Treatment for Sensory Processing Disorder

Sensory processing disorder (SPD) can make participation in life activities—what occupational therapists refer to as occupations—very difficult. Luckily, there are options and strategies to help improve sensory processing and make life much smoother and more enjoyable.

DSCN0996

Sensory-based occupational therapy (OT), may look like play to adults, but to the child it is their work and necessary for improving overall abilities to process sensory information more appropriately. Jumping, swinging, climbing and playing in multisensory mediums—such as shaving cream, beans, rice, or play dough—all have a place in their growth and the development of sensory processing abilities.

As the child plays and learns more about their body and how to use it through treatment for sensory processing disorder, their brain improves its ability to process sensory information more efficiently. These children are then able to handle situations more appropriately and participate in everyday activities including self-care, fine motor and social skills.

This process can take months for long lasting effects, but parents often see a difference after the first few visits.

Occupational therapists that specialize in SPD and autism are especially adept at helping individuals on the spectrum succeed. These therapists are skilled in testing and providing treatment, compiling strategies to modify the environment, developing home programs, and giving suggestions to schools and vocational programs to improve participation in life’s activities.

When looking for an occupational therapist, it is important they have advanced training in sensory integration or SPD and, if possible, are SIPT (Sensory Integration and Praxis Test) certified.

Though occupational therapy services may be provided in a variety of settings—including home and school—the clinical setting is much more conducive to treating SPD and the underlying causes of the child’s difficulties. This is because a clinic will have specific equipment designed to promote engagement in therapy and develop skills necessary to overcome sensory difficulties.

You also want to make sure they have an OT gym that is well equipped to treat SPD.  A phone call and an interview with the therapist may be beneficial.

Find a SIPT Certified Therapist

by Dr. Gayla A. Aguilar, OTR, OTD

Does your child have a sensory processing disorder? How does your occupational therapist help?

Motivation for Those with Aspergers: Using Reinforcement Effectively

Motivation is key when using reinforcement to change the behavior of individuals with Aspergers or HFA.

When you think about it, it makes sense that motivation is at the center of it all. If a child or individual is motivated, they are more willing to make certain changes in their behavior and do what you want.

Highway road going up

Using motivation as a behavioral tool for change occurs for neurotypicals as well. For example, if there is a position available at work that someone wants, the individual will modify their behavior to increase the chances of obtaining that position.  The specific change in behavior is a direct result of motivation (as in wanting the position).  If the position was not available, the person would less likely be engaging in the changed behaviors.

That said, there are two ways to manipulate motivation:

Deprivation

Deprivation means reducing the amount of access your child has to the reinforcer, also known as the item or activity that will be used to motivate the child to increase or decrease behavior. Deprivation increases the value of the reinforcer.

Example:  If a child absolutely loves Cheetos but has free access to them, a behavior analyst would use deprivation to increase the value of the Cheetos. Now the child can only access them if he or she performs as expected. Since the child has less access to the Cheetos but still loves them, the child is more willing to do what is asked to obtain the Cheetos—motivation.

Satiation

Satiation, on the other hand, means increasing the amount of access your child has to the reinforcer. Satiation is meant to decrease the value of the reinforcer, which is something to keep in mind when choosing a motivational tool.

Example: If a teenager receives an iPad, an object he is fascinated with, as a reinforcer and is the only reinforcer being used, it is likely that after a period of time the child will lose their interest in the iPad resulting in satiation (the iPad no longer has a strong value).

Behavior Analysts use deprivation to increase the value of the reinforcers to motivate the individual with Asperger’s or HFA, and are cautious of satiation to make sure the reinforcer does not lose its value. This encouragement can be used to help them to adapt in a situation or adjust behavior appropriately.

by Adriana Sanchez, MA, BCBA

Social Language or “Pragmatics”

Your child may not know how to use language appropriately in social situations. This undeveloped social skill can cause your child to unintentionally say harmful or rude comments to others. Even when able to say words clearly in complex sentences with correct grammar, a child still may have a communication problem – if they have not mastered the rules for social language known as pragmatics.

Speaking head

Pragmatics includes three major communication skills:

  1. Using language for different purposes

    • greeting (e.g., Hello, goodnight)
    • informing (e.g., I’m going to go to bed now.)
    • demanding (e.g., Turn out the lights, please.)
    • promising (e.g., I’m going to wake up early and make waffles.)
    • requesting (e.g., I would like an extra blanket.)
  2. Changing language according to the needs of a listener or situation

    • speaking differently to a toddler than to an adult, or with a sibling vs. a teacher
    • sharing background information with an unfamiliar listener
    • speaking differently in a movie theater than on a playground
  3. Following rules for conversations

    • turn taking
    • introducing a topic of conversation
    • staying on topic
    • rephrasing when misunderstood
    • using verbal and nonverbal signals
    • knowing how closely to stand to others
    • using appropriate facial expressions and eye contact

Remember: It is important to understand the rules of your communicative situation.

An individual with pragmatic problems may:

How to Expand A Picky Eater’s Diet: Feeding and Food Chaining

Since feeding involves all sensory systems (sight, smell, sound, touch, and taste), eating is the most difficult sensory task that children face. Feeding issues are especially common in children with autism, including those with Aspergers, because of difficulties with sensory processing. In many cases, this leads to eating challenges at mealtimes.

Little girl eating

“Food chaining,” from the book by the same name, is based on the child’s natural preferences and successful eating experiences—specifically the idea that we eat what we like. Food chaining introduces new foods that have the same flavors or sensory features as foods that are already preferred by the child, increasing the likelihood that the child will like the food.

A food chain consists of four levels that build upon one another. By following the levels of the food chain, the child will be able to build upon success with small changes.

For example, if your child’s accepted food is chicken nuggets, a sample food chain might look like this:

Level I Level II Level III Level IV
Maintain & Expand Current Taste & Texture Vary Taste & Maintain Texture Maintain Taste & Vary Texture Vary Taste & Texture
Other brands and sizes of chicken nuggets (i.e., strips/popcorn/bites, both fast food & home-prepared); fried chicken patties cut into pieces (fast food & home prepared) Different flavored chicken nuggets (barbeque, honey mustard, hickory smoked, etc.) Use sauces/dips to vary tastes. Chicken strips (not breaded); chicken leg/drumstick; chicken breast; ground chicken patties Breaded seafood (scallops, shrimp); breaded fish (fast food & home-prepared); breaded turkey breast; breaded vegetables; breaded baked chicken; crusted/breaded pork tenderloin; ground meats

Here are some other food chaining tips:

Moving Beyond Black and White Thinking and Learning to Live in the Gray Area:

Using Floortime as ABA Tactic

Once a child is becomes more competent in his or her ability to think multi-causally, the next focus of higher level social-emotional thinking is the capacity to understand the gray areas of life. Adolescents and young adults with Aspergers or HFA are especially prone to hitting an emotional rut when speaking in terms of “never” and “always”—hallmark terms associated with “black and white” thinking.

IMG_0365

“He never calls on me during class” or “She always gets to play the game first” are common phrases that parents or peers hear when the speaker’s ability to think and feel in more varied degrees is constricted. Not only is this harder to negotiate socially for the partner, but it’s not a very fun state for the black and white thinker either. Such polarized patterns of thinking can lead to social isolation brought on by the extremity of the speaker’s emotional response.

Getting unstuck can be supported through Floortime, where the parent or the therapist can spotlight the child or adolescent’s black and white ideation.

For example, Jason is a young teen with Aspergers who states that he never gets to play his media after school. Jason becomes agitated when discussing this with his mother and his therapist, flooded by feelings of anger and sadness that he has difficulty modulating.

The role of Floortime therapist or supported parent in this dynamic might be to:

Understanding Crisis Behavior in People with Aspergers

Some individuals with Aspergers or HFA may engage in crisis behavior that interferes with their learning, puts themselves or others at risk, prevents them from participating in various activities, or impedes the development of relationships. Crisis behavior can range in severity from low productivity to meltdowns that involve aggression, self-injury, or property destruction. Many individuals unfamiliar with Aspergers may believe these types of behaviors are intentional and malicious. However, it has become well known that problem behaviors often serve a function for the individual engaging in the behaviors. Additionally, deficits in the areas characterized by Aspergers may impact behavior.

Stressed teen girl screaming, shouting

Characteristics associated with Aspergers and how it may lead to crisis behavior:

Cognition

Asperger’s Syndrome is a neurological disorder that impacts the way that individuals think, feel, and react. Individuals with Aspergers are believed to react “emotionally” rather than “logically” during stressful situations and are unable to maintain self-control.

Generalization

Some individuals with Aspergers or HFA may have difficulty applying information and skills across settings, individuals, materials, and situations. Even though socially appropriate alternative strategies have been learned, the individual may be unable to “recall” the strategies while stressed.

How to Deal with Sensory Processing Difficulties in School

Many children with sensory processing disorder or related issues can have difficulties in the school setting. Problems can arise anywhere: in the classroom, cafeteria, gymnasium, hallway, playground, and even the bus. Some of these issues can be as subtle as not eating lunch, or as difficult as destroying a classroom.

Knowing what causes these problems and how to prevent them is important for both the school and the child. This is where parents can be the best advocate for their child with Aspergers or HFA and sensory issues.

Preparing a child for school is important, but it is equally important to prepare the school for the child.

Sharing their sensory concerns with the teachers, para-professionals, principals, and others is imperative to limiting sensory difficulties in the classroom.

A typical plan should include setting up a sensory-friendly classroom with a place for the student to “get away” if necessary, providing sensory activities throughout the day to help prevent problems that may arise, catering to sensory diets, and preparing the student for changes or surprises that may come up.

A school occupational therapist can help make all of this easier, if they get involved. The occupational therapist can help teachers discover problem areas and learning differences, while providing suggestions to improve success.  Some ideas they may implement include setting up lunch bunches to relieve lunchtime stresses, providing sensory activities to use throughout the day that support the student’s ongoing needs, or modifying instruction for classroom success.

Together, the parents, teachers, and occupational therapists can develop a program that is individualized for the student with sensory issues and make this year both successful and rewarding.

For more information on sensory friendly classrooms and teacher resources, go to Future Horizons Inc. There are multiple books and other resources to help the teacher prepare for these students.

by Dr. Gayla A. Aguilar, OTR, OTD

Transitioning to Adulthood with Aspergers

Individuals diagnosed with Aspergers or another autism spectrum disorder (ASD) may be presented with many challenges throughout their lives—especially during the transitional periods. As the individuals age and learn to use different skills in various environments, families, educators, medical professionals and the individuals themselves begin to anticipate the transition to adolescence and, eventually, to adulthood. Given the differences in abilities and behaviors that many individuals with Aspergers or HFA experience, it can often be overwhelming to plan for tomorrow much less several years later.

IMG_0879

Among the many skills that an individual must learn to successfully transition to adolescence and adulthood, daily living skills are often neglected.

Examples of daily living skills are bathing, grooming, preparing meals, managing finances, using public transportation, etc. These daily skills are necessary for independent functioning in the home and within the community.

A recent study discovered that individuals with ASD improved in daily living skills during adolescence and the early twenties. These skills plateaued around late twenties and began to decline in the early thirties—this shows the importance of honing these skills earlier in life instead of waiting until later.

Some positive findings were that inclusive schooling had a positive influence on adult outcomes. The study also found, “that vocational independence predicts improvements in autism symptoms and significant improvements in behavioral problems.” Daily living skills could also be increased by engaging in some type of work activity.

It is encouraging that daily living skills can continue to be gained at later points in development as other skills plateau. The authors suggest that more research is needed to develop behavioral and pharmacological interventions for older individuals on the autism spectrum.

While individuals with Aspergers or HFA may have challenges with the daily living skills necessary for transitional periods, it is important for their independence and quality of life to begin this journey at an early age to ensure success.

by Lupe Castañeda, M.S., BCBA

Have you thought about or experienced the transitional periods in your or your child’s life?

How did you cope with these experiences? 

Sources:

Smith L.E, Maenner, M.J. & Seltzer, M. (2012). Developmental Trajectories in Adolescents and Adults with Autism: The Case of Daily Living Skills. Journal of American Academy of Child and Adolescent Psychiatry.  51(6): 622–631.

5 Focuses For Creating a Learning Environment in the Home

Continued learning experiences after school

When it comes to setting the stage for learning, individuals on the Autism Spectrum need to continue their learning experiences even after school. This requires responsibility from therapists, caregivers, and parents. Each must work together to help create a learning environment in the home that continues to provide opportunity to expand the vital skills a child is working on. This includes setting up a home environment, understanding your child’s classroom setup or making suggestions at their after school program.

Child playing at home

Here are five goals to focus on when evaluating a school-related learning environment in the home for children with Aspergers or HFA.

The Two Types of Reinforcement for Individuals with Aspergers or HFA

Reinforcement in Applied Behavior Analysis (ABA) focuses on the outcome of the behavior and increasing the likelihood of certain behaviors occurring in the future. There are two types of reinforcement: positive reinforcement and negative reinforcement. Positive reinforcement is when a response is followed immediately by the presentation of a stimulus and, as a result, similar responses occur more frequently in the future. In other words, positive reinforcement means when a behavior has an increased likelihood of occurring again if something is given after it occurs.

reinforcement

An example of positive reinforcement:

You tell a child if he or she cleans up their room, they can play for 30 minutes on the Wii, an activity they enjoy. The likelihood of the individual cleaning up the room is more likely to occur in the future because they received 30 minutes of playing with something they enjoy. In order for reinforcement to work, you need to make sure that what you are giving them is something that they value.

However, let’s change the reinforcement premise–

You instead tell the child if they clean the room you will go the movies. Your child is sensitive to sounds and does not like being around large crowds, so he will be less likely to clean his room even though you think it would be fun. The purpose is to focus on the child’s likes and dislikes to achieve the desired result.

Negative reinforcement is when a response is followed immediately by the removal of a stimulus and, as a result, similar responses occur more frequently in the future. In other words, negative reinforcement means when a behavior has an increased likelihood of occurring again if something is taken away after it occurs.

An example of negative reinforcement:

You are working on having the child be more independent when doing their chores. You provide a checklist of the chores that needs to be done for the day. He or she independently completes two of the chores on the list. You tell them because they independently completed two chores without any reminders, they do not have to do the rest of the chores. In the future, the individual is more likely to independently complete the chores because the rest of the chores were taken away—assuming he does not like any of the chores that were on the list.

If, however, they really like doing laundry and that was a chore on the checklist that you removed, the negative reinforcement will not have the desired effect on behavior.

You need to always keep in mind what the child likes and does not like. You give him or her things or activities that they enjoy and take away things that they do not like to increase the likelihood of the behavior occurring again in the future. If what you are presenting and taking away is not increasing the likelihood of the behavior in the future, then you are not using reinforcement.

by Adriana Sanchez, MA, BCBA

How do you use reinforcement with your child? What types of reinforcements are most effective, in your experience?