

Say instead “how am I best to communicate with him/her?” Then get down on the floor and do it. Playing with a child, talking with them on their level and really getting to know them is the biggest compliment you can pay the child and the parent.

My biggest advice if someone is telling you their child seems to have additional needs or a developmental difficulty is to listen to them, make them feel validated, treat them as the expert on their own child and don’t belittle their experiences. Your role is not to fix the child, you can’t do that. Your role is to support the parent, build their confidence and to be their friend.

black and white boys children curiosity

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NEWS: Sensory Integration in Playgrounds from Landscape Architecture Magazine

This is a great article about a study Lucy Miller has conducted in a playground.

It also talks about Lucy’s motivation to study OT because of personal experiences when she lost her vision, including a summer mentorship to learn from Jean Ayres

You can read more here: landscapearchitecturemagazine.org/tag/sensory-integration-disorder/