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.
Submitted by guest blogger Ruth OT
Before I trained to be an occupational therapist, I studied neuroscience to masters by research level. It is so helpful in my work to have that underpinning knowledge of some of the things going on in the brain and how these affect behaviour. However, I don’t miss growing neurons in petri dishes and counting them.
Our kids are not great sleepers, to understate it considerably. We have had more sleep advice than anyone has any business accessing. It’s been variably effective. In the UK, there are several charities who offer sleep advice for children with special needs (Cerebra and Scope to name but 2), alongside advice from our children’s centres and child and adolescent mental health services (CAMHS). They’ve all been helpful, they’ve all prioritised the importance of a good consistent bedtime routine, on minimising distractions from sleep and on knowing your child’s sleep patterns. We have filled in more sleep diaries that you can shake a stick at (incidentally, this is the most effective way to make sure your child actually sleeps I have found! It’s amazing how well they sleep when you’re filling in a sleep diary to prove they never sleep).
I have promised myself I will stop reading sleep advice because I only get frustrated when we still don’t sleep, but here are some things we have found helpful (some nights at least!) and a little bit of the neuroscience of why.
Melatonin
One of our children along with many autistic people I know is taking melatonin at bedtime. The doctor tells us frequently that this is expensive, and we’d prefer to avoid medication as much as we can on general principle, so it’s worth knowing a bit about what melatonin does and how to boost it without medication.
Melatonin is a substance which the brain makes from the neurotransmitter serotonin, mostly in the pineal gland. The pineal gland is a tiny gland right in the middle of the brain and close to the visual centres of the brain. It starts making serotonin into melatonin when the light reduces, stimulating sleep onset. I don’t know whether my kids’ pineal glands are less efficient converters of serotonin to melatonin or whether their brains are less sensitive to the melatonin produced, but I just need some sleep so here are some ways we try to boost melatonin production.
Light and Screens
If melatonin is made when the light dims, it stands to reason that emphasising that light change is important, so we make sure they get lots and lots of daylight when we want them to be awake, and none when we want them to be asleep. This is not always easy in Northern England and involves a lot of getting wet and muddiness. We play outside every day we possibly can. When we can’t, we are lucky enough to have a big conservatory which we use as a playroom, and we have daylight effect lightbulbs in key rooms of the house which we use in daytime then switch to lamps in the evening. We have found that physical activity in the day can help with sleep, but if it’s all indoors such as soft play centres and swimming pools, it’s nothing like as effective as a walk outside no matter how wet the walk may be!
We have a no screens after the evening meal rule when sleep is particularly tough. Focusing visually on an (often bluish) glowing screen will inhibit melatonin production if you’re struggling to sleep, turn the technology off, it really does help.
We have blackout blinds behind blackout curtains and we close the doors of all the rooms that don’t have that every night (actually in our child who takes melatonin’s bedroom, we’ve made wooden boards which fit exactly into the window area over the Velcro blackout blind. Yes, I am serious…).
Serotonin
If melatonin is made from serotonin, it also stands to reason that it’s a good plan to have a lot of serotonin available to be converted. A large proportion of the antidepressants available have their effect by increasing the amount of free serotonin in the brain, this may explain some of why depression can affect sleep patterns. If you think mental health difficulties may be influencing sleep patterns, please talk to your doctor about this. It can be a vicious cycle that poor sleep exacerbates depression and depression then makes sleep more difficult, it is important to break that cycle.
Food
There are certain foods which contain tryptophan which the brain then makes into serotonin. I know some parents who swear by these in evenings, these include cherries, nuts, seeds, tofu, cheese, red meat, chicken, turkey (you know how we all fall asleep after Christmas dinner?), fish, oats, beans, lentils, and eggs. Just be aware that strong flavours and smells can be very alerting and so be less helpful than you’d think. Also, many of these can be allergens.
Movement
It’s also good to know that serotonin and melatonin levels rise with proprioceptive activity (movement against resistance, which helps the person to understand their own body more clearly), so including (not too vigorous) movement against resistance as part of the bedtime routine can really help- moving against the water in a warm bath, followed by squeezing yourself in a soft towel would be one example, or carrying a good sized box of bedtime stories up the stairs to bed. Movement of the head can also stimulate serotonin release in the brain and help sleep, just avoid spinning and sudden changes in speed or direction as these will counteract the effects.
Doing all of this does not mean you will get a good night’s sleep (I think we got about 2 hours last night!), but it might just improve your chances.
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?
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
Recent research from Tel Aviv University suggests that smoking cannabis can trigger schizophrenia.
The study provides evidence that in susceptible young people, smoking or using cannabis trigger schizophrenia. Susceptible young people include those for whom there is a familial history of mental illness.
Reference: Hadar Segal-Gavish, Neta Gazit, Yael Barhum, Tali Ben-Zur, Michal Taler, Shay Henry Hornfeld, Irit Gil-Ad, Abraham Weizman, Inna Slutsky, Minae Niwa, Atsushi Kamiya, Akira Sawa, Daniel Offen, Ran Barzilay. BDNF Overexpression Prevents Cognitive Deficit Elicited by Adolescent Cannabis Exposure and Host Susceptibility Interaction. Human Molecular Genetics, 2017; DOI: 10.1093/hmg/ddx139
You can read hear more about cannabis and the adolescent brain here:
The teenage brain and the behaviours it can drive in young people can be perplexing and often scary to the parents standing by, watching and supporting. Knowing” what is sensory and what is “just teenage brain” can be tricky to parents of young people with neurological diversity.
Neuroscience is helping us understand why teens can suddenly engage in extreme, rollercoastering unpredictable behaviours that challenge those caring for them.
Here is a lovely youtube explaining some of the neuroscience behind these often turbulent and troubled years.
Tomorrow at 6pm we will be exploring The Teenage Brain and Cannabis
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.
The first Sensory Ladders were made in 2001 for adults with sensory integration difficulties receiving help with mental health difficulties in Cornwall. Influenced by the paediatric Alert Program, they offered therapists a way to combine Dialectical Behaviour Therapy and Ayres’ Sensory Integration, addressing the development of the person’s self-awareness in collaboration with ward staff on an acute psychiatric inpatient unit.
The need to start with the person where they are at, before introducing learning about new ways of being, including the development of new skills, made it necessary for the Sensory Ladder to remain a very individualised and personalised journey within a close safe therapeutic relationship.
Both Ayres’ Sensory Integration(ASI) and Dialectical Behaviour Therapy(DBT) share a common understanding that development and change can only occur within a safe environment. The DBT idea of balancing safety and challenge reverberates strongly with Ayres’ concept of the ‘just right challenge’.
Creating a Sensory Ladder is about creating opportunities for an adult or child to learn to become aware of themselves in a new way – to explore and discover new things about mind, body and brain. It allows the therapist and person to do “curious wondering” together, and for the person to try new things – creating and promoting active but informed risk-taking; testing how we might feel and experience something when we do it differently; new ways of being – new ways of responding.
Making and using a Sensory Ladder is about the journey together within a safe therapeutic relationship. It’s about getting to see and know someone in a very different way, getting underneath the skin of behaviours that are perhaps being described by others as tricky or challenging.
The Sensory Ladder facilitates the reframing of behaviour that are a result of sensory integration challenges, providing the first step of acceptance of the behaviour necessary before strategies and therapy support development and change to happen.
To see more Sensory Ladders, visit our Sensory Ladder FB Page
Last week I found a copy of a therapy review that a young person wrote a few years ago.
“My sensory me is about me – and only me. It’s not about anybody else. It helps me be me. I don’t worry about what other people think I should be. I am starting to like me now. I’m not so sad anymore. Knowing why I’m different helps me to not worry anymore, and it means I can say what I need.”
He continued “before people told me what to do and how I should feel, and what I needed. It didn’t match up with what I really wanted. That confused me. It made me worry because I kept being wrong. When I did things, people didn’t understand what ‘made me’ do these things. I could see that, but I couldn’t understand why.
I loved therapy and all the stuff we could do. Making safe spaces on my first session helped me know you really knew what I was feeling inside. That was a bit scary. It was like you were a mind-reader. Then I got to know it was because you know about the brain and the senses, and you watch a lot. We did lots of experiments to discover how my body works. I liked that. All the stuff we got to use, the big golden hippo, barrel and all the swings. I loved playing Harry Potter with you – with the golden snitch, the hats and the magic wand. The swing was my fantastic flying broomstick. It was the best part of all. I liked to ride it with my cat. I really liked bouncing on the mattresses and trampette. And the hot chocolate with cream was the best.
It’s different now. I can stop and wait to find the words. Then I check it out. I have much less meltdowns. My Sensory Ladder helps me explain what is going on. I use it with my new Mum and Dad, my new Gran, my teachers and even my friends know that when I am a techy scratchy cat, then the snarly spitting cat is not far away and I need a sensory movement break.
And because of therapy, my body knows more now. I get it right more. I think I am just able to do everything easier. My new friends understand me better now. I don’t always get it right everytime.e, but it is better than ever before. I am calmer, clearer and concentrate better. I even join in with Netball now. My room is tidier now, and I can finally have shoes that have laces.
Thank you for helping me learn about how my brain is changing all the time. It means I didn’t have to worry about how it was wired. I could just work on making new wires ready for my new life.
In the beginning, therapy can be really scary. You don’t want anyone to know what is hard. The book we used to get to know more about my senses helped me know it might really work when I didn’t know it would.”
Here is a copy of the James’ My Sensory Me document including his sensory strategies – made during OT sessions. We made his Sensory Ladder together so others would know how to help and support me at school and home. He used it and practiced telling people his story until he didn’t need to use it anymore.
His Sensory Ladder was printed off and made into keyring sized tags to attach to his pencil case, his Foster Mum’s key ring with copies on the fridge at home, on his desk at school and a copy went to his first visit with his forever family.
“Our Harry Potter Therapy was the best thing I ever did and I will never forget it. I believe in the magic.”
The first Sensory Ladder was made in 2001. It is reported in articles published in 2006 and 2009.
Thank you to James’ and his forever family for allowing me to share his story, with a few changes made to protect his identity.
This feature article was written by Claire Smith, one of the first UK OT’s to deliver Sensory Integration alongside Dialectical Behaviour Therapy (DBT). I am delighted to introduce Claire to you, as she was one of the first people I ever lectured about how to apply Sensory Integration’s in Mental Health. That was way back in 2004 and tonight she features on a BBC Documentary – Girls on the Edge.
Here is what Claire would like to add about how Ayres’ Sensory Integration can be used when we work with adults who have trauma and related sensory integration challenges.
As a DBT therapist and SI Practioner I am fortunate to be able to deliver a full DBT programme, alongside an inter-disciplinary DBT team, provide ASI intervention and use sensory strategies that I believe make a real difference to people’s lives.
We combine sensory strategies with DBT skills that support young people to self-regulate and reduce high emotional arousal. These are personalised and individualised to each young person forming part of their positive behavioural support care-plan. Sensory strategies are often used to help young people become ‘talking therapy ready’ prior to starting DBT. There is much stigma around mental health and what it means to be in a secure unit.
Three teenage girls and their families will be sharing their stories and lookIng at the impact on families in a documentary on Thu 22nd Feb, Girls on the Edge, at 9pm on BBC2. Their bravery, openness and honesty helps to break some of this stigma.
The programme has footage of some of the activities offered at FitzRoy House and features glimpses of a number of OT’s I work with providing meaningful occupations and supporting young people in their journey to recovery.
You can see some short clips from the documentary here, and once it has aired, links to watch it again on the BBC.
You can learn more about DBT here.
This article from the New York Times talks about the importance of break time and free play to school children. Children often lose break time because they haven’t completed work or as a consequence for an undesired behaviour.
“…Recess also plays an important role in the ability to maintain self-control during class time. Self-control is not an unlimited resource, and by the time unstructured play rolls around, most children have depleted their reserves. They have had to resist the temptation to wiggle, eat the piece of cookie someone left on the carpet or talk to their friends in favor of focusing on math facts…”
To read the full article click here
