Tag: autism; sensory processing disorder; neurofeedback; ABA; diagnosis; occupational therapy; speech therapy

by Kay E. Born, OTR/L, SIPT, BCN

As parents we all want the best for our children. We want them to develop into happy, healthy well-behaved and well-adjusted individuals. It is important then to understand how children learn.

We are born with billions neurons, but very few connections between them. The connections are the way that our brain and body talk to each other, and the way that we as human beings make sense of the world. The first 7 years of a child’s life are referred to as the years of sensorimotor development. Our first experiences are all sensory in nature – we are rocked, swaddled, talked to, sung to, touched, kissed, fed, gazed at, and bounced, only to name a few. Young children do not have abstract thoughts or ideas; they are mainly concerned with sensation and moving their bodies in relation to the sensation.

Sensory processing is the ability to register and respond to sensory input in a meaningful way in order to build skills, interact and play with others, behave in a socially appropriate way and engage in daily life tasks. It doesn’t matter what you are doing (for example-learning to write your name, playing with a friend, brushing your teeth or taking out the trash) it all depends on the efficient integration of sensation to complete the tasks successfully. Most of us don’t think much about this process and it goes along pretty smoothly. However, for some children, their ability to process sensation is impaired, resulting in challenges in many of their lives. They may have deficits in any part of the sensory integrative process – such as detecting sensation, filtering, organizing or giving meaning to what they experience. This may result in delayed motor skills, poor social-emotional skills, challenges with daily living skills and problems with attention, academics and behavior.

We have all been taught the “5 senses”, which include seeing, hearing, touching, tasting and smelling. But, there are actually more senses than that! We have our vestibular sense, which tells us about gravity, our head, neck and eye movements and our sense of balance.  Next is our proprioceptive system, which gives us information about our bodies and movement. The last sense is interoception, which gives us information about the internal state of our bodies, whether we are hungry, thirsty, have to go to the bathroom, or are tired.

Some children may have difficulty modulating sensation. They may “over-respond”, “under-respond” or be “sensory seeking”. For other children it may affect their postural control and body awareness, making them clumsy and with little awareness of where they are in space. And yet others may have difficulty with discrimination, which is the ability to differentiate between different sensations, such as whether someone tapped you to gain your attention or pushed you, or whether the word the teacher just used was “cat” or “cap”. It may affect one sense alone or may involve all of their senses.

When children aren’t able to process and use sensation efficiently, it can be very difficult for them and may affect the entire family. Sensory Processing Disorder is a “hidden disability”. You aren’t able to see sensory processing taking place, so we must observe the behavior of the child for clues as to what is happening within the nervous system. Many children that have challenges with sensory processing are misunderstood as having behavior problems.

Occupational Therapists are the professionals that most often address sensory processing challenges. Make sure your therapist has the appropriate advanced training in treating sensory processing disorder. There are many resources available if you think that your child may have sensory processing challenges.

Resources

Sensory Integration and the Child by A. Jean Ayres

Sensational Kids by Lucy Jane Miller

The Out of Sync Child by Carol Stock Kranowitz

spdstar.org – Sensory Therapies and Research Center

S

Having had a therapy clinic for over 10 years, I have had the priviledge of working with many families that have gone through the process of receiving a diagnosis and deciding what interventions will benefit their children the most. Often times a diagnosis will be the first step into a world that can be confusing and frightening. But with the right tools, it can also be the first step in empowerment, education and progress.

The actual process of receiving a diagnosis can be difficult. Professionals will be talking about your child in clinical terms and that can be overwhelming. You are probably going to want to say “don’t you see anything good about my child?” The most important thing to remember is that your child is the same child they were before the diagnosis. They have special gifts and strengths that a diagnosis cannot change. But, identifying challenges and labeling them can be an important part of accessing much needed funding sources.

In my experience, the children that make the most progress are those that belong to families that are willing to take a risk. Those families that are willing to listen to the professional’s opinion, weigh the options and design a program that fits their child. It requires a great deal of time and research on the part of the family. But if they take the best of all different types of interventions and put it together, it is often more successful than choosing only one path. It is distressing when I hear families tell me that they have been given one option. I have yet to meet a child that is one-dimensional. Each child is unique and complicated, and needs a variety of approaches. Just ask yourself if you have learned everything you know using just one approach, or have you learned in a variety of different ways.

I will try to cover a few different options here. This is by no means an exhaustive study of the alternatives out there. I have, however, had personal and/or professional experience with each. This is not to say that you should try them, only to give you an idea that there are many paths to function. My only intention is to give information and let you research on your own what combination would best suit your family. However, I do suggest to you that it is a combination and not one approach that is the key.

Sensory Integration Therapy – This happens to be my specialty, so I say up front that I may be biased toward recommending this type of intervention. I have seen many children with ASD, ADHD and all have had sensory challenges. Sensory integration is a theory that was developed by A. Jean Ayres. Sensory integration is an individual’s ability to register sensory input, decide what to attend to and what to filter, then take what is relevant and use it to build skills. Those skills can be anything from learning to play, interact with family and friends, ride a bike, write your name, dress yourself or brush your teeth. Everything that we do requires us to use sensory input efficiently and effectively. This can be incorporated into occupational, physical and/or speech therapy sessions. Most of the time it is an occupational therapist that will be the sensory integration specialist. It is important to find a provider that has certifications and/or training in this area specifically.

Play Therapy – Play is the “occupation” of childhood; it is a child’s job and what is developmentally appropriate for them to be engaging in on a daily basis. Play has gotten a “bad wrap” as being frivolous and only to be engaged in if you don’t have anything else to do or you can fit it into your schedule. On the contrary, it is essential for the development of academic, social and life skills. This type of intervention taps into the innate drive of each child to play and connect with others. Floortime/DIR and Play Project are all programs that are worth investigating.

1. Floortime– The Greenspan Floortime Approach is a system developed by the late Dr. Stanley Greenspan. Floortime meets children where they are and builds upon their strengths and abilities through creating a warm relationship and interacting. It challenges them to go further and to develop who they are rather than what their diagnosis says. In Floortime, you use this time with your child to excite her interests, draw her to connect to you, and challenge her to be creative, curious, and spontaneous—all of which move her forward intellectually and emotionally. (As children get older, Floortime essentially morphs into an exciting, back-and-forth time of exploring the child’s ideas.) See their website at stanleygreenspan.com
2. Play Project The philosophy of the Play Project is that all parents will be supported in developing a joyous relationship with their children with autism spectrum disorders in a way that will help each child reach their full potential. Their mission is to train a global network of pediatric professionals to deliver an evidence-based, cost effective intensive developmental intervention to families of young children with autism spectrum disorders. See their website at playproject.org

ABA Therapy – ABA is a therapy that uses behavioral principles to teach skills. There are many skills that a child needs to learn that can best be taught using a behavioral approach. It can be very effective for discreet skills such as ADL’s. It is an intense program and typically they will recommend hours of ABA therapy per week ABA, applied behavioral analysis, is simply the application of behavioral principles, to everyday situations, that will, over time, increase or decrease targeted behaviors. ABA has been used to help individuals acquire many different skills, such as language skills, self-help skills, and play skills; in addition, these principles can help to decrease maladaptive behaviors such as aggression, self-stimulatory behaviors, and self-injury. There are many providers of ABA services, many of whom are quite good. Frequently, a parent will choose a qualified provider with whom they share similar philosophical approaches in the application of intensive behavioral interventions.

Integrative Medicine – Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health. www.dukeintegrativemedicine.org

Complementary Therapies

1. Neurofeedback – Neurofeedback is direct training of brain function, by which the brain learns to function more efficiently. We observe the brain in action from moment to moment. We show that information back to the person. And we reward the brain for changing its own activity to more appropriate patterns. This is a gradual learning process. It applies to any aspect of brain function that we can measure. Neurofeedback is also called EEG Biofeedback, because it is based on electrical brain activity, the electroencephalogram, or EEG. Neurofeedback is training in self-regulation. It is simply biofeedback applied to the brain directly. Self-regulation is a necessary part of good brain function. Self-regulation training allows the system (the central nervous system) to function better. Neurofeedback addresses problems of brain disregulation. These happen to be numerous. They include the anxiety-depression spectrum, attention deficits, behavior disorders, various sleep disorders, headaches and migraines, PMS and emotional disturbances. It is also useful for organic brain conditions such as seizures, the autism spectrum, and cerebral palsy. Learn more about neurofeedback at eeginfo.com
2. HBOT – Mild HBOT is a safe, effective way to get more oxygen into the body at the cellular level by using pressurized air chambers. According to the Laws of Physics, an increase in atmospheric pressure allows for more gas to be dissolved into any given liquid. Oxygen exists as a gas at room temperature, and the human body is made up almost entirely of water. Some doctors are still studying the effects of HBOT treatment for children affected with autism to see if it helps treating co-morbid issues. Issues could include: healing the gut and brain inflammation (two that may be separate issues or experienced simultaneously), blood flow to key areas of the brain, dealing with gut parasites, yeast or bacteria, help in all four areas