Bad “Behavior”? Sensory Processing Might Be the Problem
Have you ever struggled to understand why your child behaves a certain way? This is a common concern that we hear from parents because many don’t know what they can do to get their child to behave properly. At No Limits Pediatric Therapies in Bentonville, AR, our mission is to support children in overcoming their developmental challenges and reaching their full potential. Today, I want to address a common issue many parents face: understanding what’s often behind their child’s bad behavior at home and at school. Behavioral Problems Are Often a Clue to Sensory Processing Difficulties Sensory processing refers to how the body’s nervous system receives and responds to sensory input. When a child has trouble processing sensory information, it can significantly impact their daily life and behavior. Have you ever had to get work done with some annoying noise in the background distracting you? Or maybe you needed to get sleep, but it was difficult due to lights, sounds, or the temperature of the room? While most adults are able to adjust their environment to suit their needs or push themselves to adapt to distractions, this is something that children with a sensory processing disorder struggle to do. Typical Signs of a Sensory Processing Disorder Some common signs of a sensory processing disorder can include: Hitting, biting, or other aggressive behaviors Difficulty following directions Trouble getting dressed or resisting certain types of clothing Challenges during mealtimes, such as picky eating or gagging Acting out or having frequent meltdowns Avoiding social interactions or being overly aggressive towards peers Difficulty transitioning between activities Being overly sensitive to lights, sounds, or textures Seeking excessive movement or rough play Difficulty focusing or sitting still Sensory Processing Difficulties Can Create a Crisis for the Whole Family When a child struggles with sensory processing, it can create significant challenges for the entire family. Dealing with meltdowns and bad behavior can take its toll on everyone at home, which is why we often hear parents say that they truly love their child, but sometimes they struggle to like their child. This is completely understandable, but without proper support, it can lead to more challenges for your family. Our main goal in addressing a sensory processing disorder is to figure out what in the environment is triggering your child. Then we work with you, the adult, to help modify the environment for your child. At the same time, we work with your child to improve how they respond when their environment gets overwhelming. Therapy That Includes Treatment for Sensory Processing Can Improve Results Pediatric therapy that addresses sensory processing difficulties can make a world of difference for both your child and your family. We are one of the few clinics in our area that does in-depth sensory assessments that give us a greater view of a child’s sensory processing challenges. We then have a set of proven sensory protocols that we use on children. This is a vital component of pediatric therapy because it helps us uncover the reasons why your child is reacting the way they are and work with them (and you) to handle the cause. With targeted therapy, children can learn to manage their sensory processing disorder better, which can lead to improved behavior and peace of mind for your whole family. Reach Out to No Limits for an Evaluation If your child struggles with behavior or emotional regulation, don’t hesitate to reach out to our team at No Limits Pediatric Therapies. We offer a free 15-minute developmental consultation to help determine if therapy is the right step for your child. Call us at (479) 250-9838 to schedule your consultation and take the first step towards helping your child overcome their sensory challenges today. About Terrica Terrica Weatherford, MSOT, founded No Limits Pediatric Therapies in 2016. She earned her Master of Science in Occupational Therapy from the Medical University of South Carolina in 2012. For over 13 years, Terrica has been committed to helping neurodiverse children (and those who need extra support) reach their full potential. She founded her practice to ensure she could provide exceptional care for children and their families.
Activity Level vs. Arousal Level? What does it All Mean?
If you have been around No Limits Pediatric Therapies long, you have probably heard the terms AROUSAL level and ACTIVITY level; but what do these terms really mean? Let’s go to one of No Limit’s OT teams favorite sensory gurus named Dr. Julia Harper for some more information. Dr. Julie Harper, PhD, MS, OTR/L is a wife, mother, occupational therapist, business owner, psychologist, life coach & mentor, speaker and writer. She holds a BS in Occupational Therapy from SUNY Health Science Center (Downstate), Brooklyn, NY, a MS in Occupational Therapy from Boston University, Boston, MA and a PhD in Psychology from Capella University, Minneapolis, MN. She brings all of these roles together to serve her mission of helping people-all people to live their lives beyond limitations. For over 20 years, Julia has worked as a pediatric occupational therapist focusing on creating brain-based therapeutic programs that tap into neural-plasticity, the brain’s ability to adapt and change. Her world-renowned therapy center offers a W.A.Y. to H.O.P.E.™ which merges her two models: HOPE (Harper’s Optimal Protocols for Enrichment), which focuses on re-wiring the brain of those with physiological, learning and limitations in attention and W.A.Y.™ (What About You), which retrains the brain to move beyond emotional and thought limitations. Creating change is at the center of her work, as she knows that to best serve the world, she needs to be an agent of change. This begins with the work she has done to change her own life, from becoming a Certified Master Life Coach, a Master Clinician, a Certified Daring Way Facilitator and Master Practitioner of MER. She hopes that through her change, she can change her clients and have the ripple effect of changing the world. She is a firm believer that all change begins with her. Daily, she lives this change to be the change. (http://therapeeds.com/en/about-us/julia-s-story) Now you know a little background on one of our favorite resources when it comes to sensory processing, arousal level, and activity level, but what does it all mean? Activity level can be broken down into two categories: high activity and low activity. When speaking about activity level, we are referring to physical activity. The World Health Organization defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work. Both moderate- and vigorous-intensity physical activity improve health (https://www.who.int/news-room/fact-sheets/detail/physical-activity). This is leading to the idea that a child or adult who demonstrates a high activity level demonstrates significant physical activity and seeking of movement. It then leads us to an idea of a child or adult who demonstrates a low activity level demonstrates minimal physical activity at any given time. Activity level is visible, fluid and changing. You can move from high to low activity level or low to high activity level at any point in the day and it usually changes multiple times during a day. It can even change hour to hour or in shorter time spans. Remember, activity level is seen and is changing; although you may have a child who typically demonstrates either a high or low activity level. Now, let’s move on to arousal level. This can easily be confused with activity level, but it is different and cannot be used interchangeably. Your arousal level tends to remain unchanging and can be considered more as your state of being. With that said, according to Julia Harper, a child or an adult can be considered high arousal or low arousal. She describes the different neuro-chemicals and brain wave patterns within the body that determine arousal level, but that will be left for another day. What we will discuss today is that depending on your child’s arousal level, the occupational therapy team can better serve your child’s sensory needs by meeting their specific sensory input needs. This is based on neuro-chemical needs and we can then help create a protocol to meet those needs based off of Julia Harper’s research. Moving forward, let’s discuss how we determine if your child is high arousal or low arousal. We can typically describe a high arousal child as a child who thrives on routine, structure, and predictability. A high arousal child is unable to start off their day with intense sensory input such as spinning and participating in inverted activities, because intense vestibular input is only going to dysregulate your child even more. This would be working against the whole goal of working with your child to build a toolbox to help improve attention, participation and overall regulation based on their individual arousal level. They tend to benefit from deep pressure touch and passive proprioceptive input which is calming and regulating. Now on the other hand, you have a low arousal child. A low arousal child is a child who tends to be unpredictable, constantly changing, and unrhythmical. You can usually see this in everything they do. A low arousal child may always be on the go because they are seeking input to help regulate, but they do not need to start the day off with calming activities. Instead, they need to start off with intense vestibular input that is constantly changing, unrhythmical and unpredictable. Starting with intense input followed by deep pressure and tactile input will help set your low arousal child up for success. Now, here is where it gets tricky! Is my child high or low arousal? Or are we just looking at if they have a high or low activity level? This is where your OT comes in. We at No Limits want to work with you as a family and complete a variety of clinical observations to help determine if your child is high or low arousal. We can then work with you to see how their activity level usually runs at different points in the day. After determining your child’s arousal level and gaining a better idea of how their activity
Multisensory Approach to Handwriting
Handwriting is a valuable skill that doesn’t have to be taught and practiced strictly with pencil and paper! A multisensory approach to handwriting can help take away fear, pressure and the rigidness of typical handwriting practice. But what does multisensory mean? A multisensory approach to handwriting provides children with the opportunity to use their various senses (touch, visual, auditory, smell, and muscle movement) to engage in handwriting activities. How much more fun learning can be when we can incorporate a variety of textures, sounds, sights and movements to writing activities! Check out some examples of multisensory activities for handwriting below! Finger Writing in Shaving cream Painting Building letters with popsicle sticks, playdoh, clay, pipe cleaners, stickers Finger Writing in Salt, Sand, Rice or Glitter trays Finger painting Finger writing on Dry Erase markers on a window Writing with Smelly Markers Acting out the letters/big arm movements Singing letter formation during writing Writing letters in the air Chalk Writing on Bright paper, textured paper Writing to music Trace letters with a favorite toy (ex: cars, animals, small blocks, dot paint) A multisensory approach to handwriting can be helpful for all children as they all have different learning styles. Reach out to your therapist today to explore more sensory-rich experiences for your child as they practice their handwriting skills! Woodward, S., & Swinth, Y. (2002). Multisensory approach to handwriting remediation: Perceptions of school-based occupational therapists. American Journal of Occupational Therapy, 56, 305–312.
Reflexes?!?! What is the big deal?
If you have been around No Limits Pediatric Therapies long, you have probably heard one of the occupational therapists mention “primitive reflexes.” You may be wondering what is a primitive reflex? And what is the big deal? According to Webster Dictionary, a reflex can be defined as “an automatic and often inborn response to a stimulus that typical involves a nerve impulse passing inward from a receptor to the spinal cord and then passing outward from the spinal cord to an effector (such as a muscle or gland) without reaching the level of consciousness and often without passing to the brain.” For this blog post, we will be focusing on primitive motor reflexes and how they can impact your child’s function. According to the Medical Dictionary, a primitive reflex is defined as “any of various simple, stereotypic, automatic neuromuscular responses characteristics of the mature fetus and newborn but typical inhibited (or integrated) during the first year of life: primitive reflexes are directed by the brainstem centers and include Moro, rooting, and tonic neck reflexes.” It is thought that these reflexes help infants learn to organize motor behavior. Integration can be defined as “the inhibition by higher centers of neurological control which modify the reflex in such a way that the pattern of response is no longer stereotypical. The reflex does not disappear; it may reactivate under stress or during activities requiring great strength.” If these so called “primitive reflexes” continually remain to be displayed beyond the expected of typical developmental time period, their presence by indicate an underlying developmental of neurological issue. When a child’s primitive reflexes do not integrate, they may interfere with a child’s development of more advanced motor skills, which could lead to difficulty participating in one home, educational or community environments to their highest potential. Now, let’s take a look at the three primary tonic reflexes: Asymmetrical Tonic Neck Reflex (ATNR): Onset: 0-2 months Integration: 4-6months Stimulus: Rotation of the head Response: Arm and leg on the “jaw” side extends. Arm and leg on the “skull” side flex. Importance for Baby: Assists with early eye-hand regard, provides vestibular stimulation, changes the distribution of muscle tone. Significance on Early Development if Persists: May impair ability to roll, use hands smoothly together at midline, poor visual regard for object(s) being held, poor balance. May impair creeping or crawling. Baby loses balance and/or falls when rotates his head from midline; very frustrating and causes excessive fatigue. Symmetrical Tonic Neck Reflex (STNR): Onset: 4-6 months Integration: 8-12 months Stimulus: Flexion and extension of the head (neck) Response: With neck flexion the upper extremities will flex and the lower extremities will extend. With neck extension the upper extremities will extend and the lower extremities will flex. Importance for Baby: The STNR assists in the development of bilateral patterns of body movement. Allows the child to move up against gravity and assume quadruped (on all fours like a dog). Integrates as the child begins to crawl and can lift the buttocks from the heels without flexing the neck. Integrated when rocking back and forth on hands and knees. Significance on Early Development if Persists: Interferes with advanced reciprocal creeping. Impairs dissociation between the two lower extremities and transitioning between quadruped to sitting to kneeling to standing and vice versa. If strongly influenced by the STNR a baby will not be able to creep; will bunny hop versus true creeping/crawling on the floor. Tonic Labyrinthine-Prone & Supine (TLR): Onset: Birth Integration: 6 months Stimulus: Change of orientation of the head in space; position of head in relation to gravity while prone (on belly) and supine (on back). Response: In prone flexor tone will predominate with arms flexed by the child’s chest. In supine extensor tone will predominate. Importance for Baby: Allows the baby’s posture to adapt to that of the head. Significance on Early Development if Persists: Will interfere with movement that requires smooth grading of flexor and extensor muscles. In supine child will have a compromised ability to raise their head up against gravity; this will affect anti-gravity control for movements such as bringing feet and hands together and rolling. In prone (on belly) child will have compromised ability to raise head, extend spine, and bear weight on elbows. This, in turn, will limit time spent on his/her tummy for crawling and developing the movement in their pelvis and shoulders that sets the stage for moving in and out of various body positions (sitting to stand). Without such ability, the baby will be without options for exploring. This will affect social and cognitive gains. (Above graphics from “Primitive Motor Reflexes & Their Impact on a Child’s Function”) Now that we have reviewed tonic reflexes, how can the presence of these primitive reflexes effect your older child? Influences of Retained Asymmetrical Tonic Neck Reflex (ATNR): Poor isolation of individual body movements Pore sitting posture Attention & Focus Impaired pre-writing and writing Impaired scissor use Fasteners/Typing/Musical Instruments Impairments in reading Keyboard Use Impairment in gait (walking) Running Influences of Retained Symmetrical Tonic Neck Reflex (STNR): Decreased strength and balance Sitting Floor Sitting Walking Writing Ball handling skills Influences of Retained Tonic Labyrinthine Reflex (TLR): Walking Sitting Writing Balance Now, we have discussed primitive reflexes and how they may present in your older child; as well as the difficulties they may lead to. Let’s look at some activities to help integrate these reflexes. Prone for fine motor activities & games- The elbows provide a point of stability for freeing the hands for manipulating. Hold a large dowel with both hands, use this to push a ball back and forth Use arms to push a ball back and forth Color, paint, draw, read, or complete puzzle in prone Use whistles or play games that require blowing through a straw Pivot in both directions Prone on therapy ball, platform swing, or over bolster Prone on scooter board-push off with arms from wall to glide backward Prone on scooter board-being pulled by a rope while grasping onto it with both hands Superman/SuperWoman – prone extension with arms
Benefits of Heavy Work Activities
Benefits of Heavy Work Activities Emily Barber, MS, OTR/L With the craziness and busyness of summer and schedule changes, our bodies can often become disorganized, we can become more anxious and stressed due to ever-changing schedules, and lose focus and attention easier. A child experiencing this may accidentally breaks things often, appear clumsy and uncoordinated, and may have a lot of energy with the excessive need to crash and bump into objects, walls and/or people. Children seeking these movements may be seeking input to calm and organize their bodies. Heavy work activities, which are simply any type of action that pushes or pulls against the body, can help provide the deep pressure input they are craving and allow them to move their bodies in a safe way. Heavy work activities provide proprioceptive input to the joints and muscles. Proprioception is about knowing where your body is in space. Problems within our proprioceptive system occur when the messages that tell a child where he is, how to move, and how much effort to exert aren’t as strong. Proprioceptive input, or deep pressure input, can be very calming, organizing, and regulating to the body and can decrease stress and anxiety through heavy work activities. Heavy work can also increase body awareness, focus and attention. Heavy work activities might include: • Animal walks • Jumping on the trampoline • Swimming • Playing with play dough (kneading, pulling, squeezing) • Climbing on the jungle gym • Doing the monkey bars • Blowing bubbles • Jumping jacks • Push-Ups • Riding a Bike • Creating an obstacle course • Doing Yoga • Pulling a heavy wagon • A pillow fight • Running through the sprinkler • Tug of War • Carrying beanbags or weights around the house • Rock climbing • Hop-Scotch When your child appears to be craving proprioceptive input and “bouncing off the walls,” provide them with some heavy work activities! Ask your occupational therapists at No Limits Pediatric Therapies for additional suggestions or about heavy work benefits for your child!